TRAVEL MEDICINE: TRAINING, INFORMATION AND COMPUTER TOOLS FOR SWISS PHYSICIANS AND PHAMACISTS - October 2007

Interview with Professor Robert Steffen, Director of the Infectious Diseases Division of the Institut de Médecine Sociale et Préventive of the University of Zurich, Collaborating Centre of the World Health Organization and author of Tropimed®, the database for travel medicine professionals.

Prevention and treatment of diseases that may be contracted during travel are more and more important today. Avian flu or Chikungunya fever have no doubt contributed to travellers' anxiety about the sanitary risks associated with certain destinations. Many patients nowadays seek the advice of their primary physician or pharmacist before going to a vaccination centre if necessary.

Faced with this new demand, are there trustworthy and specific information sources and training available for health professionals who wish to specialise in this area? How do we handle the plethora of medical information available on the Internet?

1. A recent study [1] conducted by the Institut Tropical Suisse shows that for personal travel medical advice, travel agencies direct their customers to practitioners 38% of the time and to pharmacists 16% of the time. It is thus obvious that both professions have a role to play. What is your feeling on this matter?

These figures made me happy even if they're still far from the ideal of 100%. At least some travel agencies understand that when reserving travel to a developing destination or country, directing travellers to an office where they can obtain travel medical advice indicates a top-quality service. About twenty years ago, travel agencies were convinced that such advice would dissuade people from travelling. Judgements made in other European countries have shown that travel agencies are not qualified to provide detailed advice; they may, however, refer travellers to qualified travel medical offices.

[1] J Travel Med 2006; 13: 294-299

2. Travel medicine is an interdisciplinary specialisation not limited to tropical medicine and infectious diseases. Is there any specific training that you would recommend to physicians and pharmacists who wish to acquire more competency in the subject?

Yes, travel medicine is not limited to infectious diseases. Take the example of people who practice scuba diving or high-altitude trekking who would also benefit from appropriate advice. Moreover, we should remember that most deaths of travellers are due to accidents. In the interdisciplinary domain travel medicine, continuing education on a large number of other subjects is more than necessary. In Switzerland, for example, this training is provided in numerous small seminars for physicians and pharmacists. Moreover, outside of Switzerland there are a number of large annual conferences that focus on the latest information in travel medicine lasting several days. Courses lasting one week that can serve for preparation for a test are offered by the Institut Tropical Suisse in Basel, as well as in the United Kingdom and the United States.

3. Travel medicine is a constantly changing field of practice. Its mastery depends on knowledge that must be continuously brought up to date. To what extent can the information provided on the Internet meet this need?

researching the sources of information available on the Internet. Each week, this co-worker sends this information, when it is pertinent, to future travellers who are the Tropimed subscribers. Moreover, four times per year, she sends this information to the federal office of public health, that publishes it in the BAG bulletin.

4. All you have to do is enter the words "travel medicine" in any search engine to become aware of the amount of information available on the internet. How to does one comprehend all this? Are there any tips for finding and recognizing quality information?

In fact, there are obviously many institutions that are more or less competent that are trying to profit from travel medicine. In some specific cases, it is obvious that the sources of information are sponsored by industry and they're trying to promote and sell their products. The quality of information is best when the academic or state institutions take responsibility for the editorial content published on the various Internet sites. Differences between the national recommendations exist however because all the products are not authorised everywhere and that in some countries such as the United States, the rules relating to liability in the case of non-recommendation of certain preventive measures are completely different. Overall, the recommendations have gotten closer to each other in recent years, especially in the three German-speaking countries.

5. Other than information from official organisations such as the WHO or the CDC, are there other trustworthy sources?

The world public health organisation each year publishes the "International Travel and Health" manual that can also be downloaded on the Internet. This is specifically for health professionals; it provides fairly general directives rather than very specific recommendations for travellers for a given destination. On the other hand, the Centres for Disease Control and Prevention in Atlanta provide very precise and detailed recommendations that are not always consistent with the Swiss or European recommendations (see above).

6. For more than 10 years, you have been one of the authors of Tropimed, among the most appreciated sites by health professionals. Why have you decided to participate in this project and how do you explain its success?

After the birth of travel medicine, a growing number of colleagues asked be for advice. This is why I thought it was pertinent to develop an instrument for physicians and pharmacists that provides all the most recent information necessary for travellers going to developing countries, at all times. I had two specific requirements: the project should be financially profitable and it should publish the information in the shortest amount of time. Tropimed meets these two conditions wonderfully. Another aspect that was important for us, to me any my colleagues, was to provide access to the information necessary to the broader public, which is now possible thanks to www.safetravel.ch.