Letter April 2002 Travel Advice
Evaluation and Management of the Cardiovascular
Patient Embarking on Air Travel Annals July 20, 2004
International Travel &
General Advice to Travelers:
Update your vaccination 4-6 weeks before the
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
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
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
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
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
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
Expected lengths of stay
If they are, or may become, pregnant during travel or within three months
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
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
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
Illness after International Travel: Fever, Diarrhea,
Edward T. Ryan, M.D., Mary E. Wilson, M.D., and Kevin C. Kain, M.D.
15, 2002, Vol 347:505-516
TRAVEL SAFETY TIPS