Pre-Travel Health Consultation

1. Pre-Travel Consultation

• Form Review and Trip Details
  • Collect comprehensive details from the traveler’s pre-travel form, including the departure date, trip specifics, past medical history, immunization records, known drug allergies, past experiences with antimalarial medications, current medications, and pregnancy status.
• Itinerary Analysis
  • Confirm the exactness and flexibility of the travel itinerary to anticipate potential health care needs based on possible changes in the travel plan.
• Medical History Discussion
  • Examine implications of the traveler’s existing medical conditions or ongoing treatments that may affect their travel. Consider necessary precautions or adjustments to the travel plan.

2. Risk Assessment and Immunization

• Destination-Specific Risks
  • Evaluate the destination-specific health risks including prevalent diseases, ongoing epidemics, and health advisories. Update on yellow fever and malaria requirements according to regional health guidelines.
• Immunization Review and Planning
  • Thoroughly review the traveler’s past immunization history. Discuss and plan necessary vaccinations for the trip, ensuring all required documentation is prepared, especially for countries requiring proof of yellow fever, meningococcal, or polio vaccinations.

3. Preventive Measures and Disease Management

• Vector Protection Strategy
  • Insect Repellents: Use repellents containing DEET (N,N-Diethyl-meta-toluamide), picaridin, oil of lemon eucalyptus, or IR3535 on exposed skin.
  • Protective Clothing: Wear long-sleeved shirts, long pants, socks, and hats to reduce skin exposure to mosquitoes. Light-colored clothing is preferred as mosquitoes are attracted to dark colors.
  • Mosquito Nets: Use mosquito nets, particularly when sleeping, to prevent mosquito bites. Bed nets treated with insecticides can provide additional protection.
  • Indoor Protection: Stay in air-conditioned or well-screened rooms. Use window and door screens to keep mosquitoes out.
  • Malaria Prevention
    • Decide on the appropriate malaria prophylaxis based on the latest guidelines for the specific areas being visited, considering the length of stay and the traveler’s medical history.
• Diarrhea and Other Illnesses
  • Provide a comprehensive kit for managing diarrhea, including oral rehydration solutions and suitable antibiotics. Discuss the use of anti-emetics, antihistamines, and steroid creams for allergic reactions or other common travel-related ailments.
• Chronic Conditions and Emergency Information
  • Ensure the traveler carries a detailed letter from their doctor outlining any chronic conditions, current treatments, and recent test results, along with emergency contact information. Recommend wearing a medical alert bracelet.

4. Health Insurance and Documentation

• Insurance Coverage
  • Discuss and advise on the best health insurance options that cover international travel, especially focusing on the inclusion of emergency evacuation and repatriation.
• Documentation of Health Records
  • Update the traveler’s health records, including the WHO International Certificates of Vaccination booklet, ensuring copies are maintained both in the traveler’s possession and in the medical office. Document all vaccine batch numbers.

5. Comprehensive Medical Kit

• First-aid items
  • Adhesive dressings, sterile gauze, bandages, tape and eye pad
  • Scissors and tweezers
  • Antiseptic and sterile saline
  • Gloves
  • Needles/syringes/IV cannulae
• Illness care
  • Thermometer
  • Aspirin/paracetamol
  • Diarrhoea kit, including: –– Oral rehydration solution (especially young children) –– Azithromycin (macrolide antibiotic), for self-treatment of moderate severe diarrhoea –– Tinidazole, especially if travel is prolonged and to remote areas
  • Anti-emetic
  • Malaria emergency self-treatment (consider if prolonged travel to remote, malaria-endemic area)
  • Anti-histamine or other anti-allergy medication
  • Steroid cream
  • Other commonly required medications, e.g. thrush treatment and cold sore treatment
• Preventive care
  • DEET-containing insect repellent
  • Permethrin to impregnate bed nets, clothing
  • Antimalarial drug (prophylaxis)
  • Sunscreen (SPF 50+)
  • Ultraviolet light device, filter and/or iodine solution or chlorine tablets to disinfect drinking water
  • Condoms
  • Decongestant (for air travel with hay fever or cold)
  • HIV PEP starter pack (if appropriate)
  • Melatonin for jet lag prevention

6. Final Preparations and Prescription

• Finalize Prescriptions
  • Issue prescriptions for all medications needed for the trip that have not yet been obtained, including those for emergency self-treatment of malaria and other conditions.
• Educational and Informative Materials
  • Provide detailed written and electronic health information tailored to the travel destination, addressing common queries and potential health risks.
• Vaccination and Education Session
  • Administer final vaccinations, if required, and engage healthcare professionals such as nurses and pharmacists to provide detailed educational insights and practical demonstrations on using the medical kit effectively.

Core Vaccinations for Travel

• Routine Childhood Vaccinations:
  1. Measles, Mumps, and Rubella (MMR):
     • Especially important for travel to areas where these diseases are still common.
  2. Diphtheria, Tetanus, and Pertussis (DTaP/Tdap):
     • Ensures protection against these bacterial infections.
  3. Polio:
     • Ensure up-to-date vaccination against polio.
  4. Varicella (Chickenpox):
     • Important for those who have not had the disease or vaccination.
  5. Hepatitis A:
     • Recommended for all travelers to areas with intermediate to high levels of hepatitis A virus infection, which includes most parts of the world except for certain developed countries.
  6. Hepatitis B:
     • Recommended for travelers who might be exposed to blood or body fluids, have sexual contact with local residents, or require medical procedures.
  7. Influenza:
     • Annual flu vaccine, especially important for travelers during flu season.
  8. COVID-19:
     • Ensure up-to-date vaccination and booster doses according to current guidelines.

Additional Vaccinations Based on Travel Destination

1. Typhoid:
   • Recommended for travelers to areas with poor sanitation and hygiene, especially in South Asia, Africa, Latin America, and the Caribbean.
2. Yellow Fever:
   • Required for travel to certain parts of Africa and South America. Some countries also require proof of vaccination for entry.
3. Rabies:
   • Recommended for travelers spending time in rural areas, working with animals, or engaging in outdoor activities in countries where rabies is common.
4. Japanese Encephalitis:
   • Recommended for travelers to rural or agricultural areas in Asia and the Western Pacific during the transmission season.
5. Meningococcal Disease:
   • Recommended for travel to the meningitis belt in sub-Saharan Africa, especially during the dry season, and for those participating in the Hajj pilgrimage.