April 13, 2011
Exotic travel comes with health risks
After completing my residency in family medicine eight years ago, I volunteered to spend a year seeing patients at a clinic in Montero, Bolivia. In this underserved region, infectious and parasitic diseases run the gamut from malaria and tuberculosis to anthrax and Chagas disease, a parasitic disease that North American doctors generally only read about in medical journals. Other health problems are related to the tropical climate and poor hygienic conditions. It is not uncommon to see normal infections quickly worsen or babies with large abscesses.
If you are planning a trip to Central and South America, Asia and Africa, the best advice is to consult a travel specialist before you leave home. You can make an appointment with a travel medicine doctor even if you receive primary care elsewhere. In the UW Medicine Health System alone, there are six travel medicine clinics with ready access to routine and less common vaccinations such as typhus, yellow fever and Japanese encephalitis.
Try to schedule your appointment at least a month before your departure since most vaccines take two to four weeks to become effective. Bring your itinerary, a list of current medications and your immunization record. It is also a good idea to check whether your health insurance plan will cover travel services and vaccinations prior to the visit to avoid any unexpected charges.
Typical patients seeking travel consultations include business travelers, families returning to their native land after a long absence or with a child born in the United States, people volunteering or planning adventure travel, and patients of all ages who have medical problems that need careful attention. (Patients with chronic conditions should also discuss their fitness to travel with their primary-care provider.)
A surprisingly large number of teenagers are traveling on missions with church and school groups or for extended stays with host families. In most cases, they have never been away from the comforts of home. They have never witnessed a time when life-threatening infections were common, but through travel they will be exposed and need to be prepared.
During the travel consultation, I assess the degree of risk associated with each itinerary, check that standard vaccinations for tetanus, polio, flu, and measles, mumps and rubella are current, and recommend additional vaccinations as needed. For instance, in Central Africa, as many as six other vaccinations may be advisable. I also discuss precautions to prevent illnesses from food, water and insects: Dont eat food from street vendors; check for sanitary food-preparation conditions; dont drink tap water or drinks mixed with tap water; and protect against insect bites by wearing appropriate clothing and using repellants.
Even with these precautions, travelers diarrhea requires special consideration. Since as many as 60 percent of travelers contract this bacterial disease, I recommend that patients carry a prescription antibiotic to help treat moderate and severe cases on the road. We discuss when to take it, how to know if it is effective, and when to seek additional medical treatment. Similarly, for travel into and out of high-risk zones, a number of anti-malarial medications can be prescribed.
Patients leave the travel consultation with maps showing country-by-country health risks; special instructions for sea travel, scuba diving or high-altitude activities; and advice to pack sufficient quantities of asthma inhalers, prescription drugs, painkillers such as Advil, Motrin or Tylenol, allergy medications and other health supplies to last the entire journey. These products will not be available at a corner drug store. I also remind them to seek prompt medical care after their trip if they have a fever or lingering disease symptoms.
As Americans visit developing countries in increasing numbers, the field of travel medicine will continue to expand. My hope is that travelers will explore the world and return home in good health – guided by our expertise and this wonderful insight from Robert Louis Stevenson: “There are no foreign lands. It is the traveler only who is foreign.”
Stephen Emmons, M.D., is a board-certified family medicine doctor and travel medicine specialist at the UW Medicine Neighborhood Clinic in Woodinville. For more information or to make a travel medicine appointment, call 800.852.8546 or visit www.uwmedicine.org/uwpn.