What is a pre-travel health consultation?

A structured medical consultation at least 4-6 weeks before international travel, covering: (1) Vaccine updates: routine (MMR, Tdap) + destination-specific (hepatitis A, typhoid, yellow fever, rabies, JE, meningococcal). (2) Malaria chemoprophylaxis: drug selection based on destination, resistance patterns, duration and patient factors. (3) Health advice: food and water safety; insect protection; altitude; sexual health; sun protection; medical kit (azithromycin, ORS, antimalarial standby if remote). (4) Travel health insurance including medical evacuation. Earlier consultation = more vaccine options.

Which malaria drug is right for my destination?

Atovaquone-proguanil (Malarone): best for East Africa, most of Asia, Central America; well-tolerated; start 1-2 days before; stop 7 days after. Doxycycline: broadest coverage including mefloquine/chloroquine-resistant areas (SE Asia borders); daily; photosensitivity; not for children <8yr or pregnancy. Mefloquine: weekly — useful for long trips; contraindicated in psychiatric history, anxiety, depression, seizures. Chloroquine: very limited use now (only vivax areas without resistance). Always check current PHE/CDC/WHO destination-specific guidance.

How do I prevent traveller's diarrhoea?

"Boil it, cook it, peel it or forget it." Safe: hot food served hot; peeled fruit; bottled/carbonated water; boiled water; coffee/tea made with boiled water. Avoid: tap water/ice; raw shellfish; salads; buffet food at room temperature. Standby treatment kit: azithromycin 500mg single dose + loperamide + ORS sachets. Seek medical attention if: blood in stool; high fever; dehydration; no improvement after 48h of treatment.

What is altitude sickness and how do I prevent it?

Ascend too rapidly → insufficient acclimatisation → hypoxia symptoms. AMS: headache + ≥1 symptom (nausea, fatigue, dizziness) above 2,500m. Prevention: ascend no more than 500m per night above 2,500m; rest days every 3-4 days; never ascend with symptoms. Acetazolamide 125-250mg BD from 24-48h before ascent: reduces AMS ~50%. Emergency rules: confusion or ataxia (HACE) or severe dyspnoea at rest (HAPE) = IMMEDIATE descent — do not sleep at that altitude.

How does GMJ News cover travel medicine?

GMJ News covers pre-travel consultation timing, malaria prophylaxis (all 4 options + G6PD for primaquine), yellow fever ICVP (lifelong from single dose), altitude sickness (AMS/HACE/HAPE + acetazolamide), traveller's diarrhoea (azithromycin first-line), vaccine checklist, jet lag management, WHO Green Book, mefloquine neuropsychiatric warning, and PHIG's IHR role. Directly relevant to PHIG's international health programme and Dr Pkhakadze's extensive international travel.

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Travel Medicine

Q: How do I prevent traveller's diarrhoea?

"Boil it, cook it, peel it or forget it." Safe: hot food served hot; peeled fruit; bottled/carbonated water; boiled water; coffee/tea made with boiled water. Avoid: tap water/ice; raw shellfish; salads; buffet food at room temperature. Standby treatment kit: azithromycin 500mg single dose + loperamide + ORS sachets. Seek medical attention if: blood in stool; high fever; dehydration; no improvement after 48h of treatment.

Q: What is altitude sickness and how do I prevent it?

Ascend too rapidly → insufficient acclimatisation → hypoxia symptoms. AMS: headache + ≥1 symptom (nausea, fatigue, dizziness) above 2,500m. Prevention: ascend no more than 500m per night above 2,500m; rest days every 3-4 days; never ascend with symptoms. Acetazolamide 125-250mg BD from 24-48h before ascent: reduces AMS ~50%. Emergency rules: confusion or ataxia (HACE) or severe dyspnoea at rest (HAPE) = IMMEDIATE descent — do not sleep at that altitude.

Q: How does GMJ News cover travel medicine?

