Inadequacies in Health Recommendations Provided for International Travelers by North American Travel Health Advisors

Abstract

The rise of international travel has increased the need for more, improved travel advice from physicians and public health facilities. The quality of the health information given has not been examined on a large-scale basis by many studies, however. Surveys in Canada, Switzerland, and the United States, for example, report that only 20% to 50% of practitioners could give accurate information regarding immunization and prophylaxis about travel-related disease. Anonymous surveys were sent to 1165 American and 96 Canadian public health units and travel clinics. Using five scenarios on travel to developing countries, each source was asked to complete a standardized form giving their recommendations for immunization, antimalarials, travelers' diarrhea, and other travel issues. Of the American respondents, 60% were physicians equally distributed among private practice, university, and corporate clinics; nurses comprised 75% of the Canadian respondents, primarily from public health clinics. The number of travelers counseled per year ranged from 3 to 40,000 (American mean, 448; Canadian mean, 2180). Depending on the scenario, 20 to 75% of the immunization groups recommended were inadequate or inappropriate: most frequently, lack of tetanus/polio boosters; indiscriminant use of yellow fever/cholera vaccines; haphazard advice about meningococcal, rabies, and typhoid vaccines; and a lack of consideration of measles in young adults. Of the antimalarial recommendations given, 20 to 60% were incorrect, including prescribing medication for nonrisk areas, failure to recognize chloroquine-resistant areas, and failure to understand the use of, or contraindications to, mefloquine. Frequently, acclimatization, altitude sickness, sunscreens, and safe-sex issues were omitted. The prevention and treatment of travelers' diarrhea were adequately covered, however. Pre-travel advice given by North American health advisors shows a considerable variability in the accuracy and extent necessary for effective travel disease prevention and treatment. Despite the growing efforts to further educate those responsible, higher quality of health advice needs to become a priority.

Travel advice: a study among Swiss and German general practitioners

“…Two-thirds of the German and three-quarters of the Swiss respondents recommended vaccination against hepatitis A in the telephone interview. Similar inadequacies concerning vaccine recommendations and boosting of routine immunizations were observed in a North American study (Keystone et al 1994). Readily available, standardized information provided by the Swiss BFOPH is likely to be the reason why the Swiss group stated standard recommendations significantly more often than the German group.…”

Characteristics and Spectrum of Disease Among Ill Returned Travelers from Pre- and Post-Earthquake Haiti: The GeoSentinel Experience

“…A study looking at the quality and accuracy of information received by international travelers from North America found that Canadians received more accurate pre-travel preparation than travelers from the United States, although response rates were low, especially from United States clinics. 21 It is possible that Canadian travelers to Haiti were better prepared for their trips and acquired fewer travel-related diseases than travelers from the United States. We cannot, however, postulate a reason why the quality of preparation would have varied in a way that would have led to differentially less travel-related disease among Canadians post-earthquake.…”

Primer Centro de Medicina del Viajero en un hospital público de la Provincia de Buenos Aires, República Argentina: Dos años de experiencia

“…demostraron que la asesoria pre-viaje brindada por clínicas de Estados Unidos y Canadá fue muy variable, y que en 20 a 75% de los asesoramientos las vacunas recomendadas fueron incorrectas (indicación inadecuada de vacuna para fiebre amarilla, falta de refuerzos contra tétanos y polio, etc.) 17 .…”