When traveling, regardless of the destination, it is very important to ensure at least that children and adults are up to date in their basic vaccines. In Quebec and Canada, public health recommends a booster every ten years against diphtheria and tetanus. Although they are free, these vaccines are often overlooked.

Note that, in a travel health clinic, we of course check the patient’s vaccination status, but we also give him other tailor-made advice. “A person with diabetes who goes to Peru, for example, needs specific advice,” says Dr.^r Brabant.

What if I only go to Europe? “It all depends on where you go, but it’s important to know that, for example, the risk of hepatitis A is much higher in southern Spain and Italy than in Canada,” explains D^re Dominique Tessier, specialist in travel health and clinical lecturer in the Department of Family Medicine at the University of Montreal.

What if I’m only going to spend a week in San Francisco? “Update your basic vaccines and get vaccinated against influenza (flu), an infectious disease that you could get at any airport. This vaccine is recommended for all travelers, whatever their personal risk factors ”, specifies the D^re Tessier.

For classic sun destinations, our two experts recommend the vaccine againsthepatitis A. It protects effectively for at least 20 years against this viral disease which is very difficult to prevent and for which there is no treatment. “The vaccine costs $ 60 to $ 75, but since the disease can bed you in bed for a few weeks, it’s worth it,” says Dr.^r Brabant. “Even if we are in an all-inclusive, the food usually comes from a local culture and this is where the contamination occurs”, adds the D^re Tessier.

The vaccine againsthepatitis B is another essential precautionary measure, according to the D^re Tessier. “When traveling, the risk of injury increases and we do not always have access to care in sterile conditions,” she explains. The opportunities for sexual contact are also increasing, which is a second good reason to get the hepatitis B vaccine. Patients say they will not have sexual contact, but when traveling this resolution does not always hold up when ‘an opportunity presents itself, ”she emphasizes. This vaccine protects for life. Note that there is a combined hepatitis A and B vaccine (Twinrix®), which costs $ 70 to $ 80.

In people who are particularly vulnerable to diarrhea, the Dukoral vaccine^® can reduce the risk of suffering from it and thus avoid turning a relaxing vacation into a stressful vacation. “Although it does not prevent all diarrhea, this vaccine, initially created to prevent cholera, protects against 50% to 70% of severe infectious diarrhea and it is effective for three months », Specifies the D^r Brabant.

The ideal time to arrive at a travel health clinic is six weeks before departure. This period allows the injections to be spread out and the necessary reminders to be given so that certain vaccines are fully effective at the time of travel. “But even the day before, it’s never too late, especially in the case of hepatitis A, because the vaccine protects immediately ”, specifies the D^re Tessier.

The difficulty when you go about it late is getting a last minute appointment. “We try to respond to travelers who need an urgent appointment by offering as much availability as possible and several access points, especially in pharmacies”, explains D^r Brabant. But, although the number of travel health clinics increases, they are not sufficient to meet needs which are also growing significantly.

Consultations in travel health are not covered by the public health system. These clinics are therefore private and their prices vary, both for the consultation and for the vaccines.

Depending on the location, a consultation can cost as little as $ 15 for a typical sun destination, but usually it costs $ 30 to $ 75, which sometimes includes a medical evaluation after the trip. the cost of vaccines is added to that of the consultation. Some private health insurance plans may reimburse these costs, depending on the terms of the policy purchased.

The travel health clinics are more and more numerous, but not all are of equal value, according to our two experts. As there is not, for the moment, a structure controlling the quality of the advice offered, how do you know if the staff is qualified?

“In a good clinic, the nurse takes the time to explain the risks and describe the diseases, but there is no pressure to vaccinate at all costs. It is up to the patient to decide what is right for them, based on their risk tolerance and budget. “

Here are some tips to help you choose a travel health clinic:

• Go to a clinic supervised by a doctor. “Nurses can vaccinate without medical supervision and some have opened travel vaccination clinics in pharmacies, without having adequate training,” laments Dr.^r Brabant.
• Do business with a clinic that offers more than vaccination, as the needs of travelers go far beyond immunization.
• A certification ” designated center for yellow fever vaccination », Issued by Health Canada, is a guarantee of seriousness, even if it is no longer mandatory since 2008.

• For five years, there has been an accreditation issued by theInternational Society of Travel Medicine. Only eight health professionals in Quebec held it in January 2009 and others plan to take the exam which is given once a year. This accreditation is a good indicator of competence.

The Public Health Agency of Canada offers a list of travel health clinics Across the country. This list is not exhaustive and the fact that a clinic is listed does not mean that its standards of practice are approved by Health Canada: www.phac-aspc.gc.ca

Document before going to the travel health clinic has two advantages:

• You are not taken by surprise by what is offered and you can discuss it in a more informed way.
• You are better able to judge whether the knowledge of the staff is adequate.

The links below give you access to reliable and up-to-date information.

Canada

Public Health Agency of Canada

• Immunization recommended for travel abroad

  www.phac-aspc.gc.ca

• General recommendations for travelers

  www.phac-aspc.gc.ca

• Travel health clinics in Quebec (non-exhaustive list)

  www.phac-aspc.gc.ca

• Health tips and international reports (regular updates).

  www.phac-aspc.gc.ca

Québec

National Institute of Public Health

• Quebec Advisory Committee on Travel Health

  Monitoring of travel health news (regular updates)

  www.inspq.qc.ca

France

Institute of Health Surveillance

• Health recommendations for travelers 2008

  www.invs.sante.fr

Rouen Hospitals CHU

• Basic tips

  www3.chu-rouen.fr

• Maps of endemic areas for several diseases (yellow fever, hepatitis A, hepatitis B, malaria, etc.).

  Note: these maps are from May 2006.

  www3.chu-rouen.fr

Swiss

Federal Office of Public Health

• SafeTravel.ch

  This very well done site is a mine of information. It contains the official recommendations of the Committee of Experts in Travel Medicine and the Federal Office of Public Health. The Destination and Health Tips sections are particularly useful.

  www.safetravel.ch

English

Fitfortravel

Very well done site of the Scottish Public Health Service (National Services Scotland) www.fitfortravel.nhs.uk

Centers for Disease Control and Prevention (United States)

CDC Travelers’ Health

wwwn.cdc.gov/travel