The provision of sexual and reproductive health information and services to travellers: an exploratory survey of Australian travel medicine clinicians.

BACKGROUND: International travel can increase the risk of exposure to infectious diseases including sexually transmissible infections (STI). Pre-travel medical consultation provides an opportunity for travel-related health risk assessments and advice. This study explored how travel medicine clinicians integrate sexual and reproductive health (SRH) services into clinical practice. METHODS: A convenience sample of travel medicine clinicians completed a cross-sectional survey online or via hard-copy disseminated at an annual national Australian travel medicine conference. RESULTS: Of the 67 respondents, most (n , 51; 76.1%) had a postgraduate qualification relevant to travel medicine and 55.2% (n , 37) had worked in travel medicine for over 10years. Only 22.4% (n , 15) reported conducting a SRH history/STI risk assessment for all travel patients. STI testing pre-departure was conducted on patient request (48, 71.6%), if symptomatic (32, 47.8%) or based on risk history (28, 41.8%). SRH information pre-departure was most frequently provided if prompted by patient questions (n , 42; 62.7%), or based on the patient's history (n , 37; 55.2%). Over half the sample (n , 40; 59.7%) expressed interest in further training in SRH. CONCLUSION: Providing and engaging with additional training may assist travel medicine clinicians to take a more proactive approach to SRH consultations and STI testing. Additional research is needed to explore models of care that will allow comprehensive SRH and STI services to be integrated into standard pre- and post-travel care.

Psychological and Social Aspects of Vaccination Hesitancy-Implications for Travel Medicine in the Aftermath of the COVID-19 Crisis: A Narrative Review.

Vaccines are an important tool of preventive medicine. Although organized vaccination programs have saved large populations from serious infectious diseases, there is a considerable part of the population who oppose vaccinations. In particular, anti-vaccination perceptions, among travelers to countries with endemic diseases, are a major public health concern. Although hesitancy towards vaccinations is not a novel phenomenon, it came back to the forefront during the fight against the COVID-19 pandemic. This review explores the etiology of anti-vaccination beliefs among travelers and draws conclusions about their impact on public health and society in general. For this purpose, a purposeful search for data on the causative factors of vaccine hesitancy and their impact on people's health was conducted. A descriptive analysis of the findings and conclusions regarding possible implications in health policy and clinical practice are presented. A fear of side effects, lack of credence in the necessity of vaccines, and mistrust of medical authorities are important causative factors. Their interplay shapes hesitancy towards vaccines. However, anti-vaccination beliefs can also be an aspect of a more general unconventional stance of life. Health care professionals and organizations must be ready to tackle vaccine hesitancy by making the necessary interventions. Correcting misconceptions about vaccinations is a prerequisite for ensuring personal and public health, especially in the context of a pandemic or epidemic. Moreover, ensuring the efficacy and safety of vaccines, especially in cases of modern technology applications, is a fundamental factor in addressing people's concerns about vaccines. For this purpose, medical authorities and organizations must provide accurate and clear information on vaccines so as to eliminate misinformation. Furthermore, clinicians should cultivate their communication skills in order to convey the appropriate messages to prospective recipients of vaccinations.

Travel Medicine: Pretravel Counseling for Healthy Travelers.

Before the COVID-19 pandemic, international travel was increasing at a brisk rate. After a lull, it is picking up again and predicted to continue to climb as it had previously. International travel presents some unique health hazards, including infectious diseases, chronic disease exacerbation, environment-related illness, accidental injuries, and transportation-related illness. Many travelers appropriately seek medical consultation for advice and interventions to decrease their health risks during travel. The pretravel consultation consists of risk identification and preventive interventions. Although these consultations traditionally have occurred with infectious disease specialists, family physicians can and should provide this care. Pretravel consultations should review a patient's medical conditions, how travel can affect them, and what the patient can do to address medical needs that may arise while abroad. Balancing the risks likely to be encountered with the individual traveler's risk tolerance, patients and family physicians can collaboratively develop a strategy to mitigate these risks and increase the likelihood of an uneventful (and enjoyable) sojourn.

Travel Medicine: Travelers With Preexisting Conditions.

