title: Pre-travel health advice guidelines for humanitarian workers: A systematic review.
abstract: BACKGROUND
  In the last decades, there have been several natural disasters and global catastrophies with a steady increase in humanitarian relief work. This has resulted in increased research in the field of humanitarian aid, however the focus is mostly on the victims of the disasters and not on the individuals and organisations providing aid.
  
  
  OBJECTIVE
  The intent of this research is to review the information available on pre-deployment interventions and recommendations such as vaccinations and other health preserving measures in volunteers and professionals deploying abroad in humanitarian relief missions.
  
  
  METHODS
  We performed a systematic literature review of papers written in English, French, Italian or German. We searched the following databases: Cochrane, PubMed, CINAHL, EMBASE and also hand searched reference lists. The cut-off date for the publication search was November 20th, 2014. In addition to the literature search we also sent a questionnaire to 30 organisations to detail their approach to preparing relief workers.
  
  
  RESULTS
  We identified 163 papers of possible relevance and finally included 35 papers in the systematic review. Six organisations provided information on pre-deployment preparation of aid workers. Identified papers show that pre-deployment physical and mental fitness are paramount for success in humanitarian missions. However, in many settings, pre-travel medical and psychological assessments and/or training/education sessions are not mandatory. We identified high-risk hazards for aid workers (often location specific), these included: travellers׳ diarrhoea, vector-borne infections, accidents, violence, tuberculosis, HIV, hepatitis A, leptospirosis, typhoid fever, seasonal and H1N1 influenza.
  
  
  CONCLUSIONS
  The medical evaluation can identify problems or risk factors, such as psychological frailty, that can be exacerbated by the stressful settings of humanitarian missions. In this pre-travel setting, the status of routine vaccinations can be controlled and completed, medication dispensed and targeted preventive advice provided. A mission specific first-aid kit can be recommended. There is a lack of evidence-based literature on the theme of pre-travel advice guidelines for humanitarian workers. We propose a shared database of literature on this topic as a resource and suggest that some standardization of guidelines would be useful for future planning.
authors.affiliation: University of Zurich Centre for Travel Medicine, WHO Collaborating Centre for Travelers׳ Health, Epidemiology, Biostatistics and Prevention Institute, Zürich, Switzerland.
authors.forename: Marco
authors.initials: M
authors.lastname: Costa
authors.affiliation: Swiss Academy of Military and Disaster Medicine (SAMD), Ittingen, Switzerland.
authors.forename: Martin
authors.initials: M
authors.lastname: Oberholzer-Riss
authors.affiliation: University of Zurich Centre for Travel Medicine, WHO Collaborating Centre for Travelers׳ Health, Epidemiology, Biostatistics and Prevention Institute, Zürich, Switzerland; Swiss Academy of Military and Disaster Medicine (SAMD), Ittingen, Switzerland.
authors.forename: Christoph
authors.initials: C
authors.lastname: Hatz
authors.affiliation: University of Zurich Centre for Travel Medicine, WHO Collaborating Centre for Travelers׳ Health, Epidemiology, Biostatistics and Prevention Institute, Zürich, Switzerland; Swiss Academy of Military and Disaster Medicine (SAMD), Ittingen, Switzerland.
authors.forename: Robert
authors.initials: R
authors.lastname: Steffen
authors.affiliation: University of Zurich Centre for Travel Medicine, WHO Collaborating Centre for Travelers׳ Health, Epidemiology, Biostatistics and Prevention Institute, Zürich, Switzerland.
authors.forename: Milo
authors.initials: M
authors.lastname: Puhan
authors.affiliation: University of Zurich Centre for Travel Medicine, WHO Collaborating Centre for Travelers׳ Health, Epidemiology, Biostatistics and Prevention Institute, Zürich, Switzerland; Swiss Academy of Military and Disaster Medicine (SAMD), Ittingen, Switzerland. Electronic address: patricia.schlagenhauf@uzh.ch.
authors.forename: Patricia
authors.initials: P
authors.lastname: Schlagenhauf
mesh_terms: D000328:Adult; D000533:Altruism; D004190:Disasters; D017408:Guidelines as Topic; D015658:HIV Infections / Q000517:prevention & control; D006801:Humans; D008493:Medical Missions; D011314:Preventive Health Services; D012066:Relief Work; D012307:Risk Factors; D011795:Surveys and Questionnaires; D014195:Travel; D014376:Tuberculosis / Q000517:prevention & control; D014435:Typhoid Fever / Q000517:prevention & control; D014611:Vaccination; D014838:Volunteers / Q000193:education* / Q000706:statistics & numerical data