Travel medicine in a new era

Morgan Liotta

9/12/2021 11:22:49 AM

One expert examines what questions GPs can expect and the best advice to give.

Airport signage.
GPs can now expect longer and more complex travel health consultations.

For many, the prospect of international travel is once again on the cards with Australia having met its vaccination targets and borders reopening.
But with the emergence of Omicron, as well as other travel concerns, what can GPs expect when providing travel advice?
Bond University’s Professor Nick Zwar, who is Chair of RACGP Specific Interests Travel Medicine,  told newsGP that in the COVID-19 era, there are a number of questions and considerations that could be raised during a consult.
‘People are starting to travel again now after a long period where you hardly saw anyone coming into general practice asking about travel health advice,’ he said.
‘One of the key issues is, of course, COVID vaccination status, and some of the main questions I think GPs will be asked are what COVID vaccine and testing is required for travel − and that’s quite complicated because each country has a number of different requirements.’
In addition to staying across regularly updated online travel advice from the Australian Government, Professor Zwar recommends GPs be prepared to discuss COVID boosters and getting tested before travel, as well as what type of vaccines are recognised and accepted across each country.
Some of the questions GPs should anticipate, include:

  • what vaccine do I need to have?
  • can the vaccine that I had in Australia be accepted?
  • do I need to get a COVID-19 test before I go on a plane? And if so, what sort of test and where can I get that done?
‘Some countries won’t accept rapid antigen tests – most countries, in fact,’ Professor Zwar said.
‘So there are problems like that where they may have been quite specific about their requirement, which may not match to what the person’s had.
‘We’ve certainly had this with our students coming to work in the Queensland healthcare system for example, who had a particular vaccine overseas and then the health system here not recognising that vaccine.’
With COVID-19 vaccines now added to the travel list, Professor Zwar says it is important to consider the timing of other vaccines, particularly for those who are yet to finish their primary COVID-19 vaccine course or are due for their booster shot.
‘Because we don’t know that other vaccines may interfere [with the COVID vaccine] we are being cautious,’ he said.
‘It is likely that most wouldn’t interfere, but the lack of data on that means trying to separate them from other vaccines.
‘The other thing while you’re trying to separate them is knowing whether an adverse effect is related to the COVID vaccine or to the other vaccine if you get them on the same day − that is essential.
‘Obviously there’s been a lot of interest about what is happening with the COVID vaccines and wanting to report them and monitor them, so that’s another reason why they’ve been trying to keep them separated from [other] vaccines, as they can also occasionally cause adverse effects.’
Although no change to the timing of boosters has been announced, the latest advice from the Australian Technical Advisory Group on Immunisation (ATAGI) outlines that COVID-19 vaccines can be co-administered with other vaccines, if necessary. Professor Zwar advises GPs to regularly check for updates and assess patients on a case-by-case basis, depending on their current vaccine status.
And with Omicron making headlines and experts closely examining its impact, it is likely that GPs will also be fielding concerns about the new COVID variant when providing travel advice.
Professor Zwar said at this stage it is ‘too early to tell’, but that GPs should keep up to date with the latest advice.
‘There are a number of things about Omicron, and one is [that] it’s probably already out and has been out for a while,’ he said.
‘Although it seems to be quite infectious, it may not be that virulent … for people who are fully immunised, it might not cause terribly severe disease. We don’t know that yet for sure, but I’m trying to be hopeful.
‘[For people planning to go overseas] Omicron has raised the issue to make sure they’ve got full vaccine coverage, and that will include a third dose.’
What is clear, is that when it comes to providing travel advice, GPs will have much more to consider given the ‘new normal’ of living in a pandemic.
‘There’ll be a fair bit of talking about the complexity of travel, so [GPs should] allow lots of time,’ Professor Zwar said.
In addition to the virus and vaccination, people may also be asking about risks during air travel, which Professor Zwar noted remains one of the safest ways to travel, even with COVID-19.
‘The risk of air travel isn’t that high because aeroplane air is turned over quite rapidly and they are cleaning the surface every two seconds, [and] everyone is wearing masks,’ he said.
‘But on the bus or the train, or in the crowded situation of a departure lounge, that might be different. So that’ll be another question that people will definitely raise about travel.’
Meanwhile, time permitting, Professor Zwar says GPs can use a travel medicine consultation to opportunistically screen patients for other vaccines and routine checks that may have been missed due to COVID-19.
‘When you think about vaccines for travel, you also think about making sure people are up to date with their routine vaccinations and they haven’t missed anything,’ he said.
‘Mumps, rubella, yellow fever, meningococcal for example, if they are going to a country that requires a vaccine.
‘Have they had their cancer screening? Or have they missed out on X or Y?
‘There is always an opportunity to ask about other things … because people haven’t been coming to the doctor as much.’

Correction: This article originally indicated most countries do not accept PCR tests as proof of being COVID-negative.
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Dr Verity Jane Cooper   10/12/2021 9:14:01 AM

Thanks for that information Prof Zwar. I just wonder how much time patients are willing to pay for though? Many patients add the question about travel risks on the end of a usual consult (scripts, referrals, BP check etc in 15 minutes- already a rush) "by the way I'm heading off to ..... do I need anything" . If I have time I'll rush through things, but would have to book a long appointment to get through everything he has mentioned- and not many patients, if any , would be willing to pay for that.
Realities of general practice......