Certain conditions (eg, asthma, diabetes, physical disability, immunocompromise, severe allergies, pregnancy) may increase the risk of travel, but do not necessarily preclude it. Typical age-related physiologic changes also can increase the chances of serious injury or illness. For example, infection with malaria can result in more severe parasitemia in HIV-positive, pregnant, or older travelers. Physicians should evaluate each traveler as an individual, assessing risk tolerance and helping patients decide if the benefits outweigh the definite and potential costs. Extremes of climate and altitude, changes in time zones, and unfamiliar foodstuffs should be given particular attention. The well-prepared traveler should explore options for supplemental insurance, obtain necessary medical records and supplies (including their regular drugs and an appropriate first aid kit), receive education on how to recognize and what to do in the event of a medical emergency, and understand where to find high-quality care abroad.

Travel Medicine: Illness While Traveling.

Becoming ill while traveling is an unfortunate but common event, with gastrointestinal, febrile, dermatologic, and respiratory symptoms predominating. However, many illnesses acquired abroad can be prevented or controlled with evidence-based preventive measures and judicious use of appropriate self-care and local medical care. It is important that travelers know how to use international medical care and are aware of available tools to help them identify appropriate medical care in another country. Discussion of evacuation insurance is a crucial part of the pretravel medical evaluation. Epidemiology, prevention, and management guidelines of common travel-related illnesses, such as travelers diarrhea and febrile illnesses, should be addressed. Traveler counseling regarding the early management of serious but underrecognized considerations, such as accident-related trauma, sexual health, and mental health, should be included in the pretravel assessment. Important aspects of appropriate counseling and management of the traveler returning from an extended visit abroad include addressing reverse culture shock and evaluating symptoms that could be part of a delayed presentation of an illness acquired abroad.

Travel Medicine: Special Issues.

Risks during travel depend on travelers' comorbidities and trip activities. Travel on cruise ships, for pilgrimages or large events, or into the wilderness carries unique risks. Asking travelers about what activities they have planned or may do during travel can tailor the subsequent pretravel counseling points and help guide decisions about vaccines and drugs. Some prescriptions (eg, doxycycline for prophylaxis against leptospirosis) depend on the planned activities while abroad. Travelers should be prepared for potential emergencies and should be encouraged to research unique customs and laws in the countries they plan to visit before departure. The US State Department's website has resources that Americans traveling abroad should be familiar with, including information about the laws and customs of the destination country. It is important that travelers investigate the different insurance options or coverages before a trip, in case emergencies arise.

Travel Medicine.

International travel can cause new illness or exacerbate existing conditions. Because primary care providers are frequent sources of health advice to travelers, they should be familiar with destination-specific disease risks, be knowledgeable about travel and routine vaccines, be prepared to prescribe chemoprophylaxis and self-treatment regimens, and be aware of travel medicine resources. Primary care providers should recognize travelers who would benefit from referral to a specialized travel clinic for evaluation. Those requiring yellow fever vaccination, immunocompromised hosts, pregnant persons, persons with multiple comorbid conditions, or travelers with complex itineraries may warrant specialty referral.

Pre-travel vaccine information needs, attitudes, drivers of uptake and the role for decision aids in travel medicine.

BACKGROUND: Many travellers do not receive vaccines pre-travel. Tools such as vaccine decision aids could support informed vaccine decision-making. We aimed to characterise Australians' pre-travel vaccine attitudes, behaviours and information needs and examine the role for decision aids in travel medicine. METHODS: Online cross-sectional survey of Australian adults in December 2022. We included questions on demographics, pre-travel health-seeking behaviour, and information needs. We measured vaccine confidence (Vaccine Confidence Index Index) and used hypothetical disease scenarios to evaluate behavioural and social drivers of vaccination. We used multivariable logistic regression models to identify predictors of vaccine uptake and thematically analysed free-text responses. RESULTS: We received complete survey responses from 1223/1326 Australians (92% response rate). Amongst those reporting previous overseas travel, 67% (778/1161) reported past pre-travel health encounter(s) and 64% (743/1161) reported past pre-travel vaccination. Half (50%) strongly agreed that vaccines were important for their health; fewer strongly agreed that vaccines were safe (37%) and effective (38%). In multivariable analyses, past pre-travel vaccine uptake was associated with increasing age (OR = 1.17 [95% CI 1.08-1.27] p < 0.001 per ten-year increase) and travel to higher-risk destinations (OR = 2.92 [2.17-3.93] p < 0.001); travellers visiting friends and relatives (VFRs) were less likely to have received pre-travel vaccines (OR = 0.74 [0.56-0.97] p = 0.028). Predictors for wanting vaccination against hypothetical diseases included past pre-travel vaccination (Disease X: OR 2.60 [1.91-3.56] p < 0.001) and confidence in vaccine safety (Disease X: OR 7.18 [5.07-10.18], p < 0.001); past VFR travel was predictive of not wanting vaccination (Disease X: OR 0.72 [0.52-1.00], p = 0.049). Most (63%) were interested in using a vaccine decision aid, generally together with a trusted health professional. CONCLUSIONS: Health professionals play an important role in supporting pre-travel vaccine decision-making. However, our findings indicate that reliable, accurate and engaging digital resources, such as decision aids, could support travellers to make informed pre-travel vaccine decisions.

