Traveling this summer? Schedule your travel consult

I, like many people, will be traveling this summer – Europe, here I come! This is our second jaunt abroad with Disney Adventures (they are awesome and, no, they did not pay me to say this). But, unlike the prior trip, this time around I am having to make sure that my family is all up to date on their measles vaccines.

“Measles? This is not some third world country you are visiting!” you might be thinking. But sadly, in 2018, Europe saw nearly 80,000 cases of measles and more than 70 deaths as a result. And it’s not just traveling abroad that we have to worry about. Even travel within our own country now gives us pause. If you are headed out on a summertime road trip, you need to think about your destination. Is there a measles outbreak occurring anywhere you are headed? Best to make sure that you and your family are up to date*

But this post is more than just a discussion of the importance of updating your measles vaccine.

Travel consults are something we do with regularity in family medicine and I’d like to take this opportunity to explain the “Who, Why, When, Where, What, and How” of the travel visit. Let’s get started, shall we?

WHO needs a travel consult?

You, that’s who! Really, everyone traveling needs to consider their destination and what vaccinations and other measures may be necessary to keep them safe and healthy. But there are certain individuals for whom this is especially important; pregnant women, infants too young to have been vaccinated themselves, persons with chronic disease or immune compromise, etc. These folks are at particular risk of serious illness, were they to contract a vaccine-preventable disease while traveling. And who wants to be SUPER sick when they are far from home? Or anytime, really?

WHY are travel consults necessary?

It is not uncommon to have patients calling or emailing a couple of weeks prior to travel to request travel vaccines. But most often that call or email is met with a request to schedule an appointment for discussion. We do this, not to irk you, but because the discussion of what vaccines are needed for travel can be complex. The answer to the “What vaccines are needed?” question may change depending on where and when you are traveling.

WHEN should I have my travel visit?

Ideally, the travel visit occurs at least 6 months prior to travel. This timeframe is necessary to get in the complete series of Hepatitis A vaccines and, if you are at risk, Hepatitis B vaccines. These vaccines can protect you from potentially very serious liver infections. If these are not necessary, then remaining vaccines should be given at least a couple of weeks before travel. This way, your body has time to mount an immune response before you go!

WHERE are you traveling?

This is the most important part of our travel consult discussion. What vaccines will be needed, and what preventive measures should be taken, depend on where you are going. And not only do we need to know where you are going, we need to know when you are going and what you are doing when you get there.

WHAT vaccines should I have?

Before you travel, you should always consult the Centers for Disease Control and Prevention website for travelers (go to cdc.gov and click on Traveler’s Health to find out what vaccines are necessary based on the countries you will be visiting. Also, click here to learn of any disease outbreaks that may affect your travel plans).

In my experience doing travel counseling, the following vaccines are almost always recommended. Spoiler alert – it’s all your routinely recommended vaccines.

• Tdap
• Influenza (remember, flu season in the Northern Hemisphere is from around October to May and in the Southern Hemisphere it generally runs from April to September)
• MMR (particularly important, now that we are seeing measles and mumps outbreaks)
• Varicella
• Polio

The rest depends on, as we said, where you are going and what you are doing while there. The water supply of many countries is not as safe as ours. Infection from contaminated food and water can occur easily.

1. Vaccination to prevent Typhoid, an illness that can cause high fever and severe diarrhea and dehydration, is commonly recommended. Vaccination can either be through a live-attenuated oral vaccine that lasts 5 years or via an injectable killed virus vaccine that is good for 2 years. Note: you may have to consult a pharmacy that carries travel vaccines to get this shot, as not all doctor’s offices carry it. Talk to your doctor or other medical provider to find out which one is right for you!
2. Cholera is another nasty water-borne infection that is, thankfully, not terribly common. However, if traveling to an area of active transmission, you should consider vaccination.
3. Hepatitis A, as previously mentioned, is also transmitted via contaminated food (via the fecal-oral route… yep, that’s poop to mouth – blech). Hepatitis A vaccination confers presumed life-long immunity.
4. Traveler’s Diarrhea or “Montezuma’s Revenge” is caused by many possible different organisms. It can cause significant diarrhea and discomfort, though is usually not dangerous and usually resolves on its own. Drinking and brushing teeth with bottled water, avoiding ice made with local water, and only eating fruits that you can peel yourself are several ways this condition can be prevented.

