UPDATES
March 1, 1999 4 minutes read
UPDATES
By Carol A. Kemper, MD
Maybe Hotel Food is Better
Source: Kemmerer TP, et al. Travel Med 1998;5:184-187.
Corporate travel is a burgeon-ing part of today’s global economy. Kemmerer and associates examined several health-risk behaviors of 226 Coca-Cola employees who traveled to international destinations during a six-month period in 1994. Prior to departure, all employees were referred to a nearby university-based travel medicine clinic where they received counseling, written information, and vaccines. Despite these precautionary measures, nearly one-half of those traveling to malarious countries were noncompliant with their chemoprophylaxis, although none developed malaria. Nearly one-half drank tap water, 14% ate raw meat, and 17% ate raw or poorly cooked seafood while abroad. Although most of the travelers ate the majority of their meals at their hotel, and usually ate hot cooked food, more than one-half ate food from cold salad bars or food that had been at room temperature for a prolonged period. Nineteen percent ate food purchased from street vendors.
Not surprisingly, traveler’s diarrhea occurred in 35%. Risk analysis showed that eating in a fast-food establishment and, eating raw fish, raw meat, and foods at room temperature were all highly predictive of the occurrence of diarrheal illness, whereas eating hotel food was strongly protective. Eating food in a local home or purchased from a street vendor, or drinking tap water were not associated with illness in this study. An additional 29% of the travelers developed respiratory infection and 12% required medical attention.
Like others before them, Kemmerer et al discovered that adherence to medication and travel advice is unrelated to the education level of the individual. Coca-Cola is now exploring ways to improve employee compliance with travel recommendations, including the use of a travel kit with analgesics, antispasmodics, sinus medications, and other helpful aids.
Sexual Activity While Traveling
Source: Gehring TM, et al. J Travel Med 1998;5:205-209.
Sex tourism—or just plain casual sex while traveling—remains a significant risk factor for STDs and HIV transmission. Up to one-third of new HIV infections in European travelers are believed to be acquired while traveling abroad. Gehring and associates queried departing travelers at the Zurich airport about their planned behavior and, upon return, their actual behavior. All departing travelers (n = 1689) received written information and brochures on health and sex-related issues and condom use, and an additional 418 (41%) agreed to participate in a brief educational intervention, which included a conversation about casual sex and condom use.
Although 93% of passengers knew condoms were the cornerstone of safe sex and virtually everyone who thought they might have sex planned to use condoms, only one-half of the approximate 7% of travelers reporting casual sex actually used them. The brief educational intervention appeared to have no affect on actual behavior. Although alcohol appeared to be the most significant risk factor for unsafe sex, "confidence" and "love" for the sex partner were also frequently referred to by returning travelers as a motivating factor in the decision to proceed without protection. Both this study and the previous one indicate the problem is not knowledge but behavior. Future interventions should be directed at modifying behavior, not just providing education.
Weekly Antifungal Prophylaxis in AIDS
Source: Havlir DV, et al. Clin Infect Dis 1998;27:1369-1375.
Because of concerns over the cost-benefits of primary antifungal prophylaxis and the emergence of azole-resistant fungi, the use of prophylactic antifungal agents in patients with AIDS is generally limited to those with severe or frequent recurrences of thrush, or as secondary prophylaxis for esophagitis or other invasive fungal disease. Havlir and associates (including myself) explored whether fluconazole administered once weekly was as effective and less likely to lead to azole resistance when compared with daily dosing. A total of 636 HIV-infected subjects with CD4 counts less than 100/mm3 were randomized to receive fluconazole 400 mg weekly or 200 mg daily.
Deep fungal infection infrequently occurred, although the study was completed in 1995 (before the availability of more highly active antiretroviral therapy). Only 17 (5.5%) of those randomly assigned to daily and 24 (7.7%) of those given weekly fluconazole developed serious fungal infection (P = NS), most of which were esophageal infections, although a few cases of cryptococcal disease ocurred. Thrush occurred almost twice as often in patients receiving weekly (19.9%) compared with daily (12.3%) fluconazole. Significant fluconazole resistance was not demonstrated in either treatment group, although only a minority of the isolates were tested.
Weekly fluconazole is an acceptable alternative to daily dosing for prevention of fungal infection in patients at significant risk, although its routine use does not appear warranted in most patients.
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