The Travel Consultation

Travel medicine is a risk-management consultation: identify the specific risks of this traveller on this trip, advise on hazards by destination, and prioritise risk-reduction interventions (vaccines, medications, behaviour). Ideally at least 4–6 weeks before departure to allow vaccine courses to complete, but any consultation is worthwhile, even close to departure.

Risk assessment

Assess the traveller (age, sex, medical history, medications, allergies, pregnancy/breastfeeding, immune status, routine and prior travel vaccines, prior travel-related illness) and the trip (itinerary and dates including layovers, transport, rural vs urban, outbreaks at destination, accommodation, travel style, level of local medical care, travel companions, season, duration, reason for travel). Ask specifically about special activities that carry their own risk profile: animal interactions (farms, live animal markets), cycling/motorbiking, diving (needs a diving medical from an appropriately trained doctor), extreme sports, high-altitude travel, disaster relief/humanitarian work, and substance/psychoactive use including illicit drugs.

Higher-risk travellers who need closer attention:

• Pregnant women, infants and children, the elderly
• Chronic medical conditions (diabetes, IHD, COPD) or immunosuppression
• Those on PPIs (higher risk of travellers’ diarrhoea)
• Expatriates/long-term travellers
• Travellers visiting friends and relatives (VFR) — a higher-risk group that often underestimates its own risk (e.g. malaria), since the trip feels like “going home” rather than travel to a disease-endemic area

Fitness for travel and health maintenance

A stable chronic condition is generally compatible with travel; check airline fitness-to-fly guidelines if there’s doubt, and be prepared to have the difficult conversation of advising against travel where needed.

• Patients should carry a health summary and a sufficient supply of routine medications for the full trip, understand how to self-manage acute exacerbations of chronic disease (including mental health) while away, and have a written action plan where relevant.
• Consider whether planned minor procedures are better scheduled before departure or safely deferred until return.
• Be cautious about giving clinical advice to a patient once they’ve left Australia — this may fall outside medicolegal protection and isn’t Medicare-rebatable. The International Society of Travel Medicine (ISTM) maintains a global directory of local travel-medicine providers for patients who need in-country care.
• Remind patients to check their travel insurance explicitly covers their planned activities (e.g. diving, high-altitude trekking) and repatriation.

Carrying and managing medications while travelling

In general, the Pharmaceutical Benefits Scheme allows up to a six-month supply of subsidised drugs to be taken overseas for personal use, though this can extend to 12 months for some drugs (six months only for authority items) — prescriptions can be annotated with PBS Regulation 24 so the pharmacist dispenses the original and repeat supplies together. Travellers should carry either a prescription or a doctor’s letter stating that the traveller is under their care and that the drugs were prescribed for the traveller’s own use, specifying the drug name (generic preferred, since brand names vary by country) and dose. Medicines should be transported in their original packaging whenever possible, in hand luggage where practical; refrigeration during flight is seldom necessary, even for insulin, which remains stable at room temperature for several months.

Controlled drugs need specific planning. Country-by-country legal restrictions for potentially addictive drugs (opioids, psychotropics including amphetamines) are an area of substantial difficulty and uncertainty — International Narcotics Control Board guidelines allow up to a 30-day supply of a legally-prescribed controlled drug for personal use, but individual countries often apply stricter rules than this in practice, so it’s worth checking the specific destination rather than assuming the INCB figure applies everywhere.

Purchasing medicines overseas carries real risk. Advise travellers to buy antimalarials and other trip-specific medicines before leaving Australia rather than overseas — substandard and counterfeit medicines are a genuine problem in low- and middle-income countries, and fake antimalarials specifically are a recognised hazard. If a purchase overseas is unavoidable, a reputable pharmacy and careful inspection of packaging are the best available mitigations.

A basic travel medical kit typically includes first-aid items (antiseptic, dressings), illness-care items (analgesics, antidiarrhoeals, oral rehydration salts), and preventive items (hand sanitiser, insect repellent, sunscreen, condoms) — a commercially available kit has the advantage of a contents list and a document explaining the items are for personal use, which can help at customs.

Diabetes-specific planning: patients need a doctor’s letter to bring diabetes equipment (pen needles, insulin pump consumables, fingerprick devices, lancets) on board, a glucometer for monitoring, and a supply of glucagon or fast-acting carbohydrate for hypoglycaemia. Adjustment of insulin dosing usually isn’t needed for a time-zone change under 4 hours; larger changes need specific advice from the GP or specialist depending on the person’s regimen. In flight, bolus/mealtime insulin should only be injected once the meal has actually been served, since turbulence can delay food service.

