Health problems in travellers to Nepal visiting CIWEC clinic in Kathmandu - A GeoSentinel analysis.

Background: Nepal has always been a popular international travel destination. There is limited published data, however, on the spectrum of illnesses acquired by travellers to Nepal.

Methods: GeoSentinel is a global data collection network of travel and tropical medicine providers that monitors travel-related morbidity.

What will travel medicine look like in the COVID-19 pandemic era?

Travel medicine has virtually stopped in light of the coronavirus pandemic. It is worth contemplating how travel medicine will be affected by the ongoing pandemic when international travel starts to become more possible. How will we advise patients, and utilize the coming vaccines that may be available? Travel medicine practices are well-suited to play a major role in advising travelers in the pandemic era.

The use of acetazolamide for the prevention of high-altitude illness.

Background: Modern travel means that many travellers can arrive abruptly to high-altitude destinations without doing any trekking or climbing. Airports in high-altitude cities mean that travellers can go from sea level to over 3350-3960 m (11 000-13 000 feet) in a matter of hours, putting themselves at risk for high-altitude illness (HAI).

Methods: Acetazolamide has been shown to be an effective way to help prevent HAI on such itineraries.

Medications for the prevention and treatment of travellers' diarrhea.

Background: . Travellers' diarrhea (TD) remains one of the most common illnesses encountered by travellers to less developed areas of the world. Because bacterial pathogens such as enterotoxigenic Escherichia coli (ETEC), enteroaggregative E.

Travelers' diarrhea in Nepal: an update on the pathogens and antibiotic resistance.

Background: Diarrhea is the most common illness among travelers and expatriates in Nepal. Published data on the etiology of travelers' diarrhea (TD) in Nepal are over 13 years old and no prior data exist on antibiotic susceptibility for currently used drugs. We investigated the etiology of diarrhea and antimicrobial susceptibility pattern of bacterial pathogens and compared the results to previous work from the same clinical setting.

Etiology of enterically-transmitted hepatitis among foreigners in Nepal.

We report the etiology of hepatitis in travelers over a ten year period from January 1994 December 2003. Clinics catering to expatriates and tourists in endemic Nepal provided sera for diagnostic testing from persons with signs and symptoms compatible with clinical hepatitis and alanine transaminase levels 2 1/2 times greater than normal. Hepatitis E was determined with anti-HEV IgM, and HEV RT-PCR, and hepatitis A was determined using HAV-IgM.

Clinical features of patients with severe altitude illness in Nepal.

Background: Trekking in Nepal is a popular adventure travel activity involving more than 80,000 people of all ages annually. This study focuses on the demographic characteristics and clinical course of altitude illness patients evacuated to Kathmandu and estimates the rates of evacuation in different regions of Nepal.

Methods: During the years 1999 to 2006, all patients who presented with altitude illness to the CIWEC clinic in Kathmandu were evaluated and included in the study if the final diagnosis was compatible with high-altitude cerebral edema (HACE), high-altitude pulmonary edema (HAPE), or acute mountain sickness (AMS).

Looking for evidence that personal hygiene precautions prevent traveler's diarrhea.

In the 50 years during which traveler's diarrhea has been studied, it has always been assumed that personal hygiene precautions can prevent or reduce the likelihood of developing traveler's diarrhea. However, 7 of 8 studies that specifically addressed this issue showed no correlation between the types of food selected and the risk of acquiring traveler's diarrhea. The eighth study showed a correlation between a few dietary mistakes and a decreased risk of acquiring traveler's diarrhea.

Update in traveler's diarrhea.

TD has not proved as preventable as hoped, despite knowing that it is transmitted mainly through food. Travelers have little ability to select restaurants based on the kitchen hygiene. The rates of TD in travelers to developing countries have not changed in the past 50 years, either because the dietary precautions they are taught are not effective or they cannot be adhered to in the course of a pleasurable vacation.

Chemoprophylaxis use and the risk of malaria in travelers to Nepal.

Background: Malaria transmission in Nepal is focal and seasonal. Based on data in returning travelers the risk of malaria is low. Sources of advice give contradictory information regarding the need for chemoprophylaxis.

Cyclospora cayetanesis.

The novelty of C cayetanensis has led to some misconceptions about how best to detect its presence in stool examinations. Some reports have implied that the organism can only be seen on stained specimens, which is not true. The unstained organism can easily be identified by its characteristic size and internal structures.

Risk of possible exposure to rabies among tourists and foreign residents in Nepal.

Background: There is little data available on the actual risk to travelers of being possibly exposed to rabies. This data would be useful in advising travelers who are considering rabies pre-exposure immunization. In addition, it is not known how many travelers are already pre-immunized when they are bitten by a possibly rabid animal.

Japanese encephalitis vaccine for travelers: exploring the limits of risk.

The prevention of Japanese encephalitis in travelers presents the juxtaposition of 4 factors: a disease that is widespread throughout Asia, a disease with a low incidence in travelers, a vaccine about which there are safety concerns, and a clinical course that can result in death or permanent disability in two-thirds of symptomatic cases. Travel medicine practitioners often seem to be polarized into 2 groups: a group that gives more weight to the severity of the disease (and therefore often recommend vaccination) and another group that is more persuaded by the low occurrence of cases in travelers (and therefore rarely recommend vaccination). This review assesses the known risks of contracting Japanese encephalitis and the risks associated with the vaccine and tries to develop an appropriate way to recommend this vaccine to travelers who may be at significant risk.