In the Journals

Many high-risk travelers not adequately counseled

Nearly 20% of those who seek pre-travel medical advice are considered high-risk patients, yet many do not receive complete information on disease prevention measures due to the complexity of their condition and lack of time for counseling, study findings suggest.

“We recommend that travelers, particularly high-risk travelers, seek care early in the course of their travel planning to allow adequate time to review their needs and that they be referred to experienced travel medicine providers,” Natasha Hochberg, MD, MPH, co-director of Boston Medical Center’s Travel Clinic, and colleagues reported in Mayo Clinic Proceedings.

In a cohort of 15,440 patients who sought pre-travel counseling at five clinics in the Boston Area Travel Medicine Network (BATMN), 74.3% had medical comorbidities, 23.3% were immunocompromised travelers, 17.9% were high risk and 2.5% were pregnant, the researchers found.

Overall, 93.9% of high-risk travelers visited countries with medium- to high-risk for typhoid fever, 85.7% traveled to malaria-risk countries and 22.8% visited a yellow fever endemic country.

“For most of them, decisions about live virus vaccines were required that involved complex decisions about whether these vaccines were appropriate given their medical conditions,” the researchers wrote.

For example, fewer than half of immunocompromised (44.4%) and pregnant patients (34.8%) who visited a yellow fever endemic country were vaccinated against the disease.

Careful risk–benefit assessment is necessary when administering the yellow fever vaccine and should take into account “the precise location of travel, season, duration of exposure and degree of immunocompromise,” the researchers said.

Certain immunocompromised individuals should not receive yellow fever vaccine, and caution is urged when vaccinating pregnant women with unavoidable travel, due to the risk of infecting the fetus.

Although travel visits provide an opportunity to catch up on routine vaccines, among eligible high-risk travelers, just 35.7% received either tetanus-diphtheria or tetanus-diphtheria-pertussis vaccinations, 33.3% received influenza vaccination and 14.5% received a pneumococcal vaccination.

This may be because patients opt to defer vaccination due to cost, or practitioner concern about vaccinating immunocompromised patients despite these vaccines being considered safe for this population, according to the researchers.

Additionally, nearly 30% of high-risk travelers in the current study did not receive counseling about travel and/or evacuation insurance.

“Referral to a travel clinic 4 to 6 weeks before travel is a way to address the specialized needs for these travelers. Visits must be of sufficient length to address the additional elements of the medical history as well as to allow counseling topics to be covered thoroughly,” the researchers concluded.

Disclosure: Some of the researchers report various financial ties with Cerexa, Elsevier, Intercell, Sanofi-Pasteur, Shoreland Inc., Thompson Media LLC and Xcellerex Inc.

Nearly 20% of those who seek pre-travel medical advice are considered high-risk patients, yet many do not receive complete information on disease prevention measures due to the complexity of their condition and lack of time for counseling, study findings suggest.

“We recommend that travelers, particularly high-risk travelers, seek care early in the course of their travel planning to allow adequate time to review their needs and that they be referred to experienced travel medicine providers,” Natasha Hochberg, MD, MPH, co-director of Boston Medical Center’s Travel Clinic, and colleagues reported in Mayo Clinic Proceedings.

In a cohort of 15,440 patients who sought pre-travel counseling at five clinics in the Boston Area Travel Medicine Network (BATMN), 74.3% had medical comorbidities, 23.3% were immunocompromised travelers, 17.9% were high risk and 2.5% were pregnant, the researchers found.

Overall, 93.9% of high-risk travelers visited countries with medium- to high-risk for typhoid fever, 85.7% traveled to malaria-risk countries and 22.8% visited a yellow fever endemic country.

“For most of them, decisions about live virus vaccines were required that involved complex decisions about whether these vaccines were appropriate given their medical conditions,” the researchers wrote.

For example, fewer than half of immunocompromised (44.4%) and pregnant patients (34.8%) who visited a yellow fever endemic country were vaccinated against the disease.

Careful risk–benefit assessment is necessary when administering the yellow fever vaccine and should take into account “the precise location of travel, season, duration of exposure and degree of immunocompromise,” the researchers said.

Certain immunocompromised individuals should not receive yellow fever vaccine, and caution is urged when vaccinating pregnant women with unavoidable travel, due to the risk of infecting the fetus.

Although travel visits provide an opportunity to catch up on routine vaccines, among eligible high-risk travelers, just 35.7% received either tetanus-diphtheria or tetanus-diphtheria-pertussis vaccinations, 33.3% received influenza vaccination and 14.5% received a pneumococcal vaccination.

This may be because patients opt to defer vaccination due to cost, or practitioner concern about vaccinating immunocompromised patients despite these vaccines being considered safe for this population, according to the researchers.

Additionally, nearly 30% of high-risk travelers in the current study did not receive counseling about travel and/or evacuation insurance.

“Referral to a travel clinic 4 to 6 weeks before travel is a way to address the specialized needs for these travelers. Visits must be of sufficient length to address the additional elements of the medical history as well as to allow counseling topics to be covered thoroughly,” the researchers concluded.

Disclosure: Some of the researchers report various financial ties with Cerexa, Elsevier, Intercell, Sanofi-Pasteur, Shoreland Inc., Thompson Media LLC and Xcellerex Inc.