Supporting Patients Before International Travel

International travel exposes patients to a range of infectious disease risks, making pre-travel planning and vaccination an important part of patient care. This course reviews recent travel health updates, including vaccine recommendations, emerging safety considerations, and prevention strategies for common travel-related illnesses. You will be better prepared to provide evidence-based recommendations, assess patient risk, and counsel travelers on vaccines and preventive measures before international travel.

HOST
Rachel Maynard, PharmD
GameChangers Podcast Host and Lead, Clinical & Partnership Education, CEimpact

GUEST
Lana Saad Sherr, PharmD
Assistant Dean for Professional Affairs,
University of Maryland Eastern Shore

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 CPE INFORMATION
Learning Objectives
Upon successful completion of this knowledge-based activity, participants should be able to:
1.Describe key vaccine recommendations and safety considerations for patients traveling internationally.
2. Describe prevention strategies for common travel-related infectious diseases, including mosquito-borne illnesses.

Rachel Maynard and Lana Sherr have no relevant financial relationships to disclose.

0.05 CEU/0.5 Hr
UAN: 0107-0000-26-251-H01-P
Initial release date: 7/13/2026
Expiration date: 7/13/2027
Additional CPE details can be found here.

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Transcript

Welcome And CE Credit Details

SPEAKER_00 0:00

Here on Game Changers, we're all about helping you stay ahead of pharmacy practice. But why stop at listening? You can earn CE credit for this episode and hundreds more by visiting CEimpact.com and logging into your account or creating a new one. Get credit, get inspired, and make your learning count. Hey CE Impact subscribers. Welcome to the Game Changers Clinical Update Podcast. I'm your host, Rachel Maynard. And with summer in full swing, it's the perfect time to talk about what's most important right now in travel health. We're seeing a resurgence of measles globally, leading to more emphasis on ensuring international travelers are fully vaccinated. Plus, mosquito-borne diseases are still a common risk for travelers, and there have been some updates in prevention strategies for these two. So today we'll focus on the most pressing changes in travel health vaccines and other prevention strategies, what we as pharmacists may need to do differently in practice, and how to be prepared when patients come to us with questions. So to help us narrow in on those key updates, I'm excited to introduce our guest, expert, Dr. Lana Scher. So welcome, Lana. Thank you. Thank you, Rachel. Very excited to have you. And to help our listeners learn a little bit about you, maybe you could just share a little bit about your background and your current role and why you're interested in this topic.

SPEAKER_01 1:13

Yes, sure. My name is Lana Santair. I'm the Assistant Dean for Professional Affairs and Associate Professor at the University of Maryland Eastern Shore School of Pharmacy. I started my career as in academia and as a clinical pharmacist, and I've been doing this for the last 10 to 12 years, and I really enjoy it. I like working with patients and students at the same time. Also the founder of a functional medicine program. So we look at chronic disease prevention and treatment as well as women's health. And we also are the owner of an independent pharmacy here where we live. So I've been recently introduced more to community pharmacy. And I think that part will be relevant to our discussion today.

SPEAKER_00 2:02

Absolutely. Yes, it's definitely an area. I certainly, uh regardless of practice setting, I think travel questions come up and we can make an impact. But definitely in community pharmacies, I think patients are often maybe coming up and just sort of have questions and want their questions answered, and that we can provide that resource for them and provide that education. So absolutely. Thank you again for your time and for carving out, carving out a little bit to chat with us. But um, let's just start out with some general considerations when we're thinking about travel health. You know, I said it's summer and we're thinking about more people traveling, whether globally

Why Travel Health Needs Attention

SPEAKER_00 2:37

or or even domestically, but we're thinking more, I think, in this discussion around international travel. And so, what are some of the main safety considerations that patients need to be aware of? And we as pharmacists need to be thinking about when patients are asking or preparing for international travel.

