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Parting Shots
Specialized Travel Clinics Provide Globetrotters With a Pound of Prevention

By Hope Katz Gibbs
The Washington Post
Sunday, September 7, 1997; Page E01

Travel is a way of life for Jim Hanney, manager of international security for the U.S. Postal Inspection Service. About 20 times a year he heads to some of the world's most exotic -- and often most infection-ridden -- places. So Hanney needs to stay on top of the immunizations needed to protect him from common international diseases -- yellow fever, diphtheria, tetanus, pertussis, hepatitis A and B, typhoid fever, rabies and meningitis. Without the immunizations, Hanney could be denied entry to some countries, placed in quarantine and forced to receive the vaccine at the border station.

Like most travelers, he opts to get the shots stateside. But like an increasing number of travelers, he's turning not to his general practitioner but to a rising breed of travel medicine specialists. His preference is an Alexandria clinic called SmarTravel, founded in April by registered nurses Jane Johnson and Donna Shipley. "In addition to giving the necessary vaccines, we give travelers all the information they need about water purification, food safety, insect repellent and other things that will keep them healthy when they are abroad," says Johnson. Both she and her partner are veterans of hospital-based travel clinic operations.

Special travel clinics are becoming more common. "More people are traveling to developing countries," says Dr. David Freedman of the International Society of Travel Medicine, whose group publishes a directory of more than 500 travel clinics worldwide. "And there is more of a need for one-stop shopping for people to get vaccines, malaria pills and, most importantly, an education on how to self-treat common health problems that occur while traveling."

In the Washington area, there are numerous travel clinics, ranging from county health departments featuring limited services and hours to high-end private clinics serving corporate and leisure travelers around the clock. Advocates say the specialized clinics can provide information and services that are especially important to leisure travelers. Patients like Hanney are veteran world travelers familiar with foreign medical protocols and disease prevention. This is very different from a leisure traveler who, on a whim, decides to book a week-long river tour of Vietnam.

What to Expect

Most travel clinics follow a similar protocol. Travelers make an initial appointment and provide staff members with information about their destinations, length of stay, any relevant personal medical history and activities planned for the trip. Most travel clinics will provide the traveler with a list of shots required, recommended and suggested by the federal Centers for Disease Control and Prevention, the World Health Organization and the U.S. State Department. The only vaccine that is legally required by any country is the yellow fever vaccine, and only a limited number of countries require it (mostly in sub-Saharan Africa and a few in South America).

This does not mean that additional shots are either unwise or unnecessary. While not required, some vaccinations just make good medical sense. Some infectious diseases, for instance, vary by season. A good clinic will also monitor news services for information on late-breaking epidemics. Last May there was an outbreak of bacterial meningitis in the Gaza, Israel, and diphtheria has been in outbreak since 1992 in parts of the former Soviet Union. Obviously, a traveler would want to know about such things -- and have the appropriate vaccinations.

Clinics also provide travelers with a little yellow booklet called the International Certificate of Vaccination that lists all the vaccinations administered. Its value is primarily as an ongoing medical record should the traveler get ill, or travel again in the future. Certain countries that require travelers to be vaccinated against yellow fever demand the document at the border, but most travelers aren't going where yellow fever is endemic. Carrying the book around, however, is still a good idea.

Some clinics provide clients with additional printed materials, such as pamphlets about water purification and reports describing the vaccinations in detail. Passport Health provides perhaps the most comprehensive documentation -- a personalized, bound booklet containing details about each vaccination required, recommended and administered; other information about the disease and health status of countries being visited; copies of official government reports on the nation; and advice for dealing with general concerns such as drinking water. Most clinics will provide brochures on various travel and disease-related topics. Several of the clinics sell such travel accessories as insect repellent, water purification tablets and malaria pills.

Of course, numerous doctors provide vaccines as part of their practice. However, many aren't licensed to give the shots, or simply don't have the vaccines on hand. Others can respond to a request for a vaccine, but don't keep up with late-breaking information.

"Our office, like most doctor's offices, doesn't carry vaccines like yellow fever or typhoid," says Gregory Plemmons, a doctor at Alexandria's King Street Station Medical Center. "It isn't cost-effective. We can give a hepatitis A vaccine on short notice, but a patient would be better off going to a travel clinic where exotic vaccines are their specialty."

The Cost of Prevention

A dose of prevention doesn't come cheap. Most clinics charge about $25 to $45 for an initial consultation, and vaccines generally range from $8 to $80, though the rabies vaccine costs considerably more.

At Passport Health, which operates franchises at six Adventist HealthCare offices in the metro area, the total bill for someone traveling to Africa and who previously had none of the required shots would be $335 -- $35 for a one-hour consultation plus six vaccines (hepatitis A, yellow fever, DPT, typhoid, meningitis, cholera). Travelers heading for Europe would only need a DPT shot for a total cost of less than $100. Travelers to Latin America need a typhoid, hepatitis A and DPT, costing less than $150.

Given the alternatives, of course, these represent a small price to pay.

"If you don't have appropriately documented vaccines some people at border patrol may try to give you the vaccine or they'll make you pay money for not getting the shot," says Fran Lessans, president and founder of Passport Health. "I understand that border patrol guards don't make a lot of money and are looking to pad their pockets. I know of more than one case at a border patrol station in Africa where guards pulled a traveler into a back room and threatened to give a yellow fever shot if the traveler didn't pay $70."

That traveler paid the money, and that was the right thing to do. "Do not get a vaccine at border patrol," Lessans says. "There is nothing labeled there. They don't use disposable syringes. The sterility is questionable, and a person who gets a shot abroad can get AIDS, hepatitis B and other blood-borne diseases. Don't fool with the border guards. Take care of business and get the required vaccines before you leave."

But don't wait until the day before you leave to make an appointment. Clinics recommend patients come in six to eight weeks prior to departure because the vaccines usually need time to take effect. Some vaccines, such as those for Japanese encephalitis and rabies, also require additional boosters 14 days prior to departure.

It's Your Nickel

Vaccines may be the first line of defense when it comes to preventing disease, but many insurance companies and health maintenance organizations don't cover the cost of the shots.

"In most cases immunizations for travel are not covered because the decision to travel is voluntary, oftentimes associated with leisure activity," says Richard Coorsh, a spokesman for the Health Insurance Association of America. "It varies from plan to plan. We suggest travelers check with their employee benefits manger regarding benefits. Employers are the ones who choose what the health plans will cover."

Travel clinics will print up bills for patients to submit to insurance companies. But because clinics are fee-for-service businesses, patients are required to pay at the end of the visit.

© Copyright 1997 The Washington Post Company

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