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Melanie Cole (Host): Travelling abroad requires more than just a passport. Travel to certain foreign countries requires individuals to have certain vaccines as a health precaution. UVA has a traveler's clinic that has all the information and can provide vaccines for safe travel. My guest today is Dr. Tanya Thomas. She's an Assistant Professor in Infectious Diseases and International Health at UVA School of Medicine. Welcome to the show, Dr. Thomas. Tell us about the UVA Travelers' Clinic. What services do you provide?

Dr. Tanya Thomas (Guest): Yes, thank you, Melanie, for having me on. The UVA Travel Clinic is a medical clinic and it focuses on pre-departure assessments and personalized counseling for international travelers. You know, foreign travel is really becoming so much more common these days and it really takes on many forms. Aside from people traveling for like vacation or business-related work, we routinely see people who are traveling to study and work abroad or people who are embarking on medical missions or research trips, as well as people who are returning to their home countries or visiting friends and relatives. So, as you can gather, you know, each itinerary is just as unique as the purpose of the travel and so, our job is to really to combine our knowledge of the epidemiology and preventable conditions with the traveler's itinerary and their own medical conditions that they bring and other kind of personal risk profiles. So, we use all of this information and we cater advice to prevent injury and illness while traveling.

Melanie: So, who should seek appointments at the UVA Travelers' Clinic and how are the appointments received?

Dr. Thomas: Well, actually the Center for Disease Control and Prevention recommends that any international travel should have a travel medicine visit, but we really feel that this is especially important for those who are traveling to a low- or middle-income country and those travelers who have existing medical conditions. At the travel clinic, we really welcome any child or adult who's traveling for any reason and appointments can be made by scheduling this with our front office associate.

Melanie: So, give us some general travel health advice. What do you tell people every day, Dr. Thomas, that you want them to be aware of and when they come for that medical appointment before travel, what do you tell them about the importance of vaccinations and what they should they be bringing with them, what they should look out for? Just give us some good, general travel health advice.

Dr. Thomas: You know, I think that travel health advice really does start with just making sure that the routine kind of preventive medical conditions that we face here in America are definitely addressed and already kind of dealt with, right? So, that's just routine vaccinations for living, living here. We recommend that everyone be aware of their vaccination status, and so we do ask people to bring in their immunization records which is sometimes really hard to get, but we really try and work together in order to make sure that everything that has been recommended has already been received for domestic, everyday kind of life, but then we evaluate the individual person and really what their activities are going to include while they're traveling. We use this information to make a judgment call on what the potential risks of exposure may be and what vaccinations would be beneficial for the traveler. In many cases, there are some that are so routinely recommended that it's commonly given based on the country of travel, but for other things, it's very much dependent upon the nature of the trip, what activities the traveler is going to be engaged in, if it's kind of eco-tourism and a lot of time outdoors, if this is the season that has peak mosquito activity, and things like that to really help cater what vaccinations we recommend. In addition, we talk about conditions that every traveler should be aware of to reduce risk from a health perspective and from preventive medical conditions including things like traveler's diarrhea. We give them advice and education on how to stay safe and healthy from a food and water sanitation perspective and we also give medications for self-treatable conditions related to this.

Melanie: What about health insurance? Should they check if their health insurance works in other countries?

Dr. Thomas: That's always a very good idea to do. That's one of the three steps for being prepared is actually knowing a lot about your own medical condition and then what is going to be covered and not covered based on what insurance services you have domestically. So, a quick call to your insurance company can be very helpful with this and, in many cases, there are some things that are not covered and in those circumstances, we encourage people to get supplemental insurance, including medical evacuation insurance for emergencies. We also provide information on how to get in touch with the local US Embassies and Consulate services if there are any emergencies that occur while on the trip.

Melanie: How early do you recommend people examine what vaccines they might need if they're going to a third world country or one of those types of places where you might need a vaccine? How much in advance do you tell them that they need to start looking into this?

Dr. Thomas: Well, we like to see people in our clinic at least four to six weeks before departure and so, that means that kind of backtracking, that it would be good to really get a handle on your own vaccine records and other medical conditions, other prescriptions, things like that, at least six to eight weeks before departure. This gives us enough time in order to administer the necessary vaccines but it also allows the body sufficient time to create a robust immune response, which is going to be the key to really preventing these medical conditions while abroad.

Melanie: Dr. Thomas, what do you tell people is important for them to bring with them if they are going abroad? A prophylactic antibiotic, or if they do have a medical condition, obviously, their medications well-marked, but what else do you tell them to bring with them?

Dr. Thomas: So, a lot of this depends upon where they are going and how long they are going, right? So, every trip is slightly different, but I do recommend that people have an emergency medical kit with them, with some of the basics that one may be able to get at a local pharmacy while here, but on your travels, sometimes it's a little bit harder to access some of the things that are familiar to us. And so, in order to save them one step, we recommend that everyone have their own emergency medical kit with them. In addition, it's important to have your own prescriptions that you may be taking day-to-day here available with you on your travels in well-labeled bottles with the original prescription label on them as to prevent any kind of confusion when traveling. I think it's also really important for people to have an emergency medical card if they have any pre-existing conditions, pre-existing allergies, things like that and so, if there are any troubles, there's a way for someone to quickly identify what the high-risk things may be for that individual. And then, of course, during the travel clinic visit, we talk a lot about some of the basics for preventing any illnesses from mosquitos, right? So, we talk about the proper use of bug spray for your skin as well as for treatment of the clothing. We talk about taking malaria prophylaxis and we give medications for that, prescriptions for that. We also talk a lot about traveler's diarrhea and we provide education on how to prevent traveler's diarrhea. What are good food choices and how to be aware of proper food storage and handling tips. We talk a lot about safe water and then we review different over-the-counter medications that may be helpful to take on your travels as well as provide prescriptions for antibiotics that can treat traveler's diarrhea, if this should occur.

Melanie: What a great service you're providing. Wrap it up for us, if you would with just your best advice for people that are traveling to a foreign country and what you would really like them to know about the UVA Traveler's Clinic and when they should come see you.

Dr. Thomas: Well, I think that it's very important to be an informed traveler, to be really prepared and know about the destination that you're going to visit and be very well-versed about your itinerary and what you may come into contact with or what you anticipate or hope to come into contact with on these excursions. I think it's very important to know all about your own health status and be proactive in really being able to mitigate and minimize any illnesses and injuries while on your travels. So, at the UVA Travel Clinic, we really work with individuals to combine all of this information to make sure that these trips are as fun and rewarding, safe and healthy as possible.

Melanie: Thank you so much for being with us today and for more information on the UVA Travelers' Clinic, you can go to www.uvahealth.com. That's www.uvahealth.com. You're listening to UVA Health Systems Radio. This is Melanie Cole. Thanks so much for listening.