SARS isn't the only disease that you need to be wary of at your destination. Fortunately, many of these more prevalent ailments can be avoided with advance planning and care

A major side effect of the SARS outbreak was to sharpen awareness of global health issues. Here's a roundup of some hot topics in the travel medicine field.

DEEP VEIN THROMBOSIS
A July ruling in Britain's Court of Appeal is expected to have major implications for travelers worldwide. A group of 24 airline passengers and their families had brought a test case against 18 carriers (including British Airways, Continental, Monarch, Qantas, and Virgin Atlantic), claiming that these travelers had suffered blood clots in their legs, known as deep vein thrombosis (DVT)—in some instances with fatal consequences—as a result of flying, and that the airlines were liable. The court ruled that, according to the Warsaw Convention (the 1929 international treaty that governs carriers' liability), airlines could be held responsible only for accidents—not for any other effects of flying on health. Even if a link between flying and DVT is conclusively established, carriers cannot be held liable.

After the appellate court hearing, John Smith, a member of Britain's Parliament, introduced legislation in the United Kingdom that would give airlines a formal responsibility for passengers' health, something that has never been enshrined in law.

People differ in their vulnerability to DVT, and there are many known predisposing factors—ranging from taking birth-control pills, smoking, and being overweight to cancer treatment, recent surgery, and a history of previous DVT. Anyone at special risk should consult his or her physician, but the main precautions include wearing compression stockings, keeping well hydrated, and walking around the cabin or stretching every hour or so during flight.

DENGUE FEVER
The number of cases of this viral infection, which is spread by mosquitoes, has been rising steadily over the past 15 years and now is in excess of 50 million annually in more than a hundred countries in Africa, the Americas, Southeast Asia, and the Western Pacific. Initial infection is seldom lethal, but a more aggressive form of the disease, called dengue hemorrhagic fever (DHF), can occur with a second infection. There is no vaccine, though there are several promising candidates that could become available within the next five years. Visitors to the tropics are especially vulnerable because their immune systems have mostly never encountered this type of viral infection.

Numerous outbreaks were recorded in 2002: A massive one occurred in Brazil, with more than 700,000 cases of dengue and DHF diagnosed, resulting in 130 deaths and casting a shadow over Rio's Carnival. The disease also surfaced throughout Latin America and the Caribbean. Recent outbreaks were reported in Bangladesh, Malaysia, Taiwan, Vietnam, and, for the first time, Hong Kong. And in 2001, the disease was found in Hawaii, with more than 80 cases reported. Mosquitoes that transmit dengue fever tend to bite mainly during the day. Wear long sleeves and pants, and thoroughly apply insect repellent.