If you think because your patients aren’t big travelers that you don’t need to know about travel health, then Nancy Dirubbo, DNP, FNP-BC, FAANP, has a lesson for you.
At the American Association of Nurse Practitioners’ annual conference in Indianapolis last week, Dr. Dirubbo taught a course about the top 10 topics in travel health for the remainder of this year and next — and most of them have health implications that touch U.S. soil.
Here are some of the travel health topics that primary care providers should integrate into their practice.
1. Return of previously controlled disease.
The top example in the U.S., of course, is the measles outbreak, which recently became the worst this country has seen in 25 years. Most of the cases are in unvaccinated people, and the outbreak itself originated abroad, likely in Israel or the Ukraine.
As Dirubbo points out, measles is still common in many parts of the world, especially in Europe, Asia, the Pacific and Africa. Precision Vaccinations and the CDC are top resources for PCP amidst outbreaks of vaccine-preventable diseases.
2. Vaccine shortages.
Certain types of vaccines are necessary if you’re traveling abroad, and national vaccine shortages can affect your patients’ plans. Not to mention, the Immunization Action Coalition advises all international travelers be up-to-date on all vaccines recommended in the U.S., and shortages can prevent this from happening.
In the U.S. there are currently shortages of Hep B and Hep A vaccines, Yellow fever and Shingles among others.
3. Climate change.
First and foremost, climate change has prompted an influx of natural disasters, such as tsunamis and hurricanes. Not only do these phenomena threaten lives, but they also cause mass migrations into new regions, which can strain healthcare systems. Before a trip, stress to your patients the importance of knowing where the local U.S. embassy or consulate is so they know where to go in case of an emergency.
In addition, rising temperatures have expanded the habitat of the mosquito, making protecting against mosquitos even more important for travelers in parts of the word with life-threatening mosquito-borne illnesses, such as Dengue fever and Malaria.
4. Lack of awareness of travel insurance.
Patients often think travel insurance is a waste of money, and while that can be true in some situations (like domestic trips), during international travel, the cost of care can add up quickly. If you don’t have coverage, you also might be less likely to seek the care you need to avoid paying for it, which can aggravate medical conditions. Not to mention, if you’re traveling in an area with fewer m edical resources or on a cruise, the cost can be even greater.
5. Antibiotic stewardship.
Prescribing antibiotics as a preventative measure is a common travel health practice, but Dirubbo expressed concern that doing so is actually contributing to antibiotic resistance. PCPs who know the correct ways to prescribe antibiotics for travelers are a tremendous asset to the cause.
To start, Dirubbo recommends disregarding the common American practice of telling patients to take an antibiotic at the first sign of traveler’s diarrhea. Instead, advise using Pepto-Bismol tablets (or the generic brand) and lots of hydration. If the condition persists for a few days, only then should they take one 500 mg dose of one azithromycin.
In addition, PCPs should educate their traveling patients about what to do with their antibiotics should they not need the during the trip for which they were initially prescribed. Dirubbo’s advice? Tell them to keep the pills because their potency will last five or so years past the expiration date. (Studies have found there’s no scientific justification for expiration dates.) Not to mention, simply throwing them out can result in more antibiotics in drinking water, which contributes to resistance.
Another masterful tip from Dirubbo: If you have a traveling patient with a layover in a country with universal healthcare, you might recommend they pick up medication at a health clinic at the airport. It’ll be one-third of the U.S. price.
6. Teaching safety as a mindset.
The top reason travelers die every, according to Dirubbo, is not vaccine-preventable diseases or traveler’s diarrhea. Rather, it’s accidents. It’s crucial for PCPs, who have existing, trusting relationships with patients, to stress that they should always be on the lookout for ways they can get hurt and to avoid taking risks.
Whether you’re equipped to talk to your patients about travel safety or not, they’re going to go on trips and might not seek out the appropriate medical care. And threats to the health and safety of international travelers affect not only individuals but communities abroad and at home. After all, travel health simply means keeping the world healthy — and your community is just one place inside it.