Travel Insurance: Just How Important is It?

Source: Leggat PA, Leggat FW. J Travel Med. 2002;9:59-65.

By Carol A. Kemper, MD, FACP
While comprehensive travel insurance should be considered for almost all travelers, most folks don’t plan ahead. Few people know whether their private health insurance will cover medical and dental costs abroad some insurance will only pay for emergency medical care or hospitalization. Others, like Medical (California’s version of Medicaid) won’t pay at all. One of my HIV-infected patients learned this the hard way when he traveled to Mexico for vacation where he unfortunately acquired cryptococcal meningitis. He had no idea that Medical would not foot the bill but the Mexican hospital was quite happy to charge the entire hospital stay to his VISA card at discharge.

Leggat and Leggat examined 855 travel insurance claims (made by Australians) during a 2-year period in 1996 to 1998 to a major Australian travel insurance company. Australia, which has nationalized health insurance, has reciprocal health care arrangements with several countries, including England, New Zealand, and Canada, which provides emergency and major medical coverage. Thus, many of the claims were relatively small—but nevertheless significant—the average cost, in Australian dollars, was AUD 991. The majority of claims were for medical and dental expenses (76%); the remainder was for loss, theft, assaults, and cancellations. Chiefly, medical care was provided for respiratory ailments (20%), musculoskeletal conditions, such as fractures (17%), gastrointestinal problems (14%), ear, nose, and throat infections (12%), and dental care (7%). Just over half of the claims were made by women (57%), and half were made by persons 55 years or older. Most travelers were heading to Europe and North America; few traveled to third world countries. Most claimants took out premium or intermediate coverage (89%); only 11% paid for budget coverage. Virtually everyone traveling to the United States paid for premium coverage.

In addition to the cost of medical care, one should consider the cost of emergency evacuation, especially if you are traveling to back country. And, more significantly, the cost of air transport should you die abroad (cremation is cheaper than air travel). The next time you travel, check your health insurance and suggest the same to your patients.

Transfusion-Related Bovine Spongiform Encephalopathy

Source: ProMED-mail post, August 4, 2002; www.promedmail.org.

Public health experts and blood transfusion specialists are expressing alarm at a new report (soon to be published in the November issue of the Journal of Virology) demonstrating the risk of transmission of bovine spongiform encephalopathy (BSE) through blood transfusion. Previously, the risk of transmission of the human form of BSE (or variant Creutzfeldt-Jacob disease) was believed to be "theoretical," although Britons had been using only leukopoor blood since 2000 because of concerns that white blood cells may carry infection.

However, scientists at the Institute of Animal Health are reporting that, of 24 scrapie-free sheep transfused with whole blood or component from sheep either experimentally-infected with BSE or natural scrapie, 1 animal has contracted BSE, at least 1 (and possibly 2) more animal(s) are showing signs of clinical infection, and 4 other sheep have acquired scrapie. This study suggests that red blood cells, and even plasma, may be infective under certain conditions. Of greater concern is that infectivity may occur before a donor demonstrates any signs or symptoms of disease.

Experts will be evaluating these data and generating recommendations soon. Notably, this is the second report of this nature. Successful experimental transmission of BSE was demonstrated from sheep, fed cattle brain naturally infected with BSE, to other sheep, even in advance of symptoms of disease in the donor.

There are no data thus far to suggest transmission of BSE in humans. Twenty-two people have received donations from persons who later died of BSE; none have demonstrated disease. To date, 115 people in Britain have died of BSE; 4 had received blood transfusions but this was not believed to be the source of their infection.

Dr. Kemper, Clinical Associate Professor of Medicine, Stanford University, Division of Infectious Diseases, Santa Clara Valley Medical Center, is Associate Editor of Infectious Disease Alert.