Patients should be mindful of mosquitos. Stress the importance of preventing mosquito bites (as much as possible). Advise patients traveling to mosquito-infested areas to use insect repellents containing 30% N-diethyl-meta-toluamide (DEET) and permethrin-treated clothing.34 Tell them, too, to wear long sleeves, pants, and footwear that provides full coverage.35 Ensuring that sleeping areas are properly screened or air-conditioned will further reduce the likelihood of mosquito bites.36
FAST TRACK
Advise travelers to consider purchasing supplemental medical insurance, medical evacuation coverage, and trip cancellation insurance.
CASE After seeing the chief complaint listed as “Traveling to Kenya” on Professor R’s chart, you quickly review the CDC’s Travelers’ Health Web site. You encourage him to stay with his tour group and to wear a seatbelt whenever possible. You also review how to make a personalized travel health kit, and encourage him to register with the Smart Traveler Enrollment Program (STEP) (detailed at https://step.state.gov/rep) before leaving for the safari. You strongly suggest that he consider purchasing additional medical evacuation insurance, as well.
Given the prevalence of travelers’ diarrhea, along with dengue and malaria, in Kenya, you review food and water safety and avoidance of insect-transmitted diseases with the patient, and write a prescription for ciprofloxacin to be taken if he develops diarrhea. Professor R is not at high risk for VTE, but you encourage him to stay hydrated, avoid sedating medications, and be diligent about mobilization during lengthy flights. You recommend melatonin for jet lag.
To adjust to the heat, you recommend that he avoid strenuous exercise in the first few days and drink sufficient fluids throughout the trip. You administer the Tdap vaccine, an adult polio booster, and the hepatitis A vaccine, verify that he has received his pneumococcal and influenza vaccines, and prescribe an antimalarial medication.
And as you walk him toward the door, you offer him one final piece of advice: Take plenty of pictures.
CORRESPONDENCE Jeffrey D. Schlaudecker, MD, The Christ Hospital/University of Cincinnati Family Medicine Residency Program, 2123 Auburn Avenue #340, Cincinnati, OH 45219; Jeffrey.schlaudecker@uc.edu