Development and curricular alignment of a pharmacy travel medicine elective.

BACKGROUND AND PURPOSE: Describe the design, implementation, and value of a travel medicine pharmacy elective. Students translated skills from rotations and practice environments addressing travel health-related needs. Content and educational outcomes align with the Center for the Advancement of Pharmacy Education, American Association of Colleges of Pharmacy, and Pharmacists' Patient Care Process core components of student learning and assessment. EDUCATIONAL ACTIVITY AND SETTING: A two-credit travel medicine elective included live and pre-recorded lectures, self-learning modules, peer critiques, and patient engagement. Students shadowed in a travel health clinic interacting with patients to prepare a formal travel care plan unique to the patient's history and travel destination. Pre- and post-course surveys, quizzes, progressive assignments, and course evaluations provided the framework for curricular enhancement. FINDINGS: A cohort of 32 third-year students provided evidence of successful curricular integration. Pre-course surveys demonstrated 87% of students self-scored low knowledge and ability to apply travel health services. Ninety percent of post-course surveys reported high levels of knowledge and ability. High perceived value was evident in course evaluations with some student intent to pursue credentialing. SUMMARY: Community practice affords increased opportunities to identify patients in need of travel medicine services. The unique approach and design supported successful integration of a travel medicine elective in the University of South Florida Taneja College of Pharmacy curriculum. Upon elective completion, students were prepared to educate internationally traveling patients to safely self-manage chronic health conditions, reduce potential health risks and harm exposures during travel, and monitor health changes upon return.

Healthcare seeking during travel: an analysis by the GeoSentinel surveillance network of travel medicine providers.

BACKGROUND: International travellers may seek care abroad to address health problems that arise during their trip or plan healthcare outside their country of residence as medical tourists. METHODS: Data were collected on travellers evaluated at GeoSentinel Network sites who reported healthcare during travel. Both unplanned and planned healthcare were analysed, including the reason and nature of healthcare sought, characteristics of the treatment provided and outcomes. Travellers that presented for rabies post-exposure prophylaxis were described elsewhere and were excluded from detailed analysis. RESULTS: From May 2017 through June 2020, after excluding travellers obtaining rabies post-exposure prophylaxis (n= 415), 1093 travellers reported care for a medical or dental issue that was an unanticipated part of the travellers' planned itinerary (unplanned healthcare). Travellers who sought unplanned healthcare abroad had frequent diagnoses of acute diarrhoea, dengue, falciparum malaria and unspecified viral syndrome, and obtained care in 131 countries. Thirty-four (3%) reported subsequent deterioration and 230 (21%) reported no change in condition; a third (n = 405; 37%) had a pre-travel health encounter. Forty-one travellers had sufficient data on planned healthcare abroad for analysis. The most common destinations were the US, France, Dominican Republic, Belgium and Mexico. The top reasons for their planned healthcare abroad were unavailability of procedure at home (n = 9; 19%), expertise abroad (n = 9; 19%), lower cost (n = 8; 17%) and convenience (n = 7; 15%); a third (n = 13; 32%) reported cosmetic or surgical procedures. Early and late complications occurred in 14 (33%) and 4 (10%) travellers, respectively. Four travellers (10%) had a pre-travel health encounter. CONCLUSIONS: International travellers encounter health problems during travel that often could be prevented by pre-travel consultation. Travellers obtaining planned healthcare abroad can experience negative health consequences associated with treatments abroad, for which pre-travel consultations could provide advice and potentially help to prevent complications.