Travel Health

The number of international travelers surpassed the 1 billion mark in 2014, an increase of 51 million over 2013. Many US residents who travel internationally do not seek pre-travel health advice, even when planning trips to developing countries. Yet as many as 64% of people who have traveled to developing countries report travel-related health problems.

Today, pharmacists in both community and clinic settings are providing a full or partial range of high quality travel health services that are well accepted by patients. In some states, such as California, pharmacists can provide travel-related prescription medications and vaccines, and order relevant laboratory tests.

This issue provides an overview of the healthcare provider’s role in travel health services and serves as a primer for common travel related diseases. Table 1 lists practical facts about travel-related vaccines. The Patient Connection addresses common questions about travel immunizations and safety measures that help prevent food-, water-, and insect-borne infections.

Within the specialty of travel medicine, travel health primarily focuses on pre-travel services. The goal of a pre-travel consultation is to identify all potential health risks and to educate and equip travelers to respond to those risks. In addition to addressing vaccine and non-vaccine preventable diseases, the travel clinic provider can anticipate the need for treatment of environmental conditions such as motion sickness, altitude sickness, and jet lag. (These travel concerns will be explored in a future issue.) Ideally, the consultation takes place at least 4 to 6 weeks before travel. The travel health provider must carefully assess the health background of the traveler including age, immunization history, pregnancy status, medical conditions, and current medications.

The traveler’s geographic destinations, planned activities, duration of travel, and types of accommodations must also be considered. Based on the information gathered, advice should be personalized, highlighting the likely exposures. Appropriate vaccinations and medications, both prescription (eg, malaria chemoprophylaxis) and nonprescription, should be provided.

Vaccinations should be discussed in the context of routine, required, and recommended. Routine vaccinations that are part of normal health maintenance (eg, tetanus), should be brought up-to-date. Recommended vaccinations are those that should be obtained based on the potential for vaccine-preventable diseases that might be encountered during travel. Required vaccinations are those necessary for entry into certain countries, such as the yellow fever vaccination for travel to some West African countries (eg, Angola, Rwanda, Republic of Congo).

The traveler should be informed of destination-specific precautions concerning food, water, insects (eg, mosquitoes), arachnids (eg, ticks, spiders), and the potential for sexually transmitted infections. Providers may need expertise in water disinfection/purification methods and mosquito netting so that travelers can be appropriately educated. A thorough pre-travel consultation also includes information about travel insurance and access to medical care abroad. Patients should be instructed to seek medical attention if they develop any unexplained symptoms after they return; travel-related illness can occur days to months after travel has been completed. The interaction between the traveler and healthcare provider should be collaborative, and written information should be provided to supplement the oral advice.