Expanding the Scope of Pre-Travel Consultation from Infectious Diseases to Personal Safety: Experiences at the University of Louisville Vaccine and International Travel Center

Dawn Balcom RN BSN, Kelly Westhusing MPH CPH, Ruth Carrico PhD RN, Anupama Raghuram MD, Paula Peyrani MD. Division of Infectious Diseases, University of Louisville

ABSTRACT RESULTS, CONTINUED

REFERENCES

Background: The World Health Organization (WHO) and the Centers for Disease Control and Prevention (CDC) have expressed formal concern that travelers may be exposed to safety risks that extend beyond exotic infectious diseases1. Injuries represent the leading cause of travel-related mortality worldwide and account for 25 times more deaths than endemic infectious diseases. The University of Louisville Vaccine and International Travel Center (UL-VITC) is compiling a databank of injuries and issues concerning personal safety and security among international travelers to better understand the safety risks. This case report exemplifies one safety example from our International Travel Center.

Case Report: While visiting in Zimbabwe, Africa, a missionary couple experienced an encounter where three masked assailants armed with machetes forcefully entered the home. An altercation ensued resulting in serious head trauma to one man and multiple machete wounds forceful enough to fracture the ulna to another. First aid was provided by a local medical clinic and additional care was sought after returning to the US several days later. The UL-VITC provided post-exposure consultation, including a debriefing session to support the missionaries involved in the assault. This valuable data will provide insight regarding expanding the scope of safety-related information for future travelers.

Discussion: Initial data highlight a growing concern regarding physical safety of international travelers. Travel risk assessments can be enhanced through shared experiences from various travel experiences. Pre-travel counseling at the UL-VITC has expanded to include personal safety concerns, infectious diseases, immunization, and chronic disease management during travel.

CASE REPORT

Image 1 Missionary with their local Zimbabwean friends (top), and the consequences of their attack show head laceration (left), defensive wounds (center), discarded machete (right).

CONCLUSIONS

1. World Health Organization http://www.who.int/ith/other_health_risks/ injuries_violence/en/index.html

2. World Tourism Organization http://www.unwto.org/facts/eng/pdf/indicators/ITA_emerging04.pdf3.

The missionary couple had received pre-travel counseling at the UL-VITC. Travel information that was provided focused on infectious diseases, immunizations, and chronic disease management. Personal safety was discussed but secondary to the traditional travel topics.

Pre-travel consultation provided in the UL-VITC has expanded to comprise personal safety, travel insurance, infectious diseases, immunization, and chronic disease management during travel. Post-travel healthcare has been added to address illness in returning travelers and or follow-up for specific events. In 2014, the UL-VITC will offer during travel consultations in an effort to broaden our scope of care to our travelers.

The World Tourism Organization reports approximately one billion international travel visits occur yearly. International tourism is anticipated to increase by more than 3% each year over the next twenty years². Traditional pre-travel consultation provides international travelers with country specific health recommendations. Common topics discussed in pre- travel consultation include age- and country-specific immunization, malaria prevention, travelers’ diarrhea prevention and treatment, and altitude illness. This case report brings to the forefront the importance of interjecting personal safety and security concerns into pre-travel dialogue.

Since mid-2012, data has been compiled from patrons of the UL-VITC regarding safety concerns. Feedback from travelers experiencing both physical and non-verbal threats are documented for discussion. The goal is to develop a concise and consistent method(s) to alert travelers of increasing safety events without creating unnecessary anxiety. Image 2 Data elements now include, country involved, type of event or exposure, and actions taken by traveler.

DISCUSSION

Violent encounters reported by patients seen in the UL-VITC include:• Brazil- “fluid exposure”. Travelers had stool thrown on them as part

of a robbery attempt. • Brazil- nonverbal threats from crowd, even in presence of security

teams.• Zimbabwe- home invasion and physical assault.• Zimbabwe- tires slashed and physical assault during robbery.• Pakistan- nonverbal threat while travelers taking photos.• Honduras- nonverbal threats from crowd, even in presence of

security teams.

Zimbabwe (2)

ACKNOWLEDGMENTS

We are grateful to our clients who have granted us permission to present their photos and share their personal experiences in an effort to improve the health and safety of other international travelers.

BrazilHonduras

Pakistan

Image 2. Violent or Threatening Encounters Reported by UL-VITC Patients

A missionary couple were visiting the home of Zimbabwean friends when they became victims of a home invasion. Three masked men armed with machetes entered the home and chaos ensued. A violent struggle left one man with a serious head laceration and another man with extensive arm lacerations and a fractured ulna. The injuries required emergent care for wound closure in Zimbabwe and follow-up care in the US for orthopedic intervention and possible blood-borne pathogen exposure. Image 1