SPEAKER_01 2:53

This is a really timely topic as international travel has picked up again, you know, after the pandemic. And I guess when I was um reading about it, there's about 1.4 billion people estimated to travel annually this year. So it's a lot of traveling. And so we as pharmacists, when we work with our patients on their international travels, we first of all refer to the CDC website, and then we work with the patient in a very individualized way. So we start with basic questions, we ask the patient where they're going, how long they're going to be gone for, the purpose of their travel, and we also look at any underlying health conditions. Um, so we look at all of that information to make sure that we're aware of their destination as travel risk varies greatly depending on the destination. Another area we look at is vaccines. So we want to make sure that they're up to date on their routine immunizations. And then again, by you know, reference referencing the CDC, we could look at country-specific or region-specific vaccine recommendations that we can add before they head out to those trips. And so we think about it like your routine immunization is the baseline, and then now we need to make sure that you're protected and immune to before you go on that trip. Other things we counsel on are general, you know, infectious disease prevention. So water safety, food safety, sexually transmitted disease in certain areas that are prevalent into that. We also look at non-infectious causes of injury and also those like um road safety, personal security constitute the major risk of illnesses and deaths for travelers. So we talk about them, you know, do you have a health insurance, um, travel insurance? Do you know where you're going? If you're insured or you're sick, do you do you know where to go while you're on on your trip? So we start with a conversation with the basic questions, uh, in addition to some clinical information. Immunization, like I said, is very important. And then that will take us to um a plan, more of a like a comprehensive approach to this is what we're gonna do. And you know, that's what we want to do as well.

SPEAKER_00 5:17

Yeah,

Fast Pre Travel Risk Questions

SPEAKER_00 5:18

I uh you highlighted a number of great considerations, I think that many of us may not even consider top of mind. And and those are exactly the sorts of things that I patients may not be thinking about either, and that we can, again, really play a big role in ensuring that they're considering those aspects before they're abroad, and maybe then it's more difficult to get answers or get access to things they may need. So I the idea around not only just the patient and individualizing your recommendations based on them, but also the country and individualizing based on that, because as you said, CDC has a great website that really very clearly and easily, it's very easy to use, lays out what the potential risks are for a given country. And so the patient just needs to tell you where they're going and you can really weave those thoughts together with the patient's considerations and the country's considerations. So that was a really important discussion point there. I also appreciated that routine vaccination is the baseline. And then, as you said, the the international travel vaccines that a person may need is on top of that. But it's a great opportunity too to re-evaluate if they're up to date on routine vaccinations, because not everyone is, and then if you need to go beyond that with the travel vaccines, and then you know, you mentioned road safety and and um uh infectious diseases risks and hand hygiene and safe water use and all of those sorts of things. Um, and I even something like bringing a first aid kit, making sure they know some of the basic materials to have on hand. And I love your point about health insurance too. That was a very good call out because it can be quite expensive depending on where you are and if something were to happen. So lots of things to wrap our heads around there. So that's a great overview. If you were thinking about the most timely sort of considerations right now for international travelers, that's that's certainly a lot that we could cover. But if we only have a few minutes to chat with a patient, what are some of the most common issues right now that you'd want to be highlighting? You mean with the patient? Yeah, like so um you mentioned um vaccinations and what's coming to my mind is measles as something that's really seeing this global resurgence and making sure patients are up to date with that.

Measles Comeback And MMR Timing

SPEAKER_00 7:36

So things like that. Like, what would you for a pay? Yeah, in terms of measles specifically, let's dive into that a little bit.

SPEAKER_01 7:42

Yeah, in terms of measles specifically, and we are seeing an increased um resurgence of some of the vaccine preventable illnesses that we thought we've eradicated and moved on. But as you are seeing with measles, it's coming back whether here or whether globally. So with measles, it's a it's a very contagious pathogen. And so it spreads through the air and it lingers in the space. So people who aren't fully immune, they haven't completed their immunization series for measles, can catch the virus. And the issue that we are seeing also is that those people, when they travel back home, they're bringing the virus with them and they're exposing people around them. So it becomes more, you know, beyond just the individual, but also you're affecting people around you, the community, and that's how outbreak starts. And so for visa specifically, or any outbreak, the CDC has information on their website. They they issue travel health notices. And so, as clinicians or as travelers, it's important to look at those updates. Is there an outbreak going on somewhere? What are the vaccine recommendations? Has has there been any changes in the immunization requirements for that specific country? So all that information is available for us and for the patient as well.

