www.cdc.gov/

With daily reminders in the electronic and print media relating to the changing avian influenza situation, it is timely to look at the gold standard travel vaccination and global public health website resource Centers for Disease Control and Prevention (CDC).

CDC updates its site regularly, if not daily, and it has always appeared to me to be well ahead of the WHO equivalent. Furthermore, CDC also continues to make its site more user-friendly.

CDC was founded in 1946 to deal with the threat of malaria and is based in Atlanta, Georgia. It is administered by the governmental Department of Health and Human Services (HHS), the principal US government agency charged with protecting the health and safety of the American public.

The centres are highly proactive and concentrate mainly on cancer and other disease prevention strategies and on infectious diseases.

In recent years they have had more than enough to keep themselves occupied, with ebola, SARS, anthrax threats and now avian flu; their current operating budget is in the order of US$7.5 billion, approximately one tenth of the entire HHS operating budget.

Through its website, the CDC has access to a number of journals which are of exceptional quality. These include the Emerging Infectious Diseases Journal, MMWR (Morbidity and Mortality Weekly Report), the Preventing Chronic Disease Journal and others.

The home page (which is regularly updated) includes three main sub-headers and headline-based extracts relating to current topics.

The Avian Influenza sub-site has important links to WHO sites for latest outbreak information and also a very comprehensive section for professionals which is regularly updated, and which may even need to become one of our key sites in the future.

The health and safety topics concentrate on some of the key preventive health roles for CDC; birth defects, diseases and conditions, emergency preparedness and response, environmental health, genetics and genomics, health promotion, injury and violence, workplace safety and health, vaccinations and immunisations, and the all-important travellers' health section.

While the CDC site is aimed more at the consumer than the professional and, indeed, most of the links are not especially clinically comprehensive, CDC does give us confidence in being able to recommend a highly authoritative site for consumer-specific travel planning.

The days of looking up those hand-me-down and dog-eared pre- millennium drug catalogues and travel vaccination handbooks should be well past. One of the reasons we decided to enable internet accessibility on our nursing workstation was largely for the provision of up to date CDC travel guidelines.

Indeed, the Travellers' Health section of the CDC site is quite remarkable.

Linking onto this button leads us to an incredibly comprehensive array of disease information covering every square inch of the globe.

Each Travellers' Health section includes an area-based travel health guide to good healthcare, keeping in context the most essential vaccinations and the relevance of the diseases they protect against, especially with respect to other and sometimes more important risks in the area of travel.

A recent traveller to inland Cambodia at our practice was able to get appropriately detailed information on infectious disease risks in various regions of Cambodia and the specific regionally adjusted vaccination and/or medication recommendations.

With specialised travel vaccination clinics often admitting their consultation fees are low because their vaccinations are their predominant "high margin product", it does remind us to check how many vaccinations are in fact essential for our patients, and how many may amount to more of an expensive and somewhat superfluous antigenic assault.

It may be pertinent, perhaps, that most of our patients who have visited a travel vaccination clinic tend to have been given their own clinic website reference rather than Travellers' Health at CDC.