Abstract
International travel has increased enormously in recent years. With the greater movement of people have come increased encounters with a wide variety of diseases: malaria, dengue, cholera, typhoid fever, Ebola virus, and many more. The need for greater scope, consistency, and knowledgeability in pretravel health care to meet these challenges has been met by the emergence of the discipline of travel medicine. Travelers are well advised to become informed of the risks they face and to take steps to minimize those risks. After reviewing a traveler's medical history and a detailed itinerary, a travel medicine practitioner can offer expert advice on behavioral modifications, immunizations, and chemoprophylaxis regimens which will increase the traveler's margin of safety. The issues most frequently addressed in a travel clinic include treatment of traveler's diarrhea, malaria chemoprophylaxis, and immunizations, for hepatitis A, typhoid fever, tetanus/diphtheria, influenza, pneumococcus, hepatitis B, polio, meningococcus, measles, mumps, rubella, varicella, and rabies. Pretravel consultation must consider the age and underlying health problems of the traveler, the nature of the trip (wilderness, jungle, rural, urban, resort, or cruise), the duration of travel, and the latest available information on the site in terms of disease outbreaks, terrorism, and natural calamities.
Full Text
The Full Text of this article is available as a PDF (299.5 KB).
Selected References
These references are in PubMed. This may not be the complete list of references from this article.
- Anderson S. L., Berman J., Kuschner R., Wesche D., Magill A., Wellde B., Schneider I., Dunne M., Schuster B. G. Prophylaxis of Plasmodium falciparum malaria with azithromycin administered to volunteers. Ann Intern Med. 1995 Nov 15;123(10):771–773. doi: 10.7326/0003-4819-123-10-199511150-00005. [DOI] [PubMed] [Google Scholar]
- Behrens R. H., Roberts J. A. Is travel prophylaxis worth while? Economic appraisal of prophylactic measures against malaria, hepatitis A, and typhoid in travellers. BMJ. 1994 Oct 8;309(6959):918–922. doi: 10.1136/bmj.309.6959.918. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Besser R. E., Feikin D. R., Eberhart-Phillips J. E., Mascola L., Griffin P. M. Diagnosis and treatment of cholera in the United States. Are we prepared? JAMA. 1994 Oct 19;272(15):1203–1205. [PubMed] [Google Scholar]
- Bock HL, Löscher T, Scheiermann N, Baumgarten R, Wiese M, Dutz W, Sänger R, Clemens R. Accelerated Schedule for Hepatitis B Immunization. J Travel Med. 1995 Dec 1;2(4):213–217. doi: 10.1111/j.1708-8305.1995.tb00661.x. [DOI] [PubMed] [Google Scholar]
- Boyce T. G., Mintz E. D., Greene K. D., Wells J. G., Hockin J. C., Morgan D., Tauxe R. V. Vibrio cholerae O139 Bengal infections among tourists to Southeast Asia: an intercontinental foodborne outbreak. J Infect Dis. 1995 Nov;172(5):1401–1404. doi: 10.1093/infdis/172.5.1401. [DOI] [PubMed] [Google Scholar]
- Brook J. H., Genese C. A., Bloland P. B., Zucker J. R., Spitalny K. C. Brief report: malaria probably locally acquired in New Jersey. N Engl J Med. 1994 Jul 7;331(1):22–23. doi: 10.1056/NEJM199407073310105. [DOI] [PubMed] [Google Scholar]
- Campbell G. L., Hughes J. M. Plague in India: a new warning from an old nemesis. Ann Intern Med. 1995 Jan 15;122(2):151–153. doi: 10.7326/0003-4819-122-2-199501150-00014. [DOI] [PubMed] [Google Scholar]
