Health Background | |
Past medical history | Age Sex Underlying conditions Allergies (especially any pertaining to vaccines, eggs, or latex) Medications |
Special conditions | Pregnancy (including trimester) Breastfeeding Disability or handicap Immunocompromising conditions or medications Older age Psychiatric condition Seizure disorder Recent surgery Recent cardiopulmonary event Recent cerebrovascular event History of Guillain-Barré syndrome Severe allergies |
Immunization history | Routine vaccines Travel vaccines |
Prior travel experience | Experience with malaria chemoprophylaxis Experience with altitude Illnesses related to prior travel |
Trip Details | |
Itinerary | Countries and specific regions, including order of countries if >1 country Rural or urban |
Timing | Trip duration Season of travel Time to departure |
Reason for travel | Tourism Business Visiting friends and relatives Volunteer, missionary, or aid work Research or education Adventure Pilgrimage Adoption Seeking health care (medical tourism) |
Travel style | Independent travel or package tour Propensity for “adventurous” eating Traveler risk tolerance General hygiene standards at destination Modes of transportation Accommodations (such as tourist or luxury hotel, guest house, hostel or budget hotel, dormitory, local home or host family, or tent) |
Special activities | Disaster relief Medical care (providing or receiving) High altitude Diving Cruise ship Rafting or other water exposure Cycling Extreme sports Spelunking Anticipated interactions with animals Anticipated sexual encounters |
Vaccine | Travel-Related Occurrences and Recommendations |
Routine Vaccines (Vaccination considerations should be based on ACIP guidelines.) | |
Haemophilus influenzae type b | No report of travel-related infection, although organism is ubiquitous. |
Hepatitis B | Recommended for travelers visiting countries where HBsAg prevalence is ≥2%. Vaccination may be considered for all international travelers, regardless of destination, depending upon the traveler’s behavioral risk and potential for exposure as determined by the provider and traveler. |
Human papillomavirus (HPV) | No report of travel-acquired infection; however, sexual activity during travel may lead to HPV and other sexually transmitted infections. |
Influenza | Year-round transmission may occur in tropical areas. Outbreaks have occurred on cruise ships, and 2009 influenza A (H1N1) illustrated the rapidity of spread via travel. Novel influenza viruses such as avian influenza H5N1 and H7N9 can be transmitted to travelers visiting areas with circulation of these viruses. |
Measles, mumps, rubella | Infections are common in countries and communities that do not immunize children routinely, including Europe. Outbreaks have occurred in the United States as a result of infection in returning travelers. |
Meningococcal | Outbreaks occur regularly in sub-Saharan Africa in the “meningitis belt” during the dry season, generally December through June, although transmission may occur at other times for those with close contact with local populations. Outbreaks have occurred with Hajj pilgrimage, and the Kingdom of Saudi Arabia requires the quadrivalent vaccine for pilgrims. |
Pneumococcal | Organism is ubiquitous, and causal relationship to travel is difficult to establish. |
Polio | Unimmunized or underimmunized travelers can become infected with either wild poliovirus or vaccine-derived poliovirus. Because the international spread of wild poliovirus in 2014 was declared a Public Health Emergency of International Concern under the International Health Regulations, temporary recommendations for polio vaccination are in place for countries with wild poliovirus circulation for their residents, long-term visitors, and international travelers. |
Rotavirus | Common in developing countries, although not a common cause of travelers’ diarrhea in adults. The vaccine is only recommended in young children. |
Tetanus, diphtheria, pertussis | Rare cases of diphtheria have been attributed to travel. Pertussis has occurred in travelers, recently in adults whose immunity has waned. |
Varicella | Infections are common in countries that do not immunize children routinely, as in most developing countries. Naturally occurring disease tends to affect adults. |
Zoster | Travel (a form of stress) may trigger varicella zoster reactivation, but causal relationship is difficult to establish. |
Travel Vaccines | |
Cholera | Cases in travelers have occurred in association with travel to Haiti. |
Hepatitis A | Prevalence of hepatitis A virus infection may vary among regions within a country. Serologic testing may be considered in travelers from highly endemic countries since they may be immune. Some travel health providers advise people traveling outside the United States to consider hepatitis A vaccination regardless of their country of destination. |
Japanese encephalitis | Rare cases have occurred, estimated at <1 case/1 million travelers to endemic countries. However, the severe neurologic sequelae and high fatality rate warrant detailed review of trip plans to assess the level of risk. |
Rabies | Rabies preexposure immunization simplifies postexposure immunoprophylaxis, as adequately screened immunoglobulin may be difficult to obtain in many destinations. |
Tickborne encephalitis (vaccine not available in the United States) | Cases have been identified in travelers with an estimated risk of 1/10,000 person-months in travelers. Endemic areas are expanding in Europe. |
Typhoid | UK surveillance found the highest risk to be travel to India (6 cases/100,000 visits), Pakistan (9 cases/100,000 visits), and Bangladesh (21 cases/100,000 visits), although risk is substantial in many destinations. |
Yellow fever | Risk occurs mainly in defined areas of sub-Saharan Africa and the Amazonian regions of South America. Some countries require proof of vaccination for entry. For travelers visiting multiple countries, order of travel may make a difference in the requirements. |
Abbreviation: HBsAg, hepatitis B surface antigen. |
Immunizations | Review routine immunizations and those travel immunizations indicated for the specific itinerary and based on the traveler’s medical history. Discuss utility of titers when records are unavailable or unreliable, particularly for measles, mumps, rubella, hepatitis A, and varicella. Screen for chronic hepatitis B for people born in countries with HBsAg prevalence ≥2% (see Map 4-4). Discuss indications for, effectiveness of, and adverse reactions to immunizations. |
Malaria chemoprophylaxis | Determine if there is a risk of malaria. Discuss personal protective measures. Discuss risks and benefits of chemoprophylaxis and recommended choices of chemoprophylaxis for the itinerary. |
Other vectorborne diseases | Define risk of disease in specific itinerary and insect precautions needed. |
Respiratory illnesses | Discuss areas of particular concern (such as avian influenza in Asia or MERS in the Arabian Peninsula). Consider influenza self-treatment for high-risk travelers. |
Travelers’ diarrhea | Recommend strategies to decrease risk of diarrhea. Discuss antibiotics for self-treatment, adjunct medications such as loperamide, and staying hydrated. |
Altitude illness | Determine if the itinerary puts the traveler at risk of altitude illness. Discuss preventive measures such as gradual ascent, adequate hydration, and medications to prevent and treat. |
Other environmental hazards | Caution travelers to avoid contact with animals to reduce the potential for bites and scratches that can transmit rabies. Advise travelers to avoid walking barefoot to avoid certain parasitic infections. Advise travelers to avoid wading or swimming in freshwater where there is risk for schistosomiasis or leptospirosis. Remind travelers to apply sunscreen to skin exposed to the sun. |
Personal safety | Discuss precautions travelers can take to minimize risks, such as traffic accidents, alcohol excess, personal assault, robbery, or drowning. Provide information on travel health and medical evacuation insurance. Advise travelers to look for security bulletins related to their destination and consider areas to avoid. |
Bloodborne pathogens | Inform travelers who will provide health care overseas what to do in case of needlestick or bloodborne pathogen exposure. Discuss use of postexposure prophylaxis for HIV. See Box 2-1 for summary on sexual health recommendations for travelers. |
Disease-specific counseling | Remind travelers to keep medications and supplies in carry-on luggage. Advise travelers to prepare for exacerbations or complications from underlying disease. |
Abbreviations: HBsAg, hepatitis B surface antigen; MERS, Middle East respiratory syndrome. |