Are you destined for a healthy trip aroundtheworld?

TRAVEL MEDICINE raises three questions: where have we been, where are we now, and where are we going? We have come a long way since the Wright brothers built the first successful aeroplane in 1903. Now, with the Airbus A380, the largest passenger airliner in the world, travellers can go around the globe with increasing speed. And with more than 400 people signed up to fly with Virgin Galactic, space may yet prove to be the ultimate tourist destination. We really have travelled a long way and we will continue to do so.

UK residents made 65.7 million visits abroad in 2015, so the clinical practice of travel medicine has never been more important. Protecting the health of travellers can be complex and varied, as it involves all ages from infants to older people with all types of underlying health conditions, travelling to diverse destinations.

Completing a travel health risk assessment enables the travel health practitioner to understand what will be needed. RISK ASSESSMENT INCLUDES

recommendations for malaria tablets and, for experienced travellers, strategies for standby self-treatment. There are several varieties of malaria tablets and, following a careful review of a traveller’s health and itinerary, the most appropriate one can be prescribed. Tablets do not provide 100 per cent protection, so bite-avoidance measures such as applying DEET repellent spray are essential.

recommendations for vaccine-preventable diseases. Faster schedules have now been approved for administering courses of vaccinations such as hepatitis B, rabies and Japanese B encephalitis. As influenza is the most common vaccine-preventable disease contracted by international travellers, an annual flu vaccination is a wise precaution. It is hoped that in the future, flu vaccine will be available year round to protect travellers.

Since July 2016, yellow fever vaccination certificates are valid for life (previously a booster was required every 10 years). But boosters may still be needed in certain circumstances.

the travel health management of high-risk travellers, who should always be evaluated with care and advised accordingly. They include diabetics, the immunocompromised, those with cardiovascular, renal, neurological, gastrointestinal, malignant and other disorders, psychological and psychiatric illnesses, pregnant women, children and the elderly.

other groups requiring special consideration include gap-year travellers (pre/post university, midlife or postretirement).

other emerging travel medicine issues such as health tourism, meeting the travel health needs of those visiting friends and relatives and the important topic of migrant health.

altitude medicine consultations for more adventurous travellers tackling extreme environments. Of course the most intrepid will be those travellers whose adventurous streak stretches to exploring space, so space tourism may well be considered as the future in travel health.

Increasing numbers of people are seeking employment or looking to study abroad. Their visa application includes a medical examination and investigations such as a chest x-ray, ECG and blood tests. Travel medicine practitioners are well placed to complete these and to advise on which vaccinations should be considered, such as MMR, varicella (chickenpox) and meningitis.

After clean water, vaccination is the most effective public health intervention in the world for saving lives and promoting good health. Vaccines which have become available recently include a new human papilloma virus vaccine and a vaccine against meningitis B.

When taking advice on travel medicine, you should consult someone with knowledge of all the above, as well as an understanding of the underlying science, epidemiology and health risks of travel.

Re-emerging and emerging infections such as Zika virus act as a timely reminder of the importance of continuing surveillance.

Although the prevention of illness and infectious disease is an essential component of travel medicine, accidents are the most common cause of illness and fatality while travelling and every travel health consultation should discuss this. Dr Jane Zuckerman is consultant and clinical lead in travel medicine at the Royal Free London Travel Health and Immunisation Clinic, which runs a onestop travel-health service: vaccinations. royalfreeprivatepatients.com