Content provided in partnership with

Health Care Industry

Travel immunizations

American Family Physician, July 1, 2004 by Vincent Lo Re, III, Stephen J. Gluckman

As international travel to exotic locations becomes increasingly common, it is necessary for more physicians to maintain familiarity with current recommendations for travel health safety. Immunizations and preventive medicines are key parts of travel preparation, and careful attention to them can reduce the risks of infections acquired while abroad. Travel vaccines generally fall into one of three categories: (1) routine immunizations typically administered during child-hood that should be updated or boosted, (2) legally required immunizations necessary for entry into certain countries, and (3) recommended immunizations that may be useful, depending on the risks of expo-sure at the travel destination. (1-3) Vaccines are not available for all travel-related infections (e.g., malaria). In these cases, preventive medication may be necessary to keep the traveler healthy.

Most Popular Articles in Health: Fuel your workout: exercisers who eat before they work out have more energy ...; Soothe a dry, itchy scalp: 5 easy expert solutions; Cocktails and calories: Beer, wine and liquor calories can really add up. ...; The sour truth about apple cider vinegar - evaluation of therapeutic use; The, six best supplements you've never heard of: these secret weapons can ...; More »

Advising travelers on vaccine- and medication-preventable diseases is increasingly becoming the responsibility of primary care physicians. The approach to travel health recommendations should be based on an assessment of the risks for travel-related illnesses, the time available before trip departure, and the current epidemiology of preventable diseases. Physicians should take into account the adverse events and contraindications associated with each vaccine and medication. This article reviews the overall approach to travel immunizations and provides an overview of the immunizations that are recommended or required for international travel (Table 1). Information about preventive medication has appeared previously in American Family Physician. (4)

Risk Assessment

Immunizations should be recommended according to the patient's risk of travel-related diseases and not solely according to geographic destination. A number of resources provide updated information about risks to travelers (Table 2). (5) To properly assess a traveler's risk of illness, the physician first should consider the details of the planned journey (5-7) the exact itinerary, including all geographic destinations and possible stopovers; duration of stay in each location; type of lodging (urban or rural, hotel or tent); planned activities (animal contact, river- or lake-water exposure, eating habits); seasonal risks (time of year); and level of anticipated contact with local residents.

Physicians then should review the status of the traveler's general health, focusing on underlying diseases that may have implications during the trip. (6) Previous immunizations, allergies to medications and vaccine components (especially eggs), and current medications also should be reviewed. (5-7) The physician should make a special effort to identify travelers who are at particularly high risk for travel-related illnesses (Table 3). (3,6) An overall approach to vaccination of travelers based on risk assessment is presented in Figure 1 and Table 4.

[FIGURE 1 OMITTED]

Travelers, particularly those going to developing countries, should be encouraged to seek medical advice early in their planning (at least four weeks in advance). Consultation with a travel clinic may be helpful if the destination is high risk. The amount of time remaining before departure determines whether the standard schedule for a primary immunization series can be used or whether an accelerated schedule, if one exists, should be offered. (2) When departure is imminent and an accelerated vaccine schedule is used, vaccine efficacy may not be maximal by the time of departure, and this fact must be discussed with the patient. (2)

Physicians who provide consultations to travelers should base their recommendations on the current epidemiology of vaccine-preventable diseases at each destination. The Centers for Disease Control and Prevention (CDC) publication, "Health Information for International Travel," is one of the standard references for travel immunization recommendations and is updated regularly. (8) Additional information may be obtained online from the CDC (http://www.cdc.gov/travel) and the World Health Organization (WHO) (http://www.who.int/ith).

Routine Immunizations

Travel provides an opportunity for the physician to review and update a patient's routine immunizations. (1,6) Travelers to areas where postexposure tetanus immunization might be unavailable should consider receiving a booster dose of tetanus and diphtheria (Td) toxoids before departure if five or more years have elapsed since their last vaccination. (9)

Measles is endemic in many developing nations, and a booster of measles-mumps-rubella (MMR) vaccine is warranted for any person born after 1956 who does not have documentation of two doses of the vaccine or immunity by serum antibody testing. (10) Children six to 11 months of age should receive one dose of MMR vaccine if traveling to highly endemic areas, but they still must receive two doses of the vaccine after 12 months of age to be considered fully immunized. (10)

Polio is a good example of the need for physicians to keep current with changing epidemiology. Intensive immunization campaigns have resulted in a marked decrease in polio throughout the world. Polio remains endemic in seven countries: India, Nigeria, Pakistan, Egypt, Afghanistan, Niger, and Somalia. (11) Travelers to these countries are advised to receive a single booster of inactivated polio vaccine (IPOL) if the primary doses have already been administered.

Health Care Industry

Travel immunizations

American Family Physician, July 1, 2004 by Vincent Lo Re, III, Stephen J. Gluckman

Find Research Guides for:

Find Featured Titles for: Sports

Most Popular Articles in Health

Most Popular Publications in Health