Counseling the international traveler. Update '93

The itinerary of international travelers will largely determine the amount of pretravel counseling, number of immunizations and type of malaria prophylaxis they will need. The countries visited are also the best predictor of traveler's diarrhea. Only yellow fever and cholera vaccines are required for entry into certain countries; the latter generally given only to satisfy entry requirements. Polio vaccine is important for some areas and is frequently neglected. For most malarious areas, chloroquine once per week is recommended. Mefloquine should be prescribed weekly for travelers going to chloroquine resistant malarious areas. Traveler's diarrhea is best prevented by avoiding high risk foods and beverages. Antibiotics, generally not recommended for prophylaxis, are very effective in treatment. Travelers should be reminded to advise physicians of their travel history during future medical encounters so that otherwise exotic tropical diseases, possibly contracted during travel, may be considered in diagnoses.