You’ve booked the trip you have been dreaming of! The accommodations look great on the website! At last, after weeks of anticipation you are on the plane, all decisions of what to pack behind you now. As you settle into your seat, you think, “Did I forget anything?” Well, you did if you forgot your pre-travel health preparation.

Health preparation? Nobody mentioned that. Regardless of where you travel, it is important to be sure your routine immunizations are up to date:

• A tetanus/diphtheria booster within the last 10 years. (Since 2005, a new vaccine called Tdap now adds the protection for whooping cough, which is a reemerging disease that can be serious.)
• Measles, mumps, rubella and chicken pox vaccines if you have not had the diseases or completed the childhood series.
• Yearly flu vaccine, because you may sit near sick people in the plane and who wants to waste a longanticipated trip being ill?

When you travel beyond North America and Western Europe, additional vaccines may be recommended (or even required) for your trip.
• Frequent world travelers should consider completing the Hepatitis A and B series. Hepatitis A is a virus passed in contaminated food and water that can infect your liver. Since everyone has to eat, this vaccine makes excellent sense for travelers. Hepatitis B virus is passed by sexual contact or by blood contaminated instruments, such as manicure instruments, acupuncture or tattoo needles, medical and dental instruments.
 • Depending on where you will travel and what you will be doing during your trip, you may need additional vaccines. To check current recommendations for particular destination countries, go to the website of the US Centers for Disease Control at www.cdc.gov/ travel

Your first inclination upon hearing all this will probably be to call your regular doctor. That’s a good start because your medical record may include dates of previous immunizations. But you should consider a comprehensive pre-travel consultation with a travel health consultant, many of whom are knowledgeable nurses, especially if you will be traveling to less developed areas of the world that may pose higher risks. Travel health care is a growing specialty that offers all travel vaccines (including yellow fever vaccine) and health counseling for the many non-vaccine preventable risks (such as jet lag, traveler’s diarrhea and altitude illness). Travel health providers keep upto- date with worldwide health and safety risks.

What happens at a pretravel consultation?
• First, there is a “risk-based assessment.” The travel health care provider will review your immunization and health history and discuss the risks for your trip based on where you will go (Africa, Amazon, etc.) and what you will be doing during your trip (cruise, mountain climbing, safari).
• Depending on your personal health status, your travel health care provider may also discuss the “what ifs” of the trip. What if your chronic illness (e.g. Asthma) gets worse during the trip – what should you do? Having a plan helps secure a healthier trip. Also, carry more than enough of your personal medications, in their labeled containers, in your carry-on (not checked!) luggage.
• Travel and medical evacuation insurance will be recommended, so you will have a number to call for medical advice if you have an accident or become ill during travel. This insurance will cover the high cost of medical evacuation, if needed. If you charge your trip on a platinum charge card, you may already have evacuation coverage. Just be sure to call and confirm it. A number of companies that provide short term coverage are listed at www. cdc.gov/travel/yellowBookCh2- HealthCareAbroad.aspx.
• Immunizations are given as needed, with plans made for follow up doses.
• The travel health provider will discuss specific risks for your destination and actions you can take to maintain your good health during the trip.
Some topics might include:
• Food and water considerations
• Insect precautions to decrease risk for insect-borne diseases
• Malaria prevention for some destinations
• Any current disease outbreaks
• Animal avoidance to prevent rabies exposure
• Marine-related risks
• Personal safety and transportation issues (the #1 risk for travelers is accidents)
• Hotel fire and security concerns

These issues may not be things you want to think about, but it is far better to know about the risks before you travel and possibly avoid them, rather than to stumble onto them unawares during your trip.

Pre-travel care sounds complicated to you? You never thought about needing SHOTS for your trip? Very few of these immunizations are required, but you should hear the rationale for taking them before you decline them. Benefits can last many years (future travel!) and side effects are generally minimal – sore arms, maybe tiredness or a slight fever, but only for a day or two. Finding a travel clinic is easy. If your primary care provider or colleagues don’t know of one, you may view listings at www.cdc.gov, www.istm.org or www.tripprep.com. So now picture yourself settling into your airline seat as you leave, knowing you are well prepared health wise. Smile and enjoy – you are on your way!