By Matt Leingang
Enquirer staff writer

Jan Osborn of Clifton is vaccinated for hepatitis A and B at Passport Health in Blue Ash before a trip to Nigeria. The Enquirer/SARAH CONARD

CLIFTON - Jan Osborn knows that a polio outbreak this summer prompted the World Health Organization to issue a travel warning for Nigeria.

But the Clifton resident is going to the African country anyway.

Osborn and nine other missionaries from College Hill Presbyterian Church are scheduled to leave for a two-week trip Aug. 3. To prepare, Osborn is getting a polio booster shot along with immunizations against hepatitis A, hepatitis B, typhoid fever, cholera, tetanus and diphtheria.

"If it's anywhere in the world, chances are it's prevalent in Nigeria," Osborn said. "But I'm not concerned. I'm taking precautions."

Osborn sought advice from Passport Health, a Blue Ash-based medical practice that specializes in travel medicine.

Until recently, travel medicine was the purview of local health departments or academic-based medical centers, such as the University of Cincinnati.

But with the growth of international travel, doctors in private practice are increasingly are being asked to provide medical advice to Americans traveling abroad - college students, vacationers, missionaries, business travelers and military personnel.

TRAVEL TIPS

Immunizations of special importance • Hepatitis A: Recommended for all travelers to developing countries. • Hepatitis B: Recommended for all long-term travelers and those relocating to areas of high prevalence: Africa, southeast Asia, the Middle East (except Israel), south and western Pacific Islands and certain parts of the Caribbean. • Yellow fever: The viral illness is carried by some species of mosquitoes in Central and South America and in tropical regions of Africa. • Typhoid: Recommended for travelers to developing countries where there is prolonged travel off the usual tourist routes or where there is anticipated exposure to impure water and unhygienic food. • Tetanus: All Americans should receive a booster shot against tetanus and diphtheria every 10 years, whether traveling or not. Traveler's diarrhea Traveler's diarrhea is a common woe. To protect yourself, drink boiled or bottled water from sources you trust and avoid tap water. Eat only food that is fully cooked and make sure that fruits and vegetables have been washed and peeled. Wash your hands thoroughly and frequently. The lowdown on insects Travel to tropical climates entails contact with a variety of insects capable of transmitting infectious diseases. The best-known culprit is the mosquito, which may transmit yellow fever, malaria, Japanese encephalitis and dengue fever. What can you do? Use insect repellents containing the chemical DEET, sleep in well-screened areas and wear protective clothing such as long sleeves and pants whenever practical. The U.S. Centers for Disease Control and Prevention urges all international travelers to learn about their destinations and to seek medical advice at least six weeks before the trip. Sources: CDC, Passport Health

Many diseases, such as polio, have been eliminated in the United States, but that is not the case in other parts of world.

Some countries still have problems maintaining a sanitary water supply. Others have diseases that Americans may not normally be exposed to.

"Diseases and illnesses around the globe come back to the United States with rapid transport," said Christie Reed, an epidemiologist with the U.S. Centers for Disease Control and Prevention who studies travel and its effect on emerging infectious diseases.

In 2002, 849 cases of malaria reported to CDC were related to travel overseas. Of the 400 cases of typhoid fever reported each year in the United States, 70 percent are related to trips abroad.

About 51 million people took international flights in and out of the United States in 2003, up from 15 million in 1970, according to the Air Transport Association of America.

The Cincinnati/Northern Kentucky International Airport has direct flights to France, England, Germany, Italy, the Netherlands, the Bahamas, Canada and Mexico.

Get started early

Americans headed to developing countries should start thinking about health issues at least four to six weeks prior to travel, said Dr. Aletha Tippett, owner of Passport Health.

Osborn, for example, began her first round of immunizations at Passport Health in late May.

"Planning for good health on an international trip is as important as buying tickets and obtaining passports and visas," Tippett said. "You don't want the trip of a lifetime to turn ruined by a medical emergency."

Tippett, a family practitioner, started specializing in travel medicine two years ago. She now has an office in Fairfield and is looking to expand to Northern Kentucky next year.

In general, any primary care doctor can offer travel advice to patients, but they may not be up-to-date on the latest bulletins of emerging diseases or travel advisories, Tippett said.

A consultation with Tippett involves a series of questions about the exact nature of the trip - urban versus rural locations, camping versus first-class accommodations. She then offers advice on a range of issues, from food and water safety to the risks of sexually transmitted diseases.

Tippett gives vaccinations and anti-malarial drugs when warranted. A typical visit with vaccinations can cost between $40 and $150, depending on the vaccine.

Unfortunately, many insurance companies don't pick up the costs of these vaccines, Tippett said.

Locally, the only other specialized travel medicine practice is at the University of Cincinnati Department of Family Medicine, which has offices in Wyoming, Forest Park and West Chester.

But many large companies, such as Procter & Gamble, have onsite medical clinics for employees who make business trips or relocate to other countries, said P&G spokeswoman Jeannie Tharrington. P&G has operations in 80 countries.

Not only Third World

The most common ailment that travelers encounter is diarrhea, said Dr. Andrew Bazemore, a UC assistant professor of family medicine.

Traveler's diarrhea is caused by consuming food or water contaminated with bacteria, viruses or parasites.

"One-third of travelers who spend more than two weeks in a developing country will get diarrhea," Bazemore said. "The cases can be very benign or they could lead to something serious such as dysentery."

But Third World countries aren't the only places to take precautions.

The risk of hepatitis A, for example, is moderately high throughout Europe. The liver disease, characterized by jaundice, a yellowing of the skin, is transmitted from person-to-person contact or through food and water that has been contaminated with feces.

A little bit of precaution and preventive medicine goes a long way, Tippett said.

"Some diseases, like hepatitis or malaria, may be resistant to a cure long after your return home," Tippett said. "You don't want these to become a bad souvenir."

E-mail mleingang@enquirer.com