December 2010

December 2010: HEALTH NOTE - Do You Have The Travel Bug?

Author: Paula Hart, RN, FNP, CTH

Having “the” travel bug, can be a good thing. Having “a” travel bug is a bad thing. How do we prepare for one and prevent the other?

With international travel increasing every year, more travelers are venturing into more remote areas, selecting more varied destinations and participating in more activities that may increase their risks of illness or injury. However, one does not need to travel to unpronounceable destinations to fall in the risk category of becoming either ill or injured.

The CDC notes that the infectious disease risk to a traveler is constantly changing. Some destinations have become safer, while other destinations have shown the emergence of new diseases and, even more worrisome, increased drug resistance for treatment of some of these diseases.

While traveling for pleasure and vacation remains a major reason for crossing international borders, there has been a substantial increase of people traveling for business, mission work, study abroad programs, visiting friends and relatives, ecotourism, medical tourism, or as responders to an international disaster. No matter what group the traveler falls into, the risk of becoming ill or injured during international travel will depend on many factors.

KNOW THE DETAILS OF YOUR ITINERARY
- When are you traveling (summer, winter, will it be a country’s rainy or monsoon season)?
- How long is the trip, and how much time will you be spending in each location?
- Where are you traveling? Be specific and know where you are going within each country (rural/urban areas, cities, high altitude, rainforest or jungle).
- Why are you traveling? Is it a vacation, business trip, student abroad program, mission trip?
- What activities will you be doing while traveling (backpacking, safari, diving, remote hiking)?
- What are your accommodations (a hotel, tent, cruise line)? Is this an organized tour or is it a trip arranged by the individual traveler?

Details of a trip are important in tailoring the travel health advice and/or vaccines for each individual. For example, two travelers to Thailand but who have different itineraries and planned activities may be given different vaccines, medications and detailed advice for their trip. Not all travelers will need shots, but most should pay attention in seeking some sort of pre-travel health information.

OBTAIN PRE-TRAVEL HEALTH ADVICE
Seek advice from a health care provider or someone specifically trained or certified in travel medicine. A trained practitioner in travel medicine will have a working knowledge of specific diseases and current destination health risks, including malaria, dengue fever, travelers’ diarrhea, altitude concerns, motion sickness, food and water precautions, etc. A travel medicine clinic will provide appropriate vaccines in addition to advice on obtaining health care abroad, what to do in a medical emergency, medical evacuation insurance and more.

Travelers can also start their search by visiting the CDC website (www.cdc.gov/travel) to view health recommendations, outbreaks of disease and other information. The information on the website, along with that from a health care provider, can help prepare travelers to stay as healthy as possible during their trip.

Keep in mind that the information listed on the CDC website regarding country-specific health recommendations and/or vaccines is a guide. Just because a list of vaccines is provided doesn’t mean that all travelers need them. Again, tailoring vaccines and advice to each traveler is the key to staying healthy.

The U.S. Department of State at (www.travel.state.gov) offers tips for traveling abroad, including health issues, how to handle a medical emergency and how to locate doctors and hospitals abroad. How to locate a U.S. embassy or consulate in a foreign country is also provided on this website.

Carrying a copy of health records may be indicated for certain travelers. If a traveler has a life threatening allergy to food or medication, wearing a medical alert bracelet should be considered. Travelers who take medication should carry them in their original prescription bottles along with a list of these medications in their wallet or purse for easy access.

RISK ASSESSMENT:
Risk assessment provides the foundation for the recommendations given during the pre-travel consultation. In addition to the pertinent information gathered about the itinerary as discussed above, traveler data (allergies, current medications, vaccine history, medical and psychiatric history, age and current health status) is essential in alerting the provider to contraindications or precautions to vaccinations or medications that may be indicated.

Travel medicine is based on the concept of reducing risk. Some risks may be avoidable while others may not. Risks such as travelers’ diarrhea are common, but not life threatening, while others, such as Japanese encephalitis, are rare, but life threatening.

For many travelers, the perception of risk may determine their choice of destination. Each traveler may have individual concepts about the risks and benefits of vaccines. For example, a couple with plans to travel to the Amazon area in Brazil was recently advised of the pros and cons of receiving a yellow fever vaccine. After learning of the possible, but rare, side effects from receiving the vaccine, the couple decided to alter their travel plans to avoid the vaccine.

Apart from advising people with regard to travel-related risks, travel medicine also helps people who have “the travel bug” match their interests, abilities, fitness and sense of adventure with the right destination.

KEY POINTS – Start early in obtaining health information about your trip.

- Allow at least 4-6 weeks prior to travel for vaccines since some require several weeks to offer optimum protection.

- Seek individually tailored travel advice and vaccines.

- Obtain up-to-date information about health issues such as malaria prophylaxis and travelers’ diarrhea with a pre-travel consult. A traveler using malarial prophylaxis may need to take it only during a certain part of his trip; one kind of malarial drug may not be as effective as another for a certain country; some antibiotics have grown resistant in treating travelers’ diarrhea, particularly in Southeast Asia. Learn what’s current.

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