Preparing patients to travel abroad safely. Part 1: Taking a travel history and identifying special risks.

OBJECTIVE To present for family physicians without access to a travel clinic and the Internet the questions to ask about the medical history and itinerary of their patients traveling abroad. To suggest ways to identify and advise high-risk patients.

QUALITY OF EVIDENCE MEDLINE searches from 1990 to November 1998 located 51 articles on travel and diabetes, 37 on travel and chronic obstructive pulmonary disease (COPD), 63 on travel and heart disease, 192 on travel and pregnancy, and 298 on travel with infants or children. Additional searches were undertaken in September 1999. The quality of evidence in most articles is level III (expert opinion). There are no randomized controlled trials of the best advice for family physicians to give travelers.

MAIN MESSAGE A history should include countries to be visited, planned activities, previous tropical travel, medical history, vaccination status, whether children are traveling, pregnancy status, and patients' opinions of the risks and precautions needed. Detailed advice should be given to reduce risks. The main causes of mortality abroad are existing cardiovascular conditions and accidents. High-risk conditions to be identified in travelers are cardiovascular illness, COPD, diabetes, immunodeficiency, pregnancy, and traveling with children.

CONCLUSIONS Patients with cardiovascular illness or COPD should be advised to avoid too much exertion while traveling. Detailed instruction should be given to diabetic patients on how to maintain stable glucose levels, to pregnant women on avoiding malarial infection, and to parents on protecting their children from infections and accidents.