Prior to 2020, international travel to and from Australia had become increasingly accessible and was occurring at higher rates than ever before.1 While international travel decreased because of the global COVID-19 pandemic, it demonstrated the interconnectedness of the world in terms of the spread of infectious disease as well as highlighting international differences in healthcare access and quality. The general practice consultation is the primary environment to discuss prevention strategies for risks associated with travel, either as part of a specific pre-travel consultation or opportunistically, recognising that many individuals will not seek specific health advice prior to travel.2 General practice is also where many individuals will present with symptoms that have developed during or soon after travel and a careful assessment of these presentations is essential from an individual and public health perspective.
Travel-related risks are not limited to infectious diseases nor to international travel, and it is important that the general practitioner (GP) be able to discuss other potential risks such as altitude and climate extremes, accidents and personal safety, as well as individual risks related to age, pregnancy or underlying health conditions. Many of these risks exist for travel within Australia and there are numerous infectious diseases where epidemiology and risk differ between states and regions. Access to healthcare including screening, treatment and vaccination services may also be more challenging for those residing or travelling through regional, rural and remote Australia.3 Aboriginal and Torres Strait Islander peoples face additional challenges travelling both within Australia and internationally where they may be required to navigate unfamiliar health systems as well as language and cultural differences at their destination.4 Some types of international travel provide increased risks such as medical tourism where travel is undertaken for the purpose of undergoing a medical procedure.5 Another risk is travel to visit friends and relatives where individuals are less likely to seek pre-travel advice and often undertake more high-risk behaviours related to food and water safety or insect bite prevention.6 It is a key skill to be able to discuss travel-related behaviours in a culturally sensitive manner as health beliefs and travel risk prevention behaviours are strongly influenced by past experiences and cultural practice.
Prevention or modification of risk for travellers involves the GP being able to discuss individual risk and costs associated with risk management strategies including routine and targeted vaccinations, insect bite prevention, malaria prophylaxis, and other treatment strategies for common illnesses. It is also important to be aware of any potential challenges that may prevent rapid access to healthcare services and the limitations of travel insurance cover. The management of chronic conditions may be more challenging in the context of travel, and discussion of ways to modify this risk is an important part of the pre-travel consultation.
Over recent years the emergence of the Zika virus and the COVID-19 pandemic has shown the need for GPs to be aware of new and emerging challenges facing travellers. While new diseases and antimicrobial resistance have become challenges, this has occurred simultaneous to the development of new vaccinations, treatments and evidence-based prevention strategies for other travel-related conditions. Travellers will continue to face issues including dilemmas regarding health equity and ethical tourism, alongside their own individual risk. Travel and travel medicine continues to be a complex and evolving topic in general practice.