Are you planning to travel overseas? Then St. Louis Children's Hospital Travel Clinic should be one of the first stops on your itinerary.
Whether you're traveling for work, leisure, volunteering or studying abroad, it's important to see a specialist that will help you plan for a safer, healthier international trip.
Why is it so important to consult with a specialist prior to traveling overseas?
Listen in as Rachel Orscheln, MD shares the most common infectious diseases, why you should consult with a specialist before traveling, and the types of services the International Travel Clinic St. Louis Children's Hospital offers.
St. Louis Children’s Hospital International Travel Clinic
Featured Speaker:
Learn more about Rachel Orscheln, MD
Rachel Orscheln, MD
Rachel Orscheln, MD, is a Washington University pediatric infectious disease physician at St. Louis Children’s Hospital.Learn more about Rachel Orscheln, MD
Transcription:
St. Louis Children’s Hospital International Travel Clinic
Melanie Cole (Host): Are you planning to travel overseas? Then St. Louis Children's Hospital travel clinic should be one of your first stops on your itinerary. Whether you're traveling for work, leisure, volunteering, or studying abroad it's important to see a specialist that will help you plan for a safe and healthier international trip. My guest today is Dr. Rachel Orscheln she's a Washington University pediatric infectious disease physician at St. Louis Children's Hospital. Welcome to the show Dr. Orscheln so what are some of the most common infectious disease is someone might encounter in their travel?
Dr. Rachel Orscheln, MD (Guest): So there are a variety of infections that you don't see commonly in the United States that you might encounter when traveling to other countries. And those really depend on the location where you're going but many people are traveling more and more to areas that had a infections like malaria transmission so that's something to think about. Also an infection like typhoid fever which can be prevented by vaccination is another infection that may be encountered in places that are more resource limited where people are traveling more and more.
Melanie: So if somebody is traveling and they tell their pediatrician at the visit oh we're going to be traveling wherever it is, what would you like the pediatrician to identify as far as possible risks and to go over the vaccination schedule that the person may have already had, you mentioned typhoid there are certain vaccination schedules, what would you like the pediatrician to know about these types of travel and would you like them to know the person is traveling?
Dr. Orscheln: Yes, I think it’s really important for a patient and families that are traveling to speak with their pediatrician about their plans for travel. In that way the pediatrician can make sure they’re up to date on all their routine childhood vaccinations because there are many infections that we don’t see as commonly in the United States because of widespread vaccination, but those infections may continue to be in transmission in other parts of the world. So it’s really important that families make sure that they’re up to date on their routine childhood vaccinations and speaking with their pediatrician about that is the best way to do that. In addition, there are infections that we don’t routinely vaccinate for in this country that are in transmission in other parts of the world and the pediatrician can help identify whether a vaccine is appropriate for the traveler.
Melanie: If somebody comes back from a trip and goes to their pediatrician what symptoms should the pediatrician be looking for if someone says you know we were away and now the child feels this way, are there certain symptoms, red flags you’d like to mention?
Dr. Orscheln: Certainly. Fever, a febrile illness is one of the most common syndromes that returning travelers present to their primary care providers with and so that can be the hallmark of of course routine childhood illnesses but certainly if something more serious like malaria or other vector borne diseases that are in transmission in other parts of the world, so that would be one of the most common scenarios. Another diagnoses that patients frequently present with is acute diarrhea and then certainly skin rashes of one sort or another are common presenting complaints for patients returning from travel.
Melanie: And when would you like or think that it’s very appropriate for the pediatrician to refer to a specialist?
Dr. Orscheln: I think certainly if there’s any diagnostic uncertainty. Certainly for a patient is very ill or has been to an area where malaria is in transmission then it would be appropriate for that patient to be seen and evaluated by an infectious disease physician. Certainly if a provider doesn’t have familiarity of illness and transmission in the country where a patient has returned from then it would be important for them to be seen by a provider who would be more familiar with those illnesses that are in transmission. Often the diagnostic tests that need to be done aren’t tests that we routinely perform and so an infection disease specialist can be helpful in determining what is the most appropriate test to do for the given patient’s syndrome?
Melanie: So if a pediatrician knows in advance that one of their patients is going to be traveling to an area that you know has certain infectious diseases would you like them to consult with a specialist prior to traveling overseas and when is that important?
Dr. Orscheln: I think it’s a very good idea. There’s one resource that pediatricians and even families can access and that’s the CDC website that has the location advice for travelers. And on that website you can actually plug in your location of travel and certainly whether you’re traveling with children and it will provide information on the diseases that are in transmission and what vaccinations or medications may be appropriate. Certainly pediatricians don’t routinely stock vaccines for travel, so things like yellow fever vaccine, typhoid vaccine, rabies vaccine, that may be indicated for the given traveler so that our clinic can provide those vaccines and it’s often good to consult and be seen in a travel clinic several weeks before the planned travel so that the body has time to develop protective immunity. We also have familiarity with medications that are given for prophylaxis for diseases such as malaria so we’re also able to provide prophylaxis for the patient’s that are traveling.
