During the hot summer months when children are out of school, the number of vacationers in the United States rises. According to the World Health Organization (WHO), there were over 900 million international travelers in 2008.1 With this many people roaming the globe, serious health risks, including exposure to different diseases, changes in temperature, and various altitudes and humidity levels, may lead to more health problems. Nothing can spoil a long-awaited vacation like an unexpected illness, especially when visiting a foreign country. For most people planning a trip, making airline and hotel reservations and searching out the must-see tourist attractions often take priority over taking measures to keep healthy on vacation. By taking precautions, however, many travel risks can be minimized.1
Travel health is a branch of medicine that specializes in diseases and conditions acquired during travel. Besides dedicated travel clinics, NPs also provide this service in a variety of practices. Many NPs obtain additional training to develop skills in assessing the health needs of individuals before and after they travel. Recommendations for any traveler normally depend on a number of factors besides the destination and length of stay, including the patient's current health status, medical history and medications, allergies, and risky behaviors. In some cases, the entire process might be straightforward; in others, the NP may need to consult with an infectious-disease expert.
Give your patients homework
The CDC promotes the Three P's of Safe and Healthy Travel: Be Proactive, Be Prepared, and Be Protected, available at http://wwwnc.cdc.gov/travel/content/survival-guide.aspx.2 When patients make an appointment for travel advice, refer them to this site and encourage them to do a little homework before the first visit. The site hosts many easy-to-read articles or, for the technologically savvy, patients can listen to different podcasts at their own pace to learn general information about travel and specific requirements for their destination. These CDC podcasts are accessible at http://wwwnc.cdc.gov/travel/content/podcasts.aspx. Also, be sure to instruct patients to return to the site after the office visit to reinforce any detailed information you provided.
Points to cover during the travel health visit
It is important for patients to know that not every illness is vaccine-preventable. Recently, the CDC announced outbreaks of dengue fever in the tropics and subtropics, chikungunya fever in Asian countries bordering the Indian Ocean, and Q fever in the Netherlands. The most common illness that affects vacationers is traveller's diarrhea. Depending on the geographic location, the condition takes on dramatic, somewhat comical names such as Montezuma's Revenge, the Aztec Two-step, Delhi Belly, and the Tokyo Trots. More serious conditions also exist: Malaria is the fifth leading cause of death from infectious diseases worldwide (after respiratory infections, HIV/AIDS, diarrheal diseases, and tuberculosis). For this reason, NPs should be sure to review the use of mosquito and insect repellants, food and water precautions, and sun protection, as well as immunizations and malaria prophylaxis during the travel health visit. In addition, it is important to address the sometimes-overlooked area of using protection to prevent sexually transmitted infections and other conditions associated with behavior choices, including alcohol and drug use.
Vacations are an enjoyable and much-needed escape from everyday life. Help your patients avoid losing those precious days to illness or injury by offering them your expert preparedness and prevention advice.
Jamesetta Newland, PhD, RN, FNP-BC, FAANP, FNAP Editor-in-Chief
[email protected]
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