Pharmacists are an important source of health advice for travellers. Travellers may visit a pharmacy to ask for advice about travel vaccinations or over the counter medications for travel-related illness. Travellers may also present with a travel vaccine prescription from their general practitioner (GP).
In any scenario, when a pharmacist supports a traveller's pre-travel healthcare needs, it is important that a traveller receives comprehensive assessment and advice based on their individual needs. This may require referral to, or further communication with, a GP or travel medicine practitioner.
The travel consultation
Pharmacists should provide opportunistic travel advice during a vaccine consultation. It is important to educate overseas travellers about risks to health that are not vaccine preventable.
The travel consultation is an important opportunity to discuss a traveller's plans, which may include the following actions:
- Review of the itinerary to determine potential health risks in the areas of travel, and how they interact with the traveller’s medical history and health status.
- Educate the traveller about anticipated risks and methods for prevention, including safe behaviours.
- Supply and administer travel vaccinations, appropriate for the person’s travel plans.
- Recommend medication for prophylaxis or self-treatment of travel-related illness. Where relevant medication requires a prescription, refer to the person's GP.
- Recommend they have adequate travel insurance.
Assessing the risk of a traveller's planned trip
A useful framework to apply when assessing an individual's risk from travel to a particular destination is 'this person, this trip, this time.' A summary of the considerations within this framework is given below. A person identified as high risk should be referred to their GP, or a travel clinic for additional review and advice.
- Age - especially the very young or the very old
- General health and fitness
- Medical history and chronic conditions
- Medications and the need for adequate supplies - including storage considerations for Schedule 8 medication, if appropriate
- Allergies - especially if past history of anaphylaxis
- Immune status - past exposures, past immunisation, and immunocompromised status due to medical conditions or medical treatment
- Urban, rural and/or remote
- Extremes of climate and altitude
- Length of trip, and/or risks of exposure
- Purpose of travel: holiday, business, visiting friends and relatives, expatriate, disaster relief or aid work
- Style of travel: accommodation, cruise holidays, transport, dining
- Specific or unusual activities
- Exposure to animals
- Wet or dry season
- Current disease outbreaks
- Political unrest
- Weather events
- Mass events that may result in exposure to illness
Reviewing vaccine needs
If a person requests a vaccination for travel purposes, 'The Three R's' framework - Required, Routine, Recommended - can be applied to determine the appropriate vaccines for the trip.
- Determine which, if any, vaccines are required to cross international borders under International Health Regulations or as specific country requirements. See the WHO International Travel and Health website for detailed information about requirements for travel.
- Ensure the person is up to date with routine immunisations in accordance with the National Immunisation Program Schedule and the Australian Immunisation Handbook.
- Determine which additional vaccinations should be recommended based on a detailed consideration of the itinerary, individual circumstances and past immunisation history. See Fit For Travel (UK) or CDC Traveller’s Health (US) for more information.
- Develop and record a vaccination schedule that includes all the vaccines the person decides to have. Considerations include:
- Immunise opportunistically and pragmatically. Unless there are significant concerns about side effects developing while away, it is never too late to vaccinate before a trip. Particularly for longer trips, some immunity will develop during travel. Immune priming will also occur that could benefit future travel. Advice regarding incomplete immunity should be provided when relevant.
- If necessary, use accelerated vaccine regimes to provide the best possible protection during the trip, as per the Australian Immunisation Handbook.
- Ensure appropriate spacing between vaccine doses, including those given elsewhere noting that if two live vaccines are to be given they must be given together OR at least four weeks apart).
- Ensure that the person is aware of future visits to complete vaccination courses.
- Discussion of available combination vaccines.
- Refer to the person’s GP or a travel medicine clinic for additional vaccinations that are indicated but not authorised for supply without prescription in the ACT. Considerations include:
- Vaccines such as Japanese encephalitis, rabies, oral typhoid, cholera, mpox, and tickborne encephalitis.
- Where travel itinerary includes travel to a Yellow Fever endemic region, vaccination may be indicated and can only be provided by authorised providers.
Travellers who should be referred
Pharmacists are encouraged to refer any traveller to a GP or travel health clinic at any time they feel additional assessment or advice is required.
