Relationship between diseases, countries and travel behaviour

The relationship between diseases, countries and planned travel behaviour (accommodation, activities and purpose) is an important aspect of Inca Clinic that the Medical Director must configure1) (i.e., check the initial settings and change these as required initially and over time).

This information is used in a travel consultation: once the travel itinerary is input, the system uses the disease-country-behavior configuration to make a list of diseases to be considered during the vaccine schedule step. The system currently does not do the same for medications, but this is under consideration.

Note that the vaccine schedule step also lists all of the other vaccines that you have configured info the system, so if a vaccine does not appear on the “to be considered” list then it is still easy to select it. Nevertheless, the system is easier to use if you properly configure the disease-country-behavior relationships.

Each country has a list of associated diseases, divided into different risk levels:

  1. Required
  2. Standard Risk
  3. Increased Risk
  4. High Risk

Required means that vaccination for the disease is a legal requirement for entry into the country, or that the medical director has decided that the vaccination should be considered for every patient visiting that country. (The comment field can be used to distinguish between these two cases.)

Standard, Increased and High are a measure of the riskiness of the planned behaviour of the patient in that country. This allows the medical director to, for example, have the system list one set of diseases if the patient is planning to stay in a hotel, but add more for stay in a hostel.

The behaviour of the patient is a combination of

  • the planned accommodation (camping, cruise, hostel, hotel, …)
  • the purpose of the trip (assignment, business, emigrating, holiday, NGO, VFR, …)
  • the planned activities (contact sport, hiking or trekking, mountaineering, …)

The system works as follows.

Patient behaviours map onto risk levels as follows:

  • Standard Risk:
    • Accommodation: Hotel, Cruise, Residential
    • Purpose: Holiday, Business
  • Increased Risk:
    • Accommodation: Hostel, Camping, Unknown
    • Purpose: Assignment, VFR (visiting friends & relatives), Emigrating
    • Activities: Scuba Diving, Other Extreme Sports, Contact Sports, Hiking or Trekking, Swimming (Fresh water)
  • High Risk:
    • Purpose: NGO
    • Activities: Mountaineering

Using the Risk Level Visualizer

For the medical director, the Risk Level Visualizer is an important tool. It helps you understand how and why Inca Clinic displays vaccines in the “to be considered” list in the Vaccine Scheduler. You can access the Risk Level Visualizer from the Medical Information panel in the Inca Administration tab.

To get started, watch this short video showing the Risk Level Visualizer in action:

The video shows groups of diseases under each of the four risk levels. The meaning is that if the patient is visiting that country and planning any of the behaviours 2) linked to a risk level, then they are considered to be at risk of exposure to that set of diseases (and they are considered to be exposed to the set of diseases listed as Required no matter what their planned behaviour).

An important rule of the system is that if a disease is listed in a less riskier behaviour set (e.g., Standard) then a patient that is planning a higher risk behaviour (e.g., Increased) will also be considered as being exposed to diseases in the less riskier categories. High Risk is higher than Increased Risk; Increased Risk is higher than Standard Risk. Required always appears.

A simple example

Consider a country with the following sets associated with it:

  1. Required: Yellow Fever
  2. Standard Risk: Hepatitis A
  3. Increased Risk: Rabies
  4. High Risk: Japanese Encephalitis

A patient that is Hiking or Trekking, will have Rabies, Hepatitis A and Yellow Fever listed for consideration. A patient working as an NGO would have Japanese Encephalitis included.

It is important to note that all diseases (not just those in the “to be considered” list) with an associated vaccine are available during the vaccine scheduling step, and ultimately the medic makes the final decision on what vaccines are included on the patient schedule.

A Fuller Example

Risk Levels in Ghana - example

The screen above shows:

  • Yellow Fever cover is required to enter Ghana.
  • the Standard Risk behaviours result in the following diseases being listed for consideration: Hepatitis A, Poliomyelitis, Tetanus and Typhoid.
  • the Increased Risk behaviours result in the following diseases being listed for consideration: Cholera, Hepatitis B, Meningococcal Meningitis and Rabies.
  • the High Risk behaviours result in the following diseases being listed for consideration: Tuberculosis.

Given the above data

  • a patient visiting Ghana planning to do Hiking or Trekking will be considered exposed to Cholera, Hepatitis B, Meningococcal Meningitis and Rabies; and Hepatitis A, Poliomyelitis, Tetanus and Typhoid; and Yellow Fever.
  • A patient who plans to do Mountaineering will also be considered exposed to Tuberculosis.

Please note:

  • The diseases associated with each risk level will be different for each country.
  • The list of behaviours (purpose, accommodation, activities) associated with each of the risk levels (Standard, Increased, High) is fixed (it's the same for every country).
  • Remember that the list of diseases that the system presents to be considered at the vaccine scheduler step is only an aid; the medic does not need to select all of these, and in some cases may need to add others from the complete list of vaccines which appears below the “To be considered” list.

Customising Risk Levels and Itinerary Categories

The Risk Levels (Required, Standard, Increased Risk and High Risk) can be modified but we would strongly advise you to contact before doing so. If nothing else, modifying these will add more work for you.

Behaviours (sometimes called Itinerary Categories) refer to things such as accommodation, planned activities or trip purpose. If you would like to add or modify travel behaviours this is easier to do. From the Inca Administration tab, click on the Itinerary Categories link. From here you can modify which Risk Level an Itinerary Category falls under. Any new Categories will appear on the Travel Itinerary step and on the Risk Level Visualizer.

Changes made here will affect the Risk Level category a vaccine will appear under on the Vaccine Scheduler.

More Information

1) The information displayed on the Vaccine Scheduler should be interpreted by a suitably qualified medical person. No responsibility is taken by Incaplex for a communicable disease which is present in a country but does not appear on a list. Please refer to the Incaplex Terms & Conditions. For further information, please check: WHO, CDC, UK Green Book, or the appropriate authority in your location.
2) called Itinerary Categories in some parts of Inca Clinic
diseases_countries_behaviour.txt · Last modified: 2013/05/01 11:45 by sean
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