SPEAKER_00 9:10

And it changes too. So it is important to stay on top of it. And just because you maybe checked it a couple of weeks ago, not assume it's the same because those those recommendations can change for sure. But yeah, I think the the measles resurgence uh in the US and globally is is a good reminder for us to be encouraging those discussions, as you say. Like if you're talking with a patient and they let you know they're planning to travel internationally, that's a great question to ask. Okay, are you up to date? Have you received measles vaccination? Are you up to date? Because vaccination is at least right now recommended, required, uh, recommended, regardless of where people are traveling internationally. So I think the recommendation is to ensure that they're vaccinated at least two weeks before leaving. And so that also brings up questions around well, that's why it's good to be having these conversations sort of throughout the conversations we're having with patients and and throughout those patient care visits versus maybe just a week before they're planning to leave.

SPEAKER_01 10:09

Yeah, and and we really we should have those discussions four to eight weeks prior to the travel. As you know, mentioned with Mises, they have to be vaccinated two weeks prior. We, you know, we are we see also that with you know prophylactic agents, they and they have to start them a couple of weeks before and take them throughout their travel. But going back to um measles, so the MMR vaccination is recommended for anyone uh 12 months and older. And so it's uh it protects against measles, mumps, and rubella. And the diff the time difference, the time uh gap between the first and the second dose should be at least four weeks or 28 days. So here you have, you know, 28 days before between the first and the second dose, and then two weeks for the body to produce immunity. So we're talking six weeks just for that particular vaccine. And so that's why it's important to have those conversations early on so that we are prepared and help the patient be prepared and also allow their body to produce immunity before they travel to that destination.

SPEAKER_00 11:22

Absolutely. And I'll just say that that's specifically for travel vaccination. Uh, routine schedule is a different what we're talking about a compressed timeline if people need to be getting vaccinated before they travel. But the recommendations, of course, ideally we're we're having patients follow the routine MMR recommendations. But in this case, as you said, there's going to be a little bit of a compressed timeline. And so we want to be sure that we're having those act those conversations proactively. And you also alluded to the prevention considerations with uh medications and uh I'm I suspect you're talking about malaria, but maybe we can transition into some of those mosquito-borne diseases and and what considerations need to be um weighed there.

Malaria Prophylaxis And Key Options

SPEAKER_01 12:07

Yeah, so again, you know, if you check the CDC website before you travel about, you know, you research mosquito-borne illnesses. There's an extensive list there, but I'll summarize just a few of the most common. Sure. Yeah. Malaria is probably one of the most serious ones. It is a parasite that is transmitted through a mosquito bite, and it could be life-threatening if left untreated. Well, with malaria, luckily we have prophylactic drugs that the patient can start taking a week or two before their trip, they have to continue taking them during their trip, and also after they come back to make sure if they caught something towards the end, they're still covered. So there are drugs such as atovacone, the antibiotic doxycycline, antimalarial agents, uh, chloroquine, methloquine, so all of these. So depending on the drug, they may have to take it, you know, a couple of days before they leave or a couple of weeks before they leave. So we can again individualize and work with the patient on those. But there are other mosquito-borne illnesses, so Zika virus, for example. And this is mostly important for pregnant women because of the risk of birth defect. Another one is dengue or dengue fever, which is common in tropical and subtropical areas. And so that one can cause fever, body aches, but there's a complication with dengue that is um hemorrhagic dengue, which is rare, but something also to keep in mind. And then chicangonia, which is has a vaccine. We'll talk about it in a minute, but the other ones don't have a vaccine to prevent. And for Zika and dengue, for example, there are no prophylactic agents like malaria. These are viruses. So the best way to cancel the patient on those is the use of non-pharmacological ways to prevent, you know, using EPA approved insecticides, wearing protective clothing, long sleeve shirts, long pants, um, which can be tricky because you're most of them are hot and humid areas, but that's to prevent the use of mosquito nets for you know over the beds in the evenings. Um, they're actually cool. I've been to a couple hotels um in Zanzibar and Tanzania. And before you go on the safari, you sleep in these cute hotels, and it's you know, the mosquito nets are part of part of the decor, but yeah, yeah, yeah. One thing that's really cool to know is also when these mosquitoes are mostly active. So, like Denji and Zeke are more active during the day. So you know during the day that you were, you have to be more careful versus malaria is more active in the evening.

