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CDC Health Information for International Travel 2008

Chapter 8
Advising Travelers with Specific Needs

Traveling with Chronic Medical Illnesses

Deborah Nicolls Barbeau

General Preparation: Practical Considerations

Although traveling abroad can be relaxing and rewarding, the physical demands of travel (e.g., maneuvering through a crowded terminal, rushing to catch a flight) can be stressful, particularly for travelers with underlying chronic medical illnesses. With adequate preparation, however, those with chronic medical illnesses can have safe and enjoyable trips.

The following is a list of recommendations for travel advisors to help those with chronic medical illnesses:

  • Ensure that any chronic illnesses are stable. Persons with underlying medical illness should see their physicians to ensure that the management of their illness is optimized.
  • Recommend seeking pre-travel consultation early, at least 4–6 weeks prior to departure. This is to ensure that there is adequate time to respond to immunizations and, in some circumstances, to try medications prior to travel.
  • Provide a physician’s letter. The letter should be on office letterhead stationery, outlining existing medical conditions, medications prescribed (including generic names), and any equipment required to manage the condition.
  • Advise travelers to pack medications in carry-on luggage in their original containers. Ensure sufficient quantities of medications for the entire trip, plus extra in case of unexpected delays. When crossing time zones, medications should be taken based on elapsed time, not time of day.
  • Educate regarding important drug interactions. Medications used to treat chronic medical illnesses may interact with medications prescribed for self-treatment of travelers’ diarrhea or malaria chemoprophylaxis. Discuss all medications used, either daily or on an as-needed basis.
  • Recommend consideration of supplemental insurance. Consideration should be given for three types of insurance policies: 1) trip cancellation in the event of illness prior to travel; 2) supplemental insurance so that money paid for health care abroad may be reimbursed, since most medical insurance policies do not cover health care in other countries; and 3) medical evacuation insurance (see the Travel Insurance and Evacuation Insurance section in Chapter 2).
  • Help devise a health plan. This plan should give instructions for managing minor problems or exacerbations of underlying illnesses and should include information about medical facilities available in the destination country (see the Obtaining Health Care Abroad for the Ill Traveler section in Chapter 2).
  • Recommend that the traveler wear a medical alert bracelet.
  • Always advise the traveler about packing a health kit (see Travel Health Kits section in Chapter 2).

Specific Chronic Medical Illnesses

Issues related to specific chronic medical illnesses are addressed in Table 8-9. These recommendations should be used in conjunction with the other recommendations given throughout this book. Additional resources for information include—

Also, many international health-care facilities are accredited by Joint Commission International, an affiliate of the Joint Commission, which is the largest accreditor of U.S.-based health-care organizations. A list of accredited international facilities is available at their website, www.jointcommissioninternational.org (see the Obtaining Health Care Abroad for the Ill Traveler section in Chapter 2).

If travelers or their health-care providers have concerns about fitness for air travel, the medical unit affiliated with the airline is also a valuable source for information.

References

  1. Aerospace Medical Association; Medical Guidelines Task Force. Medical guidelines for airline travel, 2nd ed. Aviat Space Environ Med. 2003;74(5 Suppl):A1–19.
  2. McCarthy AE. Travelers with pre-existing disease. In: Keystone JS, Kozarsky PE, Freedman DO, Nothdurft HD, Connor BA, editors. Travel medicine. 2nd ed. Philadelphia: Mosby; 2008. p. 249–55.
  3. Chandran M, Edelman SV. Have insulin, will fly: diabetes management during air travel and time zone adjustment strategies. Clinical Diabetes 2003;21:82–5.
  4. Simons FER. 9. Anaphylaxis. J Allergy Clin Immunol 2008;121(2 Suppl):S402.

