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In 2012, the United Nations World Tourism Organization reported that international arrivals across boundaries surpassed the 1 billion mark for the first time in history, and this number continues to increase steadily, with >1.3 billion in 2017. Unfortunately, travel can lead to health problems that range from unpleasant inconveniences to life-threatening injuries and illnesses.
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It is estimated that fewer than half of travelers seek any kind of pretravel advice. Many people ask their family physicians for recommendations, and the challenge is providing recommendations that are current, complete, and itinerary specific. Individuals returning to their country of origin are less likely to consult a physician before travel, and preventable systemic illness is seen more commonly in this group than other tourists. It is important that all primary care physicians give accurate advice to travelers about both pretravel preparation and how to deal with illnesses contracted abroad. Sometimes there is not enough time to obtain the required immunizations, and priorities must be established. The goal of this chapter is to enable the family physician to provide guidance to patients wishing to be prepared before travel and address common posttravel conditions.
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Jong
EC, Sanford
C. The Travel and Tropical Medicine Manual, 5th ed. Philadelphia, PA: Saunders Elsevier; 2017.
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K, Tong
S, Weld
L,
et al. Illness in travelers visiting friends and relatives: a review of the GeoSentinel Surveillance Network.
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[PubMed: 17029140]
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PRETRAVEL PREPARATION & CONCERNS
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A 28-year-old man in good health is planning a 2-month trip to Kenya. He will be working in Nairobi but also plans to visit game parks and participate in outdoor activities.
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What medical history is important?
What specific health advice should be given?
What immunizations are needed?
Are any prophylactic medications recommended?
Where can the physician find the answers to these questions?
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The first step is to obtain a thorough history—including any preexisting medical conditions and use of medications—and to perform a focused physical examination for conditions that might impact travel risk. What is the specific itinerary, including stops en route? What accommodations will he have? Will he remain in urban areas or visit some rural regions? What is his immunization history? This information will help determine necessary immunizations and prophylaxis. The physician can also recommend important items to take on the trip, such as insect repellent. If the patient has a chronic illness, he should be given pertinent portions of his record, including list of medications and allergies, to take in case he needs medical care abroad.
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Several websites provide information about travel and health requirements (see listing at the end of this chapter). After reviewing, this patient faces several ...