Dengue Zika And Bite Prevention

SPEAKER_01 14:58

So wearing this protective clothing and sleeping under a net, you know, is also another preventative strategy. So just knowing when they're more active, so you could be more protective and you know, yeah.

SPEAKER_00 15:14

Yeah, I I think you brought up a good point too that uh these are often areas where people aren't wanting to wear any heavy clothing or long sleeve or pants. So it can be challenging. And that's why those insect repellents are also really a key prevention strategy. And again, I think those can be uh people may not feel that they want to wear an insect repellent all the time. But when you think about some of the consequences of these diseases, it can be pretty dramatic. And so it's it's worth reminding, it's just like sunscreen, right? Wearing sunscreen else is also important. And with the risk of some of these mosquito-borne illnesses, it's it's important for them to be proactive in in wearing those uh insect repellent repellents. Um, and then as you say, the whenever possible covering up, but also those mosquito nets, and ideally in places where it is a concern, like you say, the the lodging often has some of that provided as well. So just being aware of that too. But you know, I think we've seen uh sort of ebbs and flows of these outbreaks with dengue and some of these other mosquito-borne illnesses. So again, that's something just to keep on top of with CDC, but like you say, um being proactive and because those prevention medicines for malaria too also need to be potentially started in advance. Another good reason to have those conversations up front. Yeah, yeah. Yeah. Um so you alluded to the uh the vaccine that we do have a vaccine for one of these mosquito-borne uh conditions. Tell me a little bit more about

Chikungunya Vaccine Safety Update

SPEAKER_00 16:42

that.

SPEAKER_01 16:42

Yeah, so there has been a recent um change in the vaccine requirements for chicken gonia. So it there is a vaccine for it. The the old one was um live attenuated vaccine. So it's um it's not uh it's not a dead vaccine, it's a weakened vaccine that when it's administered to the human body, it stimulates immunity versus the actual illness. But there has been reports of serious complications and side effects with the use of that particular vaccine. So there has been a case report of encephalitis and a few case reports of severe cardiac complications. So the CDC has issued new recommendations for chicken gonia to use the non-live vaccine. Um, it's called um virus-like particon. And so, with that one, um the risk of having those complications it hasn't been documented. So it's a safer vaccine. And it's recommended for anyone 12 years and older going to regions with um high chic and gonya activity. So it could be an outbreak regions, or it could be if you're just going to that area and planning to stay for a prolonged period of time. And it's a one dose only, so there is no booster or anything like that, just one time, and you um should be protected against chic and gonya.

SPEAKER_00 18:05

Yeah, so that was a change within the last year or so where this non-LIVE vaccine was approved, and uh ACIP made the recommendation for it uh last last year. And so that might be something again that uh people may not be aware of that there there is a vaccine for this. And again, it depends on the area. And so that's why you need to check the CDC website to know where there might be outbreaks happening, but it is an option that's available and also that change that the previously live attenuated vaccine is is has the safety concerns, and I think it's actually no longer on the market. I think the manufacturer decided to withdraw it. So so good to know some of those changes happening too with the vaccines. Um, and you know, I I there's lots of other vaccines that we aren't uh the when thinking about travel health, there's lots of vaccines that could be considered. I don't know if you want to highlight any others that we should be

Other Vaccines And Trip Details

SPEAKER_00 19:01

thinking about or the ones that come to mind most often with international travel.

SPEAKER_01 19:05

I think um the MMR vaccine is one we talked about that. Typhoid fever is maybe polio is another one. Trying to see if I'm forgetting anything.

