Online tools can help PCPs aid patients traveling abroad

Despite the fact that more than 1 billion people travel internationally, few American adults are up-to-date on their recommended vaccinations.

According to the Centers for Disease Control and Prevention (CDC), adult vaccination rates remain low. In 2013, pneumococcal vaccination coverage was just 21.2% for adults aged 19 to 64; tetanus vaccinations were 62.9% in adults aged 19 to 49, 64% in adults aged 50 to 64, and 56.4% in adults over age 64; full Tdap coverage was 17.2%; hepatitis A coverage was 9% for adults overall; hepatitis B was 25%; and herpes zoster coverage to prevent shingles was 24.2%. Additionally, HPV coverage was 36.9% in women aged 19 to 26.

In a new report in the Journal of the American Medical Association, public health experts recommend travelers visit their physician four weeks to six weeks before planned international travel to make sure they have up-to-date vaccinations. Routine vaccinations like those listed above should certainly be up-to-date, but other vaccinations than might not normally be needed in the United States might be added depending on the individual’s travel plans.

Physicians should be sure to question patients planning international travel about their destination, and review possible health and outbreak warnings for that area. For example, yellow fever is an acute haemorrhagic disease endemic in areas of Africa and Latin America that kills about half of the people it infects. Vaccination against yellow fever is highly effective and lasts for life, but must be given 10 to 30 days before travel.

The World Health Organization (WHO) maintains a database that can be searched by country that details the prevalence of vaccine-preventable conditions across the globe.

Travel to Africa and Asia should be most scrutinized in terms of vaccinating against preventable diseases, according to the Council on Foreign Relations, which maintains an interactive map of vaccine-preventable disease outbreaks around the world. In 2015, there were nearly 200,000 cases of measles worldwide, more than 8,000 cases of pertussis, 2,000 cases of mumps, and 86 cases of polio.

Edward T. Ryan, MD, director of the global infectious diseases program, the tropical and geographic medicine center and the travelers’ advice and immunization center at Massachusetts General Hospital, co-directs GlobalTravEpiNet program, a CDC-supported national program charged with advancing the healthcare of international travelers from U.S.

“International travelers are at risk of acquiring geographically distributed infections and infections that are more common in resource-limited areas of the world (measles, dengue, zika, malaria, Ebola, typhoid, SARs, MERs, influenza),” Ryan told Medical Economics. “International travel not only poses this risk of infection for the individual traveler, but also can lead to the importation of diseases into the U.S.”

Responding to these diseases is expensive and time-consuming, and most importantly, preventable, he says.

“Data suggest that most people do not seek any medical advice and care before they travel, or if they do, they seek it on the Internet or from their primary care provider,” Ryan says. “The CDC recommends that all travelers touch base with their medical provider to make sure their routine immunization are up to date (for example measles, flu, tetanus, and chicken pox), and that travelers to higher risk or resource poor areas consider additional immunizations against typhoid, hepatitis A and yellow fever, if indicated, as well as malaria and diarrhea pills.”

Ryan says international travelers should also receive education on insect bites (dengue, malaria, chikungunya, zika), as well as accidents and trauma (the leading cause of death of healthy Americans overseas).

“Ideally the traveler would seek medical care at least 4 to 6 weeks before their trip; however, significant benefits can occur from even a last minute visit to the health care provider,” he says.

Ryan also recommends travelers utilize the Heading Home Healthy Program and TRhIPtool to learn about risks of travel, and vaccines and medications that they may need. There is also a rapid assessment tool for primary care physicians that can quickly provide travel recommendations based on the patient’s information and destination.