Travel Medicine

It can be challenging for a busy practitioner to stay abreast of the latest developments in non–routinely administered vaccines, disease outbreaks, areas of political instability, or country-specific entry requirements. However, it is important to ask parents who come from other countries if they are planning to visit their homelands and if so, when. Also, asking families with teens whether they plan on traveling for spring break or summer can be incorporated into routine office visits.

Ideally, patients planning international travel should be referred to a travel medicine clinic 1 month prior to travel. Some vaccines take up to 2 weeks to become effective, while others such as yellow fever should be received at least 10 days prior to travel and can be administered only at government-designated sites. Many vaccines, such as those against typhoid or rabies, are not routinely available at the patient's medical home.

Counseling about strategies to avoid insect and animal bites, food and water precautions, motor vehicle and water-related accidents, and interventions as simple as wearing shoes while walking on the beach is as much a part of a pretravel evaluation as are immunizations.

International travel has become so commonplace that it behooves every primary care physician to identify a travel medicine clinic in their area that can provide pretravel advice and immunizations to their patients, and to inquire about potential international travel during patient visits. Making sure the patients' routine immunizations are up to date is another way providers can assist their patients in preparing for international travel.

Not all travel medicine clinics provide services for children, so it's a good idea to find out which ones do in your area. If you are having difficulty locating a clinic, the International Society of Travel Medicine (www.istm.org/www.astmh.org/source/ClinicalDirectory/

The Centers for Disease Control and Prevention's travel site also offers a clinic locator, as well as other resources for practitioners and travelers (www.cdc.gov/travel