SPEAKER_00 19:17

Well, yellow fever comes to mind. Um yeah, and that one requires a few like specific um documentation around that. Um, I think in some regions, hepatitis A is one that people also are recommended to receive. Japanese encephalitis. I think there's it's but again, it's so variable depending on the region you're going to. And so you're probably depending on your your patients and and where they tend to travel, you're maybe more likely with some versus others. But that's why you say the CDC website is a really helpful resource to just narrow in on what you need to know.

SPEAKER_01 19:49

Yeah. And like you said, depending on what your practice looked like, where your pharmacy is located, you may not see that it could be part of your, you know, day-to-day, or it could be something that occasionally gets a patient. And so checking the resources is very important. Um, when I completed my residency, actually, I spent a few days in a travel clinic that was pharmacist run. And it made me appreciate a pharmacist in that space. But I learned so much about you know, different, you know, countries that people were going to and you know, different vaccine requirements, different um viruses, pathogens, mosquitoes in those areas. So again, you know, it depends where they're going to and what they'll be doing. So you should look at is, you know, are you going to a conference to that place where you're right, right? And you're not going to be outside much? Or are you planning to go hike, I don't know, Mount Kilimanjaro and be in urban area and be exposed to that. So the risk varies depending on where they're going and the purpose of the trip.

SPEAKER_00 20:58

Absolutely. Yeah, and how how long they'll be there too. And as you say, the types of activities, all of that comes into that uh decision making as well. Very important points to ask about. Uh, so in terms of where you'd start with a patient who say they're coming up, they're planning to travel, say they are traveling in uh several months and they're just wanting to start planning ahead. What

Using Registries And Patient History

SPEAKER_00 21:21

are sort of the highest impact questions that you might want to ask or takeaways you'd want them to be aware of?

SPEAKER_01 21:28

Yeah, so first of all, when they're leaving is the first important question to see if we have time to go through the immunization, or do we need to be creative and how we'll you know provide the same care, but like you said, more in a crunch time. So, what do we do in that the destination, where they're going, so that we can look up all that information. So the pharmacist needs time or the clinician to come up with a plan, but also, like we said, you know, back. Vaccines, medications, all of that, the patient has to be prepared and give themselves time to take them and for the immunity to kick in and all of this. As a pharmacist, I want to make sure that I have a clear idea of their health history, right? Because are they immunocompromised or pregnant? Are they on medications that may, you know, be a contraindication to getting a vaccine? So we should get a clear understanding of their medical history. Here in Maryland, we also have access to Immunet, which is the immunization registry for the state of Maryland. So we could look up information about their vaccine history. That's great. And that way we're not missing anything or duplicating because sometimes you forget, you know, there's so many vaccines and between and addition and all of this. Yellow fever, for example, every 10 years. So they don't have to get it if they've already received it. So if it's documented, they're good. So questions like that are very important for you know creating a plan for them.

SPEAKER_00 23:10

Absolutely. And yeah, it's it's so helpful when you have access to a registry or database to be able to collect that information easily. Because as you say, people not only are there so many vaccines, but there's so like they may have been received long ago and not remember exactly when that was, or was it 10 years or not? And time flies.

SPEAKER_01 23:30

So you just never know. If there's hesitancy, like if they don't know, and they'll say, Maybe I had it, maybe I didn't, and they really don't want to take another vaccine. You could test for antibodies, but all of this takes time, right? So sometimes they'll say, Well, I've had um measles before. Um, you could test and check to see, but you know, sometimes that information may not be available, or we can, or it's too quick. So the best thing to do is take that extra shot because for the majority of people it's generally safe. But yeah, yeah, looking at all of these factors.

SPEAKER_00 24:08

Yeah, absolutely. And uh, I think in some cases too, depending on the country, there may be documentation requirements. And so depending on what you have access to in the country and the vaccine you're talking about, you may or may not need to have some documentation. And again, that goes into your point about looking at this early and and working with the patient on their specific needs. So fantastic point. Anything else that we're missing from uh general uh considerations in terms of uh prevention strategies or even um management once they're there, any any sort of key takeaways that we want to be thinking about that we maybe haven't touched on yet?

