Prior to traveling internationally, it is best practice for individuals to visit a travel medicine specialist at least four to six weeks before their departure date to ensure that there is enough time to develop immunity from vaccines and ensure that any medications have enough time to become effective. However, many travelers do not have notice of a trip that far in advance. For last-minute travelers, a visit to their travel medicine specialist is still imperative. However, some vaccinations may not be effective prior to departure, making basic health precautions even more important.
Vaccines
Last-minute travel can affect which vaccinations a traveler is given prior to departure. Immunity generally takes two weeks to develop after vaccination, so individuals leaving during that window may not be completely protected from disease. Many travelers will have received standard routine vaccinations such as measles-mumps-rubella vaccine, polio vaccine, varicella vaccine, tetanus-diphtheria-pertussis vaccine, and seasonal influenza. However, if travelers are not completely up to date, the first or additional doses of these vaccines can be administered.
Certain vaccines that are given in multi-dose series can be protective after a single dose, which can be administered to last-minute travelers. Travelers can then complete the recommended series for these vaccinations upon return. Furthermore, some vaccines can be administered on an accelerated schedule and some series can be started before travel and completed after travel. Extended stay travelers or expatriates should receive guidance on clinics at the destination where their vaccination series can be completed. Bear in mind, however, that some vaccines do not have an accepted accelerated vaccination schedule.
The yellow fever vaccine is required by many countries in certain situations and must be administered at least 10 days before arrival at the destination country. Travelers may have to rearrange travel to accommodate this time frame or risk difficulty entering their destination. Further, travelers to the Hajj must obtain a visa that requires proof of meningococcal vaccine at least 10 days prior and less than three years before arriving in Saudi Arabia.
Food and Water Safety
Under the umbrella of basic health precautions, food and water safety are critically important. To avoid the risk of general foodborne illness, travelers should follow routine food hygiene practices. Ensure that food is properly handled and prepared. Wash raw produce before eating. Despite the cultural allure of many local cuisines, consider avoiding raw meat dishes, undercooked or raw fish and shellfish, and unpasteurized dairy products, which frequently harbor bacterial and parasitic pathogens. These precautions become even more important in areas where tap water is generally unsafe for consumption. Additionally, even in areas where water is potable, consider drinking bottled or purified water whenever possible, because travelers often develop diarrhea when exposed to the unfamiliar microorganisms in water from a new location.
Insect Precautions
The most common protection against vector-borne diseases is the use of insect repellents, most of which include DEET. Repellent should be applied to the neck, wrists, and ankles, while avoiding contact with the eyes, nose, and mouth. When applied to the skin, these repellents can last from 15 minutes to 10 hours, depending on the climate, the formulation of repellent used, and the effect of the specific repellent on specific vector species. Effects can be longer-lasting when applied to or impregnated into clothing.
Individuals should consider wearing long sleeved, light-colored shirts and pants to protect against mosquitoes, sandflies, and ticks. In tick-infested areas, pant legs should further be tucked into socks and heavy boots when walking through rural or forested areas. Additionally, clothing, bags, and other belongings should be examined thoroughly for ticks before entering the home, and individuals should bathe and conduct a full-body tick check within two hours of returning home, if possible.
Finally, individuals should avoid places and times when vectors are most active. For example, people can stay indoors during peak biting hours, such as dusk-to-dawn for malaria-carrying mosquitoes. Individuals can avoid walking in wooded areas with tall grass or underbrush where ticks are found and avoid contact with fresh water where schistosomiasis occurs. If such freshwater contact cannot be avoided, authorities recommend that individuals wear protective boots. Because several vector-borne diseases can be transmitted by contact with blood, secretions, organs, or other bodily fluids, individuals in affected areas should practice personal precautions and consider the safety of local blood supplies. Furthermore, in areas where Chagas disease or tick-borne encephalitis are endemic, individuals should avoid potentially contaminated food items.
Travel Health Kit
A medical first aid kit will help with minor injuries and give you a supply of common medications that may be difficult to acquire during travel. Medical kits should be easily accessible. If taking air travel, keep your first aid kit in your carry-on luggage; however, you may need to store sharp components in checked luggage due to security measures. Customize your kit to fit your travel (for example, trekking will pose different needs than visiting a city). Be sure to include supplies such as medications taken on a regular basis, over-the-counter pain relievers, antacids, bandages, antiseptic, cotton swabs, tweezers, scissors, disposable gloves, extra pair of eyeglasses or contacts, saline, sunglasses, thermometer, first aid quick reference card, and addresses and phone numbers of area hospitals or clinics. Additional supplies may be needed for outdoor/adventure travel, traveling with children, or other special cases.
Conclusions
Travelers – particularly those on urgent business – may not have the recommended four to six weeks prior to departure to consult with a travel medicine provider for the best preventative measures. Even with only a short window before leaving, travelers should seek advice from a travel medicine specialist. Travel medicine providers can brief the traveler about risks in the country and possible medications, vaccinations, and other precautions to take while abroad. Prior to departure, expatriates or those on extended-stay should consult medical providers for advice about equivalent medical care. Additionally, basic health precautions, insect precautions, food and water safety, and carrying a travel kit can help protect any traveler from health risks and are even more important for last-minute travelers.
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