Beyond COVID: Are your patients aware of these travel-related health risks?

When it comes to travel health risks, COVID, of course, is top-of-mind these days. Yet, despite headlines and warnings of the highly contagious and deadly Delta variant raging across the world, travelers continue to take to the skies, roads, and rails—some because they must, others because they can’t take another minute of lockdown.

Indeed, the CDC currently recommends that people delay domestic and international travel until fully vaccinated against COVID-19—all the while offering specific travel guidance for those in both vaccinated and unvaccinated camps, because people are going to travel.  

But COVID isn’t the only health threat to travelers—there are other health risks inherent in traveling to another destination, and we aren’t referring to the common ones, like traveler’s diarrhea. Here’s a closer look at four lesser-known health threats related to travel. 

Venous thromboembolism

The most common types of venous thromboembolism (VTE) are deep vein thrombosis (DVT) and pulmonary embolism (PE). Sitting in a cramped economy class seat is a risk factor, according to studies.

According to the authors of a review published in Vascular Medicine, “Air travel-related VTE is sometimes referred to as ‘traveler’s thrombosis’ or the ‘economy-class syndrome.’ In general, the risk of VTE after air travel is low compared with other clear risk factors for VTE such as surgery (especially orthopedic surgery), hospitalization for medical illness, and cancer. Travel-related VTE is more likely to develop after airplane flights of 8 hours or longer or several shorter flights over a few days. Most people who develop a DVT or PE related to air travel have a history of previous blood clots or have additional risk factors such as recent hospitalization, surgery, trauma, cancer, smoking, pregnancy, or the use of oral contraceptives or hormone replacement therapy.”

Intriguingly, VTEs can occur well after air travel, with the highest risk within the first 2 weeks, although risk remains elevated for 8 weeks or more.

Preventive steps include the following:

• Walk around the cabin once an hour

• Avoid alcohol or caffeine

• Keep hydrated

• Don’t smoke before travel

• Wear elastic-compression stockings of at least 15-20 mmHg

Infections (other than COVID)

Have you heard of African tick-bite fever? According to the CDC, it’s the most commonly reported tick-borne disease in travelers. These ticks are found in sub-Saharan Africa, parts of the Caribbean, and Oceania. 

Activities that increase exposure risk include camping, hiking, and hunting, with infection most common between March and August. Symptoms manifest within 2 weeks of a tick bite, and include fever, headache, swollen lymph nodes, myalgia, and rash, as well as eschars.

In addition to avoiding woody, grassy, and bush areas, as well as keeping toward the center of trails, travelers can limit infection risk by treating clothing/gear, examining for/removing ticks, and applying insect repellent.

Unfortunately, African tick-bite fever is merely one infection that travelers need to watch for. Other diseases covered by the CDC include Chagas, measles, mumps, dengue, and Zika. For a full list, click here.

In broader strokes, the US National Library of Medicine recommends updating vaccinations and, if traveling outside of North America, considering vaccination for hepatitis A, hepatitis B, meningococcal, and typhoid.

Mental disorders

No doubt that travel—especially international travel—can be stressful. This stress can exacerbate pre-existing psychiatric disorders. In fact, psychiatric emergencies are a leading cause of air evacuation, in addition to injury and cardiovascular disease. Moreover, in those predisposed to mental illness, international travel may be a trigger for an initial presentation.

According to the WHO, “Physicians caring for people in their home countries or overseas should be aware of the differences (both within and between countries) in the availability of mental health resources (for example, emergency facilities, staff, beds and investigative facilities) as well as in the type and quality of medication. Culturally compatible clinicians and support staff may be rare or non-existent, and they may not understand the native language of the traveler, so access to interpreters may be necessary.”

The WHO added, “The legal environment within which a clinician practices may also vary widely. Laws dealing with the use of illicit substances vary considerably and penalties may, in some countries, be quite severe. As a result of these differences in the infrastructure for providing mental health care and in legal systems, the first decision a clinician may have to make is whether the traveler’s care can be managed at the travel destination or whether the traveler requires repatriation.”

Violence

We’ve all cringed at the viral clips of air passengers throwing punches at 35,000 feet. In what is a concerning sign of the time, flight attendants are now taking self-defense classes. Apparently, the FAA has zero tolerance for skirmishes in the sky, according to its website.

As of September 21, 2021, there were 4,385 unruly passenger reports, 3,199 mask-related incidents, 789 investigations filed, and 162 enforcement cases initiated.

Click here to read more about travel and health on our blog, PhysicianSense.