As international travel to exotic l...

As international travel to exotic locations becomes increasingly public it is necessary for more physicians to maintain familiarity with popular recommendations for travel health safety. Immunizations and preventive medicines are key-note parts of travel preparation, and careful attention to them can bring to the risks of infections acquired while abroad. Travel vaccines generally fall into undivided of three categories: (1) routine immunizations typically administered during child-hood that should be updated or boost (2) legally required immunizations necessary for ingress into certain countries, and (3) praiseed immunizations that may be useful, depending forward the risks of expo-sure at the travel destination. (1-3) Vaccines are not available for all travel-related infections (eg malaria). In these cases, preventive medication may be necessary to restrain the traveler healthy.

Advising travelers forward vaccine- and medication-preventable diseases is increasingly becoming the responsibility of primary care physicians. The approach to travel health recommendations should be based in succession an assessment of the risks for travel-related illnesses, the time available before trip departure, and the now passing epidemiology of preventable diseases. Physicians should take into account the adverse occurrences and contraindications associated with each vaccine and medication. This article reviews the overall approach to travel immunizations and provides an overview of the immunizations that are approveed or required for international travel (Table 1) Information about preventive medication has appeared previously in American Family Physician. (4)

Risk Assessment

Immunizations should be make acceptableed according to the patient's risk of travel-related diseases and not solely according to geographic destination. A number of resources provide updated information about risks to travelers (Table 2) (5) To strictly assess a traveler's risk of illness, the physician first should consider the details of the planned journey (5-7) the exact itinerary, including all geographic destinations and possible stopovers; duration of stay in each location; mark of lodging (urban or rural, inn or tent); planned activities (animal contact, river- or lake-water exposing eating habits); seasonal risks (time of year); and flat of anticipated contact with local residents.

Physicians then should review the status of the traveler's general health, focusing forward underlying diseases that may have implications during the trip. (6) Previous immunizations, allergies to medications and vaccine constituents (especially eggs), and current medications also should be reviewed. (5-7) The physician should make a special effort to identify travelers who are at particularly high risk for travel-related illnesses (Table 3) (36) An overall approach to vaccination of travelers based in succession risk assessment is presented in Figure 1 and Table 4

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Travelers, particularly those going to developing countries, should be encouraged to solicit medical advice early in their planning (at least four weeks in advance). Consultation with a travel clinic may be helpful if the destination is high risk. The amount of time remaining before departure determines whether the standard schedule for a primary immunization series can be used or whether an accelerated schedule, if the same exists, should be offered. (2) When departure is imminent and an accelerated vaccine schedule is used, vaccine efficacy may not be maximal by way of the time of departure, and this fact must be discussed with the patient. (2)

Physicians who provide consultations to travelers should base their recommendations forward the current epidemiology of vaccine-preventable diseases at each destination. The Center for Disease curb and Prevention (CDC) publication, "Health Information for International Travel," is undivided of the standard references for travel immunization recommendations and is updated regularly. (8) Additional information may be obtained online from the CDC (http://www.cdc.gov/travel) and the World Health Organization (WHO) (http://www.who.int/ith).

Routine Immunizations

Travel provides an opportunity for the physician to review and update a patient's routine immunizations. (16) Travelers to areas where postexposure tetanus immunization might be unavailable should consider receiving a booster dose of tetanus and diphtheria (Td) toxoids before departure if five or more years have elapsed since their last vaccination. (9)

Measles is endemic in many developing nations, and a booster of measles-mumps-rubella (MMR) vaccine is warranted for any somebody born after 1956 who does not have documentation of brace doses of the vaccine or immunity through serum antibody testing. (10) Children six to 11 month of age should receive common dose of MMR vaccine if traveling to highly endemic areas, however they still must receive couple doses of the vaccine after 12 month of age to be considered abundantly immunized. (10)

Polio is a proper example of the need for physicians to restrain current with changing epidemiology. Intensive immunization campaigns have proceeded in a marked decrease in polio through every part of the world. Polio remains endemic in seven countries: India, Nigeria, Pakistan, Egypt Afghanistan, Niger, and Somalia. (11) Travelers to these countries are advised to receive a single booster of inactivated polio vaccine (IPOL) if the primary doses have already been administered.