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Travel Health

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Overview

The number of international travelers surpassed the 1 billion mark in 2014, an increase of 51 million over 2013.1 Many US residents who travel internationally do not seek pre-travel health advice, even when planning trips to developing countries.2 Yet as many as 64% of people who have traveled to developing countries report travel-related health problems.

Today, pharmacists in both community and clinic settings are providing a full or partial range of high quality travel health services that are well accepted by patients.4-7 In some states, such as California, pharmacists can provide travel-related prescription medications and vaccines, and order relevant laboratory tests.8

This issue provides an overview of the healthcare provider’s role in travel health services and serves as a primer for common travel related diseases. Table 1 lists practical facts about travel-related vaccines. The Patient Connection addresses common questions about travel immunizations and safety measures that help prevent food-, water-, and insect-borne infections.

Within the specialty of travel medicine, travel health primarily focuses on pre-travel services. The goal of a pre-travel consultation is to identify all potential health risks and to educate and equip travelers to respond to those risks. In addition to addressing vaccine and non-vaccine preventable diseases, the travel clinic provider can anticipate the need for treatment of environmental conditions such as motion sickness, altitude sickness, and jet lag. (These travel concerns will be explored in a future issue.) Ideally, the consultation takes place at least 4 to 6 weeks before travel. The travel health provider must carefully assess the health background of the traveler including age, immunization history, pregnancy status, medical conditions, and current medications.

The traveler’s geographic destinations, planned activities, duration of travel, and types of accommodations must also be considered. 3,9-11 Based on the information gathered, advice should be personalized, highlighting the likely exposures. Appropriate vaccinations and medications, both prescription (eg, malaria chemoprophylaxis) and nonprescription, should be provided.

Vaccinations should be discussed in the context of routine, required, and recommended. Routine vaccinations that are part of normal health maintenance (eg, tetanus), should be brought up-to-date. Recommended vaccinations are those that should be obtained based on the potential for vaccine-preventable diseases that might be encountered during travel. Required vaccinations are those necessary for entry into certain countries, such as the yellow fever vaccination for travel to some West African countries (eg, Angola, Rwanda, Republic of Congo).3

The traveler should be informed of destination-specific precautions concerning food, water, insects (eg, mosquitoes), arachnids (eg, ticks, spiders), and the potential for sexually transmitted infections. Providers may need expertise in water disinfection/purification methods and mosquito netting so that travelers can be appropriately educated. A thorough pre-travel consultation also includes information about travel insurance and access to medical care abroad. Patients should be instructed to seek medical attention if they develop any unexplained symptoms after they return; travel-related illness can occur days to months after travel has been completed.9 The interaction between the traveler and healthcare provider should be collaborative, and written information should be provided to supplement the oral advice.3,9-11

Details

Publication Date: 08/23/2015
Expiration Date: 08/23/2018
CE Credit: 1.5 (0.15 CEU)
Type of Activity: Knowledge-based

This program was developed by The Rx Consultant and published by Continuing Education Network, Inc. The Rx Consultant accepts no advertising or financial support from the pharmaceutical industry and is funded solely by the purchase of programs. The Rx Consultant is dedicated to providing unbiased, balanced information to health care practitioners.

Programs developed by The Rx Consultant are written by health care providers with expertise in the topic area, peer-reviewed, extensively edited, and fact-checked. This development process was created to insure that every program presents information that is current, accurate, relevant to "real world" health care providers, and written in an easy reading, "plain English" style.

Authors

Jeff Goad, Pharm.D., MPH, FAPhA is Professor and Chair, Chapman University School of Pharmacy and specializes in Travel Medicine and Immunizations. Pamela Mausner, MD, is a Medical Writer/Editor and Healthcare Advocate. Tracy Farnen, Pharm.D. is an Associate Editor for The Rx Consultant.

