Amanda Wilde (Host): Coming out of the coronavirus pandemic, the way we approach travel has shifted. Travel medicine focuses on keeping you safe on the journey. Just ahead, a conversation about how to benefit from travel medicine with Dr. Paul Jawanda, infectious diseases physician at First Health of the Carolinas.

Welcome to First Health and Wellness Podcast, connecting you to the people and medical services that make your life healthier. I'm Amanda Wilde. Dr. Jawanda, welcome and thank you for being here to talk about travel medicine.

Paul Jawanda, MD: Amanda, thanks for having me. I'm eager to let people know more about travel medicine and about our clinic and what it can offer them.

Host: Well, how should we think about that term travel medicine? What is the concept of travel medicine?

Paul Jawanda, MD: Right. I think that's a great question. In a word what is travel medicine as a specialty, you know, we were described as a specialty that focuses on prevention, early detection, and then even if needed, treatment of health-related problems associated with traveling. And as a practice, we can really offer folks some who have mandatory requirements for being able to travel to certain regions of the country that might require mandatory vaccines. And then, others where people may be having an itinerary where they're staying fairly long-term in the third world and really have a lot of questions about how they can manage their health and prevent health complications.

And then, we also have special situations where someone might be traveling to a unique area or have certain health conditions where they really want the advice of an expert on what they can do best to make their trip smoothest and prevent any health complications. So, it's a mixed bag of folks that we see where some have to see us, and you know, it's generally accepted that most people, "No, really, you know, I want to see an expert on how I can stay safe and what are the things I need to do to prevent illness." And then, others just where someone's risk tolerance, they just would really like to meet with an expert and see, you know, what's the advice on what I should do for my trip to stay healthy.

Host: Can you walk us through the process? How does travel medicine work from the first step? Do you consult with a medical professional before you take a trip?

Paul Jawanda, MD: So for travel medicine, I think, you know, the first would be the traveler, you know, wanting to reach out and say, "All right, I would like more information." And so, reaching out to a travel clinic. So, in our region of the States, that would be calling our travel clinic and asking a few questions and then being offered a travel consultation with a physician in our clinic.

Ahead of time, even before meeting with a physician, we would want to know about that person's itinerary. Just a brief off the top of their head, their recalled immunizations, their health history, and any other specific questions that they have. So, we have some information ahead of time. But then really, it's as simple as coming to the clinic and meeting face to face and getting travel advice, getting questions answered, necessary immunizations, and actually a whole lot more during that travel visit.

Host: If someone is coming to see travel medicine providers, you mentioned bringing an itinerary would be useful. Is there anything else we should bring with us?

Paul Jawanda, MD: The initial part of us meeting with someone, we would do a risk assessment. We want to know about you. So, we're not just a rubber stamp, "Here's a vaccine. You're going on your safari in Kenya." So, we want to know about, you know, specifically you, your medical history, what medications you've been on. We'd like to know any special health needs that you may have, because that figures into the advice that we would give to you. And we would also like to know your recalled vaccination history. And then, we would buttress that with, you know, at least here in North Carolina, we can check our state's immunization registry, and then also checking at least in our healthcare system documented vaccines to get a pretty good idea of what vaccination someone has had.

And then, most important for us is where are you going? So, why are you traveling to where you're traveling to? How long are you going? Where specifically in your itinerary, not just I'm going to Kenya but where in Kenya? What parks are you going to? And bringing all of that information together we know more on how we might advise you on things that you might do to prevent illness and keep you healthy.

Host: So, it sounds like a very individualized process.

Paul Jawanda, MD: It really is. And I think the thing that we have pride on is that we do get all that information and very conversationally. You know, sort of we're counseling as we're going along. And that, right now, us three providers who work in our travel clinic, we're all board-certified infectious disease physicians who have been practicing for 15 or more years, and so have that background knowledge along with a lot of up to date knowledge and things to keep you healthy when you're traveling the world.

Host: As we are coming out of the coronavirus pandemic and travel is returning to higher and higher levels, is it more important to seek travel health consultations before you take a trip than it was before?

Paul Jawanda, MD: I would say that, you know, with people getting back to a fair amount of international travel and with us being more conscious of communicable disease and that being an ongoing issue, you know, I would say yes, as well as that, even before the pandemic for certain scenarios, it really can help someone's health and prevent illness by consulting with a travel health expert.

