Toolbox: Safe Travel Medicine
Whether travelling internationally for work, vacation or athletic competition, it’s important to prepare ahead. Medical and health aspects to consider when travelling include: travel and health advisories, immunizations, medications, and jet lag.
Travel and Health Advisories
The health branch of the federal government of most countries will provide up-to-date travel advisories regarding potential health risks and information on vaccinations etc. for travellers. Some really great web-based and interactive travel resources are:
• Health Canada (www.phac-aspc.gc.ca/tmp-pmv)
• Centers for Disease Control (www.cdc.gov/travel)
• Centers for Disease Control Yellow Book (www.cdc.gov/travel)
• World Health Organization (www.who.int/ith/en/)
You can also visit a local travel clinic for consultation about health issues where you are going to travel as well as get your vaccinations performed. One should keep in mind that travel clinics usually charge a consultation fee.
Most people will have received their childhood vaccinations such as tetanus, diphtheria, pertussis, polio, measles, mump and rubella through a public health vaccination program. Some jurisdictions may additionally provide meningitis, hepatitis B and HPV vaccinations. If you are unsure if you have received all your childhood or other additional vaccinations, you can see a local public health clinic or family physician to check your vaccination records and/or have your antibody levels checked.
For international travel, especially to under-developed countries, basic vaccinations to consider getting include: Hepatitis A, Hepatitis B, combined Hepatitis A and B and traveller’s diarrhea. Other vaccinations that are destination and activity specific include: meningitis, yellow fever, cholera and rabies.
It is important to remember that each vaccine has its own injection schedule – that is, the time required for the vaccine to stimulate an immune response and the number of booster vaccinations. For example, the first injection of hepatitis B should be performed two weeks prior to travel and 2 booster injections are required at one and six months after the first injection.
Another important aspect about vaccinations to remember is cost. Vaccinations are not usually covered by public health plans and often need to be paid directly. The cost of one hepatitis B vaccination injection in Canada is about $CAD 40.
If you have a chronic medical condition that requires regular prescribed medication, it is of course important to remember to bring all your medications with you. It is also a good idea to bring at least one extra week’s supply of medication in case one’s travel plans become changed unexpectedly. One should also bring a list of their medications (with generic names), which is signed by their prescribing physician, in case you need to get more medication.
Travel to some areas of the world may also require taking preventative medications, such as for malaria. It is also important to remember to pack a small supply of non-prescribed symptomatic medication, which may include: anti-inflammatory or analgesic medications, nausea medications, anti-allergy medication, topical antibiotic and anti-allergy medications, insect repellant, sun screen etc. Bringing these medications with you saves the hassle of trying to find them at your destination.
For bicycling, in case of a crash and needing to clean and treat road-rash, bring a bottle of pressurized normal saline for irrigating your wounds!
Travelling through multiple zones results in circadian dysrhythmia, which can then cause jet lag. Symptoms of jet lag can include: fatigue, headache, insomnia, dizziness, stomach upset, reduced appetite, malaise and tiredness. From a sport performance perspective, memory, concentration, learning, and reaction time can also be affected.
The intensity of the jet lag is greater with eastward travel and if travelling more than 4 time zones westward or more than 3 times zones eastward.
There are a number of strategies to minimize jet leg:
1. If travelling more than 4 time zones westward or more than 3 times zones eastward, try to arrive at your destination at least 1 day early for each time zone crossed prior to your event.
2. Preset sleep/wake cycles to the destination time zone several days prior to departing. For eastward travel, sleep and wake earlier. For westward travel, sleep and wake later.
3. If one is prone to insomnia after arrival, then taking a prescribed sedative medication like zopiclone will help one fall and stay asleep. Some people may also find melatonin works in a similar way.
4. Light therapy/phototherapy (eg. Litebook, Lumie, etc.) can be used. Most products have web-based calculators to help determine when light exposure should be scheduled depending the departure and arrival destination.
Planning ahead for your traveling will help make you trip more enjoyable and hassle free. Happy trails.
Written by: Dr. Victor Lun, MSc., MD, CCFP (SEM), Dip. Sport Med (CASEM) is a Sport Medicine doctor who practices at the University of Calgary Sport Medicine Centre and is the team physician for a number of Canadian national sport teams.
Medical Advice Disclaimer
The information included in this article is for educational purposes only. It is not intended nor implied to be a substitute for professional medical advice. The reader should always consult their healthcare provider to determine the appropriateness of the information for their own situation or if they have any questions regarding a medical condition or treatment plan. Reading the information on this article does not create a physician-patient relationship.