MCHD's International Travel Clinic can help you get ready for your big trip

May. 19, 2022

By Mary Wade Burnside

In July, Preston County resident Amanda Wolfe will be traveling to South Africa to participate in a veterinary internship at a conservation and wildlife center before heading on to vet school.

In addition to the planning and packing Wolfe has been doing in order to prepare, she also has been addressing another necessary task before jetting to a foreign country: consultation with Monongalia County Health Department’s International Travel Clinic.

“I called them to see what I needed to get, and they helped guide me through it all,” Wolfe said.

During her first appointment, Wolfe learned she would need a typhoid fever vaccine as well as obtain some malaria medication to take with her. Because of her veterinary studies, she already had been vaccinated for rabies and she was also up to date on her tetanus (Tdap, for tetanus, diphtheria and pertussis) shot.

In her second visit, she underwent a physical exam, got the COVID-19 vaccine and picked up the malaria medication. Amanda Wolfe visited the MCHD International Travel Clinic to prepare for a veterinary internship in South Africa.Dr. Lee B. Smith, MCHD executive director and county health officer, was extremely helpful to Wolfe and a friend who will be accompanying her, she said.

“He was able to give us a list of things we should take on our trip,” she added. “He was able to go over our vaccines and what prescriptions we needed, and he emphasized the importance of each medication and their instructions.”

Wolfe planned her visit to the International Travel Clinic well in advance of her trip, starting last fall. That’s a good idea, said Jennifer Goldcamp, RN and program manager of MCHD Clinical Services, which conducts the travel clinic.

“Individuals want to make sure that they can get the vaccines they need in time for them to become fully effective,” Goldcamp said. “This is a good example of what you should do. Don’t just call the health department on your way to the Pittsburgh airport. She’s done it by the book, and that’s the ideal scenario.”

For instance, the recommended hepatitis A vaccine, which protects individuals if they eat or drink items contaminated with infected feces, is a two-shot series administered in a six-month period, while hepatitis B and the combined hep A and B vaccines are three doses in six months.

“‘An ounce of prevention is worth a pound of cure’ is really a true statement in this case,” Goldcamp said. “You really don’t want to be stuck in a foreign country with an illness, nor do you want to bring one home.”

Also, she noted, “In healthy people, hepatitis A usually resolves on its own, but it also can put you in the hospital, and some individuals even die from it. And you don’t want to be spending any part of a big, expensive trip that you’ve been planning stuck in your hotel or in a hospital with an illness.”

As Dr. Smith noted, “Becoming ill in another county can be difficult with potential problems of language, expectations, insurance, customs, communication with family and transportation.”

Sometimes there are snags. For instance, because of the COVID-19 pandemic, cholera vaccine has not been in production this past year, Goldcamp said. That means that another travel clinic patient, who is planning a trip to an area where a cholera vaccine is advised, should stick to bottled water and fruits that can be peeled, such as a banana or an orange, and forego tap water and green salads.

“You also want to make sure you brush your teeth and make ice with safe water and that sort of thing,” said Goldcamp, who noted that the Centers for Disease Control and Prevention has a web page devoted to cholera prevention.

While Monongalia County Health Department has been giving vaccines to world travelers for a while, the International Travel Clinic has expanded under the direction of Dr. Smith, a seasoned world traveler who visited his seventh and final continent — Antarctica — a few months before the start of the pandemic.

“In any given year, taking a vacation to a different part of the globe requires a great deal of health planning, not only for vaccines and medications but also advice on how to safely fly long distances and what kinds of situations might be encountered in a strange land,” Dr. Smith said.

But now, of course, with the COVID-19 pandemic still affecting all corners of the planet, there is a lot more to take into consideration in order to travel safely.

“Flying might not be the best idea for everybody right now, but individuals who plan to make a trip in the coming weeks or months need to look into how to do that as safely as possible,” Dr. Smith said.Dr. Lee B. Smith of Monongalia County Health Department is also a seasoned traveler whose knowledge comes in handy when he advises patients at the International Travel Clinic. Here he is in Antarctica, where travelers don’t really need to worry about mosquitoes, unless they are also considering a side trip to another country, such as Brazil.
Also, the travel scenario in the United States, with Disneyland reopening and talk of resuming cruises, and European Union in discussion about allowing certain travelers in, stands in stark contrast to other destinations, such as India, where the health care system has collapsed because of the overwhelming number of COVID cases.

Even before the pandemic, the CDC had established an extensive travel health website. Now, of course, COVID-19 advice is the priority, but other information, based on travel plans, is also provided.

For instance, in late April, the site noted that there was volcanic eruption in St. Vincent & the Grenadines as well as Ebola in Guinea and the Democratic Republic of Congo.

Plus, the site mentioned a breakdown in health care in Venezuela and advised against traveling there at all.

