What Does A Travel Medicine Specialist Do?

Travel is on the rise among Americans, and after weathering the COVID-19 pandemic, travelers are especially aware of the health and safety risks that come with vacations or business trips to many popular destinations. But COVID-19 is only one consideration when traveling today, especially abroad. Many travelers may not be aware that they can contract dangerous infectious diseases through contaminated food, water, soil, mosquitoes, and more. Understanding these health risks is only part of the reason to see a travel medicine specialist before traveling internationally, or domestically if you have health conditions that leave you immunocompromised. In this blog, infectious disease physician Dr. Ellen Hirsh of ID Care explains how these doctors help travelers by addressing the question you’ll need to explore as you plan your trip: What does a travel medicine specialist do?

Travel medicine specialists are like medical travel guides who offer advice, preventive measures, and treatments designed to protect your health during every phase of a trip. Infectious disease doctors like those at ID Care can provide more comprehensive guidance than doctors at walk-in travel clinics, who may simply offer a couple of vaccines and send you on your way. Infectious disease doctors are also the best choice when help is needed after a trip, as they have the most experience treating exotic diseases.

Travel medicine specialists are key partners for travelers to consult:

• Before travel, when they evaluate a patient’s health history, immunization records, and travel itinerary and offer detailed recommendations, vaccinations, and medicine to bring along.
• During a trip, when doctors can be available via phone or telemedicine to advise sick travelers or provide guidance if needed.
• After a trip, when these specialists see sick patients returning for care and treatment, although this is less frequent among those who received pre-travel guidance.

“We hate to see someone get sick abroad with a terrible illness that not only ruins their vacation but sets them back in many ways after they get home,” Dr. Hirsh said. “That’s why anyone who is traveling, whether for business or pleasure, should come see us at ID Care before they leave, as opposed to dropping into a more generalized travel clinic or doing nothing at all. This will not only prepare travelers to protect themselves but will give them somewhere to turn for immediate attention if they do get sick.”

Infectious Disease Doctors: The Best Travel Medicine Specialists

Different parts of the world harbor different types of viruses, bacteria, fungi, and parasites, and while your body may be used to certain pathogens in your native area, it may be very vulnerable to them in distant locations abroad. This is one reason a pre-travel medical consultation is so important.

Infectious disease doctors are the most qualified travel medicine specialists because:

• They understand global health trends, such as which bacteria have become resistant to specific antibiotics that are sold over the counter in some countries. As a result, they are well prepared to diagnose and treat travelers who pick up these germs.
• They can care for patients with complex medical histories. “These patients may need to avoid drug interactions, or they may have a condition that limits the kinds of treatments they can receive,” Dr. Hirsh said. “For instance, people who are allergic to eggs can’t tolerate the vaccine for yellow fever because it contains egg protein. Patients who are immunocompromised also cannot receive the vaccine as it is a live viral vaccine.”
• They are the only physicians with comprehensive expertise about all types of infections, so they are best equipped to guide travelers about infectious disease prevention, along with health risks and treatment options.

What Conditions Do Travel Medicine Specialists Treat?

An array of diseases pose a threat to people who travel internationally, and travel medicine specialists are comfortable treating all of them. Those most encountered by the travel medicine doctors at ID Care are:

• Traveler’s diarrhea, caused by bacteria, viruses, and/or fungi passed through food or water that are prevalent in parts of Asia, Africa, the Middle East, Mexico, and Central and South America.
• Malaria, caused by a parasite passed via mosquito bites and common in Africa, Asia, and South America.
• Typhoid, caused by the bacteria Salmonella typhi that are transmitted through contaminated food or water and prevalent in parts of Asia, the Middle East, Africa, the Caribbean, and Central and South America.
• Hepatitis A, a virus contracted through food, water, or close contact with an infected person and common throughout the world.

Less common but still a risk are several diseases caused by viruses transmitted by mosquitoes:

• Yellow fever, common in certain parts of Africa and South America.
• Japanese encephalitis, present in some parts of Asia and the Western Pacific.
• Dengue fever, present in many countries in the Americas, Africa, the Middle East, Asia, and the Pacific Islands.
• Chikungunya, present in countries within Africa, Asia, and the Americas, and on islands in the Indian and Pacific Oceans.

Who Should See a Travel Medicine Specialist?

As you prepare for your trip, you might wonder if you really need to reserve time to see a travel medicine specialist. Anyone traveling internationally does, especially if the destination is a developing country, a safari, or any place considered exotic – all popular travel destinations.https://idcare.com/blog/a-safety-guide-for-international-travelers/

“Special notice should also be taken by those who have moved to the U.S. but are paying a visit to family or friends in their native country, because the feel familiar with the area and thus immune, but they are not. It’s easier for these individuals to take one pill a day to prevent malaria than to come back sick,” said Dr. Hirsh.

In addition, people who are immunocompromised should see a travel medicine specialist before taking a trip anywhere, as they face a higher risk of contracting an infection.

“People who are immunocompromised may face concerns when going to different areas of the U.S., as certain infections are endemic to specific areas,” Dr. Hirsh said. “There are some fungal infections that are seen only in the Four Corners area in the Southwest, while others are seen only in the Midwest Ohio area. And of course, Lyme disease is often seen in New Jersey, but may be much less likely in other parts of the country.”

When to Book a Travel Medicine Appointment

It’s not too late to see your travel medicine specialist even if it’s the day before a trip, but “it takes two weeks to make full antibodies in response to many of our vaccines and some vaccines require a series of shots, so we like to see you around two months before your trip,” Dr. Hirsh said.

It is recommended that people bring their health and immunization records as well as a detailed itinerary to the appointment, as this information is crucial in determining what kind of care and travel guidance they will need.

