Pre-Travel Health Consultation – A Practitioner’s Observations

OLYMPUS DIGITAL CAMERANearly one billion people intend to travel internationally in 2014. In my practice I personally prepare about 10 patients per day in our travel center for their upcoming travels. And while their motives range from vacation to business to permanent moves, the fact that so many are on the move begs the questions – are they fully prepared for their journey? Sure, most focus on their airplane tickets, updating their passports, gifts for the relatives, getting business documents in order, or not forgetting their favorite bathing suit.

But what amount of preparation do they put towards their own health and well being in their new locations? Honestly, surprisingly few. In published studies, less than one third of travelers traveling from the US seek any pre-travel information, and if the traveler previously from the foreign country, (for example visiting friends or relatives), the numbers are far less. In my experience, if there wasn’t a need for a required Yellow Fever immunization, the number of patients I see would be about one half.

The take away message is simple, pre-travel health consultation has a vital place in international travel – and yet it is being overlooked by the vast majority of travelers. In one report, 59% of travelers seeking pre-travel consultation had some health issue that could impact them due to or during their journey. In another report over 75% of short-term travelers return with some travel-related malady. And the numbers are greater for trips to developing countries. So let’s discuss what is a pre-travel consultation and define its value for every traveler.

Travel Risks….or “What just moved under my skin?”

Physician in Pre Travel Consultation

On any given day, there are regional disease outbreaks. In the past, local issues generally remained local. Yet with 24/7 round the world travel accessibility to even the remotest places of the earth, local diseases now take on dimensions of significant meaning.  In 2002, six countries reported having indigenous wild-type poliovirus, but by  2007, wild-type poliovirus spread to 27 previously disease-free countries in Africa and Asia – due merely to the movement of infected travelers. Some may remember how in 2003, a health professional from China, who was caring for patients with an unrecognized respiratory illness, traveled to a family wedding in Hong Kong, unbeknownst he was sick. He spread his infection to 10 other travelers at his lodging, who all then traveled to other parts of the world, seeding a global epidemic of SARS that resulted in 8,098 cases and 774 deaths in 29 countries. Consider something as simple as fresh water, a basic human need, is often overlooked, if not completely unknown to a traveler as a source for diseases that can cause death, or an illnesses that can ruin one’s quality of life for years. In summary, what is important for a traveler to realize is they have an opportunity, some would even say as responsibility, with some forethought and planning, to protect themselves, and possible millions of people around the world from disease – all by taking pre-health preparations.

The Internet has become a source for disease information for the travelers. Nations, medical organizations and individuals post volumes of data on how to maintain one’s health and safety while traveling. The challenge for the travelers is not in the information, but in its interpretation and relevance to the individual and their trip. In my experience, an increasing number of patients come to a travel clinic armed with a list of vaccines they “need to get”, or conversely, assured that a recommendation doesn’t pertain to them. The opportunity for the traveler lies not in the right or wrong, but in the assessment and management of risk, which at the core is the purpose of the pre-travel consultation.

How to keep your bucket list dreams from turning into “kicking the bucket”

The pre-travel consultation is the time a traveler and a travel health professional can assess the nature of a person’s trip, its potential health issues, and risk mitigation strategies. It involves a professional listening to the patient’s travel plans and itinerary, learning about their health history, assessing their risks and finally educating the patient as to how they can protect themselves all while having a fun and fulfilling journey. The encounter may lead to the patient receiving vaccinations such as for Typhoid or Rabies, prophylactic medications for a disease such as malaria or to combat traveler’s diarrhea.  Or supplies such as DEET or mosquito netting may be needed. But in my opinion, the most important element in the relationship between me as a travel health professional and my patient is the discussions about travel health issues that have nothing to do with any of the above. For example, being able to advise someone how to recognize signs and symptoms of diseases. How to prepare your sleeping accommodations nightly whether staying in a youth hostel or a 5 star hotel.  How to negotiate the acceptance or rejection of “home cooked” food to minimize traveler’s diarrhea and still not offend your hosts. Or bring a traveler up to speed on the latest about counterfeit medications and water.

In future writings, I will detail more about these and other pre-travel consultation discussions. But again, the vital take away message is the health and wellness of you and the world can be significantly impacted merely by being unprepared for your journey. A pre-travel consultation lends much to reducing this risk. And keeping you well for your next adventure!

What are you thoughts on pre-travel consultations? Leave your thoughts and opinions in the comment box below!