Air travel has made lots of places accessible that weren’t before, and we Americans are now traveling abroad with greater frequency, be it for work and business, family vacations, study abroad, or real adventure experiences in remote areas of the world.
When you’re preparing for your trip, if you’re like most people, you’ve researched the sights to see, booked your hotel, and made your packing list. Ready to go, right? But have you thought about your health?
I’m not just talking about getting travel vaccines to protect against diseases like typhoid fever (although these are very important to get for travel to certain regions of the world!), but also about other aspects of your health and safety, too. For instance, do you know why motor vehicle accidents are the #2 cause of overseas deaths? Do you know you can get altitude sickness in certain areas even if you’re not planning on climbing a mountain? Do you know that different mosquitoes come out at different times of the day and carry different infections?
Well, we do.
Harvard Vanguard has a Travel Medicine Department staffed with highly experienced clinicians who specialize in travel medicine and spend all of their time counseling people about overseas destinations and providing the right medical advice and treatment to protect their health abroad.
As we get asked a lot of questions about what we do and who should see us, I’ve put together the following question and answer guide.
1. When should I consult a clinician about my travel plans?
This depends on both your destination as well as your health, and we would guide you as follows:
- In general, travelers to Asia, Africa, and Latin America (other than Mexico or most of the Caribbean islands) would benefit from seeing a Travel Medicine clinician
- People going mountain climbing or traveling to altitudes >8,000 feet would also benefit from seeing a Travel Medicine clinician
- If you are traveling to Mexico or to the Caribbean, it’s a good idea to call your Primary Care doctor and they can direct you best from there. Both of these areas are highly variable in terms of your need to see a doctor – for example, visitors who are exclusively staying in a Mexican or Caribbean resort area have a far lower risk to their health than those going to the interior of Mexico or Haiti, for example.
- People with a chronic disease traveling anyplace outside of the US should consult the clinician managing their chronic disease to discuss the trip. I would define a chronic disease not so much in terms of something like a high blood pressure problem that, while serious, can be controlled by taking regular medication, but rather in terms of diseases or conditions that can “flare up” or pose serious health risks – examples include Crohn’s disease, diabetes, transplants, cystic fibrosis, etc. Your clinician can help you plan ahead if possible (what can you do or do differently before you leave?) but can also help you prepare if something happens overseas and you’re facing unfamiliar surroundings, language barriers, etc. Preparations can range from self-triage/treatment to providing contact information in advance for a suitable specialist in the location of your travel.
2. What topics about my travel will be discussed at a travel medicine consultation?
We cover the gamut of hazards to your health that you may encounter in a particular area. First, we review your medical history in the context of where you’re going, and make sure that you are up-to-date on or provide boosters for standard vaccines such as the polio or hepatitis vaccines, as well as administer special, travel related vaccines like the yellow fever vaccine, if warranted.
We also review the particular hazards that might cause infection in the area you are visiting. Depending on where you are going, there are infections transmitted by the food or water you eat or drink. Traveler’s diarrhea, aka Montezuma’s revenge, is by far the most common, and while rarely life-threatening unless a person has an underlying health condition, it is well worth avoiding if you want to enjoy your entire trip! But a person can also contract typhoid or hepatitis A from food and drink, so we offer advice on good strategies, pointing out the dangers of eating foods from street vendors or unwashed fruits and vegetables.
Insects, especially mosquitoes, carry the threat of several diseases, including malaria, yellow fever, dengue, and chikungunya. If you are traveling to regions where these diseases exist, we will discuss various ways you can protect yourself from bites.
There are also other dangers we discuss:
- Personal safety when sightseeing in a particular area or city, such as pickpockets, high-theft areas, sexual attacks
- Road/motor safety – vehicular accidents are a leading cause of overseas deaths due to lack of familiarity with the area as well as possible lower standards for car features and/or maintenance
- Other activities (sexual encounters, drug use) can carry a very high risk factor in certain regions of the world for disease (hepatitis B, meningitis, STD’s, etc.)
- For climbers, but also for people going to high-altitude destinations like Peru, we discuss strategies to prevent altitude sickness as well as how to recognize and treat it
3. Why can’t my regular doctor do the same things for me as you do in travel medicine?
A travel medicine specialist has access to databases that the average person does not. You can consult the CDC website to get a rough idea of particular risks for your destination, but their data is at the country level. We subscribe to Travax, a premiere travel medicine website, which provides disease outbreak data that is granular to a city level. Travax also updates its site on outbreak activity on a daily or weekly basis.
So when we consult, we take your specific travel plan and look up those destinations in Travax to know exactly what might be out there and provide the appropriate preventive treatments, not only for the area but also for your current health situation. The question we ask is, “What do you really need?” and then we work with you to customize a plan based on your medical history, your itinerary and planned activities, and your personal values about risks and benefits.
Why is a more sweeping or “just in case” approach not as good? Preventive medicine for malaria is a great example: these medications do not come without some risk of side effects, etc. Our team can check the Travax system to determine the specific risk level for malaria in your destination. We then know how to factor in someone’s health history with the risk level in that area. If the area is high risk for malaria, everyone would be offered preventive medication, but if it’s low or medium, our team can then look at the patient’s specific health situation and weigh the risks of the medication against the risk for getting malaria and decide on the best course.
4. How far in advance of my trip should I make an appointment with you?
Some travel immunizations need to be given a month before your departure. In order to ensure we can schedule an appointment at a time and location [link to locations page in travel medicine] that are most convenient for you, it’s best to call us two months before your planned departure. We can arrange appointments and immunizations with less lead time, although short notice may not permit the full immunization for some destinations.
To learn how to make an appointment with our Travel Medicine Department, please click here.
5. I travel for business a lot and don’t always get two months’ or more notice about a trip. Does it still make sense for me to see you?
We understand that business trips may come up “out of the blue” or last minute, but you can still plan for them with us! You may not know exactly when, but if you often travel to a specific part of the world or can expect to travel to a region sometime within the next few years, we can make sure you’re up-to-date enough to mitigate exposure risks. We try to get people in on short notice, if necessary, but there is no guarantee, especially at peak times of the year (before the December and summer holidays).
6. I’m traveling with my family – can you see all of us?
We not only will see you as a group but we welcome and encourage this approach. We have seen people who are traveling together get different advice from different clinicians, and that creates confusion and stress – “Why did you get that and I didn’t?” Sometimes the reason is due to an individual’s medical history, but it’s helpful to come in as a group so everything can be discussed and possible differences in advice can be explained.
7. I’m traveling “back home” to the country where I grew up. Do I need to get vaccines or medications?
If you’ve been in the U.S. for 1½-2 years or longer, it’s possible – and more than likely – that you have lost some partial immunity you may have had as a natural occurrence when you were living in that environment. Therefore, it’s a good idea to contact us – based on the length of time you have been gone, the area you are traveling to, and your individual health history, a consultation may be warranted.