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Before the COVID-19 pandemic, international travel was increasing at a brisk rate. After a lull, it is picking up again and predicted to continue to climb as it had previously. International travel presents some unique health hazards, including infectious diseases, chronic disease exacerbation, environment-related illness, accidental injuries, and transportation-related illness. Many travelers appropriately seek medical consultation for advice and interventions to decrease their health risks during travel. The pretravel consultation consists of risk identification and preventive interventions. Although these consultations traditionally have occurred with infectious disease specialists, family physicians can and should provide this care. Pretravel consultations should review a patient’s medical conditions, how travel can affect them, and what the patient can do to address medical needs that may arise while abroad. Balancing the risks likely to be encountered with the individual traveler’s risk tolerance, patients and family physicians can collaboratively develop a strategy to mitigate these risks and increase the likelihood of an uneventful (and enjoyable) sojourn.

Case 1. EW is a 27-year-old patient who comes to your office for a pretravel consultation 3 weeks before travel to Thailand and Cambodia. She does not have a detailed itinerary, but the trip will include Bangkok, Chiang Mai, Phuket, Angkor Wat, and other popular tourist destinations. Her medical history is unremarkable. EW is up-to-date on standard domestic vaccinations, including those for influenza and COVID-19. She is unsure which vaccines are recommended for travel to these countries and asks whether malaria prophylaxis will be needed.

General Concepts

Traditionally, medical consultations for individuals traveling abroad often have been performed by internists and pediatricians specializing in infectious diseases. However, less than 1% of travel-related mortality is due to nonpneumonia infectious disease,1 and the causes of travel-related mortality extend far beyond infectious etiologies, as shown in Table 1.2,3,4,5 Thus, a more comprehensive approach to pretravel advice is needed.6

Approximate proportion of travelers who:
Have any sense of being ill50%
Seek any medical attention8%
Are injured while traveling5%
Top causes of traveler mortality:

At its core, travel medicine (sometimes known as emporiatrics) considers identification of risks associated with travel and preventive interventions. It first requires a health care professional with solid understanding of the traveler’s medical history, including chronic conditions; knowledge of their social history and related behavioral risk factors; and appreciation of the individual’s personal risk tolerance. Travel medicine also requires shared decision-making to determine appropriate and acceptable vaccinations, prophylactic drugs, and behavioral adaptations, all intended to keep travelers safe. This describes the travelers’ personal physician with whom they have an established, ongoing, and trusting relationship. Thus, every family physician can and should be able to provide competent pretravel consultation for most of their patients.

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