IDSA releases new travel medicine guidelines

January 2007

Travel medicine has become an increasingly important part of the infectious disease specialty. In recent years, the number of people who travel internationally has increased significantly, and infectious disease specialists are treating the majority of these travelers, as well as administering vaccines prior to their departure.

In response to the increased focus on travel medicine and the increasing needs of travelers, the IDSA recently issued comprehensive guidelines on the practice of travel medicine for infectious disease specialists. The new guidelines are based on the latest studies of travel-related illnesses.

Herbert L. DuPont, MD, chief of internal medicine at St. Luke’s Episcopal Hospital in Houston and member of the Infectious Disease News editorial advisory board, was a member of the team that developed the new travel medicine guidelines. DuPont said the guidelines were developed to help define the field of travel medicine and provide guidance for doctors who are practicing travel medicine.

“New guidelines were needed to have all the information regarding travel medicine in one place,” DuPont said. “It is particularly important when doctors are treating people prior to their travels. When doctors are thinking about what vaccines to give, it will be helpful to have a comprehensive set of guidelines to look this up.”

In the guidelines

DuPont said three of the most important aspects of the new guidelines are the sections on immunization, traveler’s diarrhea and malaria.

Prior to a trip, travelers should consult their doctor regarding any necessary vaccinations. The new guidelines state that a pre-travel visit to a physician should be used to “update vaccinations that are routinely recommended according to U.S. schedules and based on the traveler’s age and underlying health status.” Depending on the location of travel planned, these vaccinations may include those for tetanus, pertussis, diphtheria, Haemophilus influenzae type b, measles, mumps, rubella, varicella, Streptococcus pneumoniae and influenza. Vaccination against hepatitis A and B, poliomyelitis, Neisseria meningitidis, yellow fever, Japanese encephalitis, rabies, tick-borne encephalitis and typhoid fever should be administered if the traveler will be going to certain areas of Africa, Asia or South America.

The guidelines discuss new treatment options for patients with traveler’s diarrhea. Noting that traveler’s diarrhea is the most common disease among travelers, the guidelines stipulate that travelers should be educated about the condition and be given advice about its prevention. Recommendations for food and liquid hygiene during travels should also be given prior to departure.

The prevention of malaria remains an important aspect of travel medicine. According to the new guidelines, malaria should be considered a preventable disease. “Methods for prevention and best management of malaria include awareness of risk, avoidance of mosquito bites, compliance with chemoprophylaxis and prompt diagnosis in the event of a febrile illness either during or on return from travel,” the guidelines state. “When seeking medical care after return from travel, travelers should be instructed to inform their health provider of their travel history.”

The new guidelines include information on various prevention methods for malaria. Although they do not specifically recommend one treatment, the guidelines are intended to educate doctors about the various prevention methods and allow them to decide what is best for their patients.

Importance of guidelines

DuPont told Infectious Disease News that the guidelines would be beneficial to infectious disease specialists who do not work at a travel clinic but are often expected to have extensive knowledge of travel medicine.

“Like many areas of medicine, the new information in this field is coming fast and is plentiful making it hard to keep up,” DuPont said. “A survey of practicing doctors showed that not all who advise travelers know the latest recommendations. Most don’t have a working knowledge of vaccines for international travel, best medication for travelers’ diarrhea and antimalarials to prevent malaria during high-risk travel.”

DuPont said many doctors who practice at travel clinics receive weekly electronic updates regarding travel medicine. However, many infectious disease specialists do not have access to these updates because of their cost. The new IDSA guidelines are intended to help infectious disease specialists manage the constantly changing field of travel medicine.

“Most doctors who deal solely with travel medicine have software updated on a weekly basis,” DuPont said. “These doctors only account for a small fraction of infectious disease specialists. But all infectious disease specialists are expected to be experts in travel medicine. The new guidelines are available to all infectious disease doctors and will help to clarify the field of travel medicine.”

For more information:

• Hill D, Ericsson C, Pearson R, et al. The practice of travel medicine: Guidelines by the Infectious Disease Society of America. Clin Infect Dis. 2006;43:1499-1539.