GMJ News covers pre-travel consultation timing, malaria prophylaxis (all 4 options + G6PD for primaquine), yellow fever ICVP (lifelong from single dose), altitude sickness (AMS/HACE/HAPE + acetazolamide), traveller's diarrhoea (azithromycin first-line), vaccine checklist, jet lag management, WHO Green Book, mefloquine neuropsychiatric warning, and PHIG's IHR role. Directly relevant to PHIG's international health programme and Dr Pkhakadze's extensive international travel.

GMJ News knowledge hub · last reviewed August 2026 · Georgian Medical Journal

Summary Statistics Glossary GMJ news FAQ Documents Organizations Research

Travel medicine — the clinical discipline concerned with the prevention and treatment of health problems in international travellers — has become a distinct specialty as approximately 1.5 billion international tourist arrivals occur annually (pre-COVID peak), with approximately 22-64% of travellers to developing regions reporting health problems and travel-related illness ranging from the ubiquitous traveller’s diarrhoea (affecting approximately 30-80% of travellers to high-risk regions) to potentially fatal conditions including malaria (still causing approximately 600,000 deaths/year, predominantly preventable with chemoprophylaxis in travellers) and altitude sickness (including HACE and HAPE — the leading causes of non-trauma death in high-altitude trekkers) (WHO International Travel and Health). The core principle: a pre-travel consultation at least 4-6 weeks before departure — covering risk-stratified vaccine recommendations, malaria prophylaxis selection, traveller’s diarrhoea management, altitude sickness prevention, personal protective measures and travel insurance guidance — reduces travel-associated morbidity and mortality dramatically across all traveller risk categories.

Key messages

Pre-travel consultation — at least 4-6 weeks before departure

A pre-travel health consultation should occur at least 4-6 weeks before departure — some vaccines require multiple doses or time to achieve protective immunity (hepatitis B: 3 doses over 6 months; Japanese encephalitis: 2-3 doses). Walk-in travellers 1-2 weeks before departure can still receive many vaccines but have limited options for schedule completion.

Malaria — 600,000 deaths/year — travel malaria is largely preventable

Malaria causes approximately 600,000 deaths annually, but travel-associated malaria is largely preventable with appropriate chemoprophylaxis + personal protection (DEET 30-50%; long sleeves/trousers; bed nets). Prophylaxis choice depends on destination resistance patterns: atovaquone-proguanil (Malarone) — most widely used; doxycycline — broadest resistance coverage; mefloquine — weekly but check neuropsychiatric contraindications; primaquine — P. vivax radical cure (G6PD screen first).

Yellow fever — mandatory vaccine for many countries

Yellow fever vaccination is a legal entry requirement for many sub-Saharan African and South American countries. The ICVP (International Certificate of Vaccination or Prophylaxis — Yellow Card) must be carried. Single dose provides lifelong protection (WHO 2014 — no booster required for most travellers). Contraindications: age <6 months; egg allergy; immunosuppression; thymus disease; age >60 (higher YAVD risk).

Altitude sickness — HACE and HAPE are preventable emergencies

AMS (Acute Mountain Sickness) above 2,500m: headache + ≥1 other symptom. Acetazolamide 125-250mg BD, starting 24-48h before ascent, reduces AMS by ~50%. HAPE (High Altitude Pulmonary Oedema): most common cause of altitude death — immediate descent + O2 + nifedipine. HACE (High Altitude Cerebral Oedema): ataxia + confusion → immediate descent + dexamethasone 8mg + O2.

Traveller's diarrhoea — azithromycin is first-line antibiotic

TD (≥3 loose stools/24h + enteric symptom) affects 30-80% of travellers to high-risk regions. Most common pathogen: ETEC (approximately 30%). Management: ORS; azithromycin 500mg single dose (first-line — covers ETEC and Campylobacter); ciprofloxacin (alternative — increasing fluoroquinolone resistance); rifaximin (colon pathogens only — not for invasive diarrhoea); loperamide for symptomatic control.

