Corporate Travelers
Corporate Travelers
Abstract & Commentary
Synopsis: In spite of pretravel advice, food/water precautions and malaria chemoprophylaxis were not followed consistently by corporate travelers. The most common travel-related health problems encountered by corporate travelers were diarrhea and upper respiratory infections. Travel health kits appeared to be beneficial.
Source: Kemmerer TP, et al. Health problems of corporate travelers: Risk factors and management. J Travel Med 1998; 5:184-187.
A retrospective study using an electronic survey was conducted in 1994 with the employees of the Coca-Cola company who had traveled internationally during the prior six months. The survey consisted of 30 questions and examined the health risks encountered, compliance to pretravel health recommendations, and illnesses or injuries that occurred. Data were analyzed by using EpiInfo software (CDC, WHO).
A total of 226 travelers responded out of 350 surveys sent. All travelers received medical consultation from a university-affiliated travel clinic prior to travel, and some received further evaluation from a nurse at the Coca-Cola company. The mean age of the respondents was 41 and 77% were male. Eighty-four percent of the population were U.S. nationals. One hundred fifteen travelers (51%) carried the travel health kits provided by the medical department at the Coca-Cola company.
Diarrhea was the most common illness reported, affecting 35% of the travelers. Although most travelers ate meals at their hotels and chose foods that were cooked and still hot, more than half also ate foods that remained at room temperature for prolonged periods (69%). Sixty-nine percent ate from hot buffets and 53% ate from cold salad bars. Nineteen percent of the travelers also ate from street vendors, and many ate raw meat (13%) or raw or poorly cooked seafood (17%). The majority of travelers drank bottled soft drinks. Seventy-six percent also drank alcohol and 75% drank noncarbonated bottled water. Almost half drank tap water (48%).
Risk factors associated with diarrhea included: eating at fast-food establishments, eating room-temperature foods, eating raw fish or meat, and eating at buffets. Drinking tap water was not a risk factor for diarrhea, regardless of whether the individual boiled, filtered, treated, or did not treat the water.
Other common problems included upper respiratory infection (29%), skin rashes (10%), fever (7%), vomiting (4%), and musculoskeletal injuries (3%). There were no cases of hepatitis in these travelers. Twelve percent of the travelers sought medical treatment for their illnesses or injuries. Of those who traveled to malarious areas, 43% admitted to noncompliance with antimalarial recommendations.
Fifty-one percent of the travelers used the travel health kit. The items most frequently used were analgesics (33%), antidiarrheal agents (28%), sinus medication (27%), insect repellent (24%), and sunscreen (21%). The respondents felt that the most helpful pretravel advice were food and beverage precautions, immunization information, and the provision of prescriptions for medications needed during travel.
Comment by Lin H. Chen, MD
As more companies expand globally or merge with companies from other countries, more of their employees will need to travel internationally. Although studies have been done on health problems encountered by international travelers, little information is available on corporate travelers, specifically. This study by Kemmerer and associates examined the health risks encountered in a group of corporate travelers who had received pretravel consultation.
This survey was conducted via electronic mail. With a response rate of 65%, this indicates that electronic mail may be effectively used in the future for similar types of studies. Results of this study showed a pattern similar to other travelers.1-3 For comparison, a recent study explored the effect of travel-related health problems in more than 2000 individuals who had consulted the Zurich University Travel Clinic prior to visiting a developing country. This survey showed that more than one-third (37.9%) of the travelers experienced travel related illness, with 10.6% of individuals seeking medical consultation. Incapacitation was reported by 14.4% of travelers, accounting for 2% of time abroad.1 The most common health problems experienced by this group of travelers were also diarrhea and the common cold.
Kemmerer et al found that 35% of the corporate travelers experienced traveler’s diarrhea, which appeared to be even more common than in other studies, and they also identified the risks for traveler’s diarrhea. It was interesting to find that in spite of pretravel advice received, many travelers still took risks in what they ate and drank. While drinking tap water did not appear to be a risk factor for traveler’s diarrhea, the travelers may have consumed tap water only in relatively safe areas such as western Europe.
One notable finding in the current report is the low incidence of hepatitis (no cases) associated with travel. A survey of 10,524 Swiss travelers from 1981-1984 found that hepatitis occurred at an incidence per month abroad of 4/1000.3 The low incidence of travel-related hepatitis in the employees of the Coca-Cola company may indicate efficacy of immunizations against hepatitis, but more detailed data are needed.
The travel health kit appeared to be beneficial and was used by every traveler who possessed one in this study. The remedies for common ailments may enable the corporate traveler to continue working and minimize loss of time on a tight schedule. The cost effectiveness of distributing travel health kits to employees is clearly worth evaluating.
It seems that the recommendations on food and water precautions and malaria chemoprophylaxis were followed haphazardly. Kemmerer et al point out that psychosocial stressors may have influenced the compliance with pretravel recommendations. The reasons accounting for such poor compliance need further attention. The point should not be lost on those advising corporate travelers during their business travel.
References
1. Bruni M, Steffen R. Impact of travel-related health impairments. J Travel Med 1997;4(2):61-64.
2. Cossar JH, et al. A cumulative review of studies on travelers, their experience of illness and the implications of these findings. J Infect 1990;21(1):27-42.
3. Steffen R, et al. Health problems after travel to developing countries. J Infect Dis 1987;156(1):84-91.
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