TRAVEL MEDICINE: A New Specialty For Travelers

By Jan Loomis, RN, BS and James Bryan, MD

Thinking of going on a trip? An African safari, trekking in Nepal, business trip to Asia, or a quick vacation to sunny Mexico? If you are like most people, you have your packing planned, your passport in hand, and a new backpack or carry-on bag. But, what about your health? Each year millions of Americans travel abroad for business or pleasure, and each year a whopping 50% of international travelers become ill as a result of their travels. Most contract simple traveler's diarrhea, a disease that is almost always preventable and treatable. Other diseases, such as malaria, are a bit more complicated but are also preventable.

Before you jet away to a distant land, you may want to consider visiting a relatively new medical specialty, a travel health clinic. Spending money on preventative medicine is one of the best vacation investments you can make. A travel medicine clinic can help keep you healthy and safe throughout your journey.

QUESTIONS TRAVELERS OFTEN ASK REGARDING TRAVEL MEDICINE

Q. How and where do I begin?
A. Most importantly, plan ahead. Try to allow at least two months prior to your trip to get your necessary vaccines, especially if you are planning a lengthy or complicated trip. Some vaccines require a series of injections and may take as long as a month to complete. If you don't have that kind of time to spare, not to worry. Many vaccines can be put on an accelerated schedule to accommodate last-minute travel.

Do your research. Spend some time looking at one of the following excellent websites: cdc.gov or tripprep.com. Each website provides excellent information regarding vaccine requirements, recommendations and malaria prevention.

As a start, routine vaccines that should be updated include tetanus/diphtheria (within 10 years), a polio booster (if you are traveling outside the Western Hemisphere), and measles, mumps and rubella (if you have never had the disease or at least two doses of vaccine). Recommended travel vaccines for the developing world include hepatitis A, possibly typhoid and hepatitis B (depending on your length of stay and risk factors). Yellow fever vaccine is the only required vaccine, depending on the country you visit.

Q. Why can't I see my primary care provider for my travel vaccinations and advice?
A. You can, but many medical practitioners find it difficult, complicated, and time consuming to keep abreast of the current recommendations. Since disease outbreaks and vaccine requirements change regularly, many practitioners choose to send their patients to a travel health clinic, much like they refer patients to a specialist for a specific medical problem (e.g. a surgeon for an operation). Travel health clinics have specially trained nurses and physicians who will tailor their advice to your specific itinerary. Travel clinics educate on topics such as traveler's diarrhea, insect precautions, and travel safety, plus they recommend and administer appropriate vaccines. A good travel clinic will also supply their patients with an assortment of written information as well as allow adequate time for questions.

Q. How do I find a travel clinic close to where I live?
A. In Hood River, Providence Hood River Memorial Hospital has a full service Travel Health Services Clinic. For more information please call (541) 387-8950.

In small communities it may be difficult to find a travel health clinic, so you may have to travel to the nearest metropolitan area. You can start by searching on the Internet for "travel medicine clinics." The Center for Disease Control has a good link for travel clinics. Alternatively, call your county health department or try the following websites/organizations:

AMERICAN SOCIETY OF TROPICAL MEDICINE AND HYGIENE
This organization can provide you with a list of travel clinics in your area.
       60 Revere Drive, Suite 500, Northbrook, IL 60062
       (847) 480-9592

INTERNATIONAL SOCIETY OF TRAVEL MEDICINE (ISTM)
This organization can provide a list of member travel clinics throughout the world.
       P.O. Box 871089, Stone Mountain, GA 30087
       (770) 736-7060

Q. How do I find a good travel clinic?
A. A good travel health clinic should not be solely an immunization clinic. They should provide detailed and customized counseling based on your itinerary. When you are shopping for a travel clinic, ask questions. Find out if they provide counseling on traveler's diarrhea prevention and insect precautions. Ask if they provide any printed materials (handouts) and if they use any on-line services such as Travax (Travax is one of the leaders in compiling recommendations from the Centers for Disease Control). In addition, ask if they are licensed to give yellow fever vaccine. Find out if they provide malaria counseling and, if needed, the appropriate prescriptions. Ask how long a consultation will take (how much time will they be spending with you) and ask how much each vaccine will cost. If they are unhelpful or unwilling to answer your questions, keep looking.

Q. Will my insurance company pay for my travel clinic visit and vaccines?
A. In general, insurance companies will not cover any travel-related preventive medical costs. It is frustrating that insurance will usually cover hospitalizations if you contract travel-related diseases, but they are unwilling to pay for counseling and vaccines to prevent these same diseases. To use the system, consider getting your routine (non-travel related) vaccines such as tetanus, polio and mumps-measles-rubella (MMR) updated with your primary care provider or health department prior to visiting a travel medicine clinic for your travel-specific needs. Knowing in advance the risks associated with your particular itinerary will make you a healthier and smarter traveler!

OTHER GREAT TRAVEL HEALTH RESOURCES:

Centers for Disease Control and Prevention - cdc
The CDC is the worldwide authority on Travel medicine and Infectious Disease. Most other websites and organizations compile their information from the CDC in various formats. The CDC has a comprehensive web site and Traveler's Information Line.
       1600 Clifton Road, Atlanta, Georgia 30333
       (877) 394-8747, (888) 232-3228

Health Canada
This is a wonderful website that has listings of Canadian travel clinics, travel health information and disease outbreaks. Can be accessed either via the web or via their fax service.
       Fax service: (613) 941-3900

IAMAT (International Association for Medical Assistance to Travelers)
This is an outstanding non-profit organization that provides a directory of English-speaking physicians throughout the world, as well as malaria maps, and weather maps. Join IAMAT by sending a tax-deductible donation (of any amount) to any of the following offices prior to your departure:
USA
417 Center Street, Lewiston, NY 14092
(716) 754.4883, Fax: (519) 836-3412, e-mail: info@iamat.org

NEW ZEALAND
P.O. Box 5049, Christchurch 5, New Zealand
Fax: 64 (03) 352-4630

CANADA
40 Regal Road, Guelph, Ontario, N1K 1B5
(519) 836.0102, Fax: (519) 836-3412

MASTA (Medical Advisory Service for Travelers).
MASTA is located at the London School of Hygiene and Tropical Medicine.
       Keppel St, London, WC1E 7BR, England
       090-682-24-100

Medical College of Wisconsin Travelers' Clinic
The best way to navigate this sight is to search for travel medicine and click on the links that look interesting.

Shoreland Travel Health Online
Travel Clinics have used Shoreland for years. They have an excellent website with comprehensive vaccine and disease prevention information.

Travel Library
This is an excellent on-line library of travel health information.

Travelers Medical and Vaccination Centre
Probably one of the best travel medicine sites, this Australian site has information on travel medicine and disease outbreaks.

World Health Organization
Website of the World Health Organization. Includes disease outbreaks.

TRAVEL SAFETY INFORMATION

United States Department of State
Travel Advisories. To use their website, click on travel warnings. Citizens' Emergency Center. Access to medical assistance 24 hours a day. (202) 647-5225

Divers Alert Network (DAN)
One of the best travel secrets around. An excellent non-profit organization that caters to scuba divers but encourages all travelers to become members and receive travel assist and emergency evacuation benefits.
      Travel assist and emergency evacuation
      P.O. Box 61479, Durham, NC 27715
      (800) 446-2671, (919) 684-2948

Travel Health Services Main Page