- Choi H. W., Breman J. G., Teutsch S. M., Liu S., Hightower A. W., Sexton J. D. The effectiveness of insecticide-impregnated bed nets in reducing cases of malaria infection: a meta-analysis of published results. Am J Trop Med Hyg. 1995 May;52(5):377–382. doi: 10.4269/ajtmh.1995.52.377. [DOI] [PubMed] [Google Scholar]
- Collinge J., Rossor M. A new variant of prion disease. Lancet. 1996 Apr 6;347(9006):916–917. doi: 10.1016/s0140-6736(96)91407-5. [DOI] [PubMed] [Google Scholar]
- Corachán M. Schistosomiasis in Travelers. J Travel Med. 1995 Mar 1;2(1):1–3. doi: 10.1111/j.1708-8305.1995.tb00610.x. [DOI] [PubMed] [Google Scholar]
- Dawood RM. Maximum Immunization for Travel: Pro. J Travel Med. 1995 Sep 1;2(3):186–189. doi: 10.1111/j.1708-8305.1995.tb00650.x. [DOI] [PubMed] [Google Scholar]
- DuPont H. L., Ericsson C. D. Prevention and treatment of traveler's diarrhea. N Engl J Med. 1993 Jun 24;328(25):1821–1827. doi: 10.1056/NEJM199306243282507. [DOI] [PubMed] [Google Scholar]
- Echeverria P., Hoge C. W., Bodhidatta L., Tungtaem C., Herrmann J., Imlarp S., Tamura K. Etiology of diarrhea in a rural community in western Thailand: importance of enteric viruses and enterovirulent Escherichia coli. J Infect Dis. 1994 Apr;169(4):916–919. doi: 10.1093/infdis/169.4.916. [DOI] [PubMed] [Google Scholar]
- Ericsson CD. Chemoprophylaxis for Travelers' Diarrhea: Con. J Travel Med. 1994 Dec 1;1(4):221–224. doi: 10.1111/j.1708-8305.1994.tb00601.x. [DOI] [PubMed] [Google Scholar]
- Ericsson CD, DuPont HL, Mathewson III., JJ Epidemiologic Observations on Diarrhea Developing in U.S. and Mexican Students Living in Guadalajara, Mexico. J Travel Med. 1995 Mar 1;2(1):6–10. doi: 10.1111/j.1708-8305.1995.tb00612.x. [DOI] [PubMed] [Google Scholar]
- Gardner P., Eickhoff T., Poland G. A., Gross P., Griffin M., LaForce F. M., Schaffner W., Strikas R. Adult immunizations. Ann Intern Med. 1996 Jan 1;124(1 Pt 1):35–40. doi: 10.7326/0003-4819-124-1_part_1-199601010-00007. [DOI] [PubMed] [Google Scholar]
- Gardner P., Schaffner W. Immunization of adults. N Engl J Med. 1993 Apr 29;328(17):1252–1258. doi: 10.1056/NEJM199304293281708. [DOI] [PubMed] [Google Scholar]
- Genton B, Hii J, Paget S, Alpers MP. Rapid Manual Diagnosis of Plasmodium falciparum Malaria Using ParaSight-F Dipsticks Applied to Human Blood and Urine. J Travel Med. 1996 Sep 1;3(3):172–173. doi: 10.1111/j.1708-8305.1996.tb00734.x. [DOI] [PubMed] [Google Scholar]
- Gill G. V., Redmond S. Insulin treatment, time-zones and air travel: a survey of current advice from British diabetic clinics. Diabet Med. 1993 Oct;10(8):764–767. doi: 10.1111/j.1464-5491.1993.tb00161.x. [DOI] [PubMed] [Google Scholar]
- Gyorkos T. W., Svenson J. E., Maclean J. D., Mohamed N., Remondin M. H., Franco E. D. Compliance with antimalarial chemoprophylaxis and the subsequent development of malaria: a matched case-control study. Am J Trop Med Hyg. 1995 Nov;53(5):511–517. doi: 10.4269/ajtmh.1995.53.511. [DOI] [PubMed] [Google Scholar]
- Hardy I. R., Dittmann S., Sutter R. W. Current situation and control strategies for resurgence of diphtheria in newly independent states of the former Soviet Union. Lancet. 1996 Jun 22;347(9017):1739–1744. doi: 10.1016/s0140-6736(96)90811-9. [DOI] [PubMed] [Google Scholar]
- Hayunga E. G., Möllegård I., Duncan J. F., Sumner M. P., Stek M., Jr, Hunter K. W., Jr Development of circulating antigen assay for rapid detection of acute schistosomiasis. Lancet. 1986 Sep 27;2(8509):716–718. doi: 10.1016/s0140-6736(86)90232-1. [DOI] [PubMed] [Google Scholar]
