An antidote to holiday hell

Travel medicine as a discipline used to be virtually unknown outside its own practitioners. With severe acute respiratory syndrome and deep vein thrombosis both hitting the headlines since the turn of the century, and current fears about the possible international spread of avian flu viruses, this is no longer the case.

Of course, for years most travellers and their physicians were aware of the need for immunisations and the risks of traveller's diarrhoea, but that was about as far as it went. Now both have to contemplate the risks associated with air rage, muggings, accidents and repatriation, confusion following infections - not to mention the various old and emerging infections found around the world - all of which need to be addressed in pre-travel health advice geared to the needs of the individual.

Travel Medicine and Infectious Disease adds to about a dozen journals already dealing with travel and exotic medicine in one way or another, and still more if all the tropical disease journals are included. In the first editorial, Jane Zuckerman, the editor-in-chief, promises an independent and topical forum for the dissemination of leading academic reviews, research articles and case reports.

She is backed by an experienced international editorial board that spans an impressive range of specialities, including parasitology, immunology, aviation health, psychiatry, antivenins and various infectious diseases.

On reading the first five issues, I was struck by how small the world of travel medicine still is, and that some countries are considerably more aware of the discipline than others. Associations of travel medicine practitioners in most developed countries have small memberships relative to their population size - except in Scandinavia, where each national association numbers about 600 members - and those interested in a speciality, or practising, are not necessarily researching it.

Consequently, it looks as though, in the early months of the publication, pages have sometimes been hard to fill. Of the 53 articles and papers, 72 per cent were wholly or partly written by at least one member of the editorial board, as was every one of the book reviews, although I did find other authors who published more than once during that period.

The main text of each issue in the first volume is divided in a traditional manner into editorials, reviews and original articles. Volume two introduces short communications. Truly original work has centred mainly on case reports that identify some of the less usual, and thus more difficult to diagnose, presentations of familiar conditions, and also some conditions unfamiliar to most practitioners.

There have been investigations of combination drug treatments for malaria in individuals with other complications. Larger research studies, so far, have been directed mainly towards prospective or retrospective cohort studies, either looking at the health outcomes for at-risk groups as a result of travel - for example the effectiveness of pre-travel preparation for HIV-infected travellers - or tracing infections in those groups as, and if, they arise - for example the incidence of dengue in febrile travellers returning to Leicester in the UK.

These first few issues have constituted more a source of information and a learning resource than a medico-scientific research journal. The overall trend has been to provide articles designed to bring the reader up to date.

There has been a useful series of articles dealing with infectious conditions such as tuberculosis, West Nile virus, and schistosomiasis, covering recent trends in epidemiology, diagnosis and treatment options, as well as the clinical picture and risks for travellers.

Another group of articles describes resources for those in practice, such as fear-of-flying programmes, internet information resources and a study describing the effectiveness of rapid diagnostic tests for malaria that might be used as self-diagnostic tools for travellers.

However, I think the editors need to sort out what constitutes an original article. Listed among genuine reports of new data and interesting cases were several small reviews, educational update articles on particular diseases and general information articles and discussion papers about travel medicine societies and other more general topics.

The journal urgently needs an injection of genuinely original investigations to bring in the scientific element promised in the first editorial. Overall, the content needs reformatting so that readers, and possibly contributors, can gain a better idea of what to expect when they open the covers.

If the publishers were out to make an impression, they have made a bit of a shaky start. There have been a relatively high number of typographical errors, one complete set of illustrations mislabelled, repetitions of whole paragraphs and even a wrong issue number on one contents page. None of these is terminal, but if I were spending £67 each year on a subscription, I would expect a little more for my money.

I make this criticism bearing in mind that it does take a while for a journal to make its mark and entice researchers to submit their work.

However, I also have a nagging doubt about whether this may be one journal too far for current needs. The editors and publisher need to get their act together to encourage a wider authorship - and with it readership - to ensure the journal's future. I hope it works.

Ian F. Burgess is director of Insect Research and Development Limited.