Skip to content

Approach to Travel Medicine Counseling

Basics

  • Pretravel consultations assess potential health hazards, discuss risks, and optimize prevention strategies.

Epidemiology

  • 900 million international arrivals globally in 2022.

  • ~22 million international visitors to the US (2021).
  • ~10 million Americans traveled abroad (2021).
  • Travel-related illnesses and injuries expected to increase as global travel resumes.

Risk Factors

Traveler Details

  • Past medical history: age, gender, comorbidities, allergies, medications.
  • Contraindications to flying: MI within 3 weeks, thoracic/abdominal surgery within 10 days.
  • Nasal spray recommended for preexisting eustachian tube dysfunction before air travel.
  • Pregnancy: flying discouraged after 36 weeks.
  • Immunocompromised, elderly, disabilities considered.

Trip Details

  • Itinerary: countries, urban/rural, side trips.
  • Timing: length, season, time to departure.
  • Reason for travel.
  • Special activities: disaster relief, medical care, high altitude, diving, cruises, extreme sports.

General Prevention

  • Routine vaccinations: Hib, hepatitis B (accelerated schedules available), influenza, MMR, meningococcal, pneumococcal, polio, rotavirus (children), tetanus/diphtheria/pertussis, varicella, zoster, HPV.
  • Travel-specific vaccines: hepatitis A, Japanese encephalitis, rabies, tick-borne encephalitis (outside US), typhoid, yellow fever.
  • Malaria prophylaxis tailored by destination, activities, patient factors.

Malaria Prophylaxis

  • Chloroquine-sensitive: chloroquine or hydroxychloroquine weekly starting 1-2 weeks prior; continue 4 weeks post-exposure.
  • Chloroquine-resistant:
  • Atovaquone/proguanil daily starting 1-2 days prior; continue 1 week post.
  • Doxycycline daily, similar schedule.
  • Mefloquine weekly; avoid if cardiac, psychiatric, or seizure disorders.

Protection Against Arthropod Vectors

  • Avoid outbreak areas.
  • Avoid peak biting times (daytime for dengue/Zika; dawn/dusk for malaria).
  • Wear protective clothing.
  • Use bed nets.
  • Reapply insecticides/repellents regularly (DEET, picaridin, lemon eucalyptus oil, IR3535).

Zika Virus

  • Transmitted by Aedes mosquitoes and sexual contact.
  • Pregnant women advised to avoid travel to Zika areas.
  • Pregnancy planning: delay conception 2 months post-exposure.

COVID-19

  • Follow CDC vaccination and booster recommendations.
  • Check destination travel restrictions, testing, and mask mandates.
  • Consider pre/post travel COVID testing.
  • Avoid travel if symptomatic; maintain hand hygiene and physical distancing.

Mpox

  • Spread by fomites, lesions, body fluids.
  • Symptoms: flu-like illness followed by vesiculopustular rash.
  • Vaccination recommended for high-risk travelers.
  • Avoid close contact with infected individuals and practice safe sex.

Traveler’s Diarrhea

  • Etiology: 80-90% bacterial, 5-8% viral, 10% protozoal.
  • High-risk regions: Asia, Middle East, Africa, Mexico, Central/South America.
  • Prevention: food and water hygiene, handwashing, bottled water.
  • Treatment:
  • Mild: supportive; no antibiotics.
  • Moderate: antibiotics (fluoroquinolones, azithromycin, rifaximin) ± loperamide.
  • Severe: azithromycin preferred.
  • Adjunct meds:
  • Loperamide (age-specific dosing).
  • Diphenoxylate (limited pediatric use).

Altitude Illness

  • Risk at ≥8,000 feet (2,500 m).
  • AMS: headache, fatigue, nausea; resolves with acclimatization.
  • HACE: lethargy, confusion; urgent descent needed.
  • HAPE: SOB, weakness; oxygen and descent required.
  • Prevention: gradual ascent, avoid alcohol.
  • Medications:
  • Acetazolamide (125-250 mg BID adults; pediatric dosing).
  • Dexamethasone (treatment and some prevention).
  • Nifedipine, tadalafil, sildenafil (HAPE prevention/treatment).

Jet Lag

  • Adjust sleep/wake cycles 1-2 hours before travel.
  • Stay hydrated.
  • Optimize sunlight exposure.
  • Consider short-acting sedatives (zolpidem).

Motion Sickness

  • High-risk groups: children 2-12, pregnant, menstruating, migraineurs, certain meds.
  • Prevention: avoid triggers, strategic seating.
  • Treatment:
  • Dimenhydrinate, diphenhydramine (pediatric dosing).
  • Scopolamine patch (not for children).

Environmental Hazards and Other Considerations

  • Avoid barefoot walking to prevent parasites.
  • Avoid freshwater swimming in schistosomiasis/leptospirosis areas.
  • Use sunscreen.
  • Scuba diving restrictions: no flying/altitude exposure within set times post-dive.

Additional Recommendations

  • Travel insurance with evacuation coverage.
  • Carry medications in carry-on/personal luggage.

References

  • Potin M et al. Injuries and medical emergencies among international travelers. J Travel Med. 2023.
  • Brunette GW et al. CDC Yellow Book 2020.
  • Murray HW. The pretravel consultation: recent updates. Am J Med. 2020.
  • CDC Travelers’ Health website.

ICD10 Codes

  • Z71.9 Counseling, unspecified
  • Z71.89 Other specified counseling

Clinical Pearls

  • COVID-19 changed travel health landscape; CDC website is an essential resource.
  • Seek pretravel advice weeks before departure to allow vaccinations and prophylaxis.