The Goals of a Pre-Travel Appointment

During a pre-travel appointment, your travel medicine doctor will ask the details of your trip and anticipate the diseases that could be of concern. In addition, the doctor will assess your health and immunization history, including drug allergies; offer preventive vaccines and advice; and prescribe medications for diseases you may contract while away.

“We are an internal medicine-based field, so we look at everything you need, from head to toe, and advise accordingly,” Dr. Hirsh said.

Evaluating Your Itinerary

In asking about your itinerary, a travel medicine specialist will want to know:

• Timing of the trip. Whether you are visiting a country during its wet or dry season can shed light on the level of concern related to mosquitoes or ticks.
• Altitude of the destination. This can indicate the likelihood of mosquito-borne diseases or altitude sickness.
• Mode of travel. Travel medicine doctors can prescribe medications in advance for motion sickness on planes or ships.
• Activities planned. Handling animals, visiting bat caves, or traveling through an area by bicycle — which can lead to encounters with dogs — may open the door to diseases such as rabies. Meanwhile, spending time in a rural area, where there may be more mosquitoes, could increase the risk of Japanese encephalitis.
• Typical level of food and water safety in the target area. For people not local to an area, the germs that live in food and water can cause illness, even at a five-star hotel. If that problem is likely, the doctor will recommend measures such as drinking only bottled water and remembering not to use tap water when brushing teeth.
• Prevalence of polio in the destination country. Three countries still have active polio cases and others continue to use an oral polio vaccine that can transmit the disease, so travelers planning visits can benefit from a preventive booster.

Vaccines and Other Medications

Based on a traveler’s trip itinerary and health history, travel medicine doctors can determine whether a patient needs preventive measures and care. These often include vaccines given in advance of a trip and medicines to bring along in case of illness.

Vaccines might be designed to protect against diseases in the destination region, such as typhoid, yellow fever, or cholera, or to ensure compliance with standard U.S. immunizations that the patient never received or is due to repeat, which protect against conditions such as diphtheria, tetanus, shingles, and hepatitis A.

“The preventive vaccine for yellow fever, previously recommended every 10 years for travelers, is now given once as a lifetime dose,” Dr. Hirsh said. “Better yet, while not every practice is licensed to give that vaccine, ID Care offers it. This is crucial, because travelers need to show certification that they’ve had the vaccine in order to travel in and out of certain countries. We are fortunate to carry all the travel-related vaccines that are available in the U.S. at all 10 of our locations, and we can give them onsite the day of a patient’s appointment.”

Travel medicine specialists might also prescribe:

• Preventive medications such as pills to prevent malaria.
• Antibiotics that target a disease the traveler may encounter, such as traveler’s diarrhea, along with instructions for when and how to use them.
• Altitude or motion sickness
• Medication to assist with sleep when adjusting to a new time zone.

Good Advice: The Other Preventive Medicine

In addition to medical care, travel medicine specialists provide helpful advice during a pre-travel appointment that falls into several categories:

• Practical safeguards, such as travelers’ health insurance policies, which can pay to transport a patient to a qualified treatment center in an emergency.
• Self-care, such as instructions for using insect repellant to prevent diseases including malaria and yellow fever, and for avoiding and treating traveler’s diarrhea using over-the-counter medications and hydration.
• What to know in an emergency, such as where to find help while traveling internationally – ideally at the largest teaching medical center in the closest city, where doctors are most likely to speak English and provide a good standard of care.

“It’s much easier to prevent a problem than to deal with complications later if something was missed or not handled well,” Dr. Hirsh said. “That’s why it makes sense to consult an expert like those at ID Care before leaving for a trip. Once you have been seen and are a patient of our practice, we can assist whenever you need us.”

Consulting Your Travel Medicine Specialist During a Trip

Those who get sick while traveling in a less developed or exotic area might be concerned about seeking care at a local hospital, especially if they do not speak the country’s language. Fortunately, patients who have already established a relationship with a practice such as ID Care have somewhere else to turn; they can reach out to their travel medicine specialists via telephone or telemedicine.

“We always have a doctor available to help guide our patients if they encounter health problems while they’re away,” Dr. Hirsh said. “We like to have the chance to intervene so that illnesses contracted overseas don’t turn into emergencies.”

When Care is Needed After Travel

The patients who need care after a trip are usually those who did not have pre-travel consultations.

“We get called from the emergency room with questions about how to treat these patients. In addition, doctors from other practices who are not infectious disease specialists and are unsure of how to handle exotic diseases also frequently refer their patients to us,” Dr. Hirsh said. “Fortunately, we have a deep well of knowledge because we see malaria and typhoid cases each year and are comfortable treating them.”

Although it’s unusual for those who are already ID Care patients to come home sick, those who do are swiftly seen by doctors in the practice for diagnosis, treatment, or medical guidance.

Travel Medicine Specialists and Employers: In Good Company

In addition to working with individuals, travel medicine specialists make great partners for organizations that send people on international trips.

At ID Care, specialists are retained by companies to:

• Give talks about the health dangers associated with travel, preventive measures, and how a travel medicine specialist can help with all aspects of travel care.
• Meet with employees one-on-one to evaluate itineraries, assess risk, make recommendations, offer vaccines, and prescribe medicine in case of illness while away.

ID Care Provides Comprehensive Travel Medicine Care

As infectious disease doctors, ID Care physicians are experienced travel medicine specialists who can provide advice and treatment before, during, and after a trip, even for the most medically complex patients. That’s why these specialists are preferred not only by individual travelers, but by organizations, and why emergency rooms and other doctors routinely refer patients to them for diagnosis and treatment of unusual symptoms following international trips.

“One of the benefits of coming to us ahead of a trip is that, if you get sick later, you are already our patient. Our 10 offices are always staffed so that our patients have convenient access to expert help,” Dr. Hirsh said.