Travel Preparation

Aka: Travel Preparation, Pretravel Consultation, Travel Medicine, Traveler's Health, Traveling with Medications

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II. HIstory

  1. Travel destinations and dates
  2. Visiting urban, rural or high altitude destinations
  3. Reasons for travel
    1. Business or vacation
    2. Visiting local residents
    3. Medical Tourism
  4. Travel companions (including young children or elderly)
  5. Planned activities
    1. Water activities
    2. Higher risk activities (e.g. Scuba Diving, rock climbing, high altitude backpacking)
    3. Animal exposures
    4. Sex Tourism
  6. Medical History
    1. Past Medical History and active problem list
    2. Recent surgeries or hospitalizations
    3. Pregnancy or Breast Feeding
    4. Allergies
    5. Medications

III. Precautions

  1. Review specific risks and preparation (e.g. Immunizations) at least 6 weeks before travel
    1. See International Medical Concerns
    2. See Travel Immunization
    3. See Waterborne Illness Prevention
    4. See Foodborne Illness Prevention
    5. See Traveler's Diarrhea Prophylaxis
    6. See Prevention of Vector-borne Infection
    7. See Malaria Prophylaxis
  2. Avoid excessive risks associated with death
    1. Motor Vehicle Accidents (account for >18-25% of all deaths in international travelers)
      1. https://travel.state.gov/content/travel/en/international-travel/before-you-go/driving-and-road-safety.html
      2. Use Seat Belts and Car Seats
      3. Wear Bicycle helmets
      4. Avoid night driving
      5. Avoid riding in open back of pick-up truck (or open bus top)
      6. Avoid motorcycles and mopeds
      7. Drivers should become familiar with local driving laws and local road conditions before driving
      8. Use taxis and hired drivers with official credentials
    2. Drowning
      1. Avoid swimming in unfamiliar waters, above swimming ability or areas without lifeguards
      2. Wear life jackets when boating
      3. Use experienced and reputable boat captains and Scuba Diving instructors
    3. Other causes of deaths in international travelers
      1. Violence
  3. Avoid other risks
    1. Tattoos or piercing (risk of HIV, Hepatitis C)
    2. Avoid filling medications in low-income nations (risk of adulterated medications)
  4. Protect yourself and your families
    1. See Sun Exposure
    2. See High Altitude Sickness
    3. See DVT Prevention in Travelers
    4. Sexual exposure
      1. Practice safe sex (Condoms and Contraception)
      2. Consider HIV Preexposure Prophylaxis (or HIV Postexposure Prophylaxis) in high risk patients
      3. Discuss endemic risks in affected regions
        1. Zika Virus
        2. Monkeypox (consider Mokeypox Vaccine)
    5. Consider travel insurance with emergency medical evacuation coverage
      1. Especially for high risk activities (e.g. mountain climbing)
    6. Keep contact information for consular services, embassy
      1. Consider Smart Traveler Enrollment Program
        1. https://mytravel.state.gov/s/step
    7. Children
      1. See Eustachian Tube Dysfunction (related to air travel)
      2. Maintain oral hydration
      3. Frequent Hand Hygiene (e.g. hand sanitizer)
      4. Avoid contaminated food and water
      5. Teach children age appropriate safety
      6. Children should carry identification and emergency contact information on them
  5. Comorbid Conditions
    1. See Air Travel Restriction
    2. See Travel in Pregnancy
    3. General
      1. Wear medical alert bracelet if indicated
      2. Consider dental evaluation before extended travel
      3. Carry documentation of medical history
        1. Active medical conditions
        2. Medication allergies
    4. Cardiopulmonary Disease
      1. See Cardiac-Related Air Travel Restrictions
      2. Carry a copy of most recent Electrocardiogram
    5. Insulin Dependent Diabetes Mellitus
      1. See Diabetes Mellitus Related Travel Concerns
      2. Increase Glucose monitoring frequency while traveling
      3. Most Insulins may be kept unrefrigerated for up to 30 days (but keep out of excess heat)
      4. Many once weekly non-Insulin injections (e.g. GLP1 Agonists) must remain refrigerated
      5. Some Continuous Glucose Monitors may be disallowed on flights (due to bluetooth signal)
      6. Bring contingency Insulin (bolus and basal) and syringes for those using Insulin Pump
    6. Asthma and Allergies
      1. Be aware of allergy or Asthma triggers while traveling and avoid as much as possible
      2. Have all medications available for Asthma Action Plan (e.g. inhaled and oral steroids, rescue Inhalers)
      3. Have allergy and Anaphylaxis medications available (e.g. Epinephrine, Antihistamines, steroids)
  6. Medications
    1. See Medication-Related Travel Precautions
    2. Carry prescribed medications in their original containers when possible
      1. Also bring a list of the medications with both trade and generic names, along with indications
      2. Ideally, have list addended with names in destination language
    3. Bring enough medication supply to cover for extra emergency days of travel (in carry-on luggage)
      1. If medication must be purchased in destination country, review with pharmacist to verify equivalence
    4. Declare potentially suspect medications
      1. Liquid medications >3.4 ounces
      2. Syringes
    5. Inquire about controlled substances and banned substances in destination countries (including layovers) prior to travel
      1. Adderall is banned in Japan
      2. Pseudophedrine is banned in Mexico
    6. References
      1. (2022) Presc Lett 29(5): 28

IV. Risk factors: Travel related illness

  1. Backpacking trek or adventure travel
  2. Age over 65 years
  3. Immunocompromised state
  4. U.S. Immigrant returning to country of origin
  5. Long-term travel
  6. Pregnancy
  7. Uncontrolled comorbidity
    1. Congestive Heart Failure
    2. Hypertension
    3. Seizure Disorder
    4. Diabetes Mellitus
    5. Mental illness
    6. Coronary Artery Disease (Recent Myocardial Infarction or CABG)
      1. See Contraindications to Air Travel

V. Contraindications: Travel Restrictions

  1. See Contraindications to Air Travel

VI. Management: Emergency care while traveling

  1. See First Aid Kit
  2. See Emergency Contraception
  3. See Traveler's Diarrhea Prophylaxis
  4. See Travel Resources

VII. Management: Returning Travelers

  1. See Fever in the Returning Traveler
  2. See GI Conditions in Febrile Returning Traveler
  3. See Lymphadenopathy in the Febrile Returning Traveler

VIII. Prevention

  1. See Travel Immunization
  2. See Waterborne Illness Prevention
  3. See Foodborne Illness Prevention
  4. See Prevention of Vector-borne Infection
  5. See Traveler's Diarrhea Prophylaxis
  6. See Malaria Prophylaxis
  7. See Sleep Disturbance in Travel
  8. See High Altitude Sickness
  9. See Sun Exposure
  10. See DVT Prevention in Travelers
  11. See Motion Sickness

IX. Resources

  1. See Travel Resources
  2. CDC Travel
    1. http://www.cdc.gov/travel

X. References

  1. Bazemore (2009) Am Fam Physician 80(6): 583-90 [PubMed]
  2. Powell-Dunford (2021) Am Fam Physician 104(4): 403-10 [PubMed]
  3. Rupert (2025) Am Fam Physician 111(3): 245-53 [PubMed]
  4. Sanford (2016) Am Fam Physician 94(8): 620-7 [PubMed]

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