Stay Healthy While Traveling: Travel Health Counseling Tips Every Nurse Practitioner Should Know

Have you ever felt dread when looking at the “pre-travel” appointment on your clinic schedule or getting the inbox message from a patient asking for guidance on traveling to a foreign country? You’re not alone! While you may feel comfortable talking about avoiding travelers’ diarrhea, many clinicians may feel uneasy with counseling  patients on required vaccines or knowing which tropical diseases are endemic to specific locations. Pre-travel appointments are essential to keep travelers healthy while abroad. In this blog, we walk through a step-by-step approach to pre-travel appointments to make the next one a breeze. 

• 1. Initial Travel Assessment

• Any pre-travel appointment needs to start with a few key questions about the patient’s travel plans. Make sure to ask about: 

• Location of travel

• Duration of travel

• Timing of travel

• Purpose (ex: mission trip, personal, work)

• Activities during the trip

• Where they are staying (accommodations)

• Access to healthcare

• If you are not the patient’s primary care or usual provider, make sure to obtain a detailed history, including past medical history, allergies, and current medications. 

• 2. Travel Vaccinations

• First, make sure the patient’s routine vaccines are up to date. Check out the CDC’s adult or child immunization schedule for more information. Some travelers may need additional travel vaccinations. It is recommended to visit the CDC travel website to review the specific requirements and recommendations for the country that the patient is expected to travel to. 

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• 3. Consider malaria and vector-borne disease prevention

• The risk of malaria and other vector-borne diseases, including dengue fever and chikungunya, depends on the region. If the patient is traveling to an area known for malaria transmission, prescribe appropriate malaria prophylaxis. The Yellow Book has an excellent table on the various options for malaria chemoprophylaxis. 

• Educate patients on mosquito and tick bite prevention, including the use of mosquito netting while sleeping, the application of DEET-containing repellants, and the wearing of long-sleeved clothing. Travelers can also pre-treat their clothes with permethrin before travel to reduce the risk of a mosquito or tick bite.

• 4. Educate on food and water safety 

• One way to keep patients safe while traveling is to educate them on food and water safety. To avoid contamination risks, emphasize avoiding raw or undercooked meats, seafood, unpeeled raw produce, and street food. Safer choices include steaming hot meals, peelable fruits, and pasteurized dairy.  

• And don’t forget the basics—hand hygiene matters. Encourage frequent washing with soap and water or using hand sanitizer with at least 60% alcohol. 

• Travelers should also avoid tap water for drinking, cooking, brushing teeth, or making ice. Instead, recommend bottled water from sealed containers or boiled water. Ice and fountain drinks are best avoided, but sealed carbonated or pasteurized beverages are generally safe.

• You can also recommend over-the-counter or provide prescription medications for patients to use if they do encounter traveler’s diarrhea. Prophylactic antibiotics are not currently recommended; however, providing a prescription for azithromycin (1000 mg single dose or 500 mg daily x 3 doses) or ciprofloxacin (750 mg single dose or 500 mg daily x 3 doses) may be appropriate if the patient develops symptoms of severe traveler’s diarrhea. 

• Reinforce that oral rehydration is key—especially with severe symptoms—to prevent dehydration. And if symptoms persist after returning home, they should check in with their primary care provider.

• 5. Point patients to appropriate resources

• The Centers for Disease Control has a travel health website that has health information targeted to specific countries as well as general travel patient education resources. They also have a tool, the Traveler’s Rapid Health Information Portal, you can fill out with your patients in the clinic to help walk through specific recommendations based on their travel itinerary. 

• The U.S. State Department is another helpful resource to walk through with patients as they consider their personal safety and available health resources in the country they will be visiting. 

• Need more resources to help you walk through your next pre-travel visit? Check out the CDC’s travel website for healthcare providers, the Yellow Book, or the Urgent Care RAP segment, "Travel Medicine 101."