Table 8-09. Special considerations for travelers with chronic medical illnesses

Condition Absolute and relative contraindications to airline travel Pre-travel considerations Immunizations Miscellaneous
Cardiovascular diseases
  • Uncomplicated MI within 2–3 weeks
  • Complicated MI within 6 weeks
  • Unstable angina
  • CHF, severe, decompensated
  • Uncontrolled hypertension
  • CABG within 10–14 days
  • CVA within 2 weeks
  • Uncontrolled arrhythmia
  • Eisenmenger syndrome
  • Severe symptomatic valvular HD
  • Supplemental oxygen
  • Plan for self-management of dehydration and volume overload, may include adjusting medications
  • Bring copy of recent EKG
  • Bring pacemaker or AICD card
  • DVT precautions
  • Influenza
  • Pneumococcal
  • Consider hepatitis B
  • Have sublingual nitroglycerine available in carry-on bag
  • Mefloquine not recommended for persons with cardiac conduction abnormalities, particularly for those with ventricular arrhythmias
Pulmonary diseases
  • Severe, labile asthma
  • Recent hospitalization for asthma
  • Active respiratory infection
  • Pneumothorax within 2–3 weeks
  • Pleural effusion within 14 days
  • High supplemental oxygen requirements at baseline
  • Major chest surgery within 10–14 days
  • Supplemental oxygen
  • Discuss with airline need for other equipment on plane (e.g., nebulizer)
  • Plan for self-management of exacerbations (including COPD, asthma)
  • DVT precautions
  • Influenza
  • Pneumococcal
  • Consider hepatitis B
  • Consideration for carrying short course of antibiotics or steroids for exacerbations
  • Consider advising an inhaler available in a carry-on bag, even if not routinely used
Gastrointestinal diseases
  • Surgery, including laparoscopic, within 10–14 days
  • Gastrointestinal bleed within 24 hrs
  • Colonoscopy within 24 hrs
  • Partial bowel obstruction
  • Emphasize food and water precautions
  • Consider prescribing prophylactic antibiotic for TD
  • Recommend avoiding undercooked seafood if cirrhosis or heavy alcohol use (Vibrio vulnificus)
  • Influenza
  • Pneumococcal
  • Hepatitis A
  • Hepatitis B
  • May experience increased colostomy output during air travel
  • H2-blockers and PPIs increase susceptibility to TD
  • Use mefloquine with caution in any chronic liver disease
Renal failure and chronic renal insufficiency
  • None
  • Emphasize food and water precautions
  • Plan for self-management of dehydration, which can worsen renal function
  • Arrange dialysis abroad if needed
  • Adjust medications for CrCl
  • Influenza
  • Pneumococcal
  • Hepatitis B
  • Know HIV, hepatitis C, and hepatitis B status
  • Atovaquone/proguanil (Malarone) contraindicated when CrCl <30 mL/min
  • Kidney Foundation and Global Dialysis websites can help with finding dialysis centers, check for JCI accreditation
Diabetes mellitus
  • None
  • Plan for self-management of dehydration, diabetic foot and pressure sores
  • Insulin adjustments
  • Should check FSBG at 4- to 6-hour intervals during air travel
  • Discuss changes in insulin regimen or oral agent with diabetes specialist
  • Provide physician's letter stating need for all equipment, including syringes, glucose meter, and supplies
  • Influenza
  • Pneumococcal
  • Consider hepatitis B
  • Keep insulin and all glucose meter supplies in carry-on bag
  • Bring food and supplies needed to manage hypoglycemia during travel
  • Check feet daily for pressure sores
Severe allergic reactions
  • None
  • Plan for managing allergic reaction while traveling, and consider bringing short course of steroids for possible allergic reactions
  • Should carry injectable epinephrine and antihistamines (H1 and H2-blockers)—always have on person
  
  • Many airlines already have policies in place for dealing with peanut allergies
  • Make sure to carry injectable epinephrine in case of severe reaction while in flight

AICD = automatic implantable cardioverter defibrillators, CABG = coronary artery bypass graft, CHF = congestive heart failure, COPD = chronic obstructive pulmonary disease, CrCl = creatinine clearance, CVA = cerebrovascular accident, DVT = deep vein thrombosis, EKG = electrocardiogram, FSBG = fingerstick blood glucose, HD = heart disease, JCI = Joint Commission International, MI = myocardial infarction, PPIs = proton-pump inhibitors, TD = travelers’ diarrhea.

  • Page last reviewed: July 27, 2009
  • Page last updated: July 27, 2009
  • Page created: July 27, 2009
  • Content source:
    Division of Global Migration and Quarantine
    National Center for Preparedness, Detection, and Control of Infectious Diseases
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