Third, we may have excluded (or included) too many subjects with inflexible travel plans, as the exclusion criteria was solely based on whether a traveler had a fixed itinerary or not. Other factors such as chronic medical illness or fixed income could have limited a traveler’s ability to change their trip substantially. Lastly, we chose to measure only Selleckchem Dasatinib a selected number of factors that we felt may have been affected by changes in travel plans. However, there may have been other vaccine or prophylaxis recommendations that could have been significantly affected (eg, AMS prophylaxis, fitness to travel, etc.). In our study, the pre-travel history
was not a good predictor of a traveler’s actual activities overseas. According to pre-travel history, actual travel-related risks were more often underestimated than overestimated. With the exception of recommendations for rabies vaccine, disagreement between the pre- and post-travel history had no major consequences on the need of vaccine prescription. This is probably due to the fact that vaccine recommendations do not rely solely on one planned activity. For example, we typically recommend Japanese encephalitis vaccine only for travelers who spend at least 4 weeks in a rural zone in risk areas of Asia. Since the median duration of travel was
21 days (IQ 3–368 d), many travelers would not have been recommended this vaccine regardless of a change in their planned activities
learn more or destination. During the dry season in the countries of the “meningitis belt” of sub-Saharan Africa, travelers are advised to be vaccinated against meningitis independent of other risk factors such Protein kinase N1 as a stay in rural zone or with local people.[5] Unlike Japanese encephalitis and meningitis vaccine, rabies vaccine is indicated when travelers to endemic risk areas plan to ride a bike or have close contact with animals independently from other potential risk factor (eg, spelunking, sleeping outdoors in the jungle, remoteness to adequate medical care). Travel duration and general destination plans were the most important elements of pre-travel assessment. Travel duration of more than 1 month determined the prescription of most of the vaccines, irrespective of at-risk activities (ie, typhoid fever and hepatitis B, rabies in the Indian subcontinent and meningitis in the countries of the “meningitis belt” of sub-Saharan Africa). General destination plans almost never changed. Among the 58 travelers who changed the destination, only 4 changed the country and continent, 15 traveled to another region within the same country, and all others traveled to alternative countries in the same continent. Little change in general destination plans probably explains the fact that a change in malaria prescription would have been recommended in only 5% of travelers.