“Even in a normal year, you want to assess your travel plans in advance to see what the health care system is like in case something happens,” Dr. Smith said. “Now, individuals must realize that their destination’s hospitals already might be compromised by COVID-19, which makes any illness or accident more difficult to negotiate.”

Another CDC website provides specific guidelines in regard to COVID. For instance, on April 27, the CDC acknowledged that vaccinated individuals should be able to travel freely in the United States, but cautioned them to follow basic protocols, including wearing a mask, staying 6 feet away from others and washing hands thoroughly and often.

That was then changed on May 13 when the CDC said vaccinated individuals could remove their masks in most situations, except on public transportation, health settings or if a business still mandated it.

“This is a time in which CDC directives will be updated frequently, so anyone who plans to travel should check back often to see what the current status is,” Dr. Smith said.

Of course, noted Dr. Smith, getting a COVID-19 vaccine for travelers is highly recommended and might be required depending on where someone plans to go.

Until recently, individuals who are making travel arrangements had to coordinate their vaccines because they couldn’t have had any other vaccines two weeks before getting a COVID-19 inoculation, nor two weeks after. For Wolfe, that meant she had to space out her COVID-19 and typhoid vaccines.

However, the CDC ruled on May 12 that COVID-19 vaccines can be administered in conjunction with other vaccines.

Vaccines available at the clinic that are frequently recommended for travelers — depending on which places they plan to visit — include hepatitis A, hepatitis B or Twinrix (which includes both hepatitis A & B), typhoid, adult polio, Yellow Fever, Japanese encephalitis, cholera (as noted, currently not available), rabies pre-exposure vaccine, Tdap (tetanus, diphtheria and pertussis), influenza, meningitis, varicella (chickenpox) and pneumonia.

Obviously, like Wolfe, many individuals may already be vaccinated against some or many of these illnesses.

Also, as of now, Wolfe said she will be required to have a negative COVID-19 test three days before her arrival date, and then another negative test upon her return home.

“For those who need to show proof of a negative COVID-19 test within a certain time frame of traveling, we are happy to report that people who take advantage of our free testing on Mondays and Fridays at the WVU Rec Center can get their results within 24 hours,” Dr. Smith said.

In addition to specific vaccine advice, individuals who take advantage of the MCHD International Travel Clinic will also have the opportunity to discuss their plans with Dr. Smith.

Some travel tips he might discuss:

• In addition to drinking a lot of water on long flights, wearing compression hose also will keep ankles from swelling. And keep contact lenses in the container and opt for eyeglasses.
• Make sure you will have plenty of your prescribed medications with you, as well as proper documentation to get them through customs. Also, “When adding antimalarials, anti-nausea medications and medications for traveler’s diarrhea, consideration should be given to possible medication interactions which could disrupt or ruin a long-awaited trip,” Dr. Smith said.
• In addition to food safety, personal safety, skin protection and insect repellents are essential topics to cover.
• And do you know which to apply first, sunscreen or mosquito repellent, the latter of which you really want to slather on in areas with mosquito-borne diseases such as Zika, Dengue, West Nile viruses and/or malaria? 

Also, while mosquito bite-prevention recommendations to avoid illnesses such as malaria, Zika and West Nile Virus might differ for travelers to the same country depending on if they will be staying in a rural area or at an all-inclusive fancy resort, as Dr. Smith likes to say,
“I’m not sure the mosquito knows where the geopolitical line starts and stops, particularly out in the bush.”

The season when you are traveling also matters. Your chances of getting Japanese encephalitis in countries such as Japan, Vietnam, Laos and Thailand are worse in the rainy season than the dry season, and low overall. But if you get it, recovery might be difficult — especially if you are in an area that doesn’t have good medical care.

“If you’re going to spend more than a month in Asia, you should seriously consider getting the Japanese encephalitis vaccine,” Goldcamp said.

“A lot of it also depends on your itinerary. If you’re going to spend one month in Beijing, we’re not going to recommend Japanese encephalitis vaccine. But if you’re going to a rural place like Thailand, or if you’re going to go to an elephant sanctuary or sleeping outside or without screens, I would strongly consider that.”

And you probably already know this, but if you are traveling to Australia from June to August, pack a warm coat, because it will be winter down under.

“Now, during the COVID-19 pandemic, we really encourage individuals to take advantage of these vital services,” Dr. Smith said. “Ever since the International Travel Clinic started, we’ve been able to provide a lot of good advice to our patients.”

Wolfe, who appreciated what she learned during her appointments, agreed. “He made us both feel good about our trip and how we can stay safe while being there,” she said.

To make an appointment, call 304-598-5119. Here is more info on COVID-19 testing and vaccines.

Mary Wade Burnside is the public information officer at Monongalia County Health Department.