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See also Current  SARS Crisis  

See also The Medical Letter April 2002 Travel Advice
Evaluation and Management of the Cardiovascular Patient Embarking on Air Travel    Annals July 20, 2004

International Travel & Vaccinations          

General Advice to Travelers:

  • Update your vaccination 4-6 weeks before the trip.
  • Carry an updated vaccination certificate,
    a list of your medical problem & medications with names & dosages, your insurance policy number and phone, your physician's name, phone, & address; keep prescription medications in their original bottles.
  • Carry a standard first-aid kit
    with thermometers, bandages, antiseptic solutions or ointment, pain & fever medications, medicatins for motion sickness such as Dramamine (dimenhydrinate) or scopolamine patch.
  • Follow the recommended food & water precautions:
    avoid salads, use bottled water at all times, avoid eating from street vendors, do not add ice cubes to beverages, eat fruits with thick skins that can be peeled, avoid improperly cooked items such as shellfish, preferably use bottled water to brush teeth.
  • Medications for Travelers' Diarrhea:
    Peptobismuth 2 tablets 4x/day (can have black stools);
    Ciprofloxacin 500 mg 2x/day for 3 days , esp. for immunocompromised travelers;
    Loperamide (Imodium) 2 mg 2 tab first, then 2 mg after each loose stool up to 16 mg/day.
  • Malaria chemoprophylaxis for Malaria areas:  
    Use insect repellants as 25-30% DEET repellants for adults.
    Mefloquine (Lariam) 250 mg once a week, or
    Chloroquine (Aralen) 500 mg PO once a week, start 1 week before travel & continue for 4 weeks after return. (Precautions: Avoid in  pts with seizures, psychiatric disorders, or on cardiac drugs as quinidine, propranolol.)
    Doxycycline 100 mg PO daily. Start 1 day before travel & continue for 4 weeks after return  
        (Pracautions: Avoid in pregnancy, children under eight years of age. Photosensitivity)

Vaccinations for Travelers in high risk areas:

  • Immunoglobulin for hepatitis A  2 mL IM  (0.02 mg/kg IM for < 3 months;  0.06 mg/kg IM for > 3 months); repeat q 5 months.
  • Hepatitis A vaccines  1 mL  Havrix 1440 units IM or Vaqta 50 units IM for adults, repeat 6-12 months later.
  • Hepatitis B (Engerix B) vaccines 3 doses at 0,1, & 6 months.
  • Typhoid fever vaccine (Vivotif) : One capsule every other day, Total of 4 doses.  Repeat booster in years or Typhoid vaccine  Vi 0.5 mg IM
  • Polio vaccine for the unvaccinated:  3 doses IM or Sc one month apart.  One booster dose for the vaccinated.
  • Cholera vaccine 2 doses IM or SC one or more weeks apart.  Repeat booster in 6 months.
  • Meningococcus vaccine one dose SC, may repeat in 3 yeras in high risk groups.

Rx for Motion Sickness

  • Transdrm-Scop /Scopolamine 1 patch q72h
  • Antivert / Meclizine 25-50 mg tab 2-3x/day PO
  • Dimenhydrinate 50-100 mg q4-6h PO
  • Cycliziine / Marezine 50 mg q4-6h PO
  • Phenergan / Promethazine 12.5-25 mg PO for nausea
  • Reglan / Metoclopramide 10 mg qid PO for nausea

Websites for Travelers:                                                                             

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American College of Physician Info on Travel Immunization 2002

Travel Immunizations

Encourage patients to contact you as soon as they know their travel destinations outside of the U.S. Advance notice is important because some vaccinations need time before they reach full protection, or may require two or more shots administered over a couple of weeks' time.

Information you should screen your traveling patients for

  • Destination(s)
  • Departure date
  • Expected lengths of stay
  • If they are, or may become, pregnant during travel or within three months afterward
  • If they are, or will be, breastfeeding during travel or shortly after
  • If they are under treatment for a chronic health condition, particularly HIV infection or other condition that compromises immune systems
  • If they have already received the recommended "domestic" vaccinations:
    • influenza - in the fall of each year
    • pneumococcal - for those at risk, every ten years
    • Hepatitis A or B - for those at risk
    • varicella (chicken pox) - two doses if you have never had chicken pox
    • measles mumps rubella (MMR) at some time in your life
    • tetanus and diphtheria (Td) booster within the past ten years
  • Whether they have already received vaccinations for travel to this or other destinations during their adulthood.
  • Any prescription medications they need refills for to cover the duration of their travel
  • Will they need proof of immunizations before being able to return to the United States? Their travel agents should have this information if not known.

Some of the common travel immunizations include:

  • Polio - one dose of the inactivated polio vaccine (IPV) for travelers over 18 who already received the oral polio vaccine or inactivated polio vaccine at some time in their lives. Needed for developing countries in Africa, Asia, Middle East, Indian subcontinent, and the majority of the new independent states in the former Soviet Union.
  • Measles - for persons born after 1957. (This should be their second dose in a lifetime.)
  • Yellow fever - needed for certain parts of Africa and South America.
  • Hepatitis A and/or immune globulin - recommended for travelers to all areas except Japan, Australia, New Zealand, Northern and Western Europe, and North America (excluding Mexico).
  • Hepatitis B - recommended for those spending more than six months in areas with a high rate of hepatitis B and who will have frequent close contact with local people.
  • Typhoid - recommended for areas where food and water precautions are indicated, such as in developing countries.
  • Meningococcal - needed for sub-Saharan Africa during the dry season (December - June)
  • Japanese Encephalitis or tick-borne encephalitis - recommended for long-term travelers to areas of risk.

All of these vaccines can be safely administered at one physician visit except for yellow fever and cholera. (Immune globulin diminishes the effectiveness of live-virus MMR and varicella vaccines if given simultaneously.)

Additional information is available from the CDC on Travel Health and Immunizations.

Illness after International Travel: Fever, Diarrhea, Skin Lesions   
Edward T. Ryan, M.D., Mary E. Wilson, M.D., and Kevin C. Kain, M.D.  
NEJM August 15, 2002, Vol 347:505-516  



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