Welcome to the second part of my interview with Dr. Douglas Zeiger, a travel medicine specialist! (See part 1 of our interview here.) I’ve found his medical advice invaluable whenever I’ve prepared for my own trips over the past 4+ years, and I’ve asked him to share some of his knowledge with my readers.
VG: Are there any medicines I should take with me? Which ones are required or recommended for certain areas?
DZ: Depending on the region, your travel doctor may prescribe antimalarial or antidiarrheal medications, but he or she should review that with you during your appointment.
In addition, you should bring with you any over-the-counter medications that you take on a regular basis, such as acetaminophen or ibuprofen. Bring diphenhydramine (antihistamine) for allergies and a topical ointment for insect bites, and if you have a life-threatening allergy don’t forget a supply of epinephrine autoinjectors. Make sure, though, that your medications are permitted in your destination country: diphenhydramine is illegal in Zambia, for example, and in most countries epinephrine autoinjectors require prescription documentation from a doctor.
VG: I’ve used the Centers for Disease Control travel site before a trip to check for any health concerns in destinations outside the USA. Is that the best website to consult, or do you recommend others?
DZ: The CDC travel site is very good, but its data isn’t clearly spelled out. This can lead people to neglect certain vaccines, particularly updates of vaccines they received as children. The CDC site doesn’t make firm distinctions between recommendations and requirements, and instead urges people to contact travel doctors. Although I’m glad the CDC promotes the use of travel medicine specialists, I do think the website’s lack of clarity can confuse visitors and even lead some people to make incorrect assumptions about their vaccination needs.
For example, I’ll routinely have patients about to travel tell me, “The CDC says I need vaccines for hepatitis A and yellow fever.” But after reviewing their records and seeing what vaccines haven’t been updated, I often find they also need tetanus, rubella, diptheria, polio, pretusis, measles, mumps, and rubella—all of which are childhood vaccines that people often forget about.
One of my favorite travel health sites is Fit for Travel, from NHS National Services Scotland. It’s one of the most comprehensive sites available and presents much of its data in map form. Disease maps, for example, show what areas of a country have a certain disease, such as malaria (a common disease in many parts of the world). This is a great site to review with your doctor, when you have your exact trip itinerary in hand.
VG: Do certain countries require travel vaccinations to enter the country?
DZ: Requirements are few, but recommendations are many. When people rely only on Internet searches for information about vaccines for travel, they often miss out on the distinction between the two categories. “Recommendations” are about the traveler’s health, and “requirements” are about protecting a country’s residents from illnesses brought from other countries.
“Required” means that country doesn’t grant entry to travelers who lack that particular vaccine. Many countries won’t admit people coming from countries with certain illnesses unless they have the appropriate vaccines. For example, because Brazil is a country with a risk of yellow fever, many other countries refuse entry to non-vaccinated travelers who are coming from Brazil, even if they only passed through that country. This actually happened to me when I was entering China in 2012: because my passport showed I’d traveled to Brazil earlier in the year, I had to prove I’d received a yellow fever vaccine.
Your travel doctor will provide you with a form that easily fits in a passport holder and lists the dates you received vaccines (and the doctor’s credentials). Based on my own experience, I would never enter a foreign country without bringing this document with me just in case there are any questions about my vaccines.
That said, the “required” category rarely appears, because countries usually want to encourage tourism (they want visitors to spend money in their country!). If you call a country’s embassy for health information, the staff won’t necessarily mention any diseases in their country, because they don’t want potential visitors to think that their country is dangerous. That’s why going to a travel doctor is worthwhile: he or she serves as a unbiased source of information about diseases and recommended vaccines.
VG: What should a person do if he or she becomes ill outside the USA?
DZ: There are many great doctors out there, and doctors in your destination country are probably pretty well versed on what you may pick up there and will know how to treat you. If you’re sick with a disease that is endemic to Burma, for example, the doctors there will be accustomed to handling it. There is a tiny chance that you can pick up something that is a complete mystery to the local medical community—then again, you do sign up for certain risks when traveling to remote regions of the world.
Upon your return, bring your records to your travel doctor to determine if additional follow-up treatment is required. The more detailed the records you can get from the doctor who treats you in your destination country, the better off you’ll be when you come back to the USA.
Individuals who are ill or pregnant or have age-related health issues may want to avoid less-developed areas and travel only to places with low risk of infectious diseases. Or at a minimum, they should book accommodations in higher-end hotels with English-speaking doctors on staff, just in case they become ill.
VG: How far ahead of my departure date should I see a travel doctor?
DZ: Ideally, two months. One month is fine, but the smallest window is two weeks. Vaccines take time to build up in your system. They don’t work right when you get them, so you need time for them to be fully effective. All vaccines are based on antibodies your body develops, and some work more quickly than others.
Also, some vaccination require a series of shots, so you need enough days (or even weeks) to get them all in before you leave the country.
VG: Any recommendations on where I can find a travel doctor if I don’t already have one?
DZ: Ask your PCP. Ninety percent of the patients who come to my practice are sent by other doctors.
VG: Do health insurance policies and Medicare typically cover visits to a travel doctor?
DZ: It depends on the policy. If you call your insurance agency and ask about your coverage, whatever they tell you will probably be wrong. My office hasn’t yet found a way to find out in advance if an insurance provider will cover treatment. The only way we find out is by seeing what happens when we submit a claim!
Although my office will submit the bill first to your insurance company (to seek payment), then follow-up with patients for anything that isn’t covered, this practice isn’t the norm. Most travel medicine clinics require patients to pay up front for treatment and submit reimbursement claims themselves.
So there you have it! I’d like to thank Dr. Zeiger for taking the time to answer some basic question about travel medicine.
Of course, the information presented in these two posts is only the tip of an iceberg. You’ll definitely want to consult with a travel medicine specialist about your own needs, based on your health and destination. But now at least you have a good idea of what travel doctors do and why it’s a good idea to visit one before a trip—particularly if you’re traveling with an aging parent. Keep those questions coming!