Travel Health: What Your Patients Need to Know

MAY 12, 2017
Anyssa Garaza, PharmD
Traveling abroad can expose patients to a number of risks—infectious diseases, foodborne illness, and transportation accidents. Pharmacists can help their patients keep their travels exciting, fun, and safe. This article focuses on what patients need to know about traveling smart for their health.

The data have revealed that only 1% to 3.6% of deaths are due to infectious diseases, whereas 25% of deaths are due to motor vehicle accidents. Other injuries and accidents, such as drownings and falls from heights, account for 15%.1

When preparing for travel, it is common to automatically think about travel immunizations. However, few people think about the risk of injuries and accidents, specifically motor vehicle accidents. Some reasons motor vehicle accidents are the leading cause of death among travelers include poorly maintained roads, unfamiliarity with local traffic laws, and lack of access to emergency care.2 While educating patients who are planning to travel, be sure to provide the following tips to reduce the risk of being injured in a motor vehicle accident while traveling2:
  • Wear seatbelts and keep children in car seats at all times.
  • When possible, avoid driving and/or riding in a car in a developing country in the dark.
  • Avoid riding motorcycles; if you must, always wear a helmet.
  • Know and understand local traffic laws before driving.
  • Never drink and drive.
  • Make sure to ride only in marked taxis that have seatbelts.
  • Try to avoid overcrowded, overweight, or top-heavy vans or buses.
  • Always be alert when crossing the street, especially in countries where driving is on the left side of the road.
Although not necessarily preventable, 50% of reported deaths while traveling are due to cardiovascular problems, such as heart attacks, in male travelers older than 60 years.1



PACK YOUR BAGS
Before your patients pack their bags, educate them on the following to ensure they are prepared for their trip. Start by assessing their health. Patients who require extra attention and have specific health needs include those with diabetes, chronic obstructive pulmonary disease, and cardiac disease. Other patients requiring extra attention include children and patients who are immunocompromised or pregnant. In addition, educate your patients on avoiding disease and maintaining their health while on their trip.1

Ask them the following questions:
  • Where are you planning to travel?
    • Which countries?
    • Are the areas urban or rural?
    • What are the time zones?
  • When are you traveling?
    • What are the dates?
    • What are the seasonal risks?
  • What is the style of travel?
  • What is the reason for travel? Is it for business, personal, or both?
  • How long will you be away?
  • What are your travel plans, and where will you be staying?
  • What international travel have you done before?
Next, help your patients collect the required information to complete their traveler’s health history so they can take it with them on their trip. Table 11 lists this health information.1

Knowing the answers to these questions can help to determine the immunizations, supplies, and prophylactic medications to prepare for common medical problems that may arise while traveling. Give your patients recommendations for traveling with their medications. Patients should be counseled 4 to 6 weeks before they travel abroad. Individuals planning to travel for an extended time period may need to start preparing months in advance.1



TRAVEL MEDICINE
Common medical problems to prepare for may include malaria, traveler’s diarrhea, increased sun exposure, and insect-vectored diseases. In addition, preparation may be needed for issues associated with changes in altitude, climate, humidity, and time zones.1

Medications to consider for a traveler’s personalized medical kit may include their current prescription medications, medications for high-altitude sickness, and antiparasitic medications.1 For a more detailed list of suggested items and medications, refer to Table 21 and Table 31. The personal medical kit should be based on the individual traveler’s health conditions, style of travel, and destination(s).1



TRAVELING WITH MEDICATIONS
Recommend that your patients take at least several days’ of medications in their carry-on bag because checked luggage is more likely to be lost or stolen.1,3
The FDA recommends that travelers not purchase prescription medications abroad because some medications sold in other countries contain impure or toxic ingredients.3 In addition, there is a growing number of expired, improperly stored and counterfeit medications around the world.1,3

IMMUNIZATIONS FOR TRAVEL
What is the difference between required and recommended vaccinations? For a country-by-country list of vaccinations required for entry into various countries, refer to the “The Yellow Book,” which is the CDC’s Health Information for International Travel (see CDC. gov). In some instances, although the yellow fever vaccine is not required for entry, the vaccination may be recommended and typically depends on the traveler’s in-country itinerary and intended activities.1

END NOTE
Regardless of your patients’ type of travel and destination, you are in the perfect position to ensure that your patients have a safe trip. It is advisable to follow up with your patients once they return. 
Dr. Anyssa Garza received her doctor of pharmacy degree from the University of Texas at Austin before becoming the director of pharmacy for a Central Texas Department of Aging and Disability facility. She now serves as the vice president of Content and Patient Education Programs at RxWiki. In this role, she provides patients with medication information and medical knowledge that can contribute significantly to the quality of care they receive and improve their quality of life and health outcomes. Her work focuses on educating patients and providing them with the resources they need to navigate the health system and their health care issues. She also is an adjunct assistant professor at the University of Texas at Austin College of Pharmacy.

References
  1. Sanford CA, Jong EC, Pottinger PS. The Travel and Tropical Medicine Manual. 5th ed. Marrickville: Elsevier; 2016.
  2. International road safety. CDC website. https://wwwnc.cdc.gov/travel/page/road-safety. Accessed January 29, 2017.
  3. Stay healthy while traveling abroad. FDA website.  http://www.fda.gov/ForConsumers/ConsumerUpdates/ucm049047.htm#before. Accessed January 29, 2017.
  4. Image Courtesy of Dorian2013z | Dreamstime.com https://thumbs.dreamstime.com/x/travel-world-landmarks-background-blue-sky-46083021.jpg. Accessed January 28, 2017.


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