Domain – Travel medicine (guiding topics)

Rationale for Travel Medicine in General Practice

Increasing Accessibility and Impact of COVID-19:

• Prior to 2020, international travel to and from Australia was increasingly accessible and occurring at higher rates.
• The COVID-19 pandemic highlighted the interconnectedness of the world regarding the spread of infectious diseases and differences in healthcare access and quality.

Role of General Practice:

• General practice is the primary environment to discuss prevention strategies for travel-related risks.
• This includes specific pre-travel consultations or opportunistic discussions, as many individuals do not seek specific health advice before travel.
• GPs also play a crucial role in assessing symptoms that develop during or after travel, considering individual and public health perspectives.

Travel-Related Risks Beyond Infectious Diseases:

• Risks include altitude and climate extremes, accidents, personal safety, and individual risks related to age, pregnancy, or underlying health conditions.
• These risks are relevant for both international and domestic travel within Australia.

Healthcare Access Challenges:

• Access to healthcare, including screening, treatment, and vaccination, is more challenging for those in regional, rural, and remote Australia.
• Aboriginal and Torres Strait Islander peoples face additional challenges, such as navigating unfamiliar health systems and dealing with language and cultural differences.

Special Travel Risks:

• Medical tourism: Travel for undergoing medical procedures carries increased risks.
• Visiting friends and relatives: This group is less likely to seek pre-travel advice and may engage in high-risk behaviors related to food and water safety or insect bite prevention.

Cultural Sensitivity:

• It is essential to discuss travel-related behaviors in a culturally sensitive manner as health beliefs and risk prevention behaviors are influenced by past experiences and cultural practices.

Risk Prevention and Management:

• GPs need to discuss individual risks and costs associated with risk management strategies, including routine and targeted vaccinations, insect bite prevention, malaria prophylaxis, and treatment strategies for common illnesses.
• Address potential challenges that may prevent rapid access to healthcare services and the limitations of travel insurance cover.
• Managing chronic conditions in the context of travel and discussing ways to modify these risks is crucial.

New and Emerging Challenges:

• Awareness of new diseases (e.g., Zika virus, COVID-19) and antimicrobial resistance.
• Development of new vaccinations, treatments, and evidence-based prevention strategies for travel-related conditions.

Complex and Evolving Topic:

• Travel and travel medicine continue to be complex and evolving topics in general practice, requiring GPs to stay informed about new developments and challenges.

TOPICS

• Provide travel advice tailored to the individual, the destination and the planned activities.
• Discuss general travel health education and prevention including:
  • prevention ofinfectious diseases:
    • the need for routine, catch-up and destination-specific vaccinations
    • prevention of blood-borne andsexually transmissible infections 
    • insect bite prevention
    • food and water hygiene
    • personal hygiene
  • management of pre-existing conditions whilst travelling
  • prevention of non-infectious illness and injury:
    • deep vein thrombosis prevention
    • jet lag management advice
    • advice about minimising risk, such as road traffic accidents or avoiding high-risk activities, such as extreme sports
    • advice about personal safety.
• Provide destination-specific information and advice to reduce the risk of injury, illness or infection including from:
  • current outbreaks
  • risks to personal safety; for example,due to crime, war or political instability 
  • altitude-related illness
  • ingestion of contaminated food or beverages:
    • hepatitis A
    • traveller’s diarrhoea
    • typhoid
    • cholera
  • insect-borne (particularly mosquito-borne) infections:
    • malaria (including risk minimisation and prophylactic medication)
    • dengue
    • Japanese encephalitis
    • tick-borne encephalitis
    • yellow fever
    • leptospirosis
    • Zika virus
    • chikungunya virus
  • aerosol and/or droplet transmission:
    • influenza
    • coronavirus infections
    • measles
    • tuberculosis
  • blood-borne, body fluid and sexually transmitted infections
    • hepatitis B
    • hepatitis C
    • human immunodeficiency virus (HIV)
    • syphilis
    • gonorrhoea
    • ebola
  • exposure to other agents:
    • schistosomiasis
    • rabies
    • leptospirosis​
• Provide specific advice for populations at higher risk or with specific circumstances, including:
  • Aboriginal and Torres Strait Islander peoples
  • travellers visiting friends and relatives overseas
  • extended travel
  • working or volunteering overseas
  • travellers with occupational risk
  • travellers attending mass gatherings
  • children and infants
  • pregnant travellers
  • travellers with disability
  • immunocompromised travellers
  • older travellers
  • travellers with pre-existing medical conditions
  • medical tourism
  • sex tourism.
• Manage conditions and presentations in the returned traveller, such as fever, traveller’s diarrhoea and other specific illnesses.
• Provide routine, catch-up and travel-specific immunisations.