SPEAKER_01 24:47

I

Medication Kits And Time Zone Dosing

SPEAKER_01 24:48

think when it comes to prevention, there are no prioritization. I think everything is important, right? So we can't rank them like that. But when I talk to the patients, like layering prevention. So start with the things you could do, all of your non-pharmacological avoiding the injury or the risk. Not that we want them to worry about that so much on their trip. You want to have fun on your trip, but sure, um, you know, layering those preventative strategies, making sure that you are up to date on your vaccine, that you're, you know, have the sprays if needed, that you have your travel insurance, that you have the your medication kit. Um, another point for pharmacist um counseling point that pharmacists can do is make sure that the patients have their prescription, um, make sure that the the patients have their prescriptions medications. Oh, absolutely. You know, when we travel, my husband, my husband and I are both pharmacists, and we have this little pharmacy that travels with us and we have prescription medications, some OTC, anti-diarrheal agents. You know, our kids that are traveling with us, you know, your children's medication, an epipen if somebody's allergic or has had an anaphylactic reaction. So the basics. And also as pharmacists, one thing we should never forget is if they're going to a different time zone, counsel them on the timing of when to take those medications so that they're still on schedule and that the first dose they take when they're abroad is not too far or too close to the last dose they took. So things that we may not think about on a day-to-day basis, but when it comes to travel medicine, we should be thinking about all of these um things.

SPEAKER_00 26:40

Yeah, absolutely. I I that's a great point too, the the time zone changes and helping to adjust timing of medications and not because it can be very confusing in general with with lack of sleep and or extended time time zones and how to navigate that. So again, that has to be a very patient-specific conversation depending on the medication and how far they're traveling and what the time zone difference is. So I'm glad you brought that up too. Good reminder. Yeah. So we're about out of time, but um, this is our game changers podcast. So I do want to wrap up with what you would say is the most important takeaway that you'd want our listeners to

Preparation Is The Game Changer

SPEAKER_00 27:20

walk away with. What is the game changer for this topic?

SPEAKER_01 27:23

Yeah. So if I want to leave with one takeaway, I think preparation is the game changer. So, you know, for our patients, I say make sure that you're not, you don't wait to the last minute. Schedule those appointments, pre-travel appointments, four to six or even eight weeks before the travel date. And then for pharmacists, you know, help the patient be prepared so that they are, you know, equipped before they travel, that they've received their immunization, they have all the drugs that they need. You know, at the end of the day, like we said, we want them to enjoy the trip and not worry about all of these extra factors. So, you know, some things you can't prevent, right? Um, but if there is, if there are risks that are preventable and we as pharmacists can help prevent, then this is the time to do it. Um, and you know, travel smart and you know, yeah.

SPEAKER_00 28:16

Absolutely. I yeah, prevention is key here, and just I it can be as easy as something like, oh, do you have any travel plans this summer? And that can be the cue that then leads you down the path to have a really proactive conversation about it.

SPEAKER_01 28:33

So Alana, thanks so much. Oh, yeah, go ahead. I was gonna say that's the cool part about working in a community pharmacy. You get to know your patients, and sometimes it could be just a side conversation you're having next thing that they're going, and that's where absolutely start, yes.

SPEAKER_00 28:49

Yeah, yeah. Alana, thank you so much for your time for making time out of everybody's schedule. I really appreciate your insight on this, and it is a topic that will continue to come up year after year and every time a year too, because people travel at all times of year. But uh with summer, we thought it was a good time to relook at this. So thank you for taking the time. Appreciate it.

SPEAKER_01 29:06

Yeah, thank you, Rachel. I enjoyed being part of that conversation as well. Excellent, thank you.

SPEAKER_00 29:13

Well, we talked about a lot of great practical tips today, and these will all be summarized in the practice resource that goes along with this podcast on the CE Impact website. Listeners, be sure to claim your CE credit for this episode of Game Changers by logging in at ceimpact.com. And as always, have a great week and keep learning. I can't wait to dig into another game changing topic with you all next week.