Host: Now, we've been talking about everything you should do to prepare for a trip. Is there anything people should do when they return from an overseas trip?

Paul Jawanda, MD: One of the things that we focus on, just one, is if someone is traveling to an area with the risk of vector-borne disease, so could someone get an infection by a mosquito bite? We think about things that are potentially preventable' malaria by taking a prophylactic medication or yellow fever by taking a vaccination, and that as well as others. If someone returns from their trip and feels ill soon afterwards, they might have significant diarrhea and unexplained fever or illness, that would be a reason to consult with their doctor. And then also, reach out to us. We are always available for any traveler who returns home. And we'd specifically say it's interesting for educating people about malaria when someone travels to a malaria-endemic area. The way the life cycle of that parasite works, it could lie dormant in the body and then re-emerge anywhere up to a year after returning from a malaria-endemic area. So, that's something that we always remind folks about.

Host: It's really not terribly uncommon to bring something back or get a bite from an insect that your body is not used to and things like that, like you said, that'll come up later on.

Paul Jawanda, MD: So from an injury we may have had, from something we've consumed, from a mosquito bite, from a tick bite, so there are different possibilities of injury or even infection that could be acquired abroad and might need attention when someone comes home.

Host: Are there sort of general guidelines you would give to all travelers, even those who might not have considered a travel health visit or who aren't going to an exotic place?

Paul Jawanda, MD: Absolutely. So, I think, I mean, one, for a traveler in general who may not decide to come to a travel clinic, as well as travelers coming to visit us. So, are you traveling to an area of the world where you have risk of infections transmitted by mosquitoes? And if so, you know, malaria or yellow fever? These are things that can be prevented by, malaria, a prophylactic medication, yellow fever vaccination, or others, dengue fever; Zika is still in certain areas and that's when you want to avoid getting bitten by a mosquito. So, these are things that someone should think about as far as their itinerary, where are they traveling to in the world.

We think about things with even risk of prolonged travel, risk of getting a blood clot, you know, sort of careful that you're up and moving about the cabin and staying as mobile as possible. When we're sedentary and not moving on a long trip, we're at risk of such things. We definitely think about risk of food and waterborne illness and that's in the third world largely and, you know, how do we avoid that? You know, we don't drink the tap water. We avoid ice. We're careful about eating cooked foods. And so, a lot of attention to this. And you know, how would we deal with if we had traveler's diarrhea while we're abroad? What would I need to seek treatment for? Should I maybe bring some medication along that I might need to treat minor or significant symptoms? And then really, for other than that, some more specific scenarios based on what sort of activities someone might be doing or areas that they're travelling to.

Host: Well, because again, it's so individualized, it sounds like there's really no downside to connecting with your local travel medicine clinic if you're going on a trip.

Paul Jawanda, MD: I would say not. I think, you know, in a nutshell, I mean, just as far as what we do for folks, so coming in, we'll do a assessment. We want to know about you, your medical history, where you're going. And we will, we'll give you general advice on, just in general, you know, what should I do for staying healthy? And that general advice might be more specific if someone has different types of planned itineraries. And then, we'll talk about are there advised immunizations that someone should have to protect themselves. And in general, for those immunizations, we would look at it as, you know, sometimes there's absolutely required vaccinations for traveling certain areas of the world. You're not going to get into certain countries if you don't have a yellow fever vaccine. And then, there are recommended vaccines that you might protect yourself. And then, we'll even discuss, we'll educate people about routine vaccines and how this works. And then, other than that, we may talk about prescribing uh, prophylactic medication to prevent illness and even prescribed medicine that they might use to self-treat themselves in the event of becoming ill.

Host: This is such an important and useful service as travel sort of returns to a new normal. Thank you for being here, Dr. Jawanda, to talk about travel medicine.

Paul Jawanda, MD: And Amanda, I'd like to thank you for having me. I love getting to let people know about the help we can offer with healthy travel.

Host: Dr. Paul Jawanda is an infectious diseases physician at First Health of the Carolinas. To learn more, visit firsthealth.org/travel. If you found this podcast helpful, please share it on your social channels and you can check out the full podcast library for other topics of interest to you. Thank you for listening to First Health and Wellness podcast brought to you by First Health of the Carolinas. We look forward to you joining us again.