Pretravel Consultation

Written by Student Health Services Physician, Tiffany Skaggs, M.D.

If you fail to plan, you’re planning to fail.”

Benjamin Franklin

While making travel plans, plan to protect your health with a pretravel consultation at Student Health Services. Key components of a pretravel consultation include data gathering regarding itinerary, medical history, immunizations, malaria prophylaxis, and personal protection measures against arthropod bites, traveler’s diarrhea, and personal injury.

Pretravel Consultation is most effective when completed at least 6 weeks to 2 months prior to departure date to get maximum protection from immunizations. A full medical history is needed prior to the consultation (including immunization records, medications, allergies, and medical conditions). Certain conditions may increase health risks in travelers and your health care provider can help navigate these risks prior to travel.

Immunization-Preventable Diseases:

  • Hemophilus Influenza type B
  • Hepatitis A
  • Hepatitis B
  • Herpes Zoster Virus (adults age 60 and older)
  • Human Papilloma Virus
  • Influenza
  • Measles, mumps, rubella
  • Meningococcal
  • Pneumococcal (all infants, some conditions, all adults age 65 and older)
  • Varicella

The above diseases are also considered routine immunizations in the United States.

Travel-Specific Vaccines: Your travel provider will evaluate and prescribe these based on risk factors.

  • Typhoid Fever
  • Yellow Fever: Travelers may be required to show proof of vaccination for yellow fever to enter or return from nations with endemic regions)
  • Japanese Encephalitis
  • Rabies
  • Cholera
  • Malaria Prophylaxis: In addition to measures to minimize mosquito exposure, travelers to endemic regions should receive malaria prophylaxis. The choices of medications used depend on location of travel and evaluation of the patient’s health status. Medication is started prior to travel and continues while in the malaria-endemic zone and for a certain period of time after leaving the malaria zone.

Zika Virus Infection:

Zika virus is primarily transmitted by mosquitoes, but it can also be transmitted sexually. Since May of 2015, this disease has spread to some parts of Mexico, Central and South America, and the Caribbean. Risk of microcephaly in a newborn if a woman is infected in the first trimester of pregnancy has been estimated at 1% to 13%. Pregnant women should avoid travel to areas with Zika transmission. Men who live in or visit a Zika-endemic area should use a condom or abstain from sex with a pregnant partner for the remainder of the pregnancy. Pregnant women and women of childbearing age who are trying to conceive should postpone travel to Zika-endemic areas.  If they do visit these areas, they should be vigilant about arthropod avoidance measures. Men and women (whether they are trying to conceive or not) living in areas with no active transmission of Zika virus, but returning from active transmission areas, should abstain from sex or practice safer sex for a period of at least 6 months upon return. These recommendations apply to both symptomatic and asymptomatic persons.

Traveler’s Diarrhea (TD):

Protect yourself:  boil it, cook it, peel it, or forget it. 

TD is a very common problem among international travelers with rates ranging from 30-70% depending on destination and season of travel. Taking medications that reduce gastric acidity such as proton pump inhibitors and antacids significantly increases the risk as does younger age, diabetes, and immunosuppression.

80-90% of TD is bacterial in origin. Other cases are viral or protozoal. Bacterial and viral TD usually present as a sudden onset of loose stools, cramping, and nausea. Other symptoms may include abdominal pain, fever, vomiting, and blood stools. Protozoal infections, such as Giardia tend to have slower onset and milder disease with a longer duration.

Your travel medicine provider can prescribe preventive medications and/or prescribe treatment based on your individual risk.

Protection against Arthropod-Borne Diseases:

Follow the below steps for an increased protection against mosquito- and tick-borne illnesses.

  • Apply insect repellant to all exposed skin. The most effective insect repellents contain 20-50% DEET or 20% Picaridin. Avoid DEET in travelers 2 months of age or younger. Reapply regularly. Lemon Eucalyptus (PMD) is another option. IR3535 is also available as Skin-So-Soft Bug Guard Plus does not provide adequate protection against the Anopheles mosquitoes and should not be used in malaria endemic areas.
  • Permethrin applied to clothing or purchase of pretreated clothing is also helpful.
  • Bed nets impregnated with Permethrin are recommended.
  • Avoid activities when mosquitoes are most active: dusk, nighttime, and dawn hours.
  • Checking for ticks should be done by inspection of body after outdoor activity and at the end of the day with the aid of a mirror or companion.
  • Climate Modification: most malaria transmission occurs at temperatures between 77 F (25 C) to 86 F(30 C), so air conditioning below 77 is helpful.
  • Clothing: wearing long sleeve and pants tucked into socks and wearing closed toed shoes are beneficial but may be difficult in hot or humid climates.

Risk Reduction for Selected Travel Hazards:

  • Blood-borne illnesses: Getting tattoos or piercings in low income nations increases the risk of blood-borne illnesses including HIV and Hepatitis C because unclean needles may have been previously used.
  • Medications: Counterfeit, adulterated, or expired medications may be more common in low-income countries. Fill any medications prior to traveling abroad.
  • Crime/security: Use of a money bag under clothing, around neck or waist, reduces the likelihood of pickpocketing.
  • Drowning: Learn to swim. Use approved personal flotation devices. Avoid going into the water after drinking alcohol or any sedating substances; know water currents, conditions, and hazards.
  • High Altitude Sickness: Acute Mountain sickness is common in those traveling to areas above 8000 ft. (2400 m). It is much less likely in those who ascend slowly. Also, your travel medicine provider can assess need and medical condition and prescribe prophylactic medication.
  • HIV infection in medical volunteers: medical volunteers who could be exposed to HIV may consider traveling with post-exposure prophylaxis medications. Your travel medicine provider can assess need and condition and provide prophylactic medication.
  • Motor Vehicle Crashes: Use seat belts and bicycle or motorcycle helmets. Risk of injury is higher in some modes of transport than others such as:  motorcycles, night travel, riding on the roof of a bus, or in the back of an open truck.
  • Sexually transmitted infections and unintended pregnancy: Abstinence or latex condoms should be used when engaging in sexual activity.
  • Solar injury: Wear sunscreen with a minimum SPF of 15 that protects against UVA and UVB rays. Apply sunscreen BEFORE insect repellent.
  • Blood Clots: Walk around frequently, do calf muscle exercises if sitting for long periods (2 hours or greater) to encourage blood flow and decrease risk of venous thromboembolism (VTE).

To learn more about the pretravel consultation, please contact the SHS Preventive Medicine department at (979) 458-8345.To schedule an appointment for a pretravel consultation, please contact our Appointment Line at (979) 458-8250.

Reference:

Sanford C; McConnell A; Osborn J. Am Fam Physician. 2016 Oct 15;94(8):620-627

By | 2017-11-10T08:04:28+00:00 February 1st, 2017|Health, Travel, Vaccines|0 Comments