Whether for business, tourism, study, or aid work, more individuals are traveling to more parts of the world. The World Tourism Organization estimates that in 2011, there were 990 million international tourist arrivals worldwide. Health problems associated with travel are common, especially in developing countries where as many as 22% to 64% of travelers self-report a travel-associated health problem and 8% seek healthcare while traveling or after return. Healthcare providers can play a critical role in minimizing the risk of illness and injury during travel.

General approach

While administration of travel-related vaccinations and malaria prophylaxis remain cornerstones of the pre-travel consultation, providing advice on managing chronic medical conditions, food and water hygiene, physical safety, and disease vector avoidance is also important. Noninfectious causes of morbidity and mortality such as injury and exacerbation of chronic illness are typically the most common health issues travelers encounter. Important considerations include:

• Pre-existing medical conditions, current medications, and allergies

• Itinerary, including details of travel within countries, duration of stay, and sequence of countries visited

• Purpose of travel, accommodations, and activities

• Previous vaccination history and recommended vaccines for the itinerary

• Need for prophylactic and self-treatment medications, including those for malaria prevention, treatment of travelers’ diarrhea, and altitude sickness.

Referral to a travel health specialist should be considered, particularly for medically complex travelers, for those traveling to developing nations, and when travel-specific vaccines are indicated. Since vaccines typically take 10 to 14 days to elicit full immune responses, and some require a primary series to become effective, travelers should ideally be evaluated in a travel clinic at least 4 to 6 weeks prior to departure. However, when this is not possible travelers should still be seen, even when travel is imminent.