Joey Wahler (Host): An overseas vacation can suddenly turn bad if a family member gets sick on the trip. So, we're discussing how Maimonides helps prepare you and yours for a safe, healthy experience abroad. Our guest, Dr. Rabia Agha. She's Director of the Pediatric Infectious Diseases Division at Maimonides Children's hospital who also oversees their Family Travel Medicine Service team.

Host: This is Maimo Med Talk, a podcast from Maimonides Medical Center. Thanks for listening. I'm Joey Wahler. Hi, Dr. Agha. Thanks for joining us.

Rabia Agha, MD: Hi, Joey. Thank you for having me.

Host: Great to have you aboard. So first, this Maimonides Travel Medicine Service Team, Family Travel Medicine Service team, is authorized and licensed by the federal government as an official international vaccination site. So, give people, please, to start us off, an idea of what that means actually.

Rabia Agha, MD: Well, there are a lot of travel clinics all over the city and all over the country, but there are a few that are licensed to provide certain vaccines. One specifically is the yellow fever vaccine. The CDC itself, the Center for Disease Control, vets and approves certain sites where we can administer the yellow fever vaccine. And they have to ensure that the providers are adequately trained, adequately licensed and can adequately store the vaccine that is to be given. So, that's what it means to be licensed and authorized by the federal government.

Host: Gotcha. And before we go any further, when you mentioned yellow fever, for those unfamiliar, what is that exactly?

Rabia Agha, MD: Yellow fever is the viral infection which is transmitted by the bite of a mosquito. And unfortunately, it is downhill after that. There's no treatment for the disease and there is no cure. The only thing we can do for it is prevent it by giving the yellow fever vaccine which has excellent efficacy, and that is what is advised to people who go in areas where yellow fever virus is rampant.

Host: Okay. So to backtrack for a moment, the first step here when planning a trip is forming a pre-travel medical plan. So, what does that involve working with you and yours?

Rabia Agha, MD: Well, the medical plan is tailored to the specific destination of travel, how long they will be traveling for, and what are the activities of the travelers. The plan also will take into account any existing medical problems in our patients and any medication that they are already prescribed or using. So basically, we take that into account and then we make a plan for that individual. So, there's no one plan that fits all. Every plan has to be individualized depending on where you travel and what underlying problems you may have.

Host: Sure. So basically, your history and what's coming directly ahead. So, this medical travel prep is, of course, doctor, necessary for adults and kids alike. But what are some factors from your experience that are particularly important for children

Rabia Agha, MD: One thing to note is that children are vulnerable, and especially during international travel, especially if they have not traveled very often, then they are exposed to bacteria, viruses, germs that are local to the area that they are going to, which they may not have been exposed to prior to travel. So, they need to be provided guidance of how to do the necessary precautions in terms of food, in terms of water, in terms of how to avoid bug bites, how to stay away from certain animals, what is accepted, what are the do's and what are the don'ts for every child who's traveling.

Also, traveler's diarrhea is very common. And in adults, we manage it differently. In children, there's a different treatment for it, so that information has to be given to them, and as well as keeping the child up-to-date with their usual childhood immunization, because we have to assume that they are at least protected from the infections that they are supposed to be protected from. And then, we give them additional vaccines or medications or advice depending on where they're going.

Host: Understood. So speaking of immunization, when addressing that before departing on an overseas trip, tell people please about planning ahead because some vaccines take time before their maximum effectiveness, right?

Rabia Agha, MD: Absolutely. That's true for most vaccines. And the minimal time that we recommend is a two-week period from the time that you receive the vaccine to when it starts becoming effective. Maximum efficacy comes up around four weeks from the time of the vaccination. So if you know you're going to travel, please prepare in advance with the family travel clinic, so that you come at least a month or a little bit longer before that, so that you can get all the precautionary advice and treatment as needed.

Host: Now, vaccines, doctor, prevent diseases that are uncommon but can be fatal if contracted and some that have been eradicated in the US remain active in some other countries. So, what are some of those that people should be aware of?

Rabia Agha, MD: Well, polio has been eradicated from the United States. It's a viral illness. And most other countries also, it has been eradicated. But there are still pockets of polio virus in certain parts of the world. So if the person is traveling to those areas, we have to ensure that they are up-to-date with their polio vaccine. Another infection we've talked about was yellow fever, which can be fatal. And there is no treatment for it. In addition to that, there would be the rabies vaccine and Japanese encephalitis vaccines. Those will also protect you from diseases that are typically untreatable and fatal.

Host: How about when planning a trip? Are there any countries from your experience that provide the greatest medical challenge in general, the places where things can be the most dicey that people should be aware of there?

Rabia Agha, MD: I would say, when you come to the travel clinic, you're given specific instructions. And the doctor who you're dealing with will let you know if there are any major outbreaks or problems in the country that you're traveling to. I really feel that being informed is more important than where you end up going. And if you're well prepared and well informed, you are really able to travel quite safely in most parts of the world.

Host: Great point. So a couple of other things, how about just in general what we're discussing here? The need to prepare properly and ahead of time. Do enough people heed that advice, that warning? Or do you think there are still too many out there that let's say are focused more on making sure their passport paperwork is in order as opposed to worrying about whether they have the right shots before they get on the airplane?

Rabia Agha, MD: Exactly. I think that's the majority of people, and they spend a lot of time planning their vacation, their hotels and their flights and travel plans and where all they want to go to, but they don't think back and say that that whole travel could become so stressful if any one member of the family became ill. So if they are well guided and better prepared with all the necessary medications, repellents, the vaccines, they are going to ensure that they have a wonderful time. And I think one forgets that until a child or an adult falls sick during travel, and then they wish they would have thought about this earlier.

Host: How about in order to keep kids as healthy as possible on an overseas trip, is there anything that parents tend to overlook, any misconception that maybe they have where they're not aware of something that they need to be more prepared for?

Rabia Agha, MD: I think food and water precautions are really the crux of what they need to be prepared for. And one doesn't even think twice in the United States about drinking tap water, having ice drinks, eating salad and uncooked vegetables. Whereas in many parts of the world, that would be the biggest source of infection for the child. So, I think awareness is really, really key here and that's what we could help with.

Host: One of those things that oftentimes people living their whole life in the United States take for granted, the things you mentioned, right?

Rabia Agha, MD: Exactly, exactly.

Host: How about when returning from an international trip, anything patients should do to follow up with a doctor at that point once they're safely back?

Rabia Agha, MD: Once they're safely back, if they have any health concerns or if any one of the members of the group is unwell, then definitely they need to be in touch with the travel physicians because not only do we do preventive, but we can also treat and diagnose any infections they may bring back with them when they are abroad.

Host: Because you certainly don't want to bring something back with you on the plane other than of course a gift for a family member, right?

Rabia Agha, MD: Exactly.

Host: Well, folks, we trust you're now more familiar with how Maimonides can prepare you and your family and your kids of course for an overseas trip. Dr. Rabia Agha, thanks so much again,

Rabia Agha, MD: Thank you.

Host: And for more information, please visit maimo.org. Again, that's M-A-I-M-O.org. For an appointment, please call 718-283-8578. Again, that's 718-283-8578. If you found this podcast helpful, please share it on your social media. Thanks again for listening to Maimo Med Talk, a podcast from Maimonides Medical Center. I'm Joey Wahler.