Tips for the health-seeking traveler planned in new Yellow Book

January 2005

Chapters on norovirus, severe acute respiratory syndrome (SARS), pneumococcus, Legionella, jet lag, fish poisoning, sunburn, the health-seeking traveler and healthy travel are being added to the new edition of the Yellow Book.

“Health Information for International Travel” (the Yellow Book) is published every two years by the CDC as a reference for providers and sophisticated travelers. A new edition is scheduled to be released in early spring.

“We have identified that a large number of persons travel for health,” said Christie Reed, MD, MPH, head of the Travelers’ Health Team at the CDC. “These people may be seeking surgery, transplant or dental care. We want to alert people that the standards in other places may not be the same standards that they expect in the United States.” There are sections on healthy travel designed to assist short-term travelers as well as expatriates and new Americans returning to their countries of birth.

More on treatment, certain populations

“In the past, we’ve provided a description of the disease, the occurrence worldwide, the risk for travelers and prevention efforts,” said Reed at the 53rd Annual Meeting of the American Society of Tropical Medicine and Hygiene meeting in Miami. “We are now including clinical presentation and treatment because we expect the Yellow Book to be a resource for providers that are experienced and for those that only see the occasional traveler, or the only provider for hundreds of miles. For instance, we are not offering in-depth treatment options. If treatment other than supportive is available, the reader will be referred to appropriate resources.”

Sections of the Yellow Book have also been expanded, based on questions received. “In the past, we’ve addressed a traveler with HIV, but not all immunocompromised travelers,” Reed said. With advancements in health, “we have more persons who are traveling either post-chemotherapy or post-transplant. We also address preconception, pregnancy and breast-feeding for travelers. We’ve turned to our experts internally at CDC and externally for guidance.”

Graphics

New maps are included in the pending Yellow Book. “Yellow fever illustrates the difficulties in trying to put something into press that is current, accurate and addresses the topic adequately,” Reed said. “There are environments that foster transmission of yellow fever; for example, jungles with nonhuman primates. However, the population may not be present for these conditions. Surveillance and accuracy of reporting may also vary among parts of the world. In addition, because of vaccination, a particular local area may not be seeing high numbers of cases, but the risk is still there for the traveler.”

Consequently, the Yellow Book will have zones where conditions are present that would place a traveler at potential risk. “This is based on information obtained through all the sites we normally evaluate for reports of activity and persons or activities and sylvan cycles,” Reed said. “We contact the ministers of health in these countries to try to verify the zone of yellow fever activity and where yellow fever vaccination should be discussed with travelers.” Although the new yellow fever maps will look similar to the current edition, there are some addendums along the borders, especially the northern border of Africa and the eastern edge of South America.

“Our overall mission is to decrease the morbidity and mortality from infectious diseases among mobile populations destined for or traveling from the United States,” Reed said. “We also seek to decrease the risk of importation and spread of infectious diseases by humans — whether they are immigrants, refugees or travelers – animals and cargo.”

Advance orders for the new Yellow Book will be available on the CDC Travelers’ Health Web site (www.cdc.gov/travel) as the publication date nears. “Whenever we undertake a revision process, we start from the beginning and go through the entire book,” Reed said. “This includes a major content review. Every chapter is re-examined, updated and rewritten as needed. We also broaden the scope. Just as CDC has gone from being the communicable disease center to disease control and prevention, we’ve expanded from an infectious disease focus to encompass safety and health.”

Yellow Book online

Reed noted that the Internet has been a boon for the CDC. “It allows us to post information as accurately and as quickly as possible,” she said. “We can also respond to e-mails.” A new feature of the CDC Web site is travel notices. “During SARS, for the first time ever, we had alerts and advisories. We posted a recommendation that nonessential travel be curtailed,” Reed said. The CDC Web site now has four categories related to travel: In the News, Outbreaks, Alert and Advisories. “The bulk of new events are contained in In the News,” Reed said.

For more information:

• Reed C. Update on the Yellow Book and Centers for Disease Control and Prevention recommendations for travelers. Presented at the 53rd Annual Meeting of the American Society of Tropical Medicine and Hygiene. Nov. 7-11, 2004. Miami.