How to Turn a Travel Health “Triple Play”

Dr. Mark Doidge has directed the Travel Vaccine Clinic in Toronto since 1992. His clinic is designated by Health Canada as a Yellow Fever Vaccination Centre and is located in new offices at 640 Queen St. E. He founded Canadian Physicians for Aid Relief, which reports assisting 2.4 million persons in seven countries. He also helped found a precursor of the Ontario Telemedicine Network.

 

Falling ill can be upsetting, particularly while travelling. So we asked a veteran of travel medicine, Dr. Mark Doidge, for advice. We spoke about travel vaccines, other preventive measures, and how to save time and money at a travel medical clinic. Let’s call these three strategies to travel health the “triple play”—the fastest way in baseball to get up to bat.

 

First Base: The Importance of Vaccinations

Who is vulnerable to infection while travelling?

Travellers may encounter exotic diseases when visiting new places. They may go where common diseases are more prevalent, yet they lack immunity. Or they may return to a place where they once lived, having lost the immunity they had earlier in life.

The risk of disease is higher…

  • Where safety, hygiene, and medical standards may be low
  • Outside of major cities, and anywhere in a less affluent nation
  • While sleeping and eating in local homes instead of hotels
  • For travellers in their advanced years
  • For travellers with an existing illness
  • For travellers who come in contact with infected individuals, animals, or insects
  • The longer the time that the traveller is away from home

Want to know more? Learn about the various diseases you may be subject to while travelling.

 

Why bother with vaccinations?

Vaccines prepare your body’s immune system. This gets you ready to defend against infections, just as spring training camps help baseball stars get ready to win games. According to the Public Health Agency of Canada, there are certain diseases and infections that we need to protect against, whether we travel or stay at home. The recommended vaccines include measles-mumps-rubella, diphtheria-pertussis-tetanus, varicella (chickenpox), and the yearly influenza shot. It is extremely important for children and adults alike to follow the vaccination schedules recommended for their age groups. Other vaccines are recommended for travel, particularly to certain parts of the world. Contaminated food or water anywhere could transmit hepatitis A. Contaminated needles, blood, or new sexual partners anywhere could transmit hepatitis B. There are places where rabies is more common, especially where there are stray dogs, bats, and other wildlife.

Need a vaccine? Learn more about vaccines and their associated costs.

 

Should I worry about a vaccine’s side effects?

Vaccines sometimes interact with medication you take regularly. Some are recommended for healthy adults but may not be appropriate for children, pregnant women, the elderly, or adults on medication for existing health conditions. So it is always a good idea to consult with both your physician and pharmacist before getting vaccinated. While no vaccine is 100 per cent safe or effective, “serious adverse reactions are rare,” says the Public Health Agency of Canada. “The dangers of vaccine-preventable diseases are many times greater than the risks of a serious adverse reaction to the vaccine.”

 

How should I decide whether or not to take a vaccine?

“The best way to decide whether or not to take a vaccine or drug,” says Dr. Mark Doidge, “is to try to obtain a good understanding of all of the benefits and all of the risks. Then, and only then, balance the two sides of the case to make a decision. It is unwise to look only at potential side effects, or only at benefits. Balance is all.” But, of course, always speak with your physician first.

 

When should I get my vaccinations?

The Public Health Agency of Canada tells us: “A health care provider or travel medicine clinic ideally should be consulted two to three months in advance of travel in order to allow sufficient time for optimal immunization schedules to be completed. Even if a traveller is leaving at short notice, a pre-travel consultation will be beneficial.” Some vaccines require second or third doses, and appointment times may not be available soon. So plan ahead. “Long trips to remote locations need more advanced notice,” notes Dr. Mark Doidge.

 

How should I prepare for a vaccination?