- Hill DR, Behrens RH. A Survey of Travel Clinics Throughout the World. J Travel Med. 1996 Mar 1;3(1):46–51. doi: 10.1111/j.1708-8305.1996.tb00696.x. [DOI] [PubMed] [Google Scholar]
- Hoke C. H., Nisalak A., Sangawhipa N., Jatanasen S., Laorakapongse T., Innis B. L., Kotchasenee S., Gingrich J. B., Latendresse J., Fukai K. Protection against Japanese encephalitis by inactivated vaccines. N Engl J Med. 1988 Sep 8;319(10):608–614. doi: 10.1056/NEJM198809083191004. [DOI] [PubMed] [Google Scholar]
- Hoofnagle J. H., di Bisceglie A. M. The treatment of chronic viral hepatitis. N Engl J Med. 1997 Jan 30;336(5):347–356. doi: 10.1056/NEJM199701303360507. [DOI] [PubMed] [Google Scholar]
- Huzly D, Schönfeld C, Beuerle W, Bienzle U. Malaria Chemoprophylaxis in German Tourists: A Prospective Study on Compliance and Adverse Reactions. J Travel Med. 1996 Sep 1;3(3):148–155. doi: 10.1111/j.1708-8305.1996.tb00729.x. [DOI] [PubMed] [Google Scholar]
- Jackson L. A., Schuchat A., Reeves M. W., Wenger J. D. Serogroup C meningococcal outbreaks in the United States. An emerging threat. JAMA. 1995 Feb 1;273(5):383–389. [PubMed] [Google Scholar]
- Jelinek T, Nothdurft HD, Löscher T. Malaria in Nonimmune Travelers: A Synopsis of History, Symptoms, and Treatment in 160 Patients. J Travel Med. 1994 Dec 1;1(4):199–202. doi: 10.1111/j.1708-8305.1994.tb00595.x. [DOI] [PubMed] [Google Scholar]
- Jelinek T, Nothdurft HD, Löscher T. Schistosomiasis in Travelers and Expatriates. J Travel Med. 1996 Sep 1;3(3):160–164. doi: 10.1111/j.1708-8305.1996.tb00731.x. [DOI] [PubMed] [Google Scholar]
- Kass R. Chemoprophylaxis for Travelers' Diarrhea: Pro. J Travel Med. 1994 Dec 1;1(4):219–220. doi: 10.1111/j.1708-8305.1994.tb00600.x. [DOI] [PubMed] [Google Scholar]
- Kemper CA, Linett A, Kane C, Deresinski SC. Frequency of Travel of Adults Infected with HIV. J Travel Med. 1995 Jun 1;2(2):85–88. doi: 10.1111/j.1708-8305.1995.tb00632.x. [DOI] [PubMed] [Google Scholar]
- Keystone JS, Dismukes R, Sawyer L, Kozarsky PE. Inadequacies in Health Recommendations Provided for International Travelers by North American Travel Health Advisors. J Travel Med. 1994 Jun 1;1(2):72–78. doi: 10.1111/j.1708-8305.1994.tb00566.x. [DOI] [PubMed] [Google Scholar]
- Khan W. A., Bennish M. L., Seas C., Khan E. H., Ronan A., Dhar U., Busch W., Salam M. A. Randomised controlled comparison of single-dose ciprofloxacin and doxycycline for cholera caused by Vibrio cholerae 01 or 0139. Lancet. 1996 Aug 3;348(9023):296–300. doi: 10.1016/s0140-6736(96)01180-4. [DOI] [PubMed] [Google Scholar]
- Kuschner R. A., Trofa A. F., Thomas R. J., Hoge C. W., Pitarangsi C., Amato S., Olafson R. P., Echeverria P., Sadoff J. C., Taylor D. N. Use of azithromycin for the treatment of Campylobacter enteritis in travelers to Thailand, an area where ciprofloxacin resistance is prevalent. Clin Infect Dis. 1995 Sep;21(3):536–541. doi: 10.1093/clinids/21.3.536. [DOI] [PubMed] [Google Scholar]
- Lacey S. W. Cholera: calamitous past, ominous future. Clin Infect Dis. 1995 May;20(5):1409–1419. doi: 10.1093/clinids/20.5.1409. [DOI] [PubMed] [Google Scholar]
- Lobel H. O., Miani M., Eng T., Bernard K. W., Hightower A. W., Campbell C. C. Long-term malaria prophylaxis with weekly mefloquine. Lancet. 1993 Apr 3;341(8849):848–851. doi: 10.1016/0140-6736(93)93058-9. [DOI] [PubMed] [Google Scholar]
