Travel medicine is fundamentally a process of risk assessment and risk reduction. The primary factors in assessing risk are the traveler’s personal health history and the destinations of travel. An important part of our consultation is to inform our patients how to travel safely by assessing risks present in their unique travel plans. For U.S. travelers, risk by destination can be roughly categorized into three zones.
The Low risk zone consists primarily of travel to industrialized countries in temperate climates. Itineraries would include travel through most of North America, Europe, northern Asia, as well as New Zealand and Australia.
The diseases endemic to these environments are familiar and relatively infrequent. Health care systems are robust. Public health programs, sanitation and public safety are all well-established and highly functional. Even in these environments, however, the traveler is more likely to become ill or injured than would be the case if they remained home.
Unfamiliarity with a given health care system coupled with language barriers multiply the risk of travel related illness or injury. Even within the U.S., travel activities such as camping or exploring can make access to urgent health care difficult.
The Moderate risk zone consists of destinations where either health care and public safety systems are underdeveloped, or destinations that are endemic to diseases unfamiliar to most North American travelers.
Examples of moderate risk zones include the Middle East, sections of South and Central America, and many island nations. In these regions the traveler is at greater risk of contracting viruses, bacteria and parasites that are generally not found in more temperate climates.
Furthermore, accessing comprehensive, quality healthcare may be difficult or impossible. Safe travel requires basic education regarding prevention, diagnosis and treatment for unique illnesses found in destination countries.
The traveler should be equipped with stand-by emergency treatments (SBET) when indicated, should know how to access the local health care system and should be aware of symptoms that might develop even after returning to their home country.
High risk zones are those countries or regions where both serious diseases are endemic and where the health care systems are underdeveloped. Examples of high-risk zones include sub-Saharan Africa, portions of Central and South America as well as portions of Southeast Asia.
These regions have high incidences of parasitic infections including malaria as well as mosquito borne viruses such as Dengue Fever and Zika Virus. Recent studies suggest that the incidence of illness among travelers to developing nations is between 25% and 75%!
Travel to these regions, therefore, should always be preceded by a comprehensive consultation with a travel medicine specialist. Travelers returning home with symptoms of illness may also benefit from a post-travel medical consultation.
Regardless of the risk zone, several other factors independently increase risk. Longer stays at the destination or travel to visit family is associated with increased risk of illness. Adventure travel or remote travel entail unique risks regardless of destination. Lastly, travel is inherently stressful, both physically and emotionally. Therefore, persons with a significant burden of disease at baseline have much higher incidence of injury or illness while traveling. At Voyager Medical, our goal is to encourage safe and enriching experiences abroad by providing the traveler with the education and resources they need to minimize risk.
Crossing more than two time zones unpleasantly disrupts the normal sleep/wake cycle. Traveling east is generally worse than traveling west, but ‘jet lag’ occurs in both directions and negatively impacts the travel experience. There are several proven strategies to minimize the effects of jet lag:
1- Try to move your sleep schedule 2-4 hours in the direction of your destination during the week preceding travel.
2- Plan sleep times for after arrival. Use short naps to manage daytime sleepiness.
3- Expose yourself to daylight as much as possible in your destination country.
4- Eat meals that correlate with the day/night schedule in your destination country.
5- Moderate exercise on the day of arrival may be helpful.
6- Melatonin can be used at bedtime each evening for several days after arrival in country.
Nearly 50% of foreign travelers will experience diarrhea during their trip. The most common cause of travelers diarrhea is E. Coli although a number of other bacteria, viruses and parasites can cause similar symptoms. If symptoms are mild and not substantially interfering with planned activities, loperamide or bismuth subsalicylates can be used. If symptoms are moderately severe and impacting travel plans, most travelers will benefit both from anti-diarrheal medications such as loperamide as well as antibiotics. If symptoms are severe and incapacitating, anti-diarrheal medications and antibiotics should be initiated and the traveler should consider medical care for dehydration, bloody diarrhea, or fever.
Mosquitos transmit a wide variety of parasitic and viral illness including Malaria, Dengue Fever, Yellow Fever, West Nile Virus, Zika Virus, Chikungunya, and Japanese Encephalitis. Most of these diseases are more common in tropical, low elevation countries but the distribution of disease is quite complex. Each of these illnesses may cause symptoms so mild as to not be noticed, or severe enough to cause blindness, birth defects, or even death. Understanding the risk of mosquito borne illnesses and taking concrete steps to avoid inoculation is critical to safe travel.
Zika virus is a mosquito borne virus known to increase the risk of birth defects if contracted by a woman early in pregnancy. The virus is found in tropic regions worldwide. The incidence of Zika infection fluctuates widely from region to region and year to year. In 2016, for example there was a large number of infections originating in Brazil. Since then, however, Zika infections have declined dramatically. Your Voyager Medical consultation includes up to the minute information on Zika risk specific to your travel itinerary.
Malaria is the most common and most important mosquito borne illness in the world and represents a major risk to travelers in Central America, South America, Oceania and Sub-Saharan Africa. In Sub-Saharan Africa in particular, malaria prevention through mosquito bite prevention and prophylactic malarial medications is essential for all foreign travelers. Determining the optimal medications for malaria prevention is complex. It requires a detailed assessment of patient characteristics, specific locations of travel, drug resistance patterns, medication side-effects and seasonality of disease prevalence. Tailored plans for malaria prevention are a critical aspect of many travel medicine consultations.
Parasitic infections are common in tropical, low-elevation countries. Stories about elephantiasis, eye worms, intestinal worms and brain cysts create a substantial amount of anxiety in many travelers. Fortunately, such infections are relatively uncommon and generally preventable with non-medical interventions such as food safety, skin protection, and bite prevention. Nonetheless, a responsible traveler will want to be clearly aware of those parasitic infections endemic to the countries they will visit and should have a clear plan to minimize risk.
While many infectious illnesses are less common at elevation, altitude itself can pose a significant risk to travelers. Even at the modest elevation of 7000 ft, up to 40% of visitors will experience acute mountain sickness (AMS) with symptoms of headache, nausea and fatigue. For an unfortunate few, AMS will progress to High Altitude Pulmonary Edema or High Altitude Cerebral Edema, both of which are life-threatening if not managed quickly and correctly. Your travel medicine physician can provide guidelines on appropriate acclimatization, along with medications to prevent and treat altitude related illnesses.
Every traveler should strongly consider insuring their trip. While a traveler may be willing to risk the financial investment in their trip, the greater risk to insure against is the cost of medical care or evacuation in the event of an injury or illness while traveling. Persons who would never consider letting their health insurance lapse commonly ignore the fact that they are essentially uninsured when traveling abroad and are at a significantly higher risk of getting sick or injured. Lastly, if a traveler becomes ill while abroad and needs medical evacuation the costs can be enormous. At Voyager Medical we have vetted for our patients the best travel insurance options available.
Voyager Medical helps you prepare for every adventure so you can explore more confidently than ever before. We care about traveling smarter, trust us to keep you informed.
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