Travel to areas where mosquito-borne disease is more common may require…

1. Malaria prophylaxis (antibiotics taken to prevent infection) – these typically have to be started prior to travel and continued during travel and for some duration after (depending on the antibiotic chosen)
2. Vaccination for Yellow Fever
3. Vaccination for Japanese Encephalitis
4. Zika virus is another mosquito-borne illness that can have serious consequences. Unfortunately, we do not yet have a vaccination against Zika. Prevention entails physical barriers such as mosquito netting, specific bug sprays, wearing long clothing, etc.

When traveling to sub-Saharan Africa, a part of the world known as the “meningitis belt”, you may need to be vaccinated with the meningococcal vaccine(s).

If you are going to be in nature for prolonged periods, spelunking, or working with animals during your travels, you should consider rabies vaccinations.

For those doing medical work or potentially coming into contact with blood or body fluids during your travels, Hepatitis B vaccination is strongly suggested.

HOW can I protect myself while traveling?

What can you do apart from scheduling your travel consult and updating your vaccinations? Here is a list of tips and tricks to help you stay healthy during your travels.

• If traveling to regions at high altitude, you may need a prescription for Acetazolamide to prevent altitude sickness. Also, your travel schedule should allow time to acclimate to the thinner air before ascent to even higher altitudes.
• If vacationing in areas where Traveler’s Diarrhea is a concern, take two chewable Pepto Bismol tabs before each meal and at bedtime (this is not recommended for pregnant women or children under 3 years old). Doing so can decrease the chance of getting Traveler’s Diarrhea by up to 50%.
• If you contract diarrhea while on vacation, use of antidiarrheals like Imodium are okay, as long as you don’t have blood in the stool or fever. If you have blood or fever, you should not use antidiarrheal medications and you should consult a medical provider. You may want to talk to your medical provider about getting a prescription of antibiotics prior to travel to use in case of severe diarrhea.
• If taking antibiotics for malaria prevention or other reasons, be especially good about using your sunscreen. Many of these medications can increase your sensitivity to the sun.
• When traveling to areas where mosquito-borne illness is a concern, pack long pants and long-sleeve shirts, sleep with mosquito netting or in enclosed and air conditioned rooms, and use bug sprays that contain DEET, IR3535, OLE (oil of lemon eucalyptus), or Picardin.
• Traveling with sinus congestion? Consider a cocktail of Ibuprofen, Sudafed, and Afrin nasal spray taken one hour before take-off (assuming you have no contraindications to any of these medications, of course – check with your doctor to make sure these would be okay for you). These will help relieve pressure and inflammation and keep your ears from hurting as much during flight. PS – please do not fall in love with Afrin. If used for more than a few days at a time, your body gets  “addicted” to it and you will require Afrin in order breath through your nose.
• Finally, pack your regular and as needed medications in their original packaging if possible. And pack enough to cover you if your flights are delayed or travel plans change. Take these in your carry on. Do not check them with your checked luggage.

Well, that’s about it, folks. See your doctor prior to travel to check what vaccinations and other preventive measures might be necessary to keep you healthy on your vacation. Happy travels and have an amazing summer!

*Up to date means 2 MMR vaccines or having been born before 1957, in which case you are presumed immune due to infection in your youth (read more about adult measles vaccination here). An infant can receive an MMR vaccine as early as 6 months for travel. However, this will not count for school-required vaccines. They must still complete the two shot series that is routinely recommended.