High Risks and Special Needs
Travellers with special itineraries and/or expeditions can be exposed to significant health risks. Travel to polar environments, mountaineering, desert environments, jungle/tropical environments, kayaking or rafting, scuba diving expeditions, etc. There are also increasing travelers to remote destinations that include employees of petroleum, mineral and construction companies; scientists; military; adventure and eco travelers. Such travelers require pre-travel screening with particular attention to unrecognized medical, dental, and psychiatric conditions. Travel advice should stress awareness about in-country access to pre-arranged medical services and the value of advanced medical/travel kits. Personal security is a major concern for travel to remote and conflict destinations.
The number of passengers and popularity of cruise ship travel has increased several thousand-fold over the past decade. The most common diagnoses of cruise passengers in cruise ship infirmaries include upper respiratory infection, injury, seasickness and gastrointestinal disease (diarrheal diseases).
The availability of convenient international (and domestic) travel has opened up possibilities for travelers with special needs to travel.
Special needs travelers includes:
- Malaria poses considerable hazard to mother and child.
- Food and water precautions are essential in the prevention of pathogens that are of particular high risk in pregnancy (eg hepatitis E, listeriosis, toxoplasmosis).
- Cardiovascular disease and accidental trauma are the leading causes of death.
- All older travelers, regardless of their health should have adequate health insurance to cover medical and repatriation costs while abroad.
Travelers with Pre-existing Disease
- When indicated, assessment of fitness to fly or to travel should be arranged especially for those with recent surgery or known cardio-respiratory disease.
- Patients with diabetes, renal or gastrointestinal disease should maintain adequate hydration and consider antibiotic prophylaxis for the prevention of traveler’s diarrhea during short trips.
- Copies of prescription medications and medications in original containers should be carried in hand luggage.
- Many travelers take high dose corticosteroids (Prednisone) or other agents such as antimetabolites (eg methotrexate) and alkalating agents (eg exclophosphamide) for connective tissue diseases and other immune-mediated disorders.
- Immuno-compromised travelers include those with HIV, organ transplantation and hematological malignancies, and a wide range of chronic diseases and associated drug therapies (chronic renal failure, cirrhosis, inflammatory bowel disease, rheumatoid arthritis, etc.).
- Careful planning regards medications and appropriate and effective vaccination programs are essential.
Visiting Friends and Relatives
- Those visiting friends and relatives (VFRs) make up a substantial portion of international travelers.
- VFRs traveling to certain countries are at increased risk of typhoid fever, malaria, STD’s (sexually transmitted diseases) and possibly TB.
- Children of VFRs born in industrialized countries, young VFR’s, and those from higher socio-economic society may be at greater risk of hepatitis A.
Short Term Corporate Travelers
- The frequent short-term corporate traveler should have his/her immunizations updated regularly to anticipate last minute travel.
- Jet lag, traveler’s diarrhea, casual sexual activity and security concerns are particularly important for this group of travelers.
- Prophylaxis for malaria is often best done with agents that can be discontinued soon after potential exposure.
- The disabled have the same rights to travel as the able bodied, but restrictions or conditions may apply where safety is an issue.
- Specific needs and attention that may be required should be arranged ahead of time whenever possible.