Concise Review for CliniciansMedical Advice for International Travelers
Section snippets
PRETRAVEL SCREENING
Pretravel screening helps to stratify risk of the traveler. Risk stratification involves reviewing the itinerary, behavior patterns (such as eating habits), underlying medical history, and vaccine or medication contraindications. Details of the itinerary, lodging, budget, duration, and time to departure are extremely helpful in preparing the traveler for the trip. Prolonged travel, backpacking, low-budget travel, foreign-born individuals returning to visit friends and family, and imminent
GENERAL ADVICE
Elderly persons or those with chronic medical diseases may benefit from a pretravel physical examination. Travelers should carry a letter stating medical diagnosis, list of medications with doses, and needles or syringes. Some medications, such as methylphenidate hydrochloride, are prohibited in certain countries. Carrying a letter from a physician may prevent problems at airports. Travelers should carry enough essential medications to last the duration of the trip, and the supply should be
IMMUNIZATIONS
An important part of advice to travelers is vaccination against common and travel-related vaccine-preventable diseases. A review of immunization against diseases such as diphtheria, measles, and polio is advised because some of these diseases are prevalent in many developing countries. Although specific travel-related vaccinations may not be cost-effective,11 they are beneficial and may be required or recommended depending on travel history. Vaccine recommendations are best individualized to
MALARIA PREVENTION
Annually, 300 to 500 million cases of malaria occur in more than 100 countries, and the numbers are increasing because of climate and other factors. Malaria among travelers is also increasing. Plasmodium falciparum contributes to most malaria-related deaths. Approximately 30,000 travelers from industrialized countries contract malaria annually.3 In the United States, about 1000 cases are reported annually to the Centers for Disease Control and Prevention; however, some may be unreported.20 The
TRAVELER'S DIARRHEA
Traveler's diarrhea is common during international travel, especially travel to developing countries. It accounts for 64% of all illnesses affecting tourists, and the most common cause is bacterial. Enterotoxigenic Escherichia coli, Campylobacter, Salmonella, and Shigella account for most cases. Enterotoxigenic E coli occurs in 17% to 70% of TD in South America. Rotavirus, Campylobacter, and Salmonella occur more often in the winter. Parasitic etiology is not common in short-term travelers.
CONCLUSIONS
Although it has associated risks, travel to any part of the world can be safe with adequate pretravel preparation. The key to appropriate pretravel advice is to obtain details of the itinerary, review the medical history, and be aware of current recommendations. Special risk groups, such as pregnant women, immunocompromised hosts, small children, and elderly persons with medical problems, may require additional preparation.
Questions About Medical Advice for International Travelers
- 1.
Which one of the following viral vaccines is
contraindicated in organ or bone marrow transplant recipients?
- a.
Japanese encephalitis vaccine
- b.
Hepatitis A vaccine
- c.
Hepatitis B vaccine
- d.
Yellow fever vaccine
- e.
Meningococcal vaccine
- a.
- 2.
Which one of the following is the most common preventable cause of mortality while traveling?
- a.
TD
- b.
Malaria
- c.
Yellow fever
- d.
Cardiovascular diseases
- e.
Accidents
- a.
- 3.
Which one of the following is contraindicated for concurrent administraton with γ-globulin?
- a.
Measles-mumps-rubella
- a.
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