Contraception-specific planning: travel across time zones can cause confusion about pill timing, especially for the progestogen-only pill, where flying west (which extends the interval between doses if timed to the destination) risks reduced effectiveness — advise keeping a second watch set to home time, and erring towards a shorter rather than longer dosing interval when adapting to local time. Implants and the vaginal ring aren’t affected by time-zone changes. Traveller’s diarrhoea can also affect oral contraceptive pill absorption — the general advice is to keep taking the pill but use additional contraception for the duration of the illness plus a further 7 days.

Vaccination

See also the National Immunisation Schedule and Pre-Travel Vaccinations for the full commonly-available-vaccine table, dosing detail and a closer look at yellow fever risk–benefit.

• Routine/catch-up — ensure MMR, dTpa, polio, influenza and COVID-19 are up to date before travel.
• Required for entry — yellow fever (an International Certificate of Vaccination or Prophylaxis, ICVP, may be a mandatory entry requirement; single dose confers lifelong validity under current WHO policy); meningococcal ACWY (mandatory for Hajj/Umrah pilgrims). Use a conjugate MenACWY vaccine (e.g. Menveo, Nimenrix, Menactra) rather than the older polysaccharide form — conjugate vaccines give better and longer-lasting immunity and are now the standard recommendation for travellers, including for Hajj/Umrah, where a conjugate ACWY vaccine has been a Saudi entry requirement for pilgrims for some years.
• Recommended by destination/risk — hepatitis A (and B for long-term or frequent travellers, or those at risk of sexual contact/medical procedures/ blood exposure in developing countries), typhoid, Japanese encephalitis, rabies (pre-exposure for long-term travellers to endemic areas), cholera (selected high-risk travellers only — not a routine vaccine, and not effective against traveller’s-diarrhoea-causing ETEC).
• Rabies — every traveller to an endemic area should have an animal-bite plan (immediate wound washing, urgent medical review for post-exposure prophylaxis) regardless of whether they’ve had pre-exposure vaccination; sourcing rabies immunoglobulin can be difficult in some destinations, which is itself an argument for pre-exposure vaccination in higher-risk itineraries. The Australasian College of Tropical Medicine (ACTM) publishes an Australia/NZ-specific rabies guideline.
• Live vaccines need care in pregnancy and immunocompromise.
• Exact schedules, dosing and current brand availability change — verify against the Australian Immunisation Handbook

Specific Vaccine Dose Schedules

• Hepatitis A — monovalent inactivated vaccine given as a 2-dose IM course; the second dose is given 6 months after the first (the Handbook permits a 6–12 month interval). Protection begins within 2 weeks after the first dose, so dose 1 can still be given close to travel, with dose 2 completing the course for lifetime immunity. No booster is required after the full course. A combination hepatitis A/B vaccine is also available on a separate (3- or 4-dose) schedule.
• Typhoid — two options:
  • Parenteral Vi polysaccharide (injectable) — single 0.5 mL IM dose for adults and children ≥2 years; booster every 3 years if ongoing risk.
  • Oral live attenuated (Vivotif) — for adults and children ≥6 years; 3 or 4 capsules (the 4th dose is optional and may give better protection than 3), taken on days 1, 3, 5 (and day 7 for the 4-dose schedule), 1 hour before food. Longer protection than the injectable but capsules are unsuitable for young children; contraindicated in pregnancy and immunocompromise. Separate from oral cholera vaccine by ≥8 hours.
  • Multidrug-resistant strains are increasingly common in South/Southeast Asia.
• Yellow fever — single dose conferring lifelong validity; can only be given at a certified Yellow Fever Vaccination Centre; contraindicated/high-risk in the elderly (≥60), infants <9 months, immunocompromise, egg anaphylaxis, and past thymus disease.

• Japanese encephalitis — for travellers spending time in endemic rural areas of Asia/Oceania during the transmission season (traditionally ≥1 month, but shorter trips may still warrant it). Two vaccines are available:
  • Imojev (live attenuated) — single subcutaneous dose, for ages ≥9 months; preferred where not contraindicated; considered to give lifelong cover in adults ≥18. Contraindicated in pregnancy and immunocompromise.
  • JEspect / Ixiaro (inactivated) — 2-dose IM schedule from age 2 months, doses 28 days apart (accelerated 7-day schedule available for adults ≥18 at imminent risk). Infants/children aged ≥2 months to <3 years receive 2 doses of 0.25 mL. Booster recommended after 1–2 years with ongoing exposure risk; safe in breastfeeding.