Melanie: So speak about the international travel clinic at St. Louis Children’s Hospital, what type of services do you offer and what can a patient expect?
Dr. Orscheln: So we see both children and families that are planning international travel. Prior to the visit we like to have an idea of their itinerary so that we know the locations and types of activities in which they will be participating in during their travel. We like to see them lie we said previously several weeks in advance of that travel so that we can provide appropriate vaccinations for travel. The types of vaccinations that we have available that may not be routinely available in the pediatricians office include things like yellow fever vaccination, typhoid vaccination, we can also provide other routine childhood vaccinations if those are appropriate and the patient hasn’t been vaccinated. And then again we provide medications for prevention of malaria and also traveler’s diarrhea.
Melanie: Dr. Orscheln, who can be seen at children’s hospital at the international travel clinic? Is it just children?
Dr. Orscheln: Well we will see children and their parents if they’re traveling. So we do not just routinely schedule adults for travel but if parents are traveling with a child then we are happy to provide these services so we can provide sort of one stop shopping for travel visit.
Melanie: Do patients need a referral to come there?
Dr. Orscheln: They do not necessarily need a referral; they can be self-referred to our clinic. We do like to routine them through our nurse who can evaluate their plans for travel and decide what vaccinations are appropriate with them and then discuss them with the family ahead of time prior to the visit.
Melanie: And how much prior to their vacation would you like them to come to the travel clinic?
Dr. Orscheln: It depends somewhat on the type of vaccine they’ll need. So we like for a vaccine series to be completed at least 2 weeks prior to travel. So some vaccines require multiple doses and so it is a good idea to make plans for a travel visit about four weeks prior to your planned travel.
Melanie: And Dr. Orscheln, for parents, what do you tell them about bringing certain medications if they’re going internationally and the importance of bringing medications? Should they bring prophylactic medications, antibiotics and such, or Motrin or Advil, any of these kinds of things, what do you tell t hem about what they should pack?
Dr. Orscheln: Well our general advice is certainly that patients should have all their own medications for their own chronic illnesses packed with them on travel with a sufficient quantity to get them through their travel plus any potential delays. Then we routinely, depending on the location, provide medications for the prevention of malaria and then we certainty will provide patients with a prescription that they can use in the event of developing traveler’s diarrhea.
Melanie: Are you seeing certain things, like measles, coming back from various countries? And a problem with the vaccination schedule?
Dr. Orscheln: Well I don’t think we have a problem with the vaccination schedule, per say. In the United States we routinely vaccinate children first a t about 12 months of age. And so we have had cases where children have traveled before 12 months of age and have come home with measles infection. Now we do know that for travel any infant over 6 months of age who is traveling abroad can be vaccinated and should be vaccinated against measles. This won’t actually count for their two dose series of MMR but it will provide them with some protection against measles infection while they’re traveling.
Melanie: What about countries such as Mexico where people are told not to necessarily drink the water or eat fresh vegetables and such and rotavirus and stomach issues, gastroenteritis, so what do you tell them when they’re going to a place like that?
Dr. Orscheln: Well we certainly do give advice about safe eating habits and so you know people who are traveling to a lot of locations in the world need to be careful about food and water consumption. So certainly making sure that fruits and vegetables they eat are peeled or cooked completely before eating those. Making sure drinking water is bottles and the lid is firmly tightened so that the water hasn’t been refilled and making sure not to eat from things like street vendors and places where people might not have access to frequent hand washing. So doing those sorts of things can reduce the chances that people will get traveler’s diarrhea.
Melanie: In summary doctor, please tell other pediatricians what you’d like them to know about recognizing infectious diseases and the travel clinic at St. Louis Children’s Hospital.
Dr. Orscheln: Well I would say that pre-travel consultation is important for families that are traveling. The Centers for Disease Control has an excellent website that provides advice about what medications and vaccines are appropriate for travel and St. Louis Children’s Hospital is happy to provide those specific travel related vaccines that may not be routinely available in the pediatric offices. Also when patients return from travel with illnesses, such as febrile illnesses or infectious diarrhea, we’re happy to see those patients in consultation and evaluation.
Melanie: And what can a pediatrician expect from your team at St. Louis Children’s Hospital after referring a patient to you?
