[Analysis of prevention of diseases in travellers on the basis of latest results in travel medicine].

When we survey the possibilities of prevention in travel medicine, it is soon detected that the "classical" or "infectology-oriented" approach of prevention (vaccination - chemoprophylaxis - pretravel advice) cannot respond to all peritravel medical problems. These newly arisen challenges require a new, complex outlook for travel medicine, mainly in the field of prevention, treatment and management of travel-related illnesses. Although travellers are still exposed to various infectious diseases, which are mostly preventable by the primary prevention methods (biomedical prophylaxis), the majority of travellers suffer from non-infectious diseases and fall ill or suffer accident by other, travel-relating factors. Moreover, the predominant destination is Europe for an average Hungarian traveller. The travellers, whose destination is not any tropical or developing country, i.e. adventure travellers, people in extreme sports, chronic patients all require same-level peritravel (prevention-oriented) advice, too. Thus besides vaccination, helmets, salt-tablets, medical kit, mobile oxygenator must belong to a travel doctors' arsenal. We also have to mention the travellers' acute illness/accident abroad, travellers who require repatriation, and also the appropriate travel insurance policy which should be worked out following evidence-based medical considerations. The above-mentioned complex task requires not only a broad-spectrum, multidisciplinary knowledge, but an appropriate co-operation between the travel medicine physician, the general practitioner of the patient, and the doctor of the insurance company. But, above all, we have to redefine the topic of travel medicine, its subspecialties and role in the three-level (primary, secondary and tertiary) prevention. We have to redefine the different prevention levels and the used methods relating to the different subdisciplines of travel medicine. Upon the recent scientific researches, we can lay down four topics of travel medicine: biomedical prophylaxis, assistance medicine, wilderness medicine and travel-insurance medicine. This "four-leaf clover" model is fit for the complex approach of the newly generated peritravel medical problems, both in Hungary and abroad. This kind of approach makes the doctor (who contacted the travellers at any respect: travel medicine specialists, GPs, occupational medicine specialists, insurance physicians) able to participate in the peritravel treatment or pretravel advising of travellers. The basic ideas of the prevention levels have to be established in each subdiscipline of travel medicine. Another urgent task is to establish a countrywide network of travel medicine facilities as well as the organisation of gradual and postgraduate education of physicians and professionals. We have to implement new forms and methods during training. Travel advising and peritravel prevention require well and continuously trained doctors.