Travel Advisories: What physicians need to know

A record-setting 80 million Americans traveled to international destinations in 2016, up 8 percent from 2015, according to data from the U.S. Department of Commerce. This upward trend continued in 2017, with preliminary data showing a 9 percent increase in U.S. citizen travel to international destinations.

Just over 25 percent of Americans who travel internationally visit less developed countries, where the incidence of tropical and infectious diseases are typically higher. So, as Americans dust off their passports in preparation for the 2018 summer travel season, physicians should keep their eyes on international travel health advisories and provide pretravel counseling to their patients as needed.

Types of travel health advisories

The Centers for Disease Control and Prevention issues three types of travel health notices to keep travelers and clinicians informed about health issues related to certain travel destinations. These health issues may arise from disease outbreaks, special events or gatherings, natural disasters, or other conditions that may affect the health of travelers.

  • Level 1 (Watch): The risk associated with travel to this destination is at or slightly above baseline. The impact to the traveler is limited, and usual precautions should be taken.
  • Level 2 (Alert): A destination with a level 2 alert poses an increased risk in defined settings or associated with specific risk factors. Travelers should follow enhanced precautions, and certain high-risk populations may wish to delay travel to the destination.
  • Level 3 (Warning): A destination with a level 3 health warning poses a high risk to travelers. Nonessential travel to this location should be avoided.

Pretravel counseling

Between 50 and 75 percent of people who travel to tropical and subtropical regions report minor medical complaints. Physicians can help to reduce their patients’ risk of illness during international travel by providing pretravel counseling. In addition to making sure patients are up to date on all of their routine immunizations, pretravel counseling sessions provide physicians the opportunity to advise their patients on required and recommended immunizations and provide preventive education and medications as needed.

During the counseling session, an individualized plan of care and immunization schedule can be created based on the patient’s current health, medical history, and risk factors, as well as destination and itinerary-specific requirements and risks.

Some travelers, such as pregnant women, children, elderly people, and people with chronic health conditions, have a higher likelihood of developing an illness while traveling out of their home country. These high-risk travelers should be referred to a travel medicine professional to ensure that their unique needs are met. It may also be a good idea to refer patients who are traveling to destinations with low levels of surveillance or physician reporting to a travel medicine professional.

The World Health Organization recommends that medical counseling take place at least 4–8 weeks before travel. Ultimately, WHO stresses, patients are responsible for seeking information and counseling in order to protect their health while traveling. However, including a quick “travel check” as part of routine medical examinations can go a long way toward helping to prevent the incidence and spread of infectious diseases as a result of international travel.

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