Medical advice for travelers should include evaluation of the risk for adverse outcomes depending on the traveler’s medical conditions, the itinerary, anticipated activities, and potential exposures. The pretravel evaluation should provide advice about the risks for vaccine – preventable infections, the appropriate immunizations, and prophylaxis against travelers’ diarrhea and malaria. Fewer than quarter of travelers seek travel advice, and majority of the clinicians are not aware of the most appropriate advice regarding preventive measures. Travel medicine or emporiatrics is the branch of medicine that deals with the prevention and management of health problems of international travelers. It is one of the most ignored branch of medicine. Travel – associated infections may be acquired via oral, respiratory, vector – borne, and / or sexual exposures. In addition to variability of health risks according to destination, travel duration, type of travel, activities undertaken, specific traveler characteristics, and other factors influence the chances of presenting for healthcare with various infections.
Medical consultation should be obtained at least one month before travel to allow time for thorough evaluation and for immunizations. Understanding the itinerary, duration, and purpose of a trip can help to estimate the risks of exposure to locally prevalent diseases. The immunizations should be tailored to individual itinerary details. The pretravel visit provides an opportunity to know about the immunization status of the traveler, regarding routine immunizations like influenza, tetanus, diphtheria, pertussis, measles, mumps rubella, poliovirus, and varicella. The various travel immunizations include yellow fever vaccine, meningococcal vaccine, typhoid vaccine, hepatitis A vaccine, hepatitis B vaccine, polio, rabies vaccine, cholera vaccine, and Japanese encephalitis vaccine. There is absolute requirement of documentation of vaccination against SARS-CoV2, almost at all the places. There is immense importance of a specialist to guide about the appropriate immunization for a particular traveler. It is prudent to be careful of food and water in areas where sanitation and personal hygiene may be poor. Hands should always be washed before eating. Infections transmissible by contaminated food and water include travelers’ diarrhea and hepatitis A and E. Transmission of parasitic infections can also occur. They should sought instructions from a specialist, regarding methods to prevent bites from mosquitoes. These measures are also generally effective for reducing risks of bites from sandflies, ticks, and other insects. Swimming in chlorinated or salt water is safe. Rafting and other water – related activities, including exposure to flood waters, can also result in exposure to leptospirosis. Travelers should be warned against approaching animals and should be advised regarding potential risks from animal bites and scratches, including rabies. Accidents, especially motor vehicle accidents, are the most common cause of death among travelers. They should be reminded to diminish risks by avoiding driving at night, using seat belts, becoming familiar with local driving conditions, and avoiding alcohol consumption while driving. Travelers should be cautioned about sexual contacts, especially in areas with high prevalence of HIV, hepatitis B, and other sexually transmitted infections. Prolonged immobilization during flight may cause venous thrombosis in individuals with preexisting thrombotic or venous disease. Jet lag may result when travel extends over several time zones. For patients with impaired cardiopulmonary function or other health problems, supplemental oxygen may be needed during air travel. East – west travel across time zones often requires adjustments in insulin dosing. Travelers need to carry their syringes, medications, and snacks in carry – on bags. Specific pretravel advice and medication related to altitude illnesses, including acute mountain sickness, high altitude pulmonary edema, and high – altitude cerebral edema, should be provided to travelers to high altitude. Scuba divers should wait 12 to 48 hours before boarding a commercial aircraft to avoid developing decompression sickness. Travel medicine is a rapidly evolving and a highly dynamic science. Travelers should become aware of it and guidance should always be sought from a specialist.
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