Joyce Skeet, MSc (Travel Medicine), RN.
Practice Nurse, Holbrook Surgery, Horsham and Chanctonbury Primary Care Trust, West Sussex
The number of travellers presenting at the surgery requesting travel immunisations continues to increase; however, vaccination protects against only a small number of the health risks to which a traveller could be exposed. A thorough risk assessment and health promotion advice are therefore an essential part of travel medicine.
British residents made 56.8 million overseas trips in 2000 (Office for National Statistics, 2002), and the number visiting Africa, Asia and Latin America is growing. Sixty-seven per cent of these trips were for holidays, 17% were for business reasons, with the remaining 16% of travellers going abroad to visit family and friends.
By 2010, the Office for National Statistics predicts that UK residents will make as many as 86.8 million trips abroad for a range of reasons (ONS, 2002). Overseas travellers include tourists, business people, diplomats, journalists, students, technical troubleshooters, aid workers, pilgrims, immigrants, refugees, military personnel, sporting participants and spectators, and many others.
Travel medicine has evolved from a need to keep the traveller safe and healthy without destroying the joy of travel. In the past, travellers would have seen their GP to receive the correct travel immunisations. Because of the large number of travellers going abroad today and the general public’s heightened awareness of travel-related illnesses and diseases, primary health-care teams - and especially practice nurses - are now providing comprehensive pre-travel advice, as well as immunisations (Kassianos, 2001).
Health promotion has been part of the daily work of the primary care team for many years and research has indicated that pre-travel clinics could significantly reduce morbidity and incidence of illness among travellers (Kassianos, 2001). Primary-care travel clinics can provide a comprehensive service, which not only benefits the patient and family, but also generates income for the practice. One of the principal objectives of the health professional is to ensure that travellers are well informed about the health risks and diseases they could encounter abroad (Chiodini, 1998).
The public can get pre-travel health advice and information from many different sources, but the reliability of the information varies considerably. Some get advice from their travel agent when they book their holiday, others visit their GP or practice nurse, while others go to dedicated travel clinics. Now, with widespread use of the internet, many get their advice from the web.
Most patients in the UK are registered with a GP, where the practice nurse will be the main provider of travel health advice. It is important that practices offering a pre-travel health service have a nurse who has completed an accredited training course in travel medicine and that regular updates are encouraged to ensure that the most up-to-date information is available to those attending (Carroll et al, 1998). Doctors and practice nurses trained in travel medicine can spend considerable time giving pre-travel advice and administering vaccines to travellers, including time spent advising travellers on the telephone, making appointments, stocktaking, ordering and claiming for the vaccines.
In the primary care setting the practice nurse or GP will have access to the patient’s medical history, current medication, known allergies and immunisation record, but the importance of an individual risk assessment for each traveller cannot be overemphasised. These details will enable the travel health adviser to tailor the advice offered to the individual and assess which immunisations and malaria prophylaxis are recommended.
Following the pre-travel risk assessment, an immunisation schedule can be planned with the traveller. Explaining the rationale behind this schedule is important, to enable the traveller to make an informed choice and ensure that consent is valid (Parker, 1998). Most travel vaccinations are not compulsory, but a certificate of yellow fever vaccination is required for travellers visiting, or in transit through, an infected area. Some countries, including Australia and South Africa, require a valid international certificate of vaccination for yellow fever from travellers over one year of age coming from an infected area, such as countries in sub-Saharan Africa and tropical South America (DoH, 2001).
Immunisations for travellers can be divided into five groups.
Most of the cases of malaria in the UK are acquired abroad and over half occur in travellers who have visited family or friends who live in endemic regions of the world. In 2001 there were 1081 cases of malaria notified to the Public Health Laboratory Service (2001) in England and Wales.
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