Illness and injury to students on a school excursion to Peru

Illness among US resident student travellers after return to the USA: a GeoSentinel analysis, 2007-17

Background

The number of US students studying abroad more than tripled during the past 20 years. As study abroad programmes' destinations diversify, students increasingly travel to resource-limited countries, placing them at risk for infectious diseases. Data describing infections acquired by US students while travelling internationally are limited. We describe illnesses among students who returned from international travel and suggest how to prevent illness among these travellers.

Methods

GeoSentinel is a global surveillance network of travel and tropical medicine providers that monitors travel-related morbidity. This study included the records of US resident student international travellers, 17-24 years old, who returned to the USA, had a confirmed travel-related illness at one of 15 US GeoSentinel sites during 2007-17 and had a documented exposure region. Records were analysed to describe demographic and travel characteristics and diagnoses.

Results

The study included 432 students. The median age was 21 years; 69% were female. More than 70% had a pre-travel consultation with a healthcare provider. The most common exposure region was sub-Saharan Africa (112; 26%). Students were most commonly exposed in India (44; 11%), Ecuador (28; 7%), Ghana (25; 6%) and China (24; 6%). The median duration of travel abroad was 40 days (range: 1-469) and presented to a GeoSentinel site a median of 8 days (range: 0-181) after travel; 98% were outpatients. Of 581 confirmed diagnoses, the most common diagnosis category was gastrointestinal (45%). Acute diarrhoea was the most common gastrointestinal diagnosis (113 of 261; 43%). Thirty-one (7%) students had vector-borne diseases [14 (41%) malaria and 11 (32%) dengue]. Three had vaccine-preventable diseases (two typhoid; one hepatitis A); two had acute human immunodeficiency virus infection.

Conclusions

Students experienced travel-related infections, despite the majority having a pre-travel consultation. US students should receive pre-travel advice, vaccinations and chemoprophylaxis to prevent gastrointestinal, vector-borne, sexually transmitted and vaccine-preventable infections.

Mountain medical kits: epidemiology-based recommendations and analysis of medical supplies carried by mountain climbers in Colorado

OBJECTIVE

: To provide medical kit recommendations for short mountain wilderness recreation trips (hiking, trekking, backpacking, mountaineering etc.) based on the epidemiology of injury and illness sustained and best treatment guidelines. Additionally, to compare these recommendations to the medical kit contents of mountain climbers in Colorado.

METHODS

: A primary literature review concerning the epidemiology of injury and illness in mountain wilderness settings was performed. This information and literature on the efficacy of given treatments were used to derive recommendations for an evidence-based medical kit. The contents of 158 medical kits and the most likely demographics to carry them were compiled from surveys obtained from mountain climbers on 11 of Colorado's 14 000-foot peaks.

RESULTS

: Musculoskeletal trauma, strains, sprains and skin wounds were the most common medical issues reported in the 11 studies, which met inclusion criteria. Adhesive bandages (Band-Aids) were the most common item and non-steroidal anti-inflammatory drugs were the most common medication carried in medical kits in Colorado. More than 100 distinct items were reported overall.

CONCLUSION

: Mountain climbing epidemiology and current clinical guidelines suggest that a basic mountain medical kit should include items for body substance isolation, materials for immobilization, pain medications, wound care supplies, and medications for gastrointestinal upset and flu-like illness. The medical kits of Colorado mountain climbers varied considerable and often lacked essential items such as medical gloves. This suggests a need for increased guidance. Similar methodology could be used to inform medical kits for other outdoor activities, mountain rescue personnel, and travel to areas with limited formal medical care.

Tintin's travel traumas: Health issues affecting the intrepid globetrotter

BACKGROUND

Despite the highly hazardous life-style led by comic book characters such as Tintin, we are unaware of any previous systematic description of the challenges and health impairments faced by Tintin in the course of his adventures.

METHODS

We evaluated the spectrum of health impairments (HIs) that Tintin sustained in his 23 adventures as well as their causes, consequences, and relation to travel. We diagnosed Tintin's HIs according to descriptive terms in the text. We then classified HIs as traumatic and non-traumatic, and distinguished between intentional (those perpetrated by others) and unintentional events.

RESULTS

We found 236 events leading to 244 HIs, 13 kidnappings, six hospitalisations and two surgical procedures. There was a median of 8 HIs/adventure (range 1-30/adventure). The mean number of HIs per adventure was much greater before 1945 than subsequently (14.9 vs. 6.1; P=0.002), which was also true of the number of kidnappings (11 vs. 2; P=0.001). Of the 244 HIs, there were 191 cases of trauma (78.3%) and 53 non-traumatic problems (21.7%). The most common form of trauma was concussion (62%) whereas the most common forms of non-traumatic problems were sleep problems (15.1%), depression/anxiety (13%), and gas or chloroform poisoning (13%). Overall, we found 46 losses of consciousness (LoC), including 29 traumatic and 17 non-traumatic LoCs. Of the 236 events, there were 69 (29%) perpetrated by others against Tintin (including 55 homicide attempts), and 167 (71%) events that were not (including 69 events related to Tintin's actions).

CONCLUSION

Tintin's almost superhuman qualities, a luxury afforded him by his fictional status, make him highly resistant to trauma. He is also not susceptible to the usual travel-related illnesses but is easily influenced by his friends and Snowy, his faithful hound.