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Derek Evans

Welcome to Evans Travel Health

Blog     posted on Wednesday 4th August 2021

       How to prepare for Travel Medicine post-Covid

"We are all aware of that the impact of Covid infections has had on travel and continues to do. With the advent of vaccination programs and sophisticated testing and recording systems in place travel is starting to increase.

However the types of travel such as short haul continues to expand according to the determination of national governments whilst long haul remains dormant. The traveller groups have changed and the emphasis on routine vaccinations being sought by first time travellers going to exotic destinations has shifted to business and essential workers.

With this in mind the marketing of any specific travel medicine services will need to understand these changes. Following lockdowns and extended restrictions many travellers are now attempting to visit families and friends (VFRs) who they have only seen through video links. These VFRs will be a key target group during the revival of travel medicine demands and services.

A key part of the practitioners will be the flexibility to react to short time departures and supply necessary vaccines and medication where required. This parallels with the quick turn around that Covid tests are required for entry into another country before departure from the UK. It seems that a mix of PCR and rapid antigen tests are required within a range of departure times from 24 to 96 hours before departure.

The underlying point here is that this increased cost needs to be allowed for during any travel consultation and also the returning costs of testing and/or isolation. It is unlikely that these costs will be removed in the short term and certainly Covid will become another disease to be routinely covered during a travel medicine risk assessment."


Reasons for not having Vaccines

Posted on February 6, 2017 at 11:00 AM


This is an age old problem in travel health, in that the traveller gives reasons for not having vaccines and many opinions have been postulated why. It is a story that continues and recently in the Journal of Travel Medicine and Infectious Diseases(1), a report of a 10 member French family returning from Algeria where they had all been in contact with a rabid dog and received poor post exposure care.


A article published in the Journal of Travel Medicine(2) has recently looked at this situation again to try and establish the underlying reasons, rather than opinions for not having vaccines prior to travel. To provide some form of standardised approach traveller's were asked to reply to their refusal using one of 3 reasons; these being cost concerns, safety concerns, not concerned with the illness.


The cohort size of the study was around 24,500 patients and most commonly related to typhoid, hepA and influenza vaccines which were advised for their destination. Whereas we may have expected refusal to primarily being made due to financial considerations, the results showed that this was not the case and patients were more likely not to be concerned with with the risk of illness. In a further analysis it was determined that VFRs in low or medium human development countries were less likely to accept all of the recommended vaccines compared to non-VFR travellers.


So what can we conclude from these 2 studies. Firstly, the concern regarding the safety of vaccines does not appear to raise a concern. Following this is an excellent article in PLOS titled "Why Vaccines Don't Cause Autism" (3) which provides scientifically researched reasons with up to date articles. Secondly, both articles feature VFRs as having higher risks from non-vaccinations. Finally, the most common was a lack of concern relating to the illness reflecting that more information needs to be made available of diseases related to travel.


The solution to disease awareness in the UK is about developing a culture that when booking a foreign holiday, disease prevention is as high as a consideration as the purchase of sun block. Often this level of decision making can be initiated at the booking process and it is interesting to read the travel agents ABTA Code of Conduct Guidance which says in paragraph 2F

"Make sure that your clients are made aware of compulsory vaccinations etc. You should also advise clients to seek advice on recommended vaccinations and precautions from a health professional - either a GP, a practice nurse, a pharmacist or a travel health clinic - ideally at least eight weeks before departure "

Perhaps we can look at working with travel agents to improve the levels of advice.


1. Antwi S et al, 9th January 2017. Familial cluster of exposure to a confirmed rabid dog in travellers to Algeria. PMID 28089844

2. Lammert S et al, 2016. Refusal of recommended travel-related vaccines among US international travellers in Global TravEpi Net. Journal of Travel Medicine, doi 10.1093/jtm/taw075

3. Hoetz P, 2017, Why Vaccines Don't Cause Autism.

4. ABTA Code of Conduct Guidance.


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