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International travel by persons with medical comorbidities: understanding risks and providing advice.
Mayo Clin Proc. 2013 Nov; 88(11):1231-40.MC

Abstract

OBJECTIVE

To describe the medical conditions, travel plans, counseling, and medications prescribed for high-risk international travelers.

PATIENTS AND METHODS

This 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).

RESULTS

Of 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.

CONCLUSION

High-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.

Authors+Show Affiliations

Department of Medicine, Boston University School of Medicine, Boston, MA; Department of Epidemiology, Boston University School of Public Health, Boston, MA. Electronic address: nhoch@bu.edu.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't
Research Support, U.S. Gov't, P.H.S.

Language

eng

PubMed ID

24120073

Citation

Hochberg, Natasha S., et al. "International Travel By Persons With Medical Comorbidities: Understanding Risks and Providing Advice." Mayo Clinic Proceedings, vol. 88, no. 11, 2013, pp. 1231-40.
Hochberg NS, Barnett ED, Chen LH, et al. International travel by persons with medical comorbidities: understanding risks and providing advice. Mayo Clin Proc. 2013;88(11):1231-40.
Hochberg, N. S., Barnett, E. D., Chen, L. H., Wilson, M. E., Iyer, H., MacLeod, W. B., Yanni, E., Jentes, E. S., Karchmer, A. W., Ooi, W., Kogelman, L., Benoit, C., & Hamer, D. H. (2013). International travel by persons with medical comorbidities: understanding risks and providing advice. Mayo Clinic Proceedings, 88(11), 1231-40. https://doi.org/10.1016/j.mayocp.2013.07.018
Hochberg NS, et al. International Travel By Persons With Medical Comorbidities: Understanding Risks and Providing Advice. Mayo Clin Proc. 2013;88(11):1231-40. PubMed PMID: 24120073.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - International travel by persons with medical comorbidities: understanding risks and providing advice. AU - Hochberg,Natasha S, AU - Barnett,Elizabeth D, AU - Chen,Lin H, AU - Wilson,Mary E, AU - Iyer,Hari, AU - MacLeod,William B, AU - Yanni,Emad, AU - Jentes,Emily S, AU - Karchmer,Adolf W, AU - Ooi,Winnie, AU - Kogelman,Laura, AU - Benoit,Christine, AU - Hamer,Davidson H, Y1 - 2013/10/08/ PY - 2013/05/02/received PY - 2013/07/08/revised PY - 2013/07/09/accepted PY - 2013/10/15/entrez PY - 2013/10/15/pubmed PY - 2014/1/10/medline KW - BATMN KW - Boston Area Travel Medicine Network KW - CDC KW - Centers for Disease Control and Prevention KW - HIV KW - VFR KW - YF KW - human immunodeficiency virus KW - visiting friends and relatives KW - yellow fever SP - 1231 EP - 40 JF - Mayo Clinic proceedings JO - Mayo Clin Proc VL - 88 IS - 11 N2 - OBJECTIVE: To describe the medical conditions, travel plans, counseling, and medications prescribed for high-risk international travelers. PATIENTS AND METHODS: This 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). RESULTS: Of 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. CONCLUSION: High-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. SN - 1942-5546 UR - https://www.unboundmedicine.com/medline/citation/24120073/International_travel_by_persons_with_medical_comorbidities:_understanding_risks_and_providing_advice_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0025-6196(13)00681-2 DB - PRIME DP - Unbound Medicine ER -