II. HIstory
- Travel destinations and dates
- Visiting urban, rural or high altitude destinations
- Reasons for travel
- Business or vacation
- Visiting local residents
- Medical Tourism
- Travel companions (including young children or elderly)
- Planned activities
- Water activities
- Higher risk activities (e.g. Scuba Diving, rock climbing, high altitude backpacking)
- Animal exposures
- Sex Tourism
- Medical History
- Past Medical History and active problem list
- Recent surgeries or hospitalizations
- Pregnancy or Breast Feeding
- Allergies
- Medications
III. Precautions
- Review specific risks and preparation (e.g. Immunizations) at least 6 weeks before travel
- Avoid excessive risks associated with death
- Motor Vehicle Accidents (account for >18-25% of all deaths in international travelers)
- https://travel.state.gov/content/travel/en/international-travel/before-you-go/driving-and-road-safety.html
- Use Seat Belts and Car Seats
- Wear Bicycle helmets
- Avoid night driving
- Avoid riding in open back of pick-up truck (or open bus top)
- Avoid motorcycles and mopeds
- Drivers should become familiar with local driving laws and local road conditions before driving
- Use taxis and hired drivers with official credentials
- Drowning
- Avoid swimming in unfamiliar waters, above swimming ability or areas without lifeguards
- Wear life jackets when boating
- Use experienced and reputable boat captains and Scuba Diving instructors
- Other causes of deaths in international travelers
- Motor Vehicle Accidents (account for >18-25% of all deaths in international travelers)
- Avoid other risks
- Tattoos or piercing (risk of HIV, Hepatitis C)
- Avoid filling medications in low-income nations (risk of adulterated medications)
- Protect yourself and your families
- See Sun Exposure
- See High Altitude Sickness
- See DVT Prevention in Travelers
- Sexual exposure
- Practice safe sex (Condoms and Contraception)
- Consider HIV Preexposure Prophylaxis (or HIV Postexposure Prophylaxis) in high risk patients
- Discuss endemic risks in affected regions
- Zika Virus
- Monkeypox (consider Mokeypox Vaccine)
- Consider travel insurance with emergency medical evacuation coverage
- Especially for high risk activities (e.g. mountain climbing)
- Keep contact information for consular services, embassy
- Consider Smart Traveler Enrollment Program
- Children
- See Eustachian Tube Dysfunction (related to air travel)
- Maintain oral hydration
- Frequent Hand Hygiene (e.g. hand sanitizer)
- Avoid contaminated food and water
- Teach children age appropriate safety
- Children should carry identification and emergency contact information on them
- Comorbid Conditions
- See Air Travel Restriction
- See Travel in Pregnancy
- General
- Wear medical alert bracelet if indicated
- Consider dental evaluation before extended travel
- Carry documentation of medical history
- Active medical conditions
- Medication allergies
- Cardiopulmonary Disease
- See Cardiac-Related Air Travel Restrictions
- Carry a copy of most recent Electrocardiogram
- Insulin Dependent Diabetes Mellitus
- See Diabetes Mellitus Related Travel Concerns
- Increase Glucose monitoring frequency while traveling
- Most Insulins may be kept unrefrigerated for up to 30 days (but keep out of excess heat)
- Many once weekly non-Insulin injections (e.g. GLP1 Agonists) must remain refrigerated
- Some Continuous Glucose Monitors may be disallowed on flights (due to bluetooth signal)
- Bring contingency Insulin (bolus and basal) and syringes for those using Insulin Pump
- Asthma and Allergies
- Be aware of allergy or Asthma triggers while traveling and avoid as much as possible
- Have all medications available for Asthma Action Plan (e.g. inhaled and oral steroids, rescue Inhalers)
- Have allergy and Anaphylaxis medications available (e.g. Epinephrine, Antihistamines, steroids)
- Medications
- See Medication-Related Travel Precautions
- Carry prescribed medications in their original containers when possible
- Also bring a list of the medications with both trade and generic names, along with indications
- Ideally, have list addended with names in destination language
- Bring enough medication supply to cover for extra emergency days of travel (in carry-on luggage)
- If medication must be purchased in destination country, review with pharmacist to verify equivalence
- Declare potentially suspect medications
- Liquid medications >3.4 ounces
- Syringes
- Inquire about controlled substances and banned substances in destination countries (including layovers) prior to travel
- Adderall is banned in Japan
- Pseudophedrine is banned in Mexico
- References
- (2022) Presc Lett 29(5): 28
IV. Risk factors: Travel related illness
- Backpacking trek or adventure travel
- Age over 65 years
- Immunocompromised state
- U.S. Immigrant returning to country of origin
- Long-term travel
- Pregnancy
- Uncontrolled comorbidity
V. Contraindications: Travel Restrictions
VI. Management: Emergency care while traveling
VII. Management: Returning Travelers
VIII. Prevention
- See Travel Immunization
- See Waterborne Illness Prevention
- See Foodborne Illness Prevention
- See Prevention of Vector-borne Infection
- See Traveler's Diarrhea Prophylaxis
- See Malaria Prophylaxis
- See Sleep Disturbance in Travel
- See High Altitude Sickness
- See Sun Exposure
- See DVT Prevention in Travelers
- See Motion Sickness
IX. Resources
- See Travel Resources
- CDC Travel