NED 3.0: Occupational and Student Travel Case Studies

Occupation Health: Short-term and Long-term Cases

  1. A 60 yo male employee leaving for two weeks in Bangkok. Comes in 10 days before trip. Cannot recall any immunizations. Would like to visit Elephant farm in Chang Mai during his free weekend. Consultant to agricultural company-may visit new GMO rice farms near Cambodian border. Staying in hotel with 2 other colleagues- one from Canada and one from Belgium. Took some prednisone for recent bout of poison ivy.
    • What are additional questions for the pre-travel assessment of this short-stay employee? What more do you want to know about his health history and his itinerary?
    • Develop a list of recommended vaccinations based on the health history and itinerary search.
    • Develop a list of priority health counseling topics based on the heath history and the itinerary search. Now list the top 7 topics that you will discuss with this traveler.
  2. Same employee now returning to Southeast Asia to help with development of 6 more rice farms. Expects to remain 3 or 4 months and travel extensively through the region. Staying in rental apartment. Recently diagnosed with adult onset asthma with multiple environmental triggers. Unable to return to asthma specialist as yet for f/u. Leaves in 3-4 weeks. Recently bought a motorcycle.
    • What are additional questions for the pre-travel assessment of this longer-stay employee? What more do you want to know about his health history and his itinerary?
    • Develop a list of recommended vaccinations based on the health history and itinerary search.
    • Develop a list of priority health counseling topics based on the heath history and the itinerary search. Now list the top 7 topics that you will discuss with this traveler.

Student Travel Case

  1. Female college student traveler 20 yo on need based scholarship who participates in a dog rescue project at home now going with large college group to Peru for 5 week winter session. This will be her first time out of the US with classes in Cusco and weekend trips throughout the country- Amazon, Lima, mountain village schools. She has a home stay for two weeks for language development; onsite dormitory for remaining time in country; her professor has made trip 4 times with no health or safety issues so he tells group no pre-travel care is really needed.
    • What are additional questions for the pre-travel assessment of this student? What more do you want to know about her health history and his itinerary?
    • Develop a list of recommended vaccinations based on the health history and itinerary search.
    • Develop a list of priority health counseling topics based on the heath history and the itinerary search. Now list the top 7 topics that you will discuss with this traveler.

Some Discussion Topics for Case #1 & #2

At the NED, each of these cases generated much discussion- clinical and administrative. The following topics are listed as just some of the important elements in the cases.

What are 6 or 7 most important counseling topics for this traveler? (We do not want to overwhelm the departing traveler. Prioritizing our prevention messages is an important part of the pre-travel visit. Not everything listed below can be included in a counseling session and substituting paper or internet for in-person counseling is not recommended.)

  • MVA-reminder of #1 risk to travelers
  • Birthdate and measles-significance from CDC perspective?
  • Aedes illness
  • JE-options for one dose, lower cost vaccines used and approved abroad?
  • Rabies- options abroad, non-vaccine counseling points
  • Last minute travel-maximizing prevention opportunities
  • Lack of vaccine record
  • Malaria-including knowlesi risk
  • Typhoid
  • Health maintenance challenges for frequent flyers and employees posted abroad
  • Travel stress
  • STIs
  • International differences in travel health preparation, vaccines, etc- how / why important to explain to traveler why their colleague MAY HAVE received different pre-travel guidance
  • Caring for the traveler with allergies
  • Post travel considerations- fever work-up, etc
  • Company policies, ADA, worker's comp, travel assistance insurance
  • Different foci of short term vs longer-term pre-travel counseling

Some Discussion Topics for Case #3

What are 6 or 7 most important counseling topics for this traveler?

  • Implications of no prior international travel
  • State Dept / IAMAT features useful for this student
  • Student identity card and travel assistance insurance
  • Reproductive issues, STIs, and other issues of female travelers, including travel medical kit items
  • Acute Mountain Sickness
  • Lack of funds- with implications/options for vaccines and meds
  • Men B-any role at all for travelers?
  • Rabies-options for this very costly, 3 dose series?
  • TD
  • Impact of peer pressure as member of group
  • Coordination with professor who may not follow CDC recommendations
  • Oral vs injectable typhoid- advantages/disadvantages for student travel
  • Isolated malaria risk- how to address "spotty" malaria risk going from place to place
  • YF vaccine need/shortage access
  • Post-travel implications

NED 3.0 References Utilized for Occupational and Student Travel Cases

Bazemore AW. The Pre-travel consultation. Am Fam Physi. 2009, Sep 15: 80(6): 583-90.

Burkholder JD et al. Health and Well-Being Factors Associated With International Business Travel. J Trav Med. 2010; 17 (5): 329-333.

Chen LH, et al. Business travelers: vaccination considerations for this population. Expert Rev Vaccines. 2013 Apr; 12(4):453-66.

Heywood et al. Travel risk behaviours and uptake of pre-travel health preventions by university students in Australia. BMC Infectious Diseases. 2012 Jan; 12:43.

Khan N et al. Pre-travel medical preparation of business and occupational travelers: An analysis of the TravEpiNet Consortium 2009-2012. JOEM. 2016; Jan; 58, 1.

Noble LM, et al. Travel clinic consultation and risk assessment. Infect Dis Clin North Am. 2012 Sep; 26(3):575-93. Review.

Rodgers B et al. An Update on Travel Vaccines and Issues in Travel and International Medicine. Workplace Safety and Health. October 2016

Sanford C, McConnell A, Osborn J. The Pretravel Consultation. Am Fam Physician. 2016 Oct 15; 94 (8):620-627.