If you think because your patients aren’t big travelers that you don’t need to know about travel health, then Nancy Dirubbo, DNP, FNP-BC, FAANP, has a lesson for you. At the American Association of Nurse Practitioners’ annual conference in Indianapolis, Dr. Dirubbo