- Marchou B., Excler J. L., Bourderioux C., Salaun J., Picot N., Yvonnet B., Cerisier J. E., Salomon H., Auvergnat J. C. A 3-week hepatitis B vaccination schedule provides rapid and persistent protective immunity: a multicenter, randomized trial comparing accelerated and classic vaccination schedules. J Infect Dis. 1995 Jul;172(1):258–260. doi: 10.1093/infdis/172.1.258. [DOI] [PubMed] [Google Scholar]
- Matteelli A, Chiodera A, Castelli F, Caligaris S, Minardi C, Carosi G. Failure of Mefloquine Chemoprophylaxis for Malaria in Mozambique. J Travel Med. 1995 Dec 1;2(4):260–261. doi: 10.1111/j.1708-8305.1995.tb00673.x. [DOI] [PubMed] [Google Scholar]
- Mattila L. Clinical features and duration of traveler's diarrhea in relation to its etiology. Clin Infect Dis. 1994 Oct;19(4):728–734. doi: 10.1093/clinids/19.4.728. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Mattila L, Siitonen A, Kyrönseppä H, Simula I, I, Peltola H. Risk Behavior for Travelers' Diarrhea Among Finnish Travelers. J Travel Med. 1995 Jun 1;2(2):77–84. doi: 10.1111/j.1708-8305.1995.tb00631.x. [DOI] [PubMed] [Google Scholar]
- Millet P. Current Status and Prospects for Vaccines Against Malaria. J Travel Med. 1994 Dec 1;1(4):216–218. doi: 10.1111/j.1708-8305.1994.tb00599.x. [DOI] [PubMed] [Google Scholar]
- Morell V. Chimpanzee outbreak heats up search for Ebola origin. Science. 1995 May 19;268(5213):974–975. doi: 10.1126/science.7754392. [DOI] [PubMed] [Google Scholar]
- Murdoch DR. Altitude Illness Among Tourists Flying to 3740 Meters Elevation in the Nepal Himalayas. J Travel Med. 1995 Dec 1;2(4):255–256. doi: 10.1111/j.1708-8305.1995.tb00671.x. [DOI] [PubMed] [Google Scholar]
- Nahlen B. L., Parsonnet J., Preblud S. R., Tsai T. F., Brink E. W. International travel and the child younger than two years: II. Recommendations for prevention of travelers' diarrhea and malaria chemoprophylaxis. Pediatr Infect Dis J. 1989 Nov;8(11):735–739. doi: 10.1097/00006454-198911000-00001. [DOI] [PubMed] [Google Scholar]
- Newton J. A., Jr, Schnepf G. A., Wallace M. R., Lobel H. O., Kennedy C. A., Oldfield E. C., 3rd Malaria in US Marines returning from Somalia. JAMA. 1994 Aug 3;272(5):397–399. [PubMed] [Google Scholar]
- Nichol K. L., Lind A., Margolis K. L., Murdoch M., McFadden R., Hauge M., Magnan S., Drake M. The effectiveness of vaccination against influenza in healthy, working adults. N Engl J Med. 1995 Oct 5;333(14):889–893. doi: 10.1056/NEJM199510053331401. [DOI] [PubMed] [Google Scholar]
- Nosten F., Luxemburger C., Kyle D. E., Ballou W. R., Wittes J., Wah E., Chongsuphajaisiddhi T., Gordon D. M., White N. J., Sadoff J. C. Randomised double-blind placebo-controlled trial of SPf66 malaria vaccine in children in northwestern Thailand. Shoklo SPf66 Malaria Vaccine Trial Group. Lancet. 1996 Sep 14;348(9029):701–707. doi: 10.1016/s0140-6736(96)04465-0. [DOI] [PubMed] [Google Scholar]
- Nosten F., ter Kuile F., Maelankiri L., Chongsuphajaisiddhi T., Nopdonrattakoon L., Tangkitchot S., Boudreau E., Bunnag D., White N. J. Mefloquine prophylaxis prevents malaria during pregnancy: a double-blind, placebo-controlled study. J Infect Dis. 1994 Mar;169(3):595–603. doi: 10.1093/infdis/169.3.595. [DOI] [PubMed] [Google Scholar]
- Olliaro P., Cattani J., Wirth D. Malaria, the submerged disease. JAMA. 1996 Jan 17;275(3):230–233. [PubMed] [Google Scholar]
