Preparing patients to travel abroad safely - Part 1: Taking a travel history avid identifying special risks

OBJECTIVE To present for family physicians without access to a travel clini c and the Internet the questions to ask about the medical history and itine rary of their patients traveling abroad. To suggest ways to identify and ad vise high-risk patients. QUALITY OF EVIDENCE MEDLINE searches from 1990 to November 1998 located 51 articles on travel and diabetes, 37 on travel and chronic obstructive pulmo nary disease (COPD), 63 on travel and heart disease, 192 on travel and preg nancy, and 298 on travel with infants or children. Additional searches were undertaken in September 1999. The quality of evidence in most articles is level III (expert opinion). There are no randomized controlled trials of th e best advice for family physicians to give travelers. MAIN MESSAGE A history should include countries to be visited, planned acti vities, previous tropical travel, medical history, vaccination status, whet her children are traveling, pregnancy status, and patients' opinions of the risks and precautions needed. Detailed advice should be given to reduce ri sks. The main causes of mortality abroad are existing cardiovascular condit ions and accidents. High-risk conditions to be identified in travelers are cardiovascular illness, COPD, diabetes, immunodeficiency, pregnancy, and tr aveling with children. CONCLUSIONS Patients with cardiovascular illness or COPD should be advised to avoid too much exertion while traveling. Detailed instruction should be given to diabetic patients on how to maintain stable glucose levels, to pre gnant women on avoiding malarial infection, and to parents on protecting th eir children from infections and accidents.