Grand Rounds: Avoiding travel-related infections during pregnancy

For months, your patient has been planning her dream vacation-an African safari. Shortly before the trip, she discovers she's pregnant. While your mind is filled with pictures of malaria, typhoid, and other maladies, she is still seeing visions of elephants, giraffes, and zebras. And the task of advising her will likely fall to you, her obstetrician.

In complicated pregnancies, the best advice may be for her to cancel or postpone the trip. Because of employment or for other reasons, however, this may be impractical. The goal then is to make her trip as safe as possible by minimizing her risks.

What shots does your patient need?

When it comes to shots and medications, you need to find a balance between avoidance and acceptable risk (Table 2). Some shots, for instance, can be safely omitted and the patient given a waiver to satisfy travel requirements. Often, however, the disease poses more of a risk than the medicine or the vaccine. Very few medications and none of the currently available vaccines have been shown to be definitely harmful in pregnancy. A recent American College of Obstetricians and Gynecologists bulletin summarizes the comparative risks and benefits.⁴

Fortunately most American women are already up-to-date on the live virus vaccines. In the rare instance where a non-immune woman will be unavoidably exposed to measles, rubella, or varicella, she should be counseled regarding the risk that these diseases present. She will then need to make an informed choice, recognizing that the risk of the vaccine is theoretical while the risks from the disease are very real.^7-9

Remember to tell patients: "Don't drink the water!"

As you may already know, food-borne illnesses represent the most common infections in travelers, and may be more of a hazard in pregnancy. Decreased gastric acidity and slowed intestinal transit, for instance, make traveler's diarrhea more severe in these patients. The resulting dehydration and ketosis could lead to premature labor or other problems.¹⁰

Impress upon patients the need to be meticulous about washing their hands and be very careful about food and water purity-even on cruise ships. Food should be thoroughly cooked and served steaming hot. Patients also need to beware of buffets, and except in the most refined of settings, skip the salads and raw fruits. They should stick to bottled drinks (without ice) or water that has been boiled or filtered.