During the past two decades, travel medicine, a relatively new medical specialty, has grown in response to the enormous increase in international travel. The worldwide number of international tourist arrivals in 2001 was 693 million, which represented a decrease of 0.6 percent, or 4 million, from the 697 million in 2000 (because of the terrorist attacks of September 11, 2001). One billion international tourist arrivals are expected by 2010 to 2015. For many developed and developing countries, tourism is an important source of foreign-currency earnings and employment. Because of the need to consider so many diverse aspects of travel-related health, vaccination, and prevention of malaria, the practice of travel medicine is demanding not only for physicians who practice in international-travel clinics but also for general practitioners. There are short- and long-term travelers, expatriates, aid workers, missionaries, military personnel, refugees, and migrants. Age limits no longer exist for travelers, and people with chronic diseases are no longer reluctant to travel. Immigrants returning to their native countries to visit friends and relatives, sometimes after a long absence, often do not seek medical advice before departing. For these reasons, practitioners of travel medicine need an overview of the field and regular updates of their knowledge. They need knowledge not only of tropical diseases but also of other disciplines from the perspective of travel medicine -- ear, nose, and throat diseases, dermatology, gynecology, diabetes, and chronic heart disease, to name a few. Numerous reliable, informative sources now exist, and a growing body of literature in the form of books, journals, brochures, and Web sites has emerged. It was a rewarding task, as well as a pleasant challenge, to read Principles and Practice of Travel Medicine from cover to cover. Its editor, Jane N. Zuckerman, is an internationally known authority in the field of travel medicine. The authors are from both sides of the Atlantic -- a guarantee of a well-balanced view. The book has a handy format combined with a pleasant layout, and it covers nearly all domains and disciplines related to travel medicine. The book has five sections. The first two give concise overviews of travel medicine and infectious diseases in travelers for beginners in travel medicine. The chapters on viral, bacterial, and vector-borne parasitic diseases are very readable introductions but are no substitute for the more in-depth presentations in classic textbooks and review articles. A discussion of malaria is embedded in the chapter on vector-borne parasitic diseases; given its importance, a more extensive discussion in a separate chapter in the third section of the book would have been useful. This third section, "Prevention and Management of Travel-Related Disease," addresses the core activities in a travel-medicine clinic: vaccinations, prevention and management of traveler's diarrhea, the care of the returning traveler, and tropical skin infections. In "Vaccine-Preventable Disease," Zuckerman gives a comprehensive overview of vaccination practices in the context of a pretravel consultation. The discussion is concise and didactic, but some paragraphs are too brief, and many statements lack scientific references (although there is a comprehensive list of further readings). The background information for the various diseases is given in three chapters in the preceding section, but a page-referring reminder would have been useful. The field of vaccines and vaccination practices, one of the most rapidly evolving in this discipline, is also characterized by an extreme diversity of schedules and practices, not only between continents but also between countries on the European continent. Although the author has anticipated many imminent changes (e.g., a booster dose for hepatitis A vaccination only after 20 years), some of the presentation is already outdated. One author has written this important chapter, and it undoubtedly represents an authoritative guideline for the United Kingdom. A multiauthored version, however, would provide more representative and more recognizable guidelines for the whole of Europe and the United States. The following section provides thorough, scientific discussions of problems related to aviation, high altitudes and expeditions, diving, cruise-ship travel, travel-related injury, "aeromedical repatriation" (i.e., air-ambulance transfers of ill or injured travelers to their native countries), poisons, venomous bites and stings, and ophthalmologic conditions in travelers. The last section discusses, in a very practical manner, travel-related problems in children, pregnant women, immunocompromised persons, older persons, those who are disabled or chronically ill, and finally, aid workers, expatriates, and migrants and refugees. The chapter on aid workers and expatriates is a comprehensive overview of a topic on which there is relatively little literature available. This book is not intended to be read as if it were a novel, but every chapter is certainly well worth reading. It is intended for inexperienced health care workers (who may find it useful as an introductory textbook), as well as for experienced health care workers (who can use it to refresh their knowledge in various areas). The book deserves a place beside the few other textbooks on travel medicine. However, its relatively high price will probably discourage readers from buying a new, updated version anytime soon.
Alfons Van Gompel, M.D.Copyright © 2002 Massachusetts Medical Society. All rights reserved. The New England Journal of Medicine is a registered trademark of the MMS.
"The case histories throughout help to highlight the subjects. This textbook will be a welcome addition to those involved in training and those advising travellers and a valuable resource for study and reference." (
Royal College of Nursing Travel Medicine Forum Newsletter, January 2002)
"To put together such a valuable and useful reference as this is a monumental task, and the book deserves a place on the shelves of all travel clinics." (Transactions of the Royal Society of Tropical Medicine and Hygiene)
"...This is a good book. It is comprehensive, covers the major problems fully, while providing at least a short entry on the less common and more exotic..." (Tropical Doctor)
"...easy to read and highly informative...will be invaluable and will replace my usual reference sources..." (Family Practice, Vol.19, No.4, 2002)?
"...overviews general principles for keeping people healthy while they travel..." (SciTech Book News, Vol. 26, No. 2, June 2002)
"...I would highly recommend this book...the content is invaluable..." (Practice Nurse, 27 September 2002)
"The book deserves a place beside the few other textbooks on travel medicine." (New England Journal of Medicine, October 10, 2002)
