International Travel by Persons With Medical Comorbidities: Understanding Risks and Providing Advice |
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Authors: | Natasha S. Hochberg Elizabeth D. Barnett Lin H. Chen Mary E. Wilson Hari Iyer William B. MacLeod Emad Yanni Emily S. Jentes Adolf W. Karchmer Winnie Ooi Laura Kogelman Christine Benoit Davidson H. Hamer |
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Affiliation: | 1. Department of Medicine, Boston University School of Medicine, Boston, MA;2. Department of Epidemiology, Boston University School of Public Health, Boston, MA;3. Department of International Health, Boston University School of Public Health, Boston, MA;4. Maxwell Finland Laboratory for Infectious Diseases, Boston Medical Center, Boston, MA;5. Travel Medicine Center, Mount Auburn Hospital, Cambridge, MA;6. Department of Global Health and Population, Harvard School of Public Health, Boston, MA;7. Center for Global Health and Development, Boston University, Boston, MA;8. Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, Atlanta, GA;9. Division of Infectious Disease, Beth Israel Deaconess Medical Center, Boston, MA;10. Travel and Tropical Medicine Clinic, Lahey Clinic, Burlington, MA;11. Division of Geographic Medicine and Infectious Diseases, Tufts Medical Center, Boston, MA |
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Abstract: | ObjectiveTo describe the medical conditions, travel plans, counseling, and medications prescribed for high-risk international travelers.Patients and MethodsThis cross-sectional study was conducted from March 1, 2008, through July 31, 2010, in 5 clinics in the greater Boston area. We assessed all travelers seen for pretravel care and compared demographic characteristics, travel plans, pretravel counseling, and interventions for healthy and high-risk travelers (as defined by medical history or pregnancy).ResultsOf 15,440 travelers, 2769 (17.9%) were high-risk; 644 of 2769 (23.3%) were immunocompromised travelers, 2056 (74.3%) had medical comorbidities, and 69 (2.5%) were pregnant women. The median age of high-risk travelers was 47 years compared with 32 years for healthy travelers (P=.0001). High-risk travelers visited the clinic a median of 25 days (range, 10-44 days) before departure. Overall, 2562 (93.9%) of high-risk travelers visited countries with medium or high risk of typhoid fever, 2340 (85.7%) visited malaria-risk countries, and 624 (22.8%) visited yellow fever–endemic countries. Of travelers to yellow fever–endemic countries, 8 of 23 (34.8%) pregnant women and 64 of 144 (44.4%) immunocompromised travelers received yellow fever vaccine. Of eligible high-risk travelers, 11 of 76 (14.5%) received a pneumococcal vaccine, 213 of 640 (33.3%) influenza vaccine, and 956 of 2681 (35.7%) either tetanus-diphtheria or tetanus-diphtheria-pertussis vaccine.ConclusionHigh-risk travelers made up nearly 20% of patients in these travel clinics, and they mostly traveled to destinations with malaria and typhoid risk. For health care professionals caring for travelers with underlying medical problems, providing appropriate travel counseling and making vaccine decisions, such as for yellow fever, are complex. Travelers with complicated medical histories may warrant evaluation by an experienced travel medicine specialist. |
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Keywords: | BATMN" },{" #name" :" keyword" ," $" :{" id" :" kwrd0025" }," $$" :[{" #name" :" text" ," _" :" Boston Area Travel Medicine Network CDC" },{" #name" :" keyword" ," $" :{" id" :" kwrd0035" }," $$" :[{" #name" :" text" ," _" :" Centers for Disease Control and Prevention HIV" },{" #name" :" keyword" ," $" :{" id" :" kwrd0045" }," $$" :[{" #name" :" text" ," _" :" human immunodeficiency virus VFR" },{" #name" :" keyword" ," $" :{" id" :" kwrd0055" }," $$" :[{" #name" :" text" ," _" :" visiting friends and relatives YF" },{" #name" :" keyword" ," $" :{" id" :" kwrd0065" }," $$" :[{" #name" :" text" ," _" :" yellow fever |
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