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Crain’s New York Business



An epidemic of polio strikes in Tel Aviv, meningitis breaks out in New Delhi, hepatitis unexpectedly erupts in Shanghai. If business or pleasure takes you to such locales, do you know whether you’ve been properly inoculated, given appropriate prescription drugs, up-to-date advice?

Because there’s nothing static about disease, immunization information and procedures vary widely in New York, with its smorgasbord of walk-in health clinics, company-operated medical units, pre-paid executive care facilities and hospitals with international care divisions, not to mention infectious disease experts in private practice and internists claiming to know the ropes.

What is a traveler to do, faced with so many options, and no sure way of knowing whether health-care providers are keeping abreast of current developments?

Become knowledgeable about inoculations, advises Dr. Diane M. Simpson, a medical epidemiologist at the Center for Disease Control in Atlanta, a national resource for travel medical data. At least two weeks before your departure, call James O’Brien, the public health adviser at the New York City Department of Health (at 212/285-4608), who will dispatch, free of charge, a rundown of diseases prevalent in the countries you plan to visit, immunizations required and a list of places licensed to provide them.

Recommendations can be outdated

But there’s a catch. Recommendations are sometimes easily outdated. Epidemics come and go, viruses suddenly resist treatment; new strains of malaria, and even travelers’ diarrhea, may require new drugs.

But armed with guidelines, you’re ready to decide who sticks you. The more exotic and complicated your itinerary, the more important it is that you be immunized by someone who stays on top of things.

To some extent, this riddle is solved for employees of corporations of multinational corporations. Chase Manhattan Bank and American Express Co., for example, send many employees to Asia and Latin America. Infectious-disease experts don’t grace their staffs, but the sheer volume of traveling executives necessitates that the company medical department keep up with developments.

The medical department at American Express, headed by Dr. Joseph P. Romano, inoculates some 100 people a month. Bulletins from the disease center and the World Health Organization keep everyone up-to-date says Dr. Romano, an internist, who reads medical journals relating to travel medicine. Like Chase Manhattan Bank, his unit is licensed to give yellow fever vaccine.

Smaller organizations--advertising agencies, non-Fortune 1000 companies--are not so favored. If medical units exist at all, they are usually staffed by nurses who may or may not know of recent outbreaks.

Not surprisingly, infectious-disease experts are skeptical of company-employed medical practitioners and pooh-pooh their ability to give needed care and advice.

Dr. Eileen Hilton, Chief of the travel immunization division at Long Island Jewish Medical Center in Queens, says, “General practitioners at large companies can give some types of inoculations but aren’t knowledgeable enough to advise patients about diseases occurring in more exotic locales.”

This opinion is shared by Dr. George V. Lombardi, an infectious-disease specialist in private practice who says that “the CDC’s beloved ‘Yellow Book,” which everyone consults, is a year old by the time it comes out. And their weekly bulletins are two weeks behind by the time they’re received.”

Dr. Lombardi says some countries suppress information about disease outbreaks if they believe it will endanger the economy by slowing the influx of tourists.

Brokerage houses usually send traveling executives to pre-paid health-care centers—Life Extension Institute on Madison Avenue, for instance. These are normally retained to conduct physical and diagnostic examinations. Travel medicine accounts for such a small part of their business that it’s unlikely you’ll get the most current immunization counseling, health experts say.

Charles Kanach, president of Life Extension, frankly admits that his company dispenses little more than cursory travel advice with inoculations.

“We take a brief history, (and) we do ask about allergies,” he says. Patients with medical problems or complicated itineraries are sent elsewhere if they need more expertise.

Jennifer Pirc, a nurse at Metro Medical, a service in the Wall Street area, also reports perfunctory pre-immunization consultations. However, she does call the disease center to get updates, and an infectious-disease specialist is available, although it is more common for such care providers to be staffed by moonlighting cardiologists and internists.

The health department’s Mr. O’Brien says these pre-paid services “charge by the shot and tend to over inoculate. If you walk through the door, they’ll try to give you everything,” he asserts.

The hazards of overinoculation

Indeed, overinoculation is one of the most difficult hazards for the traveler to guard against, says the disease center’s Dr. Simpson. “Very few things are required, and a lot of shots are recommended, so sometimes it’s a matter of opinion,” she notes.

But don’t despair. If you’re willing to shell out $175 for a consultation with an infectious-disease specialist--instead of relying on company perks or the one-two-three services of walk-in-operations--your chances of getting reliable recommendations are much greater.

Specialists at the International Health Care Service at New York-Cornell Medical Center, for example, will solicit a detailed travel and medical history before vaccinating you and will question you closely about allergies.

Don’t be surprised if there’s discussion about sexual behavior. As one physician says, “One’s mores tend to slacken when traveling, and a lot of executives come back fearing they’ve caught something horrible abroad.” You won’t be preached at, but you may be told that “no sex act is without risk,” particularly in areas with a high prevalence of sexually transmitted diseases.

You will receive similar attention at the Travel Immunization Center at Long Island Jewish, although the fee structure differs--$30 for the consultation, $25 to $50 per shot.

Even these facilities are not without their critics, however. Some medical authorities say that healthy travelers with uncomplicated itineraries are overdoing it by patronizing them--that their primary value is the treatment and diagnosis of malaria and other diseases, rarely encountered in the West. But, Mr. O’Brien says, the services are good and can be cheaper than those of other places.

Another alternative is to consult a private practitioner who specializes in travel medicine. For about $150, you will receive a half-hour consultation, a routine checkup, your inoculations and, sometimes, a follow-up visit at no extra charge.