title: Illness and injury to travellers on a premium expedition along the Asian Silk Route.
abstract: BACKGROUND
  Commercial expeditions provide an opportunity for travellers to undertake various specialised travel to more adventurous and extreme destinations in the relative security of an expeditionary group with medical cover provided by an expedition physician. Little is known about the illnesses and injuries occurring on premium expeditions to Asia. This present study was designed to investigate the prevalence of injury and illness suffered by travellers on a premium expedition along the Asian Silk Route.
  
  
  METHODS
  In 2004, the expedition physician (MTMS) diagnosed and recorded all illnesses and injuries amongst 73 travellers on a premium expedition along the Asian Silk Route, a journey from Beijing to St Petersburg travelling through China, Kazakhstan, Uzbekistan and Russia. Information recorded included age, sex, number of days into the expedition, the nature of the presenting illness, the assessment of the condition and the treatment employed. The period of the expedition was for 27 days and travel was primarily by a private train, the China Orient Express.
  
  
  RESULTS
  Forty-seven (64%) travellers sought medical advice at least once for a total of 97 consultations. Ninety-seven health presentations were reported and recorded amongst the travellers. Females presented on 54% occasions with the average age of expeditioners presenting being 64 years (SD=12) with males being significantly older (t=3.15, df=95; p=0.002). The types of primary illness diagnosed were largely those related to the following systems: respiratory 36%, gastrointestinal 21%, dermatological 8%, minor trauma 7%, ears, nose and throat 6%, musculoskeletal 5%, central nervous system 5% and other problems 12%. Of the gastrointestinal problems, diarrhoea was the most common single complaint on 19% of occasions, occurring throughout the journey. There was a mean of 3.5 presentations per day of the expedition. In total, the China phase of the trip (days 1-13) accounted for 42 presentations with phases in Kazakhstan (days 14-15), Uzbekistan (days 16-23) and Russia (days 24-28) accounting for 9, 29, and 17 presentations, respectively. Presentations were highest on day 18. More than one third of presentations (37%) were handled conservatively, and the rest required medication: 16% requiring antihistamine medications, 11% requiring antidiarrhoeal medications, 11% requiring antibiotics and 25% requiring other specific medications. There was one major accidental incident but no deaths or other emergencies.
  
  
  CONCLUSIONS
  On this premium expedition, the health problems encountered were largely similar to those reported for other expeditions. The most common problems included respiratory, gastrointestinal, dermatological conditions and minor trauma in descending order. As well as being part of the service provided to travellers, the inclusion of an expedition physician on this premium expedition increased the independence of the travellers on this journey and decreased the reliance of the tour on local health services, a source which is often scarce or absent on more remote location expeditions.
authors.affiliation: Worldwise Travellers Health Centres of New Zealand, Auckland, New Zealand.
authors.forename: Marc T M
authors.initials: MT
authors.lastname: Shaw
authors.forename: Peter A
authors.initials: PA
authors.lastname: Leggat