The following checklist may be employed to identify travellers at higher risk that should be referred to a GP or travel medicine practitioner:
- Travel to altitude >2500m above sea level
- Exposure to extreme heat or extreme cold
- Risk of malaria – patient may require prescription for antimalarial prevention
- Prolonged visits to developing countries
- Volunteer, missionary, or aid work including disaster relief
- Risk of yellow fever, Japanese Encephalitis or tickborne encephalitis
- Risk of exposure to Zika virus when pregnant or planning pregnancy, including for male partners
- Increased risk of animal bite, or likely poor, or delayed, access to post-exposure rabies prophylaxis
- Disability that may be impacted by travel
- Immunocompromise or immunosuppression (including splenectomy or non-functional spleen)
- Traveller is aged 65 years or more
- Traveller is under age 5
- Surgery or hospitalisation within last 3 months
- Underlying chronic health conditions requiring additional support
- Past history of deep vein thrombosis or pulmonary embolism or high risk of thromboembolic events
- Prescription medication may be needed for the trip:
- Prevention or emergency treatment of malaria
- Management of jet lag
- Precautionary antibiotics
- HIV PrEP
- Adequate supply of regular medications
- Previous Dengue infection and potential for exposure during intended travel
Provide travel advice specific to needs
||Possible Discussion Areas
- Ensure the traveller has sufficient supply of medications for the expected trip plus any delays.
- Discuss medication management whilst travelling - original packaging, time zone changes, appropriate storage.
- Ensure that the traveller has an official letter listing all prescribed medications, and/or a medication management app listing their medications.
- Discuss issues around travelling with medications that are restricted in destinations in the traveller’s itinerary.
|Food and water borne illnesses
- Discuss strategies to minimise food and water borne illness.
- Discuss medications which could be used to self-manage diarrhoeal illness.
- Discuss strategies to treat water for drinking, if indicated.
- Discuss vaccines that can be used to prevent food and water borne illness – Hepatitis A, Typhoid, cholera.
- Discuss hand and respiratory hygiene.
- Consider those at higher risk of severe outcomes and preventative strategies.
- Consider evidence-based supply of non-prescription medications.
- Educate travellers of risk of vector-borne diseases based on travel itinerary, including high risk time periods and activities.
- Inform travellers that avoiding mosquito (or other relevant insect) bites is essential.
- Advise travellers on insect-bite avoidance and prevention strategies including appropriate repellents, clothing, insecticide treatments for clothing and mosquito nets.
|Deep vein thrombosis (DVT) and Pulmonary embolism (PE)
- Assess risk of DVT.
- Give standard advice to all travellers.
- Discuss appropriate use of stockings, if indicated.
- Refer possible high-risk travellers to GP.
|Environmental hazards – extreme temperatures
||Ensure the person is properly equipped for the anticipated environmental conditions, including:
- cold and wet weather clothing
- hat, sunglasses, protective clothing such as long-sleeved shirts and trousers, and sunscreen
- first aid kit.
|Environmental Hazards – altitude
- Discuss risk and how to minimise based on itinerary.
- Refer for appropriate treatments for altitude sickness.
|Freshwater and Soil Infections
- For high-risk itineraries, advise of the risk of contracting infections through skin exposed to contaminated soil or freshwater.
|Sexual health and blood-borne pathogens
||Advise travellers to:
- practise safe sex when abroad with new partners
- consider taking own condoms
- avoid skin penetrating procedures like tattoos, acupuncture, or manicures.
- Assess risk of rabies exposure including place, remoteness, personal factors (age or interaction with animals).
- Consider need for pre or post exposure prophylaxis.
- Advise avoidance of all contact with animals, including those in tourist sites and national parks, to reduce the potential for bites and scratches that can transmit rabies.
- If bitten or scratched by an animal, advise the traveller to wash the wound immediately and thoroughly with soap and water and seek medical assistance as soon as possible.
- Commonly affects travellers crossing more than 5 time zones, particularly in an easterly direction.
- Advise person to avoid coffee and alcohol, drink plenty of water.
- Particularly for business travellers, be well rested in the days before travel.
- If prone to motion sickness, advise the person to avoid activities requiring close concentration such as reading.
- Don't eat large meals prior to or during the journey.
- Medications can be used in children and adults if appropriate.
|Over-the-counter medications and first aid items
Individuals may want to consider carrying some over the counter medications and first aid items. This will depend on factors including general health, travel itinerary, and access to items at destination.
Consider appropriate items, including:
- alcohol-based hand rub
- anti-diarrhoeal medication
- antifungal cream
- antiseptic liquid, cream or ointment
- decongestant or saline nasal spray
- dressings and bandages
- ear plugs for use in-flight
- insect repellent
- mild corticosteroid cream
- motion sickness medication
- rehydration products
- sports tape
- water purification tablets.
Remind the person that frequently used medicines available in the supermarket or in pharmacies in Australia may not be as readily available overseas.
Medications with poor evidence of effect should not be provided.
Links for further information
Content on this page has been modified from NSW Health, with thanks.