title: International travel by persons with medical comorbidities: understanding risks and providing advice.
abstract: OBJECTIVE
  To describe the medical conditions, travel plans, counseling, and medications prescribed for high-risk international travelers.
  
  
  METHODS
  This cross-sectional study was conducted from March 1, 2008, through July 31, 2010, in 5 clinics in the greater Boston area. We assessed all travelers seen for pretravel care and compared demographic characteristics, travel plans, pretravel counseling, and interventions for healthy and high-risk travelers (as defined by medical history or pregnancy).
  
  
  RESULTS
  Of 15,440 travelers, 2769 (17.9%) were high-risk; 644 of 2769 (23.3%) were immunocompromised travelers, 2056 (74.3%) had medical comorbidities, and 69 (2.5%) were pregnant women. The median age of high-risk travelers was 47 years compared with 32 years for healthy travelers (P=.0001). High-risk travelers visited the clinic a median of 25 days (range, 10-44 days) before departure. Overall, 2562 (93.9%) of high-risk travelers visited countries with medium or high risk of typhoid fever, 2340 (85.7%) visited malaria-risk countries, and 624 (22.8%) visited yellow fever-endemic countries. Of travelers to yellow fever-endemic countries, 8 of 23 (34.8%) pregnant women and 64 of 144 (44.4%) immunocompromised travelers received yellow fever vaccine. Of eligible high-risk travelers, 11 of 76 (14.5%) received a pneumococcal vaccine, 213 of 640 (33.3%) influenza vaccine, and 956 of 2681 (35.7%) either tetanus-diphtheria or tetanus-diphtheria-pertussis vaccine.
  
  
  CONCLUSIONS
  High-risk travelers made up nearly 20% of patients in these travel clinics, and they mostly traveled to destinations with malaria and typhoid risk. For health care professionals caring for travelers with underlying medical problems, providing appropriate travel counseling and making vaccine decisions, such as for yellow fever, are complex. Travelers with complicated medical histories may warrant evaluation by an experienced travel medicine specialist.
authors.affiliation: Department of Medicine, Boston University School of Medicine, Boston, MA; Department of Epidemiology, Boston University School of Public Health, Boston, MA. Electronic address: nhoch@bu.edu.
authors.forename: Natasha S
authors.initials: NS
authors.lastname: Hochberg
authors.forename: Elizabeth D
authors.initials: ED
authors.lastname: Barnett
authors.forename: Lin H
authors.initials: LH
authors.lastname: Chen
authors.forename: Mary E
authors.initials: ME
authors.lastname: Wilson
authors.forename: Hari
authors.initials: H
authors.lastname: Iyer
authors.forename: William B
authors.initials: WB
authors.lastname: MacLeod
authors.forename: Emad
authors.initials: E
authors.lastname: Yanni
authors.forename: Emily S
authors.initials: ES
authors.lastname: Jentes
authors.forename: Adolf W
authors.initials: AW
authors.lastname: Karchmer
authors.forename: Winnie
authors.initials: W
authors.lastname: Ooi
authors.forename: Laura
authors.initials: L
authors.lastname: Kogelman
authors.forename: Christine
authors.initials: C
authors.lastname: Benoit
authors.forename: Davidson H
authors.initials: DH
authors.lastname: Hamer
mesh_terms: D000328:Adult; D001900:Boston; D003141:Communicable Diseases / Q000453:epidemiology*; D015897:Comorbidity; D003376:Counseling; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D018570:Risk Assessment; D012307:Risk Factors; D014195:Travel / Q000706:statistics & numerical data*; D057236:Travel Medicine
keywords: BATMN; Boston Area Travel Medicine Network; CDC; Centers for Disease Control and Prevention; HIV; VFR; YF; human immunodeficiency virus; visiting friends and relatives; yellow fever