by Scott Kalish, M.D.

http://www.gayhealth.com/templates/105777949626877302722900005/general?record=73
Traveling is one of life’s great pleasures. You meet new people, experience different cultures, taste new cuisines and see spectacular sites. But you can also catch diseases and get sick when you're on the road.

Over the past decade, the size and scope of the lesbian and gay travel industry has sky-rocketed from a few small travel companies with gay resort destinations to a major industry offering all-gay cruises and adventure travel.

When planning a trip abroad, people tend to focus on finding the perfect beach, taking the right clothing (heaven forbid we forget those outfits!) and staying at the most fabulous hotel. What we often neglect to do is plan for a safe and healthy trip. This requires some preparation and often means seeing a specialist in travel medicine.

Huh? What's a travel medicine specialist?
Travel medicine is a relatively new specialty, which began approximately 15 years ago as an outgrowth of tropical medicine. While there is some overlap between the two, travel medicine focuses specifically on the health needs of travelers. With the frequent new outbreaks of epidemic diseases throughout the world, the greater number of travelers going to more exotic locales, and the development of new vaccines, it became necessary to focus on the preventive health aspects of travel. Hence, the recent birth of travel medicine.

Today, travel medicine is a separate specialty requiring advanced training and certification. When seeing a travel medicine specialist, you can expect a full health and travel evaluation. Try to schedule your visit 6 to 8 weeks before traveling to ensure adequate time to receive all necessary vaccines.

Your visit will include a review of your previous immunization and health history, recommendations for your immunizations and medication needs as well as a thorough discussion of health education issues.

What about vaccinations?
It is important to understand the three basic types of travel vaccines: routine, recommended and required. Most of us haven’t bothered to keep up with the routine vaccines that we received as children. A visit to a travel medical specialist offers the opportunity to review all routine vaccines including tetanus, polio and measles. These diseases are still prevalent in developing areas and pose some risk to travelers.

A recommended vaccine is one that is needed based on your specific destination and the type of traveling you plan. For example, if you were visiting certain rural parts of Asia, an area endemic for Japanese encephalitis, this type of vaccination would be recommended. Another example is the typhoid vaccination, which might be indicated if you’re an adventurous eater or if you’re spending an extended amount of time in certain countries.

The third type of vaccine is the required vaccine. Certain countries will not allow you to enter without official documentation that you received these vaccines. An example would include needing a Yellow Fever vaccination to visit many parts of Sub-Saharan Africa and many parts of South America.

Beyond Vaccinations
While receiving vaccines is an important part of your travel medical visit, your specialist may also talk to you about food and water precautions, malaria prevention, insect precautions, air/travel/jet lag issues and diarrhea prevention. Some specialists may even guide you through the complicated array of treatment, accident and evacuation insurance, and discuss your options if you become ill abroad, as well as additional travel safety issues. Of course, if you become sick after you return home (not an uncommon occurrence) a travel medical specialist is best prepared to diagnose and treat you.

Gay men & lesbians often have specific travel health issues. These include traveling with HIV and protecting themselves against hepatitis, HIV and other sexually transmitted diseases (STDs). There are also domestic partner rights and immigration restrictions when traveling outside the U.S., or when obtaining health insurance with a pre-existing medical condition.

Travelers with HIV have health concerns that need to be addressed before embarking on a trip abroad. An altered immune system may preclude the use, or alter the response, of certain vaccines. In general, those with T cell counts less then 200 or in advanced stages of AIDS should avoid receiving live vaccines such as Yellow Fever. Extra precautions need to be taken to avoid illness. Preparing extra doses of your medication and placing them in discrete containers may be necessary for certain destinations.

The good news is when we vacation, we relax. The bad news is we also tend to relax our guard. An ample supply of condoms should be brought from home, as many countries have inferior brands, or none at all. Vigilant use of condoms significantly reduces your risk of HIV and many other STDs.

Hepatitis A is the most common vaccine preventable disease for travelers. While it is primarily transmitted through the ingestion of contaminated food and water, it is also sexually transmitted through oral-fecal exposure and is extremely common in gay men.

Hepatitis B is a separate disease, also preventable with a vaccination, which is transmitted sexually through the exchange of body fluids. It may also be transmitted by using contaminated needles and instruments for drug injections, tattooing and body piercing. Many countries use unscreened blood and blood products for transfusion, and may reuse the same needle, both of which significantly increase your risk for Hepatitis B, HIV and other diseases. The good news is, a combination hepatitis A & B vaccine should arrive on the market in the near future.

Be smart. Visit a travel health specialist before you embark on that fabulous vacation. An ounce of prevention before your trip is worth a pound of cure. Happy and healthy travels!

ROUTINE IMMUNIZATIONS GUIDELINES FOR TRAVELERS:
A visit to a travel medical specialist is an ideal time to review and update all childhood and adult vaccines according to the latest public health standards.

* Tetanus/diptheria -- booster dose every 10 years

* Polio -- 1 booster dose as an adult

* MMR (mumps, measles, rubella) -- 1 booster dose as an adult if born after 1957

* Influenza –- every year

* Pneumomoccal -- 1 dose as an adult (may vary depending on the patients underlying medical condition)

* Varicella (chicken pox) -– 2 doses, 4 to 8 weeks apart

RECOMMENDED IMMUNIZATIONS:
Based on an individual's specific travel itinerary, style of travel and underlying medical history, a traveler may be advised to receive selected vaccines for prevention of travel–related infections.

* Hepatitis A -- 2 doses, 6 months apart

* Hepatitis B -– 3 doses: 1 and 6 months after first shot

* Typhoid -– primary dose, then booster dose every 2 years

* Meningicoccal meningitis –- primary dose, then booster dose every 3 to 5 years

* Rabies -– pre-exposure prophylaxis: day 0, 7, and 21 or 28

* Japanese encephalitis -– primary dose: day 0, 7, and 30, then booster dose every 3 to 5 years

REQUIRED IMMUNIZATIONS:
Those vaccines that are legally mandated for the crossing of international borders.

* Meningicoccal -- primary dose, then booster dose every 3 to 5 years

* Yellow fever –- primary dose, then booster dose every 10 years

* Cholera (rarely required any longer)

SAMPLE IMMUNIZATION GUIDELINES BASED ON DESTINATION
These are only examples. It is important you consult with a travel medicine specialist to obtain the necessary vaccines for your specific trip.

MEXICO AND CENTRAL AMERICA

• ROUTINE: Td (Tetanus/diptheria), MMR (Mumps, measles, rubella), Influenza, Varicella (chicken pox);
• RECOMMENDED: Hepatitis A, Typhoid, Hepatitis B;
• REQUIRED: None

SOUTH AMERICA

• ROUTINE: Td, MMR, Influenza, Varicella;
• RECOMMENDED: Hep. A, Typhoid, Hep. B;
• REQUIRED: *Yellow fever

SUB-SAHARAN AFRICA

• ROUTINE: Td, MMR, Influenza, Polio, Varicella;
• RECOMMENDED: Hep. A, Typhoid, Hep. B, Meningicoccal;
• REQUIRED: *Yellow fever

ASIA

• ROUTINE: Td, MMR, Influenza, Polio, Varicella;
• RECOMMENDED: Hep. A, Typhoid, Hep. B, Rabies, Japanese encephalitis
• REQUIRED: None

* Required in selective countries only

Updated: Thursday, April 12th 2001