Why Travel Health Belongs in Primary Care

Knowing your patients' travel plans can help you optimize their preparations—and prevent them from bringing home unwanted "souvenirs."

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Chelsea had been stationed with the Peace Corps in Ghana and decided to take her 7-year-old daughter, Amber, with her on a return trip to visit friends she had made there. They planned to spend three weeks in the African nation.

Since Amber was home-schooled, Chelsea had not felt it necessary to follow the CDC guidelines for routine childhood immunizations. Once they planned to travel abroad, however, she made appointments with their primary care provider (PCP) to update Amber’s immunizations and with the travel clinic—where I practice—for yellow fever vaccines (required for entry to Ghana) for both of them.

Chelsea explained their travel plans to the PCP, adding that she intended to get the yellow fever vaccine at another clinic. The PCP administered Amber’s varicella and MMR vaccines.

Aware that it takes 10 days for yellow fever vaccine to be effective, Chelsea scheduled their appointments with me at the travel clinic for two weeks prior to their departure—which was also one week after their visit to the PCP. Did I mention they had nonrefundable tickets?

Chelsea became very upset when I told her I could not give Amber her yellow fever vaccine. I explained the live virus vaccine rule, which states that live virus vaccines must be given either on the same day or 28 days apart.1 If they are not given 28 days apart, the second vaccine—in this case, Amber’s yellow fever immunization—is not considered effective.

Chelsea and Amber were not able to travel to Ghana as planned, because her PCP did not know enough about the administration of yellow fever vaccine. As a result, Chelsea lost $5,000 in airline tickets and cancellation fees. She insisted that her PCP pay her expenses, and her PCP did. But how easily could this have happened in your practice?

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