Dr. Orscheln: Well certainly we always like to provide consultation back to the providers both in the form of written communication and also we can in the case of a patient let’s say being admitted to the hospital also call the provider with information.
Melanie: Thank you so much for being with us today. A physician can refer a patient by calling children’s direct physician access line at 1800678HELP. You’re listening to Radio Rounds with St. Louis Children’s Hospital. For more information on resources available at St. Louis Children’s Hospital you can go to StLouisChildrens.org. This is Melanie Cole, thanks so much for listening.
St. Louis Children’s Hospital International Travel Clinic
Melanie Cole (Host): Are you planning to travel overseas? Then St. Louis Children's Hospital travel clinic should be one of your first stops on your itinerary. Whether you're traveling for work, leisure, volunteering, or studying abroad it's important to see a specialist that will help you plan for a safe and healthier international trip. My guest today is Dr. Rachel Orscheln she's a Washington University pediatric infectious disease physician at St. Louis Children's Hospital. Welcome to the show Dr. Orscheln so what are some of the most common infectious disease is someone might encounter in their travel?
Dr. Rachel Orscheln, MD (Guest): So there are a variety of infections that you don't see commonly in the United States that you might encounter when traveling to other countries. And those really depend on the location where you're going but many people are traveling more and more to areas that had a infections like malaria transmission so that's something to think about. Also an infection like typhoid fever which can be prevented by vaccination is another infection that may be encountered in places that are more resource limited where people are traveling more and more.
Melanie: So if somebody is traveling and they tell their pediatrician at the visit oh we're going to be traveling wherever it is, what would you like the pediatrician to identify as far as possible risks and to go over the vaccination schedule that the person may have already had, you mentioned typhoid there are certain vaccination schedules, what would you like the pediatrician to know about these types of travel and would you like them to know the person is traveling?
Dr. Orscheln: Yes, I think it’s really important for a patient and families that are traveling to speak with their pediatrician about their plans for travel. In that way the pediatrician can make sure they’re up to date on all their routine childhood vaccinations because there are many infections that we don’t see as commonly in the United States because of widespread vaccination, but those infections may continue to be in transmission in other parts of the world. So it’s really important that families make sure that they’re up to date on their routine childhood vaccinations and speaking with their pediatrician about that is the best way to do that. In addition, there are infections that we don’t routinely vaccinate for in this country that are in transmission in other parts of the world and the pediatrician can help identify whether a vaccine is appropriate for the traveler.
Melanie: If somebody comes back from a trip and goes to their pediatrician what symptoms should the pediatrician be looking for if someone says you know we were away and now the child feels this way, are there certain symptoms, red flags you’d like to mention?
Dr. Orscheln: Certainly. Fever, a febrile illness is one of the most common syndromes that returning travelers present to their primary care providers with and so that can be the hallmark of of course routine childhood illnesses but certainly if something more serious like malaria or other vector borne diseases that are in transmission in other parts of the world, so that would be one of the most common scenarios. Another diagnoses that patients frequently present with is acute diarrhea and then certainly skin rashes of one sort or another are common presenting complaints for patients returning from travel.
Melanie: And when would you like or think that it’s very appropriate for the pediatrician to refer to a specialist?
Dr. Orscheln: I think certainly if there’s any diagnostic uncertainty. Certainly for a patient is very ill or has been to an area where malaria is in transmission then it would be appropriate for that patient to be seen and evaluated by an infectious disease physician. Certainly if a provider doesn’t have familiarity of illness and transmission in the country where a patient has returned from then it would be important for them to be seen by a provider who would be more familiar with those illnesses that are in transmission. Often the diagnostic tests that need to be done aren’t tests that we routinely perform and so an infection disease specialist can be helpful in determining what is the most appropriate test to do for the given patient’s syndrome?
Melanie: So if a pediatrician knows in advance that one of their patients is going to be traveling to an area that you know has certain infectious diseases would you like them to consult with a specialist prior to traveling overseas and when is that important?
Dr. Orscheln: I think it’s a very good idea. There’s one resource that pediatricians and even families can access and that’s the CDC website that has the location advice for travelers. And on that website you can actually plug in your location of travel and certainly whether you’re traveling with children and it will provide information on the diseases that are in transmission and what vaccinations or medications may be appropriate. Certainly pediatricians don’t routinely stock vaccines for travel, so things like yellow fever vaccine, typhoid vaccine, rabies vaccine, that may be indicated for the given traveler so that our clinic can provide those vaccines and it’s often good to consult and be seen in a travel clinic several weeks before the planned travel so that the body has time to develop protective immunity. We also have familiarity with medications that are given for prophylaxis for diseases such as malaria so we’re also able to provide prophylaxis for the patient’s that are traveling.
