Vaccination for the expatriate and long-term traveler

Abstract

Duration of travel is an important factor in addressing travel health safety due to cumulative risk of exposure to illness and injury. The diverse group of expatriate and long-term business and leisure travelers present a different spectrum of issues for the travel medicine practitioner to address during consultation than does the short-term traveler, due to changes in travel patterns and activities, lifestyle alterations, and increased interaction with local populations. Immunization provides one safe and reliable method of preventing infectious illness in this group. We review travel patterns and available data on illnesses that they may be exposed to, including the increased risk of certain vaccine-preventable illnesses. We review the pre-travel management of these travelers, particularly the increased risk of certain vaccine-preventable illnesses as it applies to routine vaccines, recommended travel vaccines and required travel vaccines.

Keywords::

• corporate travel
• expatriate
• long-term traveler
• multinational corporation
• occupational travel
• pre-travel evaluation and advice
• travel medicine
• vaccination

Financial & competing interests disclosure

This manuscript was written as part of the academic mission of the University of Pennsylvania. The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending or royalties.

No writing assistance was utilized in the production of this manuscript.

Key issues

• Many common infections seen in long-term travelers and expatriates are preventable by vaccines, as such Travel Medicine needs to continue to encourage education of travelers and international businesses regarding the importance of seeking pre-travel guidance. Social Media is one underutilized method that merits more study, as it can provide information to large audiences inexpensively and rapidly.

• Pre-travel guidance may prevent interruptions in business and evacuation, with their inherent significant increase in direct and indirect cost for the traveler and business. Newer data obtained from large travel medicine networks have provided more robust evidence, such as a >10-fold reduction in the incidence of hepatitis A, on which to base current travel recommendations and judge the effectiveness of current management.

• Since a considerable proportion of women travelers and expatriates are in their childbearing years, vaccinations should be considered proactively and an intensive risk discussion should occur with these travelers to determine best care when disease probability is high and poses a greater risk to the woman and her fetus than does vaccination.

• Special needs travelers are increasingly taking longer trips, residing abroad and visiting at-risk areas. Adequate and safe immunization is even more important in this population and robust risk discussions are crucial.

• While pre-travel consultation for long-term travelers and expatriates is ideal 6 months before travel, vaccine schedules can be accelerated and helpful information and certain vaccines, such as hepatitis A, can be given with good effectiveness immediately prior to departure.

• Cumulative risk analysis also figures into conversations with frequent travelers and a vaccine that may not be useful for a single trip may become useful when multiple trips, or side trips to at-risk areas, are taken into consideration.