Editors’ Note: Summer is a peak time for travel abroad, which can lead to an increased exposure to health risks from infectious diseases, such as Zika and malaria. Travel doctor and infectious-disease expert Dr. Louis Weiss answers questions about how travelers should prepare for trips and how physicians can help them. What follows are his answers, which have been edited for length and clarity.
How far in advance do you recommend travelers start checking on another country’s health and safety status?
Early in the process of planning a trip, one should investigate disease and safety risks related to the destination. This is important, as some locations require that a traveler have specific vaccines in order to obtain a visa. For example, yellow fever vaccines are required for travel to several countries in Africa and South America, and meningococcal vaccine is required for travel to Saudi Arabia, if one is participating in the Hajj.
Once a trip is planned, it is useful to make an appointment with a physician knowledgeable about travel medicine. This visit should occur at least a month, and preferably two months, prior to travel to allow immune responses to develop from vaccines, particularly for those that require more than one dose, such as that for Japanese B encephalitis.
What measures can travelers take to gauge and lower health risks?
Many travel locations have disease risks that can be prevented by specific vaccinations (in addition to those that are required) for diseases, such as hepatitis A and typhoid, which are foodborne illnesses. Some illnesses can also be prevented by medications. Malaria, for instance, can be prevented by atovaquone-proguanil, mefloquine or other drugs, or by avoiding insect bites through the use of picaridin or DEET.
Information on these risks and other routine travel issues can be obtained from the excellent travel resource available from the U.S. Centers for Disease Control and Prevention (CDC). It provides country-specific recommendations for travel as well as general travel information.
Those going abroad should consider obtaining travelers’ health insurance, including evacuation insurance. Although it’s a very rare event, if a medical evacuation by airplane is needed, it is very expensive and is often not covered by standard insurance. There are many companies that provide such insurance for a particular trip. At Einstein our students and faculty are covered by an international policy, which provides travel information for health and security risks, as well as medical assistance to those covered.
How do you know whether you’re healthy enough to travel?
Most people can travel, but one needs to be realistic about the risks both of travel and of the country to which one is traveling. If you have a chronic illness, realistic planning and logistics for the provision of necessary healthcare are needed.
For instance, live-virus vaccines are a concern for those traveling to regions that require yellow fever vaccines. Such vaccines should not be used by patients with immune suppression, and patients with significant immune problems should avoid travel to countries and areas that require yellow fever and other live vaccines. If they must travel, these travelers can get exemption certificates, but they will be at an increased risk for getting yellow fever.
Another example: If a patient has severe chronic obstructive pulmonary disease and requires oxygen, then travel on a plane can be difficult; oxygen levels are lower in a plane, and having an oxygen supply available in the country one is visiting requires advance planning.
On a similar note, patients who need dialysis can visit other countries, but need to arrange for dialysis in the locations they are going to visit before getting there.
Are there any health conditions that one should never travel with?
This depends on where one is going and what one is going to do on arrival. For example, travel to Bangkok, Thailand, for a business meeting in a hotel is very different from a trip to Thailand where one plans to hike in rural areas and stay in hostels. This is why it is best to review planned travel with a physician who understands travel medicine and to do research on the risks before embarking on a specific itinerary. For many conditions, there are adjustments that can be made for travel—for example, how to adjust and store insulin during a trip.
Pregnancy is a major issue for travel as it complicates the use of many medications, such as malaria prophylaxis, and some vaccines, and involves an increased risk from specific diseases such as Zika. A patient must carefully balance the risks of and need for travel in such cases to arrive at the best decision.
What should couples planning a family do if they’re going to a place with Zika virus?
Zika is of particular concern during pregnancy, but recent data suggest that transmission can occur through semen after a male acquires this disease. The CDC provides guidance on this issue for patients and clinicians. If only the male partner, or both partners, travel to an area with a risk of Zika, the couple should consider delaying pregnancy (and using condoms) for six months, based on the time that the virus is known to stay in semen. If only the female partner travels to an area with a risk of Zika, then the couple should consider delaying pregnancy (and using condoms) for two months. Patients with Zika can be asymptomatic, so this CDC recommendation is not based on having an illness during or after travel.
All travelers should use insect protection to avoid insect-borne illnesses such as Zika, dengue, chikungunya and malaria. This can include the use of topical DEET or picaridin and the use of permethrin treatment of clothing.
Should travelers fear venturing abroad, in general, due to health risks?
The need for these types of precautions and preventive measures should not deter travel. The vast majority of travelers do not acquire severe illnesses, especially if they take appropriate preventive measures prior to travel.
Is there a resource that helps healthcare providers learn and understand more about travel vaccines and medications?
There are both commercial and public websites that offer advice for healthcare providers on travel medicine. The CDC travel website has a specific portal for clinicians that contains detailed information. This is an excellent resource that can be used by any clinician for the provision of travel counseling and advice.