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This week’s CMAJ highlights The Canadian Task Force on Preventive Health Care’s “Recommendations on screening for breast cancer in average-risk women aged 40-74 years”. These guidelines, which I believe were last published in 2001, make some dramatic new recommendations, such as, it is no longer worthwhile for doctors or women themselves to perform breast examination.
Why is this pertinent on a travel medicine website? Well, you might have wondered what guidelines travel medicine professionals adhere to. Why does one travel doctor suggest a typhoid shot for travel to China, and another not. Does everyone need Twinrix vaccine (hepatitis A and B)?
How about the pricey ones … do I need Japanese encephalitis and rabies vaccine for that five week trip to Asia? Which antimalarial is best?
Well, we do have several sources of reputable guidelines. These include the Centres for Disease Control (CDC), the Public Health Association of Canada (PHAC) and the World Health Organization (WHO). In fact, these three sources are not always in agreement with each other. But that is the way things are with guidelines. They are not etched in stone. They reflect the opinions of those who publish the guidelines, and their perspectives may differ from a geographic, political and economic point of view.
The Europeans don’t recommend antimalarial medications for travellers to India … rather, use personal protective measures, and seek medical attention if you develop a fever during or after travel. We here in North America do. The Americans are still suggesting antimalarials for tourists to the Dominican Republic. Canada, to the best of my knowledge isn’t.
Likely more important than any guidelines are the opinions of the traveller and his or her medical advisor. Some travellers won’t accept any risk at all – “Give me all of the shots! What’s the downside?” Others might say ““The risk is low. I can use my common sense, and use my vaccine money for a month’s woth of meals!!” Some travel health professionals may recommend the “whole enchilada! I don’t wanna take any risk on your behalf … and in fact, I am making a profit on the vaccines which you take“. (a bit controversial).
Others might also say “Your risk is low. Be careful and use the loot to pay for your youth hostels for a month.”
That’s probably how it should be. A mixture of guidelines, combined with the traveller’s and their health advisor’s opinions. That’s how it is in the rest of medicine, and perhaps life. Here are the guidelines … here’s what I think. What do you want to do?
A plug for one of my children, Carrie, who is a social worker in Kingston, Ontario. She has opened her private practice for counselling, with a special interest in eating disorders. If you are in the Kingston area and could use her services, check out her website.