The Pretravel Consultation

 

Key components of the pretravel consultation include intake questions regarding the traveler's anticipated itinerary and medical history; immunizations; malaria prophylaxis; and personal protection measures against arthropod bites, traveler's diarrhea, and injury. Most vaccinations that are appropriate for international travelers are included in the routine domestic immunization schedule; only a few travel-specific vaccines must also be discussed. The most common vaccine-preventable illnesses in international travelers are influenza and hepatitis A. Malaria prophylaxis should be offered to travelers to endemic regions. Personal protection measures, such as applying an effective insect repellent to exposed skin and permethrin to clothing and using a permethrin-impregnated bed net, should be advised for travelers to the tropics. Clinicians should offer an antibiotic prescription that travelers can take with them in case of traveler's diarrhea. Additional topics to address during the pretravel consultation include the risk of injury from motor vehicle crashes and travel-specific risks such as altitude sickness, safe sex practices, and emergency medical evacuation insurance.

Data show that 1.1 billion persons crossed an international border in 2014, and this number is projected to increase to 1.8 billion persons in 2025.1 Tourism is increasing in both high- and low-income destinations, and is the first- or second-largest source of revenue in 20 of the 48 least developed countries.2

WHAT'S NEW ON THIS TOPIC: THE PRETRAVEL CONSULTATION

Pregnant women and women of childbearing age who are trying to conceive should postpone travel to Zika-endemic areas. If they do visit these areas, they should be vigilant about arthropod avoidance measures. Because Zika is also transmitted by sex, men who visit Zika-endemic areas should use condoms with pregnant sex partners.

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SORT: KEY RECOMMENDATIONS FOR PRACTICE

Clinical recommendationEvidence ratingReferences

International travelers should receive routine domestic immunizations as well as travel-specific immunizations to reduce the risk of illness and death from vaccine-preventable diseases.

A

15, 16

Use of personal protection measures, including applying DEET or picaridin on exposed skin and permethrin on clothing, and using a permethrin-impregnated bed net, reduces risk from arthropod-borne illnesses (e.g., malaria, dengue fever) in travelers.

C

18, 19, 22

Travelers to endemic regions should receive malaria prophylaxis.

A

24, 25

A short course of antibiotics reduces the duration of traveler's diarrhea.

A

34, 35


DEET = diethyltoluamide.

A = consistent, good-quality patient-oriented evidence; B = inconsistent or limited-quality patient-oriented evidence; C = consensus, disease-oriented evidence, usual practice, expert opinion, or case series. For information about the SORT evidence rating system, go to http://www.aafp.org/afpsort.

SORT: KEY RECOMMENDATIONS FOR PRACTICE

Clinical recommendationEvidence ratingReferences

International travelers should receive routine domestic immunizations as well as travel-specific immunizations to reduce the risk of illness and death from vaccine-preventable diseases.

A

15, 16

Use of personal protection measures, including applying DEET or picaridin on exposed skin and permethrin on clothing, and using a permethrin-impregnated bed net, reduces risk from arthropod-borne illnesses (e.g., malaria, dengue fever) in travelers.

C

18, 19, 22

Travelers to endemic regions should receive malaria prophylaxis.

A

24, 25

A short course of antibiotics reduces the duration of traveler's diarrhea.

A

34, 35


DEET = diethyltoluamide.

A = consistent, good-quality patient-oriented evidence; B = inconsistent or limited-quality patient-oriented evidence; C = consensus, disease-oriented evidence, usual practice, expert opinion, or case series. For information about the SORT evidence rating system, go to http://www.aafp.org/afpsort.

Only a minority of international travelers—36% in one study—seek pretravel counseling; of those, 60% see a primary care clinician, 10% see a travel subspecialist, and 30% turn to friends and family.3 Although research supports some portions of the pretravel encounter (e.g., malaria prophylaxis, immunizations), the benefit of counseling on other topics (e.g., motor vehicle crashes, safe sex) has not yet been demonstrated.4

Although consulting a clinician is beneficial to patients at any time before international travel, pretravel visits should ideally occur at least six weeks before departure to maximize benefit of immunizations and other preventive measures. The pretravel consultation is likely to be particularly useful in those visiting low-income nations.

Table 1 outlines the recommended components of the pretravel consultation,5,6  and Table 2 provides resources for clinicians who provide pretravel services. Physicians who perform pretravel consultations only occasionally or who have minimal training in travel medicine may want to refer complex cases to a clinician

The Authors

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CHRISTOPHER SANFORD, MD, MPH, is an associate professor in the Department of Family Medicine and Department of Global Health at the University of Washington, Seattle....

ADAM MCCONNELL, MD, is a second-year resident at the University of Washington Family Medicine Residency.

JUSTIN OSBORN, MD, is an associate professor in the Department of Family Medicine at the University of Washington and is associate director of the university's Family Medicine Residency.

Author disclosure: No relevant financial affiliations.

Address correspondence to Christopher Sanford, MD, MPH, University of Washington, 314 NE Thornton Pl., Seattle, WA 98125. Reprints are not available from the authors.

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