Dr. Mark Doidge says “you will help your travel doctors and waste less of your time in their offices if you take the trouble beforehand to track down your record of previous vaccinations. If you are under the age of 35 (and grew up in Canada), you can do this by calling your local public health agency, which may have your school vaccine records.” Doidge advises you to write down the exact name of each vaccine and the year and date when you received each one. If you grew up in one of Canada’s major cities, call the numbers below to access your records:

  • Toronto: 416-392-1250
  • Montreal: 514-528-2400
  • Calgary: 403-214-3641
  • Vancouver: 604-736-2033

To search for the immunization contact line in other cities, find your province listed under Public Health Agencies, and then click on your hometown.

 

Second Base: A Further Ounce of Prevention

What should I do after a travel vaccination?

Make a copy of your vaccination record, and carry the copy with you while travelling. When entering some countries, you may need to show an International Certificate of Vaccination or Prophylaxis for Yellow Fever. Saudi Arabia often requires proof of inoculation for Polio and Meningococcal Disease. “It may also help to be able to show your record of vaccination if you see a doctor while abroad,” says Dr. Mark Doidge.

 

What should I do if prescribed medication for travel?

“Keep your medication in the original, labelled bottle from the pharmacy and do not take unmarked pills, so as to avoid drawing undue suspicion from border authorities,” warns Dr. Mark Doidge. At least one US state, Connecticut, requires prescription drugs to be kept in their original container. Possession of even a small quantity of certain medications—without a copy of your prescription—could be seen as an offence under the Controlled Substances Act, punishable by a fine and/or a jail sentence. In other countries, the penalty for carrying unlabelled medications may be even harsher.

Unsure about the rules? Learn more about travelling with medications before you go.

 

Are there diseases vaccines cannot help, or fully protect against?

There is no vaccine against malaria. The vaccine for traveller’s diarrhea is moderately effective. “So you will need to take other precautions,” says Dr. Mark Doidge. These precautions include washing your hands as frequently as possible and carrying hand sanitizer with you at all times. If you doubt the quality of the local water, protect yourself by using bottled water to drink and brush your teeth. Avoid raw vegetables and fruit that may have been infected by water or human contact. Where malaria could be a problem, take steps to avoid mosquito bites (e.g., netting over your bed, light-coloured clothing, and insect repellant containing DEET). After consulting with a physician, you may want to take anti-malaria medication before, during, and after your travels. There are several prescribed medications and over-the-counter products that will provide relief from diarrhea as well.

Want to eat worry free? Get some tips on eating while away from home.

 

What other preventive measures can I take?

Carry a travel health kit. “First aid supplies and medication may not always be readily available in other countries or may be different from those available in Canada,” notes the Government of Canada’s travel information website. “A good travel health kit contains enough supplies to prevent illness, handle minor injuries and illnesses, and manage pre-existing medical conditions for more than the duration of your trip.”

 

What should I do if I get a fever?

Dr. Mark Doidge says a wide variety of infections and diseases related to travel could result in fever, including influenza (flu), and malaria. In the case of malaria, the US Centers for Disease Control website notes that a person could start to feel ill after contracting malaria “as early as (seven) days or as late as (one) year later.” If you have been near an infected person while away, or were ill yourself, you are required to inform a customs officer upon your return. If illness strikes later, you should consult a physician and let them know that you have been abroad.

 

Third Base: Choosing and Using a Travel Clinic

How do I choose a travel clinic?

Ask your family physician to refer you to a travel clinic. If he or she is not able or willing to do so, try entering your postal code in the Travel Health Clinics search tool to find a travel clinic near you. (Note: The distance column was not working when we tested it.) Some clinics specialize in travel medicine, while others provide vaccinations as a sideline to a family medical practice or other medical services. You may have to call more than one. Some clinics supplement their service with helpful websites, but only some clinics disclose their prices online.

 

Are travel medical clinics certified?

Clinics that offer yellow fever vaccinations must be certified to provide them. You can find a list of clinics that are qualified by clicking on the name of your province in the accompanying chart, or by visiting the Public Health Agency of Canada website. The Royal College of Physicians and Surgeons of Canada does not set educational requirements for travel medicine. Most of those who operate travel clinics are family physicians, says Dr. Mark Doidge. They refer to textbooks and up-to-date online sources, to better inform themselves and their patients.

 

Are travel medical clinics rated?

