Know before you go: medical travel consultations

James Jacobs
Dr. James Jacobs, executive director of Stanford’s Vaden Health Center.

According to research from the university’s travel registry, many Stanford students, faculty and staff travel internationally during the summer whether for recreation or research. Well-prepared travelers will include these two items on their checklist of to-do tasks: reviewing the Provost’s International Travel Policy and registering their trip with the university travel registry. The Office of International Affairs met with Dr. James Jacobs, the new executive director of Vaden Health Center, to discuss the importance and benefits of a pre-departure travel medicine consultation.

What is a travel medicine consultation?

The purpose of a travel medicine consultation is to help prepare you for potential health consequences of travel to specific regions of the globe where the health risks are different from those you have had to consider when in the continental U.S. At a minimum, the consultation provides advice about vaccines (typhoid, yellow fever, hepatitis A and others) and prophylactic medications (e.g., against malaria). Travel medicine consultations rarely include any type of physical examination, but note that more extensive assessment, potentially including examination and laboratory testing, is required for some visas and programs.

Who needs one?

If you are traveling to most regions of Canada or Western Europe you are admittedly less likely to benefit from a consultation, but there is still value in ensuring that you are current with routine vaccines, including tetanus and measles-mumps-rubella. For all other itineraries, a travel medicine consultation is strongly recommended for students, faculty and staff.

How does it work?

A travel medicine consultation generally involves a face-to-face meeting with a health care professional with special training in travel medicine. You should bring (often you will be asked to supply these in advance) a detailed list of current medications and medication allergies, a detailed vaccination history and an itinerary listing not only countries and cities but also special activities. With regard to the latter, travel to a high-risk country may actually be very low risk if you move directly from the airport to a Westernized hotel for your three-day conference, and then back to the airport, but the risk profile increases dramatically if the itinerary also includes an afternoon excursion into a rural area or back country and a plan to sample indigenous cuisine.

During the consultation the health care provider will generally use a continuously updated subscription service, such as Travax, to offer medical recommendations particular to your stated itinerary. The outcome might range from simple advice on avoiding municipal water during certain legs of your trip to a list of several recommended vaccines, anti-malarial medication and a just-in-case antibiotic for severe traveler’s diarrhea. Most of the recommendations are just recommendations (though some more ardent than others), but in some situations – yellow fever being the best example – you will be advised that vaccination is actually a requirement for your itinerary.

The consultation should also provide the opportunity, where applicable, to review related topics such as altitude sickness, fear of flying, strategies to minimize the effects of jet lag, food and water precautions, and, most critically, insect precautions. In some settings there also will be discussion of pre- and post-travel testing for tuberculosis.

How long does a typical consultation last?

A typical consultation lasts 20-30 minutes. However, it is not possible to address every nuance of preparation for your anticipated travel. It is important that you also review materials, such as web links or the entire Travax report, that are provided to you as part of the consultation, as well as health information provided by the program leaders and by colleagues who have visited the area previously. It might also be necessary to separately visit your primary health care provider for refills of baseline medications. For trips lasting more than four weeks, your health insurance company may permit you to obtain a “vacation override” to obtain a larger than usual supply of medication. The travel consultation should include information about predictably problematic medications, such as the illegality in some countries of certain stimulant medications (such as for treating ADHD). Travelers have been arrested in foreign countries for possessing Aderall.

Where can a student go for a consultation?

Stanford students can obtain a travel medicine consultation at Vaden Health Center. There also are private clinics in the Palo Alto area that specialize in travel medicine. Regardless of where you go for the consultation, don’t wait until the last minute. It takes days or weeks for vaccinations to produce protective antibodies, and in the case of particularly exotic travel it might be necessary to special-order a vaccine.

Does my health insurance cover me while I am abroad?

Some health insurance plans barely provide coverage when you are in other parts of the U.S., much less so in other parts of the world. We recommend that you contact your health insurance carrier to ask about benefits while in other countries.

Stanford students, faculty and staff traveling on officially sponsored programs are automatically covered by some form of travel health insurance, but the details vary greatly from program to program, so it is important to ask your departmental or program administrator. In some cases, you will want to purchase additional coverage, which is generally relatively inexpensive and which might prove to be literally life-saving.