Travel Immunization

people looking at a map, with a camera, laptop and other travel gear around
You’ve thought of everything for your trip abroad – but did you remember your travel immunizations?

Destination-specific pre-travel consultations are customized to the needs of our patients. During the approximately 1-hour pre-travel consultation and physical examination, patients learn all potential risks of their trip and are given specific instructions for contacting us if they become ill while abroad. Pre-travel consultations also include immunity screening and prophylactic antibiotic, anti-diarrheal, altitude illness, and anti-malaria prescriptions.

Same day appointments available in our downtown San Francisco office.

All routine, required, and recommended vaccinations are available. These include vaccinations against yellow fever, rabies, meningitis, hepatitis A, hepatitis B, hepatitis A/B combined vaccine, polio, diphtheria/tetanus, oral typhoid, typhoid injection, Japanese encephalitis, influenza, pneumonia, measles, mumps, rubella, Gardasil and varicella (chickenpox). The risks and benefits of medications and vaccinations are discussed, and the patient’s questions are answered. Travel insurance and security issues are discussed in detail. All patients receive customized trip itineraries containing destination-specific health information.

Services are also available for completion of visa requirement forms for international travel.

We are the primary immunization provider for Hill Physicians HMO patients in San Francisco.

Clinical Recommendations for Traveling Abroad

  1. International travelers should receive routine domestic immunizations as well as travel-specific immunizations to reduce the risk of illness and death from vaccine-preventable diseases.
  2. Travelers to endemic regions should receive malaria prophylaxis.
  3. Traveler’s diarrhea can be reduced with a short course of antibiotics.

Also note: Using personal protection measures, like applying DEET or picaridin on exposed skin and permethrin on clothing, and using a permethrin-impregnated bed net, will reduce the risk from arthropod-borne illnesses such as dengue fever and malaria in travelers.

Emergency Medical Evacuation Insurance

Emergent medical evacuation from a low-income nation can cost $50,000 to $75,000 or more. Emergency medical evacuation insurance is particularly important for older travelers, for those with chronic medical conditions and for those engaged in high-risk activities, such as high-altitude climbing. Travelers can visit squaremouth.com to compare travel insurance options, including medical and emergency evacuation insurance

Recommended Components of the Pretravel Consultation

Assessment

The doctor will take the time to review your upcoming trip with you. You’ll discuss the dates of your travel, your itinerary and the broader reason behind your trip, what your typical travel style might be (i.e., “I will be camping in tents in the jungle,” or “My family and I will stay in a hotel in the city.”) as well as any particular special activities you may embark on, such as diving, river rafting, mountain climbing, etc.

You’ll also review your personal medical history together. What medications do you take? Do you have any known allergies? Do you have a history of surgery, hospitalization or other special conditions. Things such as pregnancy, breastfeeding, recent myocardial infarction or cerebrovascular accident, immunocompromise or psychiatric conditions are pertinent information when assessing your personal situation. Knowledge of prior immunizations, experience with malaria prophylaxis or illnesses related to travel are essential in providing adequate care and prevention before your trip begins.

Immunizations

Some of the immunizations you’ll need may be routine (see eTable A), while others will be travel-specific. For example, is there a risk of typhoid fever, yellow fever, Japanese encephalitis, rabies or cholera in the country or region you’re visiting?

Arthropod-borne disease risk reduction

Personal protection measures such as applying insect repellent (DEET or picaridin) to exposed skin and permethrin to clothing may be appropriate, depending on your destination. There may be elements you haven’t considered, such as sleeping under a permethrin-impregnated bed net in some places.

Malaria prophylaxis is the preventative treatment for malaria, a major concern for travelers in much of the world.

Traveler’s diarrhea

We’ll discuss risk reduction, such as washing your hands regularly and being cautious with where you get your food and drink while abroad. There are also carry-along medications, for example an antibiotic and antimotility agent such as loperamide (Imodium), for as-needed self-treatment.

Counseling for further risk reduction

Your personalized consultation may also involve discussing things like avoiding motor vehicle crashes, deep venous thrombosis, high-altitude illness and less commonly considered, but common issues, like drowning, crime and security.

We’ll discuss what you may need in case something catastrophic does occur, where emergency evacuation insurance can come in particularly useful and save you tens of thousands of dollars. Other topics that you may be obvious but are always a concern, for example safe sex practices and sun protection, may be of an even greater concern in foreign countries.

Additional Resources for Specific Travel Concerns

Planning on climbing a mountain? The American Alpine Club is a mountaineering association which provides some rescue benefits when you become a member.

For those planning a diving trip, the Divers Alert Network promotes diving safety and sells reasonably-priced insurance for emergency medical assistance and transportation in case of illness or injury while traveling.

