In 2005 the World Tourism Organization reported 783 million international arrivals across international boundaries. This represents over a 71% increase in 15 years. In the same year there were 29 million international departures from the United States. A figure less than pre-September 11, 2001 levels, but still an increase of 23% in just 3 years. Travelers may be business travelers to large cities where there are special dangers related to urban travel, but increasingly travelers are seeking out exotic locations as tourist destinations. Pretravel advice is often an afterthought for these travelers.
It is estimated that fewer than half of travelers seek any kind of pretravel advice. Many people ask their family physicians for recommendations, and at times the advice they receive is either uninformed or out of date. Individuals returning to their country of origin are even 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 for all primary care physicians to be prepared to 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 for illnesses and emergencies related to travel.
Hudson TW, Fortuna J: Overview of selected infectious disease risks for the corporate traveler. J Occup Environ Med 2008;50:924-934.
Jong EC, Sanford C: The Travel and Tropical Medicine Manual, 4th ed. Saunders Elsevier, 2008.
Leder K et Al: Illness in travelers visiting friends and relatives: a review of the GeoSentinel Surveillance Network. Clin Infect Dis 2006;43:1185.
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.
- What history must be obtained?
- What specific advice should the patient be given, especially regarding hygiene, safety, and food preparation?
- What immunizations are needed?
- What malaria prophylaxis is recommended?
- Where can the physician find the answers to these questions?
The first step is to obtain a thorough history—including any preexisting medical conditions and use of medications that may have side effects or may interact with other drugs that will be prescribed—and to perform a thorough physical examination. What is the patient's exact itinerary, what countries will he visit en route, in what order? 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 help the traveler ...