Disclosure Statement

Dr. Goad is a speaker for Merck & Co., Inc. and a consultant for Shoreland’s Travax 1®. Dr. Mausner and Dr. Farnen report no financial or personal relationship with any commercial interest producing, marketing, reselling, or distributing a product or service that appears in this issue.

Target Audience

This accredited program is targeted to pharmacists and nurses.

Goals & Objectives

At the conclusion of this program, participants will be able to:

    1. Describe the key components of a travel health consultation and list 4 resources for information and/or training.
    2. Discuss travel-related diseases and their major routes of transmission. State whether or not they are vaccine preventable.
    3. Discuss the indications, contraindications, doses, schedules, and side effects of common vaccines and oral medications for prevention of travel-related illnesses.
    4. List precautions for the prevention of water-, food-, and mosquito-borne infections. Discuss the self-treatment of traveler's diarrhea.

Accreditation Statements

The Rx Consultant is a publication of Continuing Education Network, Inc.

Continuing Education Network, Inc. is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education as a provider of continuing pharmacy education.

Continuing Education Network is approved by the California Board of Registered Nursing, Provider Number CEP 13118. Programs approved by CA BRN are accepted by most State Boards of Nursing.

ACPE Universal Activity Number: 0428-0000-15-008-H01-P


Exam & Credit Statement Procedures

Upon successful completion of this program and the post test (70%), 1.5 hours of continuing education credit will be awarded. To receive credit and your exam score, please complete the exam questions and program evaluation.

Editorial and Review Board

Chief Editor and CE Administrator


Terry M. Baker, PharmD

Managing Editor


Tracy Farnen, PharmD

Associate Editors


James Chan, PharmD, PhD
Pharmacy Quality and Outcomes Coordinator
Kaiser Permanente
Oakland, CA

Associate Clinical Professor
School of Pharmacy
University of California San Francisco
San Francisco, CA

Richard Ron Finley, B.S. Pharm.,R.Ph.
Clinical Pharmacist (volunteer faculty)
University of California, San Francisco (UCSF) Memory and Aging Center
Lecturer (Emeritus) UCSF, Department of Clinical Pharmacy
Health Sciences Clinical Professor, UCSF School of Pharmacy
San Francisco, CA

Consultant Pharmacist
Ray Dolby Brain Health Center, Sutter Health/CPMC
San Francisco, CA

Consult Pharmacist Aging and Adult Health Services
San Francisco Health Department
San Francisco, CA

Julio R. Lopez, PharmD, FCSHP
Chief of Pharmacy Service
VA Northern California Health Care System

Adjunct Clinical Professor
College of Pharmacy
Touro University
Vallejo, CA

Assistant Clinical Professor
School of Pharmacy
University of California, San Francisco
San Francisco, CA Adjunct Professor
Thomas J. Long School of Pharmacy
University of the Pacific
Stockton, CA

Visiting Associate Professor and Lecturer
Nursing School
Samuel Merritt University
Oakland, CA

Pamela Mausner, MD

Helen Berlie, Pharm.D. CDE, BCACP
Clinical Assistant Professor, Pharmacy Practice
Wayne State University
Detroit, MI

Ambulatory Care Specialist - Diabetes
Health Centers Detroit Medical Group
Detroit, MI

Senior Editorial Advisor


Gerard Hatheway, PharmD, PhD

Editorial Advisors


Belinda M. Danielson, RPh
Christopher M. DeSoto, PharmD
Angie S. Graham, PharmD
Cynthia Chan Huang, PharmD, MBA
Fred Plageman, PharmD

Editorial Advisor and Clinical Practice Consultant for Nurse Practitioners


Emily K.
Meuleman, RN, C, MS

About the Rx Consultant

The Rx Consultant is a monthly publication dedicated to providing health care professionals with the information they need to educate patients about drugs and manage drug therapy. The reader is responsible for confirming the information presented here and interpreting it in relation to each patient's specific situation before utilizing the information.

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