Some patients have taken the time to rate physicians who operate travel medical clinics. But, as with other anonymous online comments, these should be viewed critically. Some patients focus on personal style rather than professional issues. Some resent paying consultation fees, without considering the expenses required to provide a dedicated service. Some patients expect a quick answer to every question, but forget that a good physician may require time to do research. Remember, there are dozens of different countries and changing circumstances, and it should be reassuring if the physician takes time to do some research before making a recommendation.

 

What will a travel clinic cost?

Your provincial Ministry of Health will likely pay the cost of some routine or essential vaccines, for example influenza, measles-mumps-rubella, diphtheria-pertussis-tetanus, and varicella (chickenpox). Certain health insurance plans will pay for other vaccines. Dr. Mark Doidge points out that some employers offer “health spending accounts” or “flex-plans,” which offer the flexibility to pay for travel vaccines and other health-related expenses. If you must pay out of pocket, the price of the vaccines could be slightly higher or lower than those noted in this chart; fees will vary depending on which travel clinic you choose to visit. Remember that a drug store price may come with an additional dispensing fee, but it does not include the cost of providing an injection. Travel clinics will usually charge an initial consultation fee, as well as fees for follow-up visits.

 

Why should I check in advance whether my insurance pays for vaccines?

“Your coverage could save you hundreds of dollars, if you are going on a big trip,” says Dr. Mark Doidge. “Some vaccines are optional, and it could be a shame for people not to take them simply because they haven’t checked their coverage,” Doidge adds.

Checking in advance could shorten your time at the medical clinic. If you want your insurer to pay for the vaccines, it is critical that you bring your insurance card to your appointment. Remember that most employee medical plans are merely administered by insurers. Your employer is paying some or all of the cost, having decided it is in the best interest of the company to have employees and their families remain healthy, year round and after a trip.

 

How do I check if my insurance pays for travel vaccines?

You may have a copy of your insurance policy that you can review; if not, simply call your insurer to check on vaccine coverage. But Dr. Mark Doidge warns that not all insurance call centres are open long hours, so make sure to allot the necessary time during opening hours; also, be precise with your questions. Going online is another option. Most insurance companies offer a password-protected portal with all of your insurance information available to you in one convenient location. Whether you call or go online, you will need to know the drug information number (DIN) for the vaccines you might be prescribed. Find the DINs for some of the more common and costly vaccines below:

Need a DIN that is not listed above? Find a list of additional DINs for vaccines that may be prescribed for travel.

 

Home Base: Now You’re Up to Bat

Where can I find additional information on travel illnesses and vaccines?

  1. The Government of Canada has developed a helpful pamphlet on travel health and safety: Well On Your Way – A Canadian’s Guide To Healthy Travel Abroad.
  2. The Public Health Agency of Canada posts travel health notices, information on disease and health conditions, and tips on preventing illness here: travelhealth.gc.ca. This same website also offers up-to-date information about vaccines and illnesses provided by National Advisory Committee on Immunization.
  3. The website of the US Centers for Disease Control and Prevention has an online version of the 2012 Yellow Book, known formally as Health Information for International Travel. The 2014 update was only available in print in July of 2013.
  4. Information about international travel and health is available from the World Health Organization.
  5. The Ottawa Hospital Research Institute developed a free iPhone application to record your family’s history of vaccinations and to alert you when it’s time for updates. An app for the rest of Canada is under development.
  6. For about $100, you can buy your own Kindle version of the Canadian textbook for physicians called Travel Medicine: Expert Consult, 2012 edition. Its many authors include Dr. Jay Keystone, a specialist on leprosy and intestinal parasites at the University of Toronto Department of Medicine. He is also Director of the Medisys Travel Clinic in Toronto.

Don’t Strike Out Like Mighty Casey

Casey at the Bat, the classic baseball poem by Ernest Lawrence Thayer, ends with these words: “Somewhere men are laughing, and somewhere children shout; but there is no joy in Mudville—mighty Casey has struck out.” If you want to avoid Mudville during your travels, be sure to get your body ready to fight infection before you leave home.

 

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