The world has become a smaller place, and it's now estimated that Americans make 250 million trips to other countries each year. Ten million of these trips are to developing countries, and 60 percent of these travelers become ill as a result of their travels.

With fears about emerging infectious diseases such as the avian flu, as well as centuries-old diseases such as malaria still menacing parts of the world, wise travelers seek expert advice weeks before they travel to make sure they stay healthy.

Located on the downtown campus, the Tulane University Travel Clinic offers unique expertise in infectious diseases and tropical medicine to travelers who are going to other countries. The eco- tourism boom is leading even more Americans to travel the world, says Susan McLellan, director of the Tulane Travel Clinic. "To adequately prepare for travel, we need to look at the risks versus the benefits of various immunizations based upon where you're going and what you plan to do. We need to consider if you're going to work in a refugee camp, climb at high altitudes on the Inca trail, or go on a "Love Boat"-style cruise."

The travel clinic is one of only two such clinics in Louisiana listed by the International Society for Travel Medicine, in which McLellan is actively involved. She also holds a certificate in clinical tropical medicine and traveler's health from the American Society of Tropical Medicine and Hygiene. McLellan is an associate professor of medicine in infectious diseases at the Tulane University School of Medicine and an assistant professor of tropical medicine in the School of Public Health and Tropical Medicine.

McLellan says she loves to travel herself, having trained or worked in Haiti, Jamaica, Rwanda, Peru, the Democratic Republic of the Congo and Egypt. She currently has active projects in Haiti (tropical medicine) and Rwanda (delivery of HIV care and teaching).

McLellan cautions that there is confusion between which immunizations are required by public health authorities to prevent the spread of diseases and which immunizations are recommended by travel medicine experts to protect the health of the traveler to various countries. Many eager travelers turn to their travel agents for advice, but McLellan says it is impossible for travel agents to stay abreast of all the latest information about diseases.

"I find there's a lot of misinformation about malaria risk and anti-malarial drugs," McLellan says, "and malaria is the infectious disease that causes the most fatalities in travelers, by a large margin."

The U.S. Centers for Disease Control and Prevention provide general recommendations, but McLellan says she individualizes her consultations based on each traveler's medical history and personal health considerations as well as the itinerary.

"Even the World Health Organization makes no mandates about protecting yourself from diseases when you travel," she says.

In this age of adventure travel, doctors may encounter a feverish patient who was on safari in Africa or a patient with the bends who just returned from diving in Belize. McLellan provides consultation to physicians about diseases beyond the scope of many American emergency medicine textbooks and primary care training. Patients who need post-travel care may visit the infectious diseases clinic at Tulane University Hospital and Clinic.

In addition to advising patients about the vaccinations that are indicated for a particular trip, McLellan provides other travel tips for international travelers. "What the traveler does, in terms of behavior during travel, is at least as important as anything I can give in the office." Much of the travel-medicine visit consists of counseling to ensure the traveler knows how to avoid health risks.

While preparing for exotic vacations or international speaking engagements, travelers shouldn't forget the obvious: diarrhea is the most common illness and automobile accidents are still the first-ranked killer of travelers worldwide.

Some destinations require a series of immunizations given over several weeks. For an appointment at the clinic, call 504-988-6929.