Travel health: Sticking to the evidence is critical

These past few years have seen a rapid growth in pharmacist-led travel health services in Canada. I encourage this participation. At the same time, I want to highlight the importance of prescribing according to our Canadian guidelines.In my early days providing travel health services I was frequently confronted by physicians regarding the conflict of interest in being both the prescriber and dispenser of travel vaccines. I was able to counter this with my qualification of the CTH certification, as well as mindful attention to Canadian guidelines. In doing so I succeeded in securing the collaboration and support of other health care providers.When it comes to the risk of contracting water borne illness, the past 20 years has seen a significant reduction in risk for travellers.Many developing countries (including Mexico, Thailand, and Vietnam) have dramatically improved their food and water hygiene practices, in part, to encourage the travel industry in their countries. The broad availability of bottled water has also been a significant factor in keeping travellers from harm and reducing the incidence of illness.With this in mind the Committee to Advise on Tropical Medicine and Travel (CATMAT), an expert advisory committee that assists the Public Health Agency of Canada (PHAC) with travel health related advice, updated its recommendations on the use of typhoid vaccine (2014) and the oral cholera vaccine (Dukoral) for the use of travellers diarrhea (2015) based on the expert review of evidence.In the case of typhoid vaccine CATMAT recommends that it be used for most Canadian travellers visiting South Asia (India, Nepal) and NOT used for most travelers visiting other destinations. Some exceptions may be made for longer term travellers and remote travel.CATMAT guidelines differ from US references and practitioners are advised to refer to Canadian references when prescribing/recommending typhoid vaccine. In the case of the oral cholera vaccine (Dukoral), CATMAT recommends that the vaccine NOT be routinely administered to Canadian travellers as a means of preventing traveller’s diarrhea. This recommendation is based on a review of three randomized control trials (RCTs) that found no increased benefit of the cholera vaccine for preventing traveller’s diarrhea during travel when compared to placebo. I encourage all new practitioners to travel health to familiarize yourself with our Canadian guidelines. As Secretary Treasurer of ISTM, the highly recognized international society of travel medicine, I also encourage you to join ISTM and seek the CTH certification to support you in establishing your own best practices in travel health practice.

Travel health: Sticking to the evidence is critical

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