Elsevier

Mayo Clinic Proceedings

Volume 76, Issue 8, August 2001, Pages 831-840
Mayo Clinic Proceedings

Concise Review for Clinicians
Medical Advice for International Travelers

https://doi.org/10.4065/76.8.831Get rights and content

Each year, approximately 30 to 40 million Americans travel outside the United States. Although the most popular destinations are Europe, Central America, and the Caribbean, travel to Africa and Asia is increasing substantially. International travel, particularly to developing countries, can be associated with the risk of infectious and noninfectious diseases. These risks can be decreased, eliminated, or modified with vaccinations, prophylactic medications, and education. Optimally, pretravel advice must be individualized to a person's medical history, itinerary, and risk behavior. In addition to risk assessment-based immunizations, issues such as traveler's diarrhea, malaria prophylaxis, sexually transmitted diseases, and management of underlying medical problems must form a part of pretravel management. Adventure or prolonged travel or persons with underlying medical diseases such as insulin-dependent diabetes mellitus, transplantation, immunodeficiencies, and dialysis warrant additional preventive measures. This review primarily updates pretravel management of adults.

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

  • 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

  • 3.

    Which one of the following is contraindicated for concurrent administraton with γ-globulin?

    • a.

      Measles-mumps-rubella

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  • Cited by (0)

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