- Petruccelli B. P., Murphy G. S., Sanchez J. L., Walz S., DeFraites R., Gelnett J., Haberberger R. L., Echeverria P., Taylor D. N. Treatment of traveler's diarrhea with ciprofloxacin and loperamide. J Infect Dis. 1992 Mar;165(3):557–560. doi: 10.1093/infdis/165.3.557. [DOI] [PubMed] [Google Scholar]
- Phillips MA, Kass RB. User Acceptability Patterns for Mefloquine and Doxycycline Malaria Chemoprophylaxis. J Travel Med. 1996 Mar 1;3(1):40–45. doi: 10.1111/j.1708-8305.1996.tb00695.x. [DOI] [PubMed] [Google Scholar]
- Potasman I, I, Pick N, Abel A, Dan M. Schistosomiasis Acquired in Lake Malawi. J Travel Med. 1996 Mar 1;3(1):32–36. doi: 10.1111/j.1708-8305.1996.tb00693.x. [DOI] [PubMed] [Google Scholar]
- Preblud S. R., Tsai T. F., Brink E. W., Nahlen B. L., Parsonnet J. International travel and the child younger than two years: I. Recommendations for immunization. Pediatr Infect Dis J. 1989 Jul;8(7):416–425. doi: 10.1097/00006454-198907000-00003. [DOI] [PubMed] [Google Scholar]
- Reed JM, McIntosh IB, Powers K. Travel Illness and the Family Practitioner: A Retrospective Assessment of Travel-Induced Illness in General Practice and the Effect of a Travel Illness Clinic. J Travel Med. 1994 Dec 1;1(4):192–198. doi: 10.1111/j.1708-8305.1994.tb00594.x. [DOI] [PubMed] [Google Scholar]
- Riley P. A., Parasakthi N., Liam C. K. Development of Aeromonas hydrophila bacteremia in a patient recovering from cholera. Clin Infect Dis. 1996 May;22(5):867–868. doi: 10.1093/clinids/22.5.867. [DOI] [PubMed] [Google Scholar]
- Salam I., Katelaris P., Leigh-Smith S., Farthing M. J. Randomised trial of single-dose ciprofloxacin for travellers' diarrhoea. Lancet. 1994 Dec 3;344(8936):1537–1539. doi: 10.1016/s0140-6736(94)90350-6. [DOI] [PubMed] [Google Scholar]
- Sax P., Singer M. Routine immunization in HIV: helpful or harmful? AIDS Clin Care. 1996 Feb;8(2):11-3, 15. [PubMed] [Google Scholar]
- Scerpella EG, Sanchez JL, Mathewson III, JJ, Torres-Cordero JV, Sadoff JC, Svennerholm AM, DuPont HL, Taylor DN, Ericsson CD. Safety, Immunogenicity, and Protective Efficacy of the Whole-Cell/Recombinant B Subunit (WC/rBS) Oral Cholera Vaccine Against Travelers' Diarrhea. J Travel Med. 1995 Mar 1;2(1):22–27. doi: 10.1111/j.1708-8305.1995.tb00615.x. [DOI] [PubMed] [Google Scholar]
- Schmid R, Schick T, Steffen R, Tschopp A, Wilk T. Comparison of Seven Commonly Used Agents for Prophylaxis of Seasickness. J Travel Med. 1994 Dec 1;1(4):203–206. doi: 10.1111/j.1708-8305.1994.tb00596.x. [DOI] [PubMed] [Google Scholar]
- Shafer R. T., Correia J., Patel V., Keystone J. S. Travel advice from embassies. Lancet. 1996 Sep 14;348(9029):757–758. doi: 10.1016/s0140-6736(05)65670-x. [DOI] [PubMed] [Google Scholar]
- Smalligan R. D., Lange W. R., Frame J. D., Yarbough P. O., Frankenfield D. L., Hyams K. C. The risk of viral hepatitis A, B, C, and E among North American missionaries. Am J Trop Med Hyg. 1995 Sep;53(3):233–236. doi: 10.4269/ajtmh.1995.53.233. [DOI] [PubMed] [Google Scholar]
- Somani J., Larson R. A. Reimmunization after allogeneic bone marrow transplantation. Am J Med. 1995 Apr;98(4):389–398. doi: 10.1016/S0002-9343(99)80319-2. [DOI] [PubMed] [Google Scholar]
- Soto J., Medina F., Dember N., Berman J. Efficacy of permethrin-impregnated uniforms in the prevention of malaria and leishmaniasis in Colombian soldiers. Clin Infect Dis. 1995 Sep;21(3):599–602. doi: 10.1093/clinids/21.3.599. [DOI] [PubMed] [Google Scholar]
