“Doctor, I’m leaving for Peru,” “I’ve booked a resort in Thailand”...whether it’s to visit cities, relax by the sea, or go hiking in the mountains, Italians are increasingly choosing exotic destinations for their vacations. These are demanding trips that can hide some health risks.

The family doctor, who knows the patient and has the patient’s trust, can help them prepare as best as possible to avoid unpleasant surprises.

1. Learn about the destination

“The first step is to encourage the patient to research the characteristics of their destination,” noted Alberto Tomasi, a public health physician and past president of the Italian Society of Travel and Migration Medicine (SIMVIM). “This includes the climate, altitude, healthcare conditions, availability of medical care in case of need, and any endemic diseases requiring vaccination or prophylaxis. Be careful, for example, with ‘hidden’ altitudes: For those arriving by plane in Mexico City, it’s not immediately obvious that they’re at more than 2000 m above sea level, but someone unaccustomed to these heights may be affected. It’s best to know this beforehand.”

On the SIMVIM website, a search engine links to fact sheets on dozens of non-European countries, featuring geographic data, potential risks, recommended vaccinations, and precautions. “Our society also periodically organizes travel medicine seminars for colleagues who want to learn more about the subject,” Tomasi continued. Another useful service, which also provides updates on the political situation and any conflicts, is the Viaggiare Sicuri website, maintained by the Italian Ministry of Foreign Affairs.

2. Assess overall health

“If someone planning a demanding trip has a chronic condition, it’s advisable to schedule a medical checkup before departure,” warned Tecla Mastronuzzi, head of the Prevention Division at the Italian Society of General Practitioners. “At that time, the doctor can verify that the patient has undergone the follow-up tests required for their condition and, if necessary, adjust their treatment based on the travel destination. For example, it may be necessary to reassess the dosage of blood pressure medications in preparation for a stay in a country with a very hot climate or at high altitudes. I advise pregnant women, the very elderly, and those with serious chronic illnesses to carefully evaluate their destination and the availability of healthcare in the unfortunate event that they require medical attention.”

When more specific advice is needed, the family doctor can refer the patient to a travel medicine clinic. “There are about 300 of them spread throughout the country,” said Tomasi.

3. Get recommended vaccinations

“Preparing for a trip is an excellent opportunity to remember to get a tetanus booster shot. It should be repeated every 10 years, but many people neglect it,” said Tomasi. It is also important to verify that the traveler has been vaccinated against measles. “It’s an infection that is spreading again in countries where it was previously under control,” explained Alessandra D’Abramo, an infectious disease specialist at the Lazzaro Spallanzani National Institute for Infectious Diseases in Rome, Italy. “There are also vaccinations specifically recommended for the travel destination, such as those against arboviruses for countries in Southeast Asia. The risk of exposure to infections can vary depending on whether you plan to stay only in urban areas or visit rural areas, but if an infection is endemic in the country, it’s advisable to get vaccinated regardless of your itinerary. To assess the situation and receive up-to-date guidance, you need to visit a travel medicine clinic, where the patient’s medical history and destination will be evaluated, and the vaccines will then be administered.”

It’s best to schedule the appointment well in advance. “Sometimes during the peak vacation season, there’s a rather long waiting list,” noted Tomasi. “Furthermore, some vaccines require multiple doses, and it takes a couple of weeks after administration for their full protective effect to take hold.”

Among the vaccinations most frequently recommended for travelers is the hepatitis A vaccine, which is particularly important for those traveling to countries with sanitation and hygiene conditions different from those in Europe. Among the vaccines recommended in Italy as well, it is important to verify that routine immunizations against hepatitis B, human papillomavirus, and meningococcal B and ACWY are up to date.

Finally, in areas where malaria is endemic, it is advisable to take prophylaxis. “It should be taken before departure, during the stay, and then for a few days after returning, depending on the type of medication prescribed,” said D’Abramo. “For guidance on these matters as well, you can consult a travel medicine clinic.”

4. Check healthcare access

“This is essential for anyone with a medical condition, but in general, even healthy travelers should find out about the availability of healthcare at their destination and the conditions for accessing it,” noted Mastronuzzi. “Some countries have agreements with the Italian National Health Service, and simply presenting your health insurance card is sufficient to receive treatment. For other destinations, it’s advisable to purchase travel insurance.”

5. Know what to pack

“Patients undergoing treatment should bring the medications they normally take with them,” explained Mastronuzzi. “They should pay close attention to how they store and transport these medications during the trip. Some, such as insulin, require storage at low temperatures. I also recommend bringing acetaminophen, which is useful for both pain and fever, and an antihistamine — even for those who have never experienced allergic reactions. For patients with allergies, I also recommend bringing a corticosteroid and epinephrine. I’m not in favor of bringing a broad-spectrum antibiotic. It’s better to find out in advance about the availability of local medical care, if needed, and to take an antibiotic only if prescribed by a doctor on site.”

In addition to medications, your suitcase should include some everyday items: sunscreen, mosquito repellent, something to apply in case of a bite, adhesive bandages, and contact lens solution for those who wear them. “It’s best not to assume you’ll be able to buy these items at your destination,” added Tomasi.

6. Prevent intestinal infections

“In countries where hygiene standards are lower, travelers should be advised to follow certain guidelines to prevent intestinal infections,” explained Mastronuzzi. “Do not eat raw foods unless they have been peeled; drink only bottled water; avoid ice in beverages; use bottled water even for brushing your teeth; and wash your hands thoroughly before eating or putting them in your mouth.”

7. Prevent animal-borne infections

“To prevent infections transmitted by mosquitoes or other insects, such as malaria, it is important for travelers to take certain precautions,” warned D’Abramo. “Apply insect repellents containing more than 40% DEET to the skin, use mosquito nets on beds, wear protective clothing, and avoid staying outdoors at dusk. You should also avoid contact with wildlife in countries where rabies is endemic.”

“It’s important to keep a close eye on children, who are tempted to interact with animals,” added Tomasi. “You don’t have to be bitten to contract the infection: contact between the carrier’s saliva and an existing wound is enough.”

Before traveling to an endemic area, rabies vaccination is recommended. “But even vaccinated individuals who are exposed should seek local medical care as soon as possible to receive postexposure prophylaxis,” warned D’Abramo.

8. Prevent noninfectious risks

In addition to the risk for infections, a vacation in an unfamiliar environment can hide other dangers, about which travelers should be warned. “Those traveling to a country with a very hot climate should be careful of heatstroke, which can cause severe discomfort, fever, and loss of consciousness,” said Mastronuzzi.

“Also be careful where you swim: before entering the water, find out about the safety of stretches of the sea, lakes, or rivers, and read any warning signs or notices,” added Tomasi.

9. Prevent sexually transmitted infections

“Sexually transmitted infections are more common on vacation, when people relax and there’s a risk of letting their guard down,” warned Tomasi. “The family doctor, who has a relationship of trust with their patient, should not hesitate to address this topic as well.”

Prevention involves using condoms. “This rule applies whether you’re traveling to an exotic country, on vacation in Italy, or in everyday life,” added Mastronuzzi.

10. Ease jet lag

“Very long flights, especially those traveling from west to east, can cause discomfort due to the time zone change,” warned Tomasi. “You should expect to feel a bit groggy and sleepy for the 24 hours following arrival and avoid scheduling activities that require your full attention.”

If necessary, a melatonin supplement can help restore your circadian rhythm more quickly. “But above all, I recommend getting plenty of rest,” said Mastronuzzi. “When returning from vacation, it’s best to allow yourself a couple of days to adjust before going back to work.”

This story was translated from Univadis Italy, part of the Medscape Professional Network.