It’s just after New Year’s and Wayne and Ingrid Schultz are planning their annual mid-winter getaway. This year Ingrid has her heart set on a Caribbean vacation. The Dominican Republic travel packages seemed quite reasonably priced so she decided to book a trip for two. But the recent news that a few Canadian tourists there contracted malaria while sipping piña coladas has her second guessing her decision. Nothing ruins a relaxing vacation more than catching a bad bug. Here’s how your patients can avoid the pitfalls of travelling abroad — preplanning before boarding the plane is key.
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• Jungle Jim or lazy Susan One of the first things you need to determine is how adventurous your patient is. “There’s a big difference in risk for the person planning on staying in air conditioning most of the time and the person who will be backpacking through the bush,” says Dr Ian Crandall, PhD, a microbiologist at the Toronto General Hospital and an assistant professor at the department of medicine at U of T. Some simple questions to ask your patient are, “where are you going, when are you going, and what do you plan on doing?” Dr Jay Keystone, an infectious disease specialist at the Toronto General tropical disease unit, agrees. “If it’s a straightforward low risk destination the primary care physician can handle it,” he says. “If it’s a complex and long trip then the patient should be referred to a travel clinic.”
• The right jab For the low risk destination, Dr Keystone suggests asking, “Does the patient need any immunizations?” Both Dr Keystone and Dr Crandall think of the three Rs: routine, required and recommended. “I would say that any traveller going anywhere in the developing world should get hepatitis A and B vaccines,” suggests Dr Keystone. “I would also update the routine shots.”
“What a lot of people don’t realize,” adds Dr Crandall, “is that diseases like the measles, although not common here, are common in many tropical destinations.”
• Passport to health There are only two required vaccines, says Dr Crandall: yellow fever in parts of Africa and South America; and a meningococcal jab is required by Saudi Arabia for pilgrims visiting Medina or Mecca. You should tell patients travelling to these regions to make sure they get their shot and that they carry proof that they received the vaccine — if not they might get turned away by customs.
• Skeeters on the loose Many travellers should know how to prevent insect borne diseases. Malaria, the number one vector borne cause of death among travellers is transmitted by night biting mosquitoes, explains Dr Keystone. Dengue fever, however, is transmitted by day biting mosquitoes. Dr Keystone suggests telling your patients to use insect repellent between dusk and dawn. The product should contain no more than 30% DEET. You can also tell patients to take antimalarials before, during and after their trip.
• Boil it, cook it, peel it or forget it Travellers diarrhea is very common — about 20% of all travellers will get hit with a bout of ‘Montezuma’s revenge.’ “Don’t drink the water,” warns Dr Keystone, “don’t have ice cubes, keep salads to a minimum, and don’t drink unpasteurized dairy.” These steps are easy to remember but impossible to do, adds Dr Keystone. About 97% of all travellers make a food error within 72 hours of arriving at their destination. So, he suggests telling patients to bring along some ioperamide, some bismuth subsalicylate and an antibiotic — prescribed by you — like ofloxacin or ciproflaxin. He also adds that patients should bring along something for constipation, which he explains is common in older travellers.
• Any extras You can also advise your patients to bring along some antihistamines, preferably the non-drowsy type, a pain killer (like an acetaminophen or ibuprofen) and something for motion sickness. Patients who are taking medications should bring along enough supply for the duration of their trip. “Patients should always put their medications in the carry-on luggage, never in the checked luggage,” advises Dr Keystone. “In some remote areas they should carry their prescription meds in their original containers with the labels.”
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