Starting travel health clinics in India: need, scope, structure and role of points of entry

INTRODUCTION

Travel medicine is a new interdisciplinary field that has the ultimate goal to keep the travelers free from infectious diseases.¹ International travel is growing progressively, in year 2012 more than 1 billion travellers worldwide crossed international boundaries.^2,3 Every year large number of Indians travel to countries where malaria, hepatitis A, hepatitis B and other vaccine-preventable diseases are prevalent. Perception and preparedness of international travellers for health risks associated with travel is relatively poor.⁴ In year 2018 around 18 million foreign tourists arrived in India and their contribution to Indian GDP was around USD 247 billion.⁵ The commonest purpose reported for travel are business, health care, education, pilgrimage, holidays, and personal and family visits. Similarly, millions of Indians visit other countries in the world for the same purpose.^5,6 Number of Indians travelling abroad is increasing progressively over a period of time. It increased from 4.4 million in year 2000 to 26.9 million in year 2019.⁷

Increase in international travel increases the risk of acquiring and transmitting travel-related illnesses and other health exposures. These international travellers need to be adequately educated and advised by health care providers about potential health related risks. However, evidence suggests that the pretravel care provided to international travellers is likely suboptimal.^8,9 Only a fraction of international travellers seek pretravel health advice.^10,11 Possible reason for not availing pretravel health services is non-availability of specifically trained health professionals to counsel patients on travel-related health risks.¹²

Travelling abroad specially for working and education requires adaption to the climate, language, culture and work ethics. Pressure to complete the purpose of travel in given time leads to stressful situation affecting the health, performance and outcome. To avoid the implications of ill health, there is a need for organized travel health services through dedicated travel health clinics. There are certain national and international regulatory and/or mandatory requirements like yellow fever vaccination, oral polio vaccination etc. for international travelers. A pretravel individual health risk assessment, health checkups and counselling could be very beneficial to the traveler.

The scope of travel health clinics may be as below:¹ Assessment of traveller’s health and risk to their health before travelling, analysis of their anticipated itineraries, with emphasis on infectious and non-infectious diseases and safety and security issues, provision of appropriate travel health advice to each individual traveller, recommendation and provision of vaccination specific to traveller and education on the prevention and appropriate self-treatment of travel related diseases for each traveller.

Advice on prevention of malaria through chemoprophylaxis, prevention of deep vein thrombosis, management of jetlag and prevention of frost bite, sun burn, UV radiation and high altitude-related issues need to be discussed with all potential travellers.

All travellers may be trained in first aid and should be encouraged to report or document ill health or injury incidents on return to the host country. This will help in developing a system as well as mechanism for effective management of travel health services in travel health clinics. Special travellers like pregnant women, infants, children, senior citizens and differently able people may be given specific travel advice.

Structure of travel health clinics may be facility-based services and/or teleconsultation services. Staffing pattern, administrative structure, record keeping, reporting and charges may be fixed as per the organisational norms and prevailing practices in the country.

In India, there are more than 40 PoEs through which any international passenger may enter legally. PoEs includes health units at airports, ports and land borders and primary objective is to preventing entry and transmission of infectious diseases as well as ensuring a safe environment for travellers.⁶ Functions of PoEs include surveillance, vaccination, coordination, food safety, issuing clearance to human remains, management of public health emergencies of international concerns (PHEICs) etc. Health screening of international passengers and vaccination are very important activities done most of the PoEs which is in line with the objectives of travel health clinics.^13,14

PoEs are subordinate units under directorate general of health services, ministry of health and family welfare, government of India and are evenly distributed across the country.⁷ These PoEs have adequate infrastructure and trained manpower in accordance to the IHR-2005.¹³ Resources (Infrastructure, trained manpower and experience of implementing international health) available at PoEs may be very well utilised to provide travel health services to international travellers. Starting travel health clinics will expand the mandate as well as existence of PoEs and this will be a kind of capacity building. In long run it will be advisable to collaborate with the international society for travel medicine (ISTM) for capacity-building of travel health clinics in India.

It is highly recommended that pretravel care be rendered by practitioners who hold a certificate of knowledge in the field such as that provided by the ISTM and who have regular experience in advising travellers with varying and complex health conditions, destinations, and itineraries.

Funding: No funding sources

Conflict of interest: None declared

Ethical approval: Not required

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