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Pre-travel health consultation advised before international travel

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Janet Christenbury

Before traveling abroad to certain destinations, international travelers should consider a visit with their health care provider or travel health specialist for a pre-travel consultation, according to a review issued on July 21, 2016 in the New England Journal of Medicine.

According to the report, in 2015, international tourist arrivals in all countries exceeded 1.2 billion persons. Depending on the destination, 22 to 64 percent of travelers report some illnesses (mostly mild such as diarrhea, respiratory infections and skin disorders). Some travelers, however, return to their own countries with preventable life-threatening illnesses and infections. The review points out that 20 to 80 percent of travelers do not seek pre-travel health advice.

“Non-specialists can provide information and care to healthy adults traveling to common destinations by following travelers’ health protocols by the CDC and other notable organizations,” says Phyllis Kozarsky, MD, professor of medicine in the Division of Infectious Diseases at Emory and co-director of Emory TravelWell Center, a pre- and post-travel consultation and care clinic located at Emory University Hospital Midtown.

Some of the recommended organizations include CDC’s Travelers’ Health, the International Society of Travel Medicine and GeoSentinel.

“Advice from a travel medicine specialist is beneficial to people who are planning high-risk or adventure travel, those who are immunocompromised or have underlying chronic disease, women who are pregnant or who plan to become pregnant soon, young children and travelers with complicated itineraries. Clinics, such as Emory TravelWell, take an individualized risk assessment on each traveler to look at their destination to determine what immunizations, chemoprophylaxis medications and education they may need prior to travel,” says Kozarsky, who is the senior author on this review paper.

Travel medicine experts from University of Alabama at Birmingham and Harvard Medical School in Boston also contributed to the article.

Since appropriate behavior by the traveler can substantially reduce the risk of many specific travel-related health and safety problems, the consult should include education about behavioral and self-treatment strategies. Protection again insects and ensuring the safety of food and water while traveling are most important.

Routine vaccinations, such as measles-mumps-rubella (MMR) and tetanus-diphtheria-acellular pertussis (Tdap) vaccine, should be checked. Sometimes a booster is needed, and in some cases, such as hepatitis A or Japanese encephalitis, a series of shots is needed for complete protection.

Influenza is the most common vaccine-preventable disease among travelers. Because of year-round circulation of influenza virus at different times around the globe, travelers to the tropics and to areas where it is currently winter should always receive a flu vaccine, unless there are contraindications.

Routine travel vaccines consist of hepatitis A for foodborne illness and hepatitis B for exposure to tainted blood and bodily fluids. The current U.S. population has little to no immunity to hepatitis A virus, and most U.S. adults have not been immunized with hepatitis B vaccine. Vaccination against typhoid fever may be considered for some travelers to Africa, South America, and for most travelers to South Asia.

Some vaccines, such as yellow fever vaccine, are needed for a specific region of travel, such as tropical countries in South America and sub-Saharan Africa. A pre-exposure rabies vaccine series may be given for travelers planning long stays in areas of Latin America, Asia or Africa where the rabies threat is constant.

Mosquito-bite prevention is a primary approach to protection from malaria, along with chemoprophylaxis, which is the prevention of disease using medication. The type of medication depends on the distribution and type of malaria in the area.

Other mosquito-borne illnesses include dengue, chikungunya and Zika virus infection, however there are no current vaccinations available for travelers. Clinical trials testing vaccines for dengue and Zika are ongoing.

Travelers’ diarrhea affects 10 to 40 percent of travelers. Medication can be prescribed and taken if symptoms occur while traveling. For altitude sickness, medication should be taken prior to and during a climb, hike or air travel to high-altitude destinations.

Kozarsky and colleagues believe preventive strategies and medical interventions need to be individualized. “This is really key. Not all travelers to a given country will receive the same pre-travel recommendations,” Kozarsky explains.

Also of note, any traveler who develops a fever after returning home should seek immediate expert medical advice.

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