Travel medicine

Begin with the traveller. Record age, pregnancy or plans for pregnancy, breastfeeding, immune suppression, allergies, past vaccine reactions, splenectomy, renal or liver disease, seizures, mental health, disability and current medicines. Confirm previous vaccination from records when possible rather than accepting “all up to date” as a complete history. Ask about prior malaria, altitude illness and travel-related thrombosis. Clarify who will manage a chronic condition if it destabilises abroad.

Map the itinerary precisely: countries, transit airports, regions, urban or rural setting, altitude, season, dates, trip length, accommodation and distance from medical care. Ask why the person is travelling and what they will do: visiting friends and relatives, healthcare work, animal contact, caves, freshwater swimming, mass gatherings, humanitarian work and sexual contact change risk. A traveller visiting friends and relatives may stay longer, share local exposure and underestimate familiar hazards.

Timing shapes priorities. TravelHealthPro advises assessment ideally at least four to six weeks before departure, and earlier for pregnancy or pre-existing disease. Some vaccine courses and immune responses need time, but a late appointment still allows routine catch-up, selected accelerated schedules where authorised, bite and food advice, insurance planning and an informed decision about itinerary. Never dismiss a last-minute traveller without assessment.

Separate three vaccine questions. Routine UK vaccination protects both traveller and community. Recommended travel vaccines address the individual exposure. Required vaccination or certification responds to destination or International Health Regulations entry rules. These sets overlap but are not interchangeable. Use the current Green Book, product information, patient factors and country guidance for schedule and contraindications. Do not invent a universal travel-vaccine bundle or give a live vaccine before checking immune status and pregnancy.

Yellow fever illustrates benefit-harm reasoning. Transmission risk depends on country and itinerary, while serious vaccine adverse events are more likely in some older, immunosuppressed or thymus-disorder groups. Use the dedicated checklist and an authorised Yellow Fever Vaccination Centre. A certificate can be valid for life under the International Health Regulations, but clinical revaccination decisions and entry rules still require current expert guidance. A medical exemption does not protect against infection, so itinerary and mosquito avoidance remain central.

Malaria risk varies within countries and over time. Use the 2026 UKHSA malaria prevention guideline and current TravelHealthPro maps. Prevention combines awareness, bite avoidance, chemoprophylaxis when advised and prompt diagnosis. Drug choice depends on region, resistance, age, weight, pregnancy, renal function, interactions, psychiatric or seizure history and timing. Because regimens are product- and itinerary-specific, prescribe only after checking the current recommendation and exact monograph rather than extrapolating a remembered dose.

Bite avoidance applies even without malaria tablets because dengue, chikungunya, Zika and other vector-borne infections may lack vaccines or prophylaxis. Discuss covered clothing, room barriers, nets and an effective repellent used as directed. Day-biting and night-biting vectors differ, so “only use repellent after dusk” is incomplete. Fever, rash, arthralgia, bleeding or neurological symptoms after travel need an exposure-aware clinical assessment.

Food and water advice should be realistic: hand hygiene, safe water, thoroughly cooked food and avoidance of high-risk items where sanitation is uncertain. Give an oral rehydration plan and thresholds for clinical help, especially for young children, older people and those with renal or cardiac disease. Persistent diarrhoea, blood, severe pain, high fever or dehydration needs assessment. Antibiotic standby plans are reserved for selected travellers after individual review and must specify indication, contraindications and resistance context.

Animal contact creates rabies risk. Avoid touching mammals, including apparently friendly dogs, cats and monkeys. After a bite, scratch or saliva exposure to broken skin or mucosa, wash the wound thoroughly and seek urgent expert care locally; do not wait to return to the UK. Pre-exposure vaccination simplifies but does not remove the need for post-exposure assessment. Remote travel, duration and occupational exposure influence whether pre-exposure vaccination is recommended.

Plan chronic medicines. Check legality in destination and transit countries, carry adequate supply in original labelled containers, and bring copies of prescriptions and a clinician letter when appropriate. Consider time zones, refrigeration, needles, controlled drugs and backup supply. Air travel, immobility and oxygen requirements may need specialist or airline arrangements. Pregnancy, immune suppression and complex cardiopulmonary disease often warrant earlier specialist advice and may justify changing the itinerary.