Malaria prevention

Malaria chemoprophylaxis choice depends on destination-specific resistance patterns and the traveller’s comorbidities/pregnancy status — see Malaria. VFR travellers are disproportionately under-prepared for malaria risk. The Australasian College of Tropical Medicine (ACTM) publishes an Australia/NZ-specific malaria chemoprophylaxis guideline (covering atovaquone-proguanil, doxycycline, mefloquine and tafenoquine — note tafenoquine requires G6PD deficiency to be excluded first) alongside its rabies and Japanese encephalitis guidelines.

Travel injuries

The most common serious travel harms are not infections:

• Road trauma is the single most common cause of injury while travelling — advise seatbelt use, avoiding impaired/unfamiliar driving (including unfamiliar vehicle types like mopeds), and awareness of local road rules.
• Drowning is a leading cause of death — swim between flags, understand rip currents, use lifejackets on watercraft, avoid alcohol near water, supervise children within arm’s reach. See Drowning & Immersion for rescue, resuscitation and disposition.
• Falls from height (“selfie” deaths) — remind patients to stay aware of their surroundings near cliffs/edges, especially at popular photo spots.
• Methanol poisoning and drink spiking — a genuine and under-recognised risk with counterfeit/informally-brewed spirits in some destinations; methanol poisoning classically causes visual disturbance up to blindness.
• Falls in older/vulnerable travellers — vision check, luggage management, medication review, balance assessment before departure.
• Child safety: infants under 2 should not fly on a parent’s lap where a car seat can be used instead; children under 9 should not sleep on a top bunk.

Source: Injuries in travellers: Clinical considerations for general practitioners

Environmental risks

Beyond altitude (additional consultation time is warranted above 2800 m — see Altitude sickness), destination-specific environmental exposures worth a targeted mention include fresh water (schistosomiasis), soil (helminths), forests (ticks) and some accommodation types (Chagas disease in parts of Latin America). A working knowledge of the itinerary’s geography helps target which of these are actually relevant rather than reciting the whole list.

Other health education topics commonly discussed

• Eating and drinking safely (see Traveller’s diarrhoea)
• Insect avoidance/repellent, especially for mosquito-borne disease
• Safe sex practice — antibiotic-resistant STIs and unplanned pregnancy risk are both worth explicitly raising
• Tuberculosis risk for VFR travellers, particularly children going to live long-term in high-prevalence countries
• DVT prevention on long flights — standard precautions (exercises, maintaining hydration) plus compression stockings for those with risk factors; aspirin hasn’t been shown to be effective for DVT prevention and carries a real gastrointestinal-bleeding risk, so isn’t currently advised for this purpose.
• Motion sickness
• A basic medical kit (see above) and checking access to local medical services
• Travel insurance

Running the consultation efficiently

Travel medicine is explicitly part of the RACGP curriculum and syllabus — this is mainstream general practice, not a niche add-on. Practical steps that help fit a proper risk assessment into a normal clinic day: book it as a long appointment several weeks ahead (routine chronic-disease or health assessment visits are a good prompt to ask about upcoming travel), use a proforma the patient completes before the appointment, keep a dedicated vaccine fridge stocked with the common travel vaccines, and consider practice accreditation as a yellow fever vaccination provider if there’s enough demand. Even a last-minute pre-departure consult is worthwhile — document that comprehensive advice wasn’t possible in the time available rather than skipping the consultation altogether.

Resources: CDC Yellow Book, NaTHNaC (UK), CATMAT (Canada) and the Australasian College of Tropical Medicine (ACTM — Australia/NZ-specific rabies, malaria and Japanese encephalitis guidelines) for destination risk and itinerary advice; the Australian Immunisation Handbook for vaccine schedules; Therapeutic Guidelines for travel medication regimens; the ISTM’s provider directory for in-country support.

Source: Preparing patients for travel: a primary care perspective (also source for the ACTM malaria/rabies/JE guideline mentions above).

Post-travel

Patients should be told to recognise and seek care for post-travel syndromes — fever, ongoing diarrhoea, cough, rash — see Illness in returned traveller.