Travelers with Chronic Illnesses

Travelers with Chronic Illnesses is a topic covered in the CDC Yellow Book.

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General Travel Preparation: Practical Considerations

Although traveling abroad can be relaxing and rewarding, the physical demands of travel can be stressful, particularly for travelers with underlying chronic illnesses. With adequate preparation, however, such travelers can have safe and enjoyable trips. General recommendations for advising patients with chronic illnesses include:

  • Ensure that any chronic illnesses are well controlled. Patients with an underlying illness should see their health care providers to ensure that the management of their illness is optimized.
  • Encourage patients to seek pretravel consultation ≥4–6 weeks before departure to ensure adequate time to respond to immunizations and, in some circumstances, to try medications before travel (see the Immunocompromised Travelers section in this chapter).
  • Advise patients to consider a destination where they have access to quality care for their condition (see Chapter 6, Obtaining Health Care Abroad).
  • Ask about previous health-related issues encountered during travel, such as complications during air travel.
  • Advise the traveler about packing a health kit (see Chapter 6, Travel Health Kits).
  • Advise travelers to pack medications and medical supplies (such as pouching for ostomies) in their original containers in carry-on luggage and to carry a copy of their prescriptions. Ensure the traveler has sufficient quantities of medications and proper storage conditions for the entire trip, plus extra in case of unexpected delays. Since medications should be taken based on elapsed time and not time of day, travelers may need guidance on scheduling when to take medications during and after crossing time zones.
  • Advise travelers to check with the US embassy or consulate to clarify medication restrictions in the destination country. Some countries do not allow visitors to bring certain medications into the country, especially narcotics and psychotropic medications.
  • Educate travelers regarding drug interactions (see Chapter 2, Interactions Among Travel Vaccines & Drugs). Medications (such as warfarin) used to treat chronic medical illnesses may interact with medications prescribed for self-treatment of travelers’ diarrhea or malaria chemoprophylaxis. Discuss all medications used, either daily or on an as-needed basis.
  • Provide a clinician’s letter. The letter should be on office letterhead stationery and should outline existing medical conditions, medications prescribed (including generic names), and any equipment required to manage the condition.
  • Discuss supplemental insurance. Three types of insurance policies can be considered: 1) trip cancellation in the event of illness; 2) supplemental insurance so that money paid for health care abroad may be reimbursed, since most medical insurance policies do not cover health care in other countries; and 3) medical evacuation insurance (see Chapter 6, Travel Insurance, Travel Health Insurance & Medical Evacuation Insurance). Travelers may need extra help in finding supplemental insurance, as some plans will not cover costs for preexisting conditions.
  • Encourage travelers with underlying medical conditions to consider choosing a medical assistance company that allows them to store their medical history so it can be accessed worldwide (see Chapter 6, Obtaining Health Care Abroad).
  • Help travelers devise a health plan. This plan should give instructions for managing minor problems or exacerbations of underlying illnesses and should include information about medical facilities available in the destination country (see Chapter 6, Obtaining Health Care Abroad).
  • Advise travelers to wear a medical alert bracelet or carry medical information on his or her person (various brands of jewelry or tags, even electronic [through medical records apps], are available).
  • Advise travelers to stay hydrated, wear loose-fitting clothing, and walk and stretch at regular intervals during long-distance travel (see Chapter 8, Deep Vein Thrombosis & Pulmonary Embolism).

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General Travel Preparation: Practical Considerations

Although traveling abroad can be relaxing and rewarding, the physical demands of travel can be stressful, particularly for travelers with underlying chronic illnesses. With adequate preparation, however, such travelers can have safe and enjoyable trips. General recommendations for advising patients with chronic illnesses include:

  • Ensure that any chronic illnesses are well controlled. Patients with an underlying illness should see their health care providers to ensure that the management of their illness is optimized.
  • Encourage patients to seek pretravel consultation ≥4–6 weeks before departure to ensure adequate time to respond to immunizations and, in some circumstances, to try medications before travel (see the Immunocompromised Travelers section in this chapter).
  • Advise patients to consider a destination where they have access to quality care for their condition (see Chapter 6, Obtaining Health Care Abroad).
  • Ask about previous health-related issues encountered during travel, such as complications during air travel.
  • Advise the traveler about packing a health kit (see Chapter 6, Travel Health Kits).
  • Advise travelers to pack medications and medical supplies (such as pouching for ostomies) in their original containers in carry-on luggage and to carry a copy of their prescriptions. Ensure the traveler has sufficient quantities of medications and proper storage conditions for the entire trip, plus extra in case of unexpected delays. Since medications should be taken based on elapsed time and not time of day, travelers may need guidance on scheduling when to take medications during and after crossing time zones.
  • Advise travelers to check with the US embassy or consulate to clarify medication restrictions in the destination country. Some countries do not allow visitors to bring certain medications into the country, especially narcotics and psychotropic medications.
  • Educate travelers regarding drug interactions (see Chapter 2, Interactions Among Travel Vaccines & Drugs). Medications (such as warfarin) used to treat chronic medical illnesses may interact with medications prescribed for self-treatment of travelers’ diarrhea or malaria chemoprophylaxis. Discuss all medications used, either daily or on an as-needed basis.
  • Provide a clinician’s letter. The letter should be on office letterhead stationery and should outline existing medical conditions, medications prescribed (including generic names), and any equipment required to manage the condition.
  • Discuss supplemental insurance. Three types of insurance policies can be considered: 1) trip cancellation in the event of illness; 2) supplemental insurance so that money paid for health care abroad may be reimbursed, since most medical insurance policies do not cover health care in other countries; and 3) medical evacuation insurance (see Chapter 6, Travel Insurance, Travel Health Insurance & Medical Evacuation Insurance). Travelers may need extra help in finding supplemental insurance, as some plans will not cover costs for preexisting conditions.
  • Encourage travelers with underlying medical conditions to consider choosing a medical assistance company that allows them to store their medical history so it can be accessed worldwide (see Chapter 6, Obtaining Health Care Abroad).
  • Help travelers devise a health plan. This plan should give instructions for managing minor problems or exacerbations of underlying illnesses and should include information about medical facilities available in the destination country (see Chapter 6, Obtaining Health Care Abroad).
  • Advise travelers to wear a medical alert bracelet or carry medical information on his or her person (various brands of jewelry or tags, even electronic [through medical records apps], are available).
  • Advise travelers to stay hydrated, wear loose-fitting clothing, and walk and stretch at regular intervals during long-distance travel (see Chapter 8, Deep Vein Thrombosis & Pulmonary Embolism).

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