- Stanley S. K., Ostrowski M. A., Justement J. S., Gantt K., Hedayati S., Mannix M., Roche K., Schwartzentruber D. J., Fox C. H., Fauci A. S. Effect of immunization with a common recall antigen on viral expression in patients infected with human immunodeficiency virus type 1. N Engl J Med. 1996 May 9;334(19):1222–1230. doi: 10.1056/NEJM199605093341903. [DOI] [PubMed] [Google Scholar]
- Steffen R., Fuchs E., Schildknecht J., Naef U., Funk M., Schlagenhauf P., Phillips-Howard P., Nevill C., Stürchler D. Mefloquine compared with other malaria chemoprophylactic regimens in tourists visiting east Africa. Lancet. 1993 May 22;341(8856):1299–1303. doi: 10.1016/0140-6736(93)90814-w. [DOI] [PubMed] [Google Scholar]
- Stoute J. A., Slaoui M., Heppner D. G., Momin P., Kester K. E., Desmons P., Wellde B. T., Garçon N., Krzych U., Marchand M. A preliminary evaluation of a recombinant circumsporozoite protein vaccine against Plasmodium falciparum malaria. RTS,S Malaria Vaccine Evaluation Group. N Engl J Med. 1997 Jan 9;336(2):86–91. doi: 10.1056/NEJM199701093360202. [DOI] [PubMed] [Google Scholar]
- Tsarev S. A., Tsareva T. S., Emerson S. U., Govindarajan S., Shapiro M., Gerin J. L., Purcell R. H. Successful passive and active immunization of cynomolgus monkeys against hepatitis E. Proc Natl Acad Sci U S A. 1994 Oct 11;91(21):10198–10202. doi: 10.1073/pnas.91.21.10198. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Urbina J. A., Payares G., Molina J., Sanoja C., Liendo A., Lazardi K., Piras M. M., Piras R., Perez N., Wincker P. Cure of short- and long-term experimental Chagas' disease using D0870. Science. 1996 Aug 16;273(5277):969–971. doi: 10.1126/science.273.5277.969. [DOI] [PubMed] [Google Scholar]
- Weekly S. J., Neumann M. L. Speaking up for baby. The case for individualized neonatal discharge plans. AWHONN Lifelines. 1997 Feb;1(1):24–29. doi: 10.1111/j.1552-6356.1997.tb01302.x. [DOI] [PubMed] [Google Scholar]
- White A. C., Jr, Runnels J. H. Mefloquine prophylaxis in pregnancy. J Infect Dis. 1995 Jan;171(1):253–253. doi: 10.1093/infdis/171.1.253. [DOI] [PubMed] [Google Scholar]
- Wilde H., Sirikawin S., Sabcharoen A., Kingnate D., Tantawichien T., Harischandra P. A., Chaiyabutr N., de Silva D. G., Fernando L., Liyanage J. B. Failure of postexposure treatment of rabies in children. Clin Infect Dis. 1996 Feb;22(2):228–232. doi: 10.1093/clinids/22.2.228. [DOI] [PubMed] [Google Scholar]
- Will R. G., Ironside J. W., Zeidler M., Cousens S. N., Estibeiro K., Alperovitch A., Poser S., Pocchiari M., Hofman A., Smith P. G. A new variant of Creutzfeldt-Jakob disease in the UK. Lancet. 1996 Apr 6;347(9006):921–925. doi: 10.1016/s0140-6736(96)91412-9. [DOI] [PubMed] [Google Scholar]
- Wilson ME. Critical Evaluation of Vaccines for Travelers. J Travel Med. 1995 Dec 1;2(4):239–243. doi: 10.1111/j.1708-8305.1995.tb00668.x. [DOI] [PubMed] [Google Scholar]
- Wittes R. C., Saginur R. Adverse reaction to mefloquine associated with ethanol ingestion. CMAJ. 1995 Feb 15;152(4):515–517. [PMC free article] [PubMed] [Google Scholar]
- Wittlinger F, Steffen R, Watanabe H, Handszuh H. Risk of Cholera Among Western and Japanese Travelers. J Travel Med. 1995 Sep 1;2(3):154–158. doi: 10.1111/j.1708-8305.1995.tb00643.x. [DOI] [PubMed] [Google Scholar]
- Wyler D. J. Malaria chemoprophylaxis for the traveler. N Engl J Med. 1993 Jul 1;329(1):31–37. doi: 10.1056/NEJM199307013290107. [DOI] [PubMed] [Google Scholar]