Risk Reduction Strategies for Selected Travel Hazards

Hazard Strategies
Blood-borne illnesses Getting tattoos or piercings in low-income nations increases the risk of blood-borne illnesses, including HIV infection and hepatitis C, because unclean needles may be used.
Counterfeit, adulterated, or expired medications Obtaining medications in low-income nations is not recommended.
Crime, security Pickpocketing is common in urban settings around the world; the use of a money bag worn under clothing, around the neck or waist, reduces the likelihood of theft.
Drowning Learn to swim, use personal flotation devices, avoid going into the water after drinking alcohol, know local water currents and conditions.
High-altitude sickness Acute mountain sickness, which can cause headache and nausea, is common in those traveling to areas above 8,000 ft (2,400 m). It is less likely in those who ascend slowly; prophylactic use of acetazolamide reduces the risk of acute mountain sickness (one commonly used dosage is 125 mg twice a day for three days, starting one day before ascent).
HIV infection in medical volunteers Medical volunteers who could be exposed to HIV may consider traveling with the first several doses of a 28-day course of HIV postexposure prophylaxis medications. The U.S. Public Health Service recommends one tablet per day of tenofovir/emtricitabine (Truvada; 300 mg/200 mg) plus one tablet twice per day of raltegravir (Isentress; 400 mg).
Motor vehicle crashes810 Use seat belts, age-appropriate car seats or booster seats, and bicycle or motorcycle helmets. Avoid riding on motorcycles, traveling in motor vehicles at night, and riding on the roof of a bus or in the back of an open truck.
Sexually transmitted infections, unintended pregnancy The incidence of travel-associated casual sex is about 20%, approximately one-half of which is unprotected.11 Latex condoms should be used.
Solar injury Travelers should be encouraged to use sunscreen with an SPF of at least 15 that protects against ultraviolet A and B rays. Sunscreen should be applied before insect repellent; combination products containing sunscreen and insect repellent should be avoided.
VTE For long-distance travelers at increased risk of VTE: walk around often, do calf muscle exercises, and sit in an aisle seat if feasible; use of properly fitted, below-the-knee graduated compression stockings that provide 15 to 30 mm Hg of pressure at the ankle is suggested during travel. Use of graduated compression stockings and aspirin or anticoagulants are not recommended to prevent VTE in other long-distance travelers.12

Personal Protection Measures Against Arthropod-Borne Diseases

Measure Comments
Insect repellent applied to exposed skin The most effective insect repellents contain 20% to 50% DEET or 20% picaridin.
DEET should be avoided in infants two months and younger. Picaridin does not have the petrochemical odor of DEET and may be better tolerated by children and travelers sensitive to the odor.
Other effective options are oil of lemon eucalyptus (PMD) and IR3535 (available as Skin-So-Soft Bug Guard Plus IR3535 lotion). IR3535 does not provide adequate protection against Anopheles mosquitoes and should not be used in malaria-endemic areas.
Insect repellent should not be applied onto or under clothing; regular reapplication is important.
Permethrin applied to clothing Travelers may apply permethrin to clothing or purchase clothing pretreated with permethrin. It should be applied to outer clothing only and not to underwear.
Bed nets A bed net is most effective when impregnated with permethrin. The bed net should reach the floor or be tucked under the mattress to provide a seal.
Activity modification Outdoor activities should be avoided during dusk, nighttime, and dawn hours when mosquitos are more active.
Checking for ticks Travelers should inspect their bodies and clothing after outdoor activity and at the end of the day with the aid of a mirror or companion.
Climate modification Air-conditioning reduces the risk of malaria; malaria transmission usually occurs between 77°F (25°C) and 86°F (30°C).
Long sleeves and pants Wearing long sleeves, tucking the shirt into pants, tucking pants into socks, and wearing closed-toe shoes are beneficial but may be difficult in hot or humid climates.

Travelers’ Health Related Sites

CDC Traveler’s Health Center
This website, which allows you to enter where you’re going and indicate the type of traveler you are (ie, with children, chronic disease, on a cruise ship, etc.) and then see which vaccines and medicines are required or appropriate for your trip.

World Health Organization
The WHO provides information on health concerns around the world and can be a valuable resource for researching your trip to a foreign destination.

The American Society of Tropical Medicine & Hygiene
The ASTMH provides information on tropical infectious diseases, and is therefore a great site to gather more information on trips to tropical destinations.

The International Society of Travel Medicine
This members-only online community provides special travel alerts, discussion groups and educational information.

International Association of Medical Assistance to Travelers
Another resource to help you research your travel destination and plan appropriately in case there are any pertinent health risks based on the information you supply. You can research topics by the health concern (ie, the disease) or region.

CIA World Fact Book
A wealth of information which goes far beyond health issues, including everything from displaying the world’s flags and time zones to content based around government, societal and history of the 267 world entities it covers.

State Department Travel Advisories
The U.S. Department of State’s website for all things world-travel related, from obtaining a passport to warnings about dangerous areas (even while you’re on your trip.)

US Customs Information
Info on traveling to and from the United States.

Country Specific Information
This website provides a plethora of information on every country in the world, including facts like land area, government officials, population, their currency and largest cities to pertinent news, including health-related matters.

World Climate Information
Average temperatures and more information, searchable down to the city or town.

International Weather Forecast
Get a picture of the entire planet’s weather at a glimpse.