The first patient of the day was a 23-year-old wife of a Marine moving to Okinawa, Japan. This is normally a pretty easy appointment (I had a similar one last week), but was made more interesting by the fact that she recently found out she was pregnant. Normally, I order vaccines for typhoid (not because they need it in Japan, but because most people who live in Japan do a lot of travel in Asia) and Japanese encephalitis (which we don't even have in clinic, currently). Since she's not planning on doing any travel outside Japan while pregnant, we deferred the typhoid vaccine until some time she's ready to travel, and Japanese encephalitis vaccine until after she's no longer pregnant. I did remind her that it's important that she protect herself against mosquitoes in the meantime.
The second family (husband, wife, four-year-old son) is going to be moving to New Delhi, India for three years. This is a map of where malaria is in India, which, as you can see, is almost everywhere. There's no malaria in New Delhi itself, but there is in the surrounding areas. We discussed the risks and benefits of malaria prophylaxis for all three years, and ultimately decided that they'd be spending most of their time in the city and wouldn't need it. I did remind them that anytime they're going to travel around or outside India, that they need to see their physician for malaria prophylaxis. They also needed typhoid vaccine and Japanese encephalitis vaccine, which presented another problem (in addition to the fact that our clinic didn't have it). The current JE vaccine in the US is only licensed for adults. That's not because it's unsafe for children, but because it hasn't been studied (we don't do studies in kids in the US, usually). It can be ordered off-label by a physician, so after discussing risks and benefits with the parents, that's what I did (and gave them phone numbers of the other military immunization clinics in the area so they could make sure they have it in stock before driving across DC). The son also got rabies vaccine, because there's a lot of rabies in India, and you can't trust four-year-olds to tell you when they've been bitten by a dog (or cat or monkey, etc, etc).
The final family of the day (mom, dad, eight- and five-year-old boys) is going to be moving to Morocco. This was probably the easiest appointment of the day, not because of the location (although, being a desert country, there's really not a lot of tropical risk), but because the family has done a lot of traveling and is pretty savvy about things. In fact, the mom grew up in Egypt, so the Sahara is not a new location to them. They actually did get a lot of vaccines, though, because they're planning on doing some traveling to sub-Saharan Africa in the three years that they'll be in Morocco. Everyone got yellow fever vaccine (except dad, who just got it three years before), meningococcal vaccine (except dad, who already had it), typhoid, and rabies. I also prescribed a few courses of azithromycin and loperamide for traveler's diarrhea, but after that, they'll have to go the embassy clinic for more. They'll also have to go to the embassy clinic for malaria medications before any of that travel to sub-Saharan Africa.
In all, not a bad day at travel clinic. A lot of notes had to be written (each person has to have his or her own note, even if the family was all seen together), but everyone was friendly and excited about traveling, so that was okay. That's the best part of travel clinic--everyone is happy, relatively healthy, and the only thing they complain about is the number of shots they have to get.
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