Passport. Check.
Tickets. Check.
Vaccinations. Huh?
A trip overseas can pose various health hazards, depending on the individual traveler’s health, type of travel, length of stay and destination. Significant changes in altitude, humidity and temperature can lead to illness, and in many parts of the world – especially developing countries and tropical locations – the risk of infectious disease is high.
“Not all countries are high-risk for travelers,” said Dr. Christopher Ohl, an infectious disease specialist at Wake Forest Baptist Medical Center in Winston-Salem, N.C. “Europe is generally safe, and so are Canada, Japan, Australia.
“But anybody planning to go to Mexico or Central America, the Caribbean, South America, Africa, most anywhere in Asia, or the Pacific islands should definitely look into what health risks they’ll encounter and what they’ll need to do to minimize their chances of getting ill.”
The Internet, of course, is loaded with material about international travel health and safety, and some sites – such as those of the U.S. State Department, federal Centers for Disease Control and Prevention and World Health Organization – are reliable sources of up-to-date information. But Dr. Noreen A. Hynes, an infectious disease expert at Johns Hopkins School of Medicine in Baltimore, cautions that even the best websites usually offer only general information about the world’s countries and often do not include specifics about particular locations or activities within those countries.
“For someone going to South Africa, for example, there’s a big difference between staying in a modern hotel in Cape Town for a week and going on a two-week budget trip to Kruger National Park, which is in a completely different part of the country,” Hynes said. “The details of an individual’s health, destination, activities, accommodations and mode of travel are very important elements, and a travel medicine specialist is best equipped to address these various factors.”
There are other advantages to visiting a travel clinic before going abroad.
“Most travel-specific vaccines are typically not stocked in general practices, and most family doctors won’t be up to date on recommendations for specific destinations, which change frequently,” said Dr. Henry M. Wu, an assistant professor of infectious diseases at Emory University in Atlanta and a former medical epidemiologist at the CDC. “But it’s not just about diseases. There are other illnesses, plus safety issues that figure in, and a good travel clinic can cover all of those bases.”
At Wake Forest Baptist’s International Travel Clinic, for example, each appointment includes a 30-minute consultation with a specially trained physician, who develops an individualized, destination- and itinerary-specific plan of immunizations and preventive and remedial medicines for the traveler. But the service doesn’t stop there.
“A lot of what we provide is education,” said Ohl, who sees clients – he doesn’t call them patients, “because they’re not sick” – two days a week at the Wake Forest Baptist clinic. “In addition to administering shots and writing prescriptions, we provide information on how to avoid insect-borne diseases, how to self-treat diarrhea and other common ailments, what to eat and drink and what to avoid eating and drinking and so on, all based on the person’s health status, where they’re going, what they’re going to be doing and how long they’re going to be there.”
And because accidents, not diseases, are the most common cause of injury and death among travelers, Ohl said the clinic also provides safety tips based on information from the State Department and authoritative foreign sources, such as whether there may be civil disturbances in a particular location, whether it’s advisable to travel at night or “if it’s safe to rent a scooter.”
Dr. Sean Ervin, an assistant professor of pediatrics and hospital medicine at Wake Forest Baptist, visited the travel clinic recently in advance of an 18-day work-related trip to Ghana and Nigeria, two countries with elevated risk for yellow fever, hepatitis A, malaria and typhoid. During his consultation with Dr. Hendren Bajillan, a fellow in infectious diseases at Wake Forest Baptist, Ervin learned what shots he should get and what medication he should start taking before leaving, what medication he should take while in Africa and much more – including that he shouldn’t wear anything blue because the color attracts tsetse flies, which carry African trypanosomiasis, or sleeping sickness.
“This is my first trip to Africa, so I definitely want to be as protected as possible against the risk of disease,” Ervin said. “I can’t imagine anyone going into that type of environment not doing the same.”
Ohl recommends that travelers – regardless of their age or the type of trip they’re planning – visit a travel clinic at least four to six weeks before departure, which allows sufficient time to get prescriptions filled and for vaccines to take effect. Even if the destination doesn’t call for any special shots, he said, a trip abroad presents a good opportunity to see that “routine” vaccinations (measles-mumps-rubella, diphtheria-pertussis-tetanus, chickenpox, flu) are up to date.
In the event a traveler returns home with something other than souvenirs, the Wake Forest Baptist clinic also provides post-travel medical care.
“That’s an important part of what we do,” Ohl said. “A number of diseases common overseas don’t present symptoms right away, some can even take months to develop, and they might not be recognized by a general practitioner here.”
While Ohl enjoys meeting the people who visit the clinic and hearing about their trips to various parts of the globe, he’s not just an armchair traveler. He went to Morocco last year and visited Zambia earlier this summer, and has been to every continent except Antarctica.
“I don’t think I’ll ever go there,” he said. “I grew up in northern Wisconsin. That’s enough cold and ice for a lifetime.”
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