Where, what, when, how long?

Clinicians begin every travel health appointment by asking for an exact itinerary. "We want to know not only where you're going, but how long you'll be staying in a particular area," says nurse practitioner Kris Ruzycki, A.P.R.N., B.C. "That information helps us gauge your risk of exposure to any disease that is endemic to that locale."

You'll also be asked what activities you have planned, information that will help the clinician shape specific recommendations. "If somebody is going for a brief trip to Brazil—say, one week—we would not normally recommend typhoid vaccine," Heller says. "But if that person plans to be an adventurous eater, buying food from street stands and such, the risk for typhoid will be higher, so we might recommend the vaccine."

Your travel health clinician also will ask about your regular medications and additional considerations—such as pregnancy, allergies, or specific medical conditions—that may be a factor with regard to vaccination or destination-specific health risks. "We don't give live vaccines, like yellow fever, to pregnant women, for example," Heller explains. "So if a woman is pregnant, or might become pregnant, and is planning an African safari, we would have to talk about the risks and benefits of immunization versus just using a lot of insect repellant, versus postponing the trip."

Based on your itinerary, length of stay, and other medical considerations, the clinician will recommend specific immunizations and write prescriptions for such things as antibiotics to be used in case of certain gastrointestinal infections common in developing countries. "The vaccines we give travelers most often are for hepatitis A, typhoid, polio, and yellow fever," Heller notes. The clinician will also want to make sure travelers are up to date on routine vaccines like tetanus and diphtheria.

"In addition, we counsel people about ways of minimizing the risk of infection from food, water, and insects," Heller adds, "particularly infections for which we do not have vaccines. One example is Dengue fever, which is endemic to South America, Central America, the Caribbean, and Asia. Since there is no vaccine, the only way to protect oneself is with diligent use of mosquito spray."

Gilbert, of the MIT-China program, appreciates the way MIT Medical clinicians tailor travel health services to the specific needs of each traveler. "Along with providing general information on travel precautions for China—things like ‘don't drink the tap water; avoid hand-prepared fruit'—MIT Medical individualizes the preparations for each of our students based on their medical histories, as well as the areas where they will be traveling," he explains. "For example, certain southern provinces of China have malaria zones, so students going to those areas might need anti-malarial drugs, while a student who will be working in Beijing would not."

Do your homework

Heller and Ruzycki recommend learning all you can about a destination before embarking on your trip. "For example, the same information I use to keep current on health threats around the world is available to anyone on the Web," Heller says. "The CDC website has the most up-to-date information about various areas of the world and is very easy to use."

In the end, Gilbert says, most of his health concerns for his China-bound students run to the more mundane. "They sometimes take buses to off-the-beaten-path areas of rural provinces over some precipitous mountain roads," he says. "Or they buy bicycles to ride in the congested streets of Beijing. Forty students per year, 400 students in the last 10 years…." He stops himself. "I'm not going to try to figure out the probabilities. The insurance companies have actuaries to think about those things; I'll let them worry."

Ruzycki agrees that crime and accidents, particularly motor vehicle accidents, are even greater threats to travelers' health and safety than disease. "This is where it pays to do your homework," she says, "and MIT Medical can help. The more you know about your destination, the safer you'll be. And you'll enjoy your trip even more if you're prepared."