Vaccine checklist — routine + destination-specific

Ensure routine immunisations up to date (MMR, Tdap, influenza, COVID-19). Destination-specific: hepatitis A (most LMIC travellers); typhoid (endemic areas); yellow fever (mandatory many countries); rabies pre-exposure (remote, animal exposure risk); Japanese encephalitis (Southeast/East Asia rural); meningococcal ACWY (Hajj mandatory; Africa meningitis belt); cholera (Dukoral — ETEC protection also).

Key statistics

~600K

malaria deaths/year globally — travel malaria largely preventable with prophylaxis

WHO 2024

30-80%

of travellers to high-risk regions develop traveller's diarrhoea

WHO/CDC

~50%

reduction in AMS risk with acetazolamide prophylaxis (Cochrane)

Cochrane/UIAA

Lifelong

protection from single YF dose — WHO 2014 no booster for most travellers

WHO 2014

4-6 weeks

minimum pre-travel consultation lead time recommended

WHO/NaTHNaC

G6PD screen

required before primaquine (radical cure P. vivax) — risk of haemolysis

WHO/CDC

Malaria chemoprophylaxis — drug properties comparison

Source: WHO/PHE. Always check current destination-specific resistance patterns before prescribing.

Glossary of key terms

Atovaquone-proguanil (Malarone)
Pharmacology/MalariaFixed-dose combination: atovaquone (mitochondrial electron transport disruption) + proguanil (→ cycloguanil; DHFR inhibitor). Active against all Plasmodium including multidrug-resistant P. falciparum. Daily with fatty food. Start 1-2 days before; stop 7 days after. Well-tolerated. Contraindications: severe renal impairment; pregnancy/breastfeeding (limited data). Expensive — barrier for budget travellers.

HAPE — high-altitude pulmonary oedema
Altitude medicineNon-cardiogenic pulmonary oedema from hypoxia-induced pulmonary vasoconstriction → elevated pulmonary artery pressure → alveolar fluid leak. Most common cause of death at altitude. Presentation: disproportionately low SpO2; exercise intolerance + dry cough (night 2 at new altitude); progresses to resting dyspnoea; pink frothy sputum; crackles. Treatment: IMMEDIATE DESCENT; O2 (SpO2 >90%); nifedipine 10mg IR (30mg ER). Prevention for HAPE-prone: nifedipine or tadalafil + slow ascent.

Mefloquine neuropsychiatric risks
Pharmacology/SafetyFDA 2013 black box warning: neuropsychiatric effects common (~25%: vivid dreams, insomnia, anxiety, dizziness) and rare but serious (psychosis, seizures, suicidal ideation). Contraindicated: personal/family history of psychiatric disorder, depression, anxiety, seizures, cardiac conduction abnormality. Start 2.5 weeks before travel (reaches steady state; allows side effects to manifest before departure). Now largely replaced by atovaquone-proguanil for most travellers.

WHO International Travel and Health (Green Book)
WHOThe definitive travel medicine reference — published annually and maintained online at who.int/ith. Country-by-country disease risk; malaria prophylaxis by region; vaccine requirements; altitude, cruise, diving health. UK equivalent: NaTHNaC TravelHealthPro (UKHSA). Both updated continuously.

Jet lag management
ChronobiologyJet lag: circadian desynchrony after crossing multiple time zones. Eastward travel harder (shortens the day). Melatonin 0.5-5mg at destination bedtime × 3-5 nights — best evidence for eastward travel. Strategic light exposure: morning light for eastward (advances clock); evening light for westward (delays clock). Sleep medications (zopiclone, zolpidem) for 1-2 nights can help but next-day sedation risk. Adjust meal times to destination schedule.

Traveller's diarrhoea — azitroomycin first-line
WHO/CDCAzithromycin 500mg single dose (or 3 days for severe): effective for ETEC and Campylobacter (the two most common TD pathogens); superior to ciprofloxacin in South/Southeast Asia (high Campylobacter fluoroquinolone resistance). Rifaximin (non-absorbable, colon-localised): suitable for non-invasive ETEC diarrhoea in adults; NOT for febrile or bloody diarrhoea (invasive pathogens require systemic antibiotics). Loperamide: reduces stool frequency; combine with antibiotic for moderate-severe TD.