Melanie: So speak about the international travel clinic at St. Louis Children’s Hospital, what type of services do you offer and what can a patient expect?
Dr. Orscheln: So we see both children and families that are planning international travel. Prior to the visit we like to have an idea of their itinerary so that we know the locations and types of activities in which they will be participating in during their travel. We like to see them lie we said previously several weeks in advance of that travel so that we can provide appropriate vaccinations for travel. The types of vaccinations that we have available that may not be routinely available in the pediatricians office include things like yellow fever vaccination, typhoid vaccination, we can also provide other routine childhood vaccinations if those are appropriate and the patient hasn’t been vaccinated. And then again we provide medications for prevention of malaria and also traveler’s diarrhea.
Melanie: Dr. Orscheln, who can be seen at children’s hospital at the international travel clinic? Is it just children?
Dr. Orscheln: Well we will see children and their parents if they’re traveling. So we do not just routinely schedule adults for travel but if parents are traveling with a child then we are happy to provide these services so we can provide sort of one stop shopping for travel visit.
Melanie: Do patients need a referral to come there?
Dr. Orscheln: They do not necessarily need a referral; they can be self-referred to our clinic. We do like to routine them through our nurse who can evaluate their plans for travel and decide what vaccinations are appropriate with them and then discuss them with the family ahead of time prior to the visit.
Melanie: And how much prior to their vacation would you like them to come to the travel clinic?
Dr. Orscheln: It depends somewhat on the type of vaccine they’ll need. So we like for a vaccine series to be completed at least 2 weeks prior to travel. So some vaccines require multiple doses and so it is a good idea to make plans for a travel visit about four weeks prior to your planned travel.
Melanie: And Dr. Orscheln, for parents, what do you tell them about bringing certain medications if they’re going internationally and the importance of bringing medications? Should they bring prophylactic medications, antibiotics and such, or Motrin or Advil, any of these kinds of things, what do you tell t hem about what they should pack?
Dr. Orscheln: Well our general advice is certainly that patients should have all their own medications for their own chronic illnesses packed with them on travel with a sufficient quantity to get them through their travel plus any potential delays. Then we routinely, depending on the location, provide medications for the prevention of malaria and then we certainty will provide patients with a prescription that they can use in the event of developing traveler’s diarrhea.
Melanie: Are you seeing certain things, like measles, coming back from various countries? And a problem with the vaccination schedule?
Dr. Orscheln: Well I don’t think we have a problem with the vaccination schedule, per say. In the United States we routinely vaccinate children first a t about 12 months of age. And so we have had cases where children have traveled before 12 months of age and have come home with measles infection. Now we do know that for travel any infant over 6 months of age who is traveling abroad can be vaccinated and should be vaccinated against measles. This won’t actually count for their two dose series of MMR but it will provide them with some protection against measles infection while they’re traveling.
Melanie: What about countries such as Mexico where people are told not to necessarily drink the water or eat fresh vegetables and such and rotavirus and stomach issues, gastroenteritis, so what do you tell them when they’re going to a place like that?
Dr. Orscheln: Well we certainly do give advice about safe eating habits and so you know people who are traveling to a lot of locations in the world need to be careful about food and water consumption. So certainly making sure that fruits and vegetables they eat are peeled or cooked completely before eating those. Making sure drinking water is bottles and the lid is firmly tightened so that the water hasn’t been refilled and making sure not to eat from things like street vendors and places where people might not have access to frequent hand washing. So doing those sorts of things can reduce the chances that people will get traveler’s diarrhea.
Melanie: In summary doctor, please tell other pediatricians what you’d like them to know about recognizing infectious diseases and the travel clinic at St. Louis Children’s Hospital.
Dr. Orscheln: Well I would say that pre-travel consultation is important for families that are traveling. The Centers for Disease Control has an excellent website that provides advice about what medications and vaccines are appropriate for travel and St. Louis Children’s Hospital is happy to provide those specific travel related vaccines that may not be routinely available in the pediatric offices. Also when patients return from travel with illnesses, such as febrile illnesses or infectious diarrhea, we’re happy to see those patients in consultation and evaluation.
Melanie: And what can a pediatrician expect from your team at St. Louis Children’s Hospital after referring a patient to you?
Dr. Orscheln: Well certainly we always like to provide consultation back to the providers both in the form of written communication and also we can in the case of a patient let’s say being admitted to the hospital also call the provider with information.
Melanie: Thank you so much for being with us today. A physician can refer a patient by calling children’s direct physician access line at 1800678HELP. You’re listening to Radio Rounds with St. Louis Children’s Hospital. For more information on resources available at St. Louis Children’s Hospital you can go to StLouisChildrens.org. This is Melanie Cole, thanks so much for listening.