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出國旅遊注意事項

發佈日期:2000-01-01
發佈單位:怡和醫院
最新更新日期:2014-06-17
隨著經濟成長,國人從事國際間的商務、觀光與休閒活動愈來愈頻繁。根據行政院觀光局公佈的國人出國統計數字顯示,2003年因為遭受嚴重急性呼吸道症候群(SARS)的影響,該年度的旅遊總人數為592.3萬人次,與前一年比較呈現負成長(-19.08%),隔年則提升為778萬人次,之後逐年上升,2010年增加到941.5萬人次,而2011年更達到958.3萬人次。由這些統計數字以及SARS的教訓,除了讓我們警惕到掌握國際疫情與積極防治傳染病的重要性外,也透露出海內外疫情對於國人旅遊安全的威脅。因此,如何從事健康無負擔的旅遊,應該更受民眾的重視。

根據統計,每年約有十億的旅客搭乘飛機,20 ~ 70 %的旅行者,在旅程中會有健康相關的問題,其中約有1-5 %的人需要醫療照顧。這些導致旅行者患病的潛在影響因素主要包括以下三點:
(1)暴露於旅遊國當地傳染病原體的威脅、
(2)旅行期間的運輸模式、
(3)與特定旅行地點相關的不尋常環境暴露。

旅遊醫學諮詢(本院由家庭醫學科門診提供相關服務)則可以提供旅遊者相關的風險評估及衛教。但,根據研究報告指出,去過高危險區域旅遊的人中只有不到一半的人曾經尋求過專業的旅遊醫學諮詢。本文除了介紹旅遊醫學的相關知識外,也探討如何因應日益增加的外籍勞工以及外籍新娘返鄉探親所需要的醫療諮詢。

● 感染性疾病
旅遊者最常見的感染模式是經由腸胃道、呼吸道、病媒物以及性行為來傳染疾病。根據研究,至開發中國家旅遊時最大的感染性疾病發生率依序為梨形鞭毛蟲症感染、 阿米巴原蟲感染症、肝炎、淋病。其他發生率較少的疾病包括有瘧疾、梅毒以及蠕蟲感染等。

● 旅遊前的評估
旅遊醫學諮詢至少應於旅遊前一個月進行,以便有足夠的時間進行完整的評估及必要預防醫療措施。評估內容包括:
1、目前的健康狀態是否適合該旅遊行程
不適合飛行旅程者,包括嚴重貧血者、六週內曾發生心肌梗塞者、有難以控制的嚴重高血壓或深靜脈栓塞者、心臟衰竭代償失調者、未控制的心律不整者; 二週內曾發生腦中風者、曾接受心臟手術或開胸手術者;而孕婦避免飛行旅程的情況包括嚴重貧血、前胎早產、子宮頸閉鎖不全等。
此外,針對已罹患某些慢性病或特殊疾病的旅遊者,更應該至專業醫師處做風險評估,以降低因為旅遊所導致的疾病惡化或是染上當地傳染性疾病的風險。例如感染人類免疫不全病毒的病人、脾臟切除、器官移植後的病人、患有癌症或免疫功能不佳的病人、洗腎的病人等等,在外出做長途的旅遊之前,應先諮詢旅遊醫學專業人員,以降低並應付旅遊所帶來的風險。
不同慢性病患者有不同的注意事項, 例如需要胰島素注射的糖尿病病患,長程旅行時若遇有時差的問題,其胰島素的注射劑量需有所調整。另外,一般人在長途飛行後罹患深部靜脈栓塞的機率約為0.01~0.04%,若患有心血管疾病的病人, 其發生率更高。因此適時的旅遊前諮詢,可獲得適當的處方與建議,以預防深部靜脈栓塞的發生。
2、瞭解旅程中所可能遭遇的健康危害
旅遊行程的評估必須包括詳細的行程內容:如旅遊的地點、當地醫療設施的可近性、旅遊地點所待的時間、旅遊目的、住宿型態與旅遊活動等。應根據旅遊者的健康情況與旅遊行程,預先評估行程中可能發生的健康問題,給予綜合建議與預防措施的指導,並告知旅行時的風險。
3、掌握旅程中可能面臨的傳染性疾病資訊,並接種適當的疫苗注射以及預防藥物
隨時注意國際疫情資訊,才能防患未然,並達成健康無負擔的旅遊。根據台灣疾病管制局的報告顯示,每年境外移入瘧疾病例平均約30例,以境外移入為主,主要來源是東南亞地區、非洲及大洋洲,而以間日瘧為最多,次為熱帶瘧,三日瘧及卵形瘧則罕見。在瘧疾的治療上,與各區域瘧疾的瘧原蟲抗藥性有極大的關聯。
目前建議的旅遊前常規預防注射包括小兒麻痺疫苗、破傷風疫苗以及兒童時期按時程所施打之疫苗。另外針對某些特殊的疫情也建議旅遊者施打相關的疫苗,包括流行性感冒疫苗、日本腦炎疫苗、腦膜炎球菌疫苗、黃熱病疫苗、肺炎鏈球菌疫苗、狂犬病疫苗、A型肝炎疫苗、B型肝炎疫苗以及節肢動物媒介的腦炎疫苗。

● 旅途期間及旅遊結束後
除了在旅遊前需要做完整詳細的評估與預先做適當的預防,在旅途結束後也應該作持續的評估與照護。旅遊前可以請醫師提供旅遊者英文病歷摘要及旅遊地點的醫療機構資訊,以便需要緊急救援服務時所需。如果旅途中不幸生病時,專業的家庭醫師以及旅遊醫學專家亦可提供電話諮詢服務,以解決因語言隔閡的就醫問題。
此外,對於出國期間曾發生健康問題者;旅遊地區發生相關疫情時,或是回國後二星期內發生高燒、腹瀉、淋巴腺腫大、全身肌肉酸痛、皮膚紅疹等任一情形,都應回醫院做疾病的評估以及持續的追蹤與治療。
結論

唯有完整的旅遊出發前健康評估及準備,大家才能恣意的享受難得的假期,否則整趟旅行之中很可能被一些突發的狀況或是環境的傷害造成相當程度的健康危害。旅行是對於增進生活品質與身心健康相當有幫助,但是正因為如此,如果在旅遊之中因為一些疏忽而破壞了這些預期的好處,甚至於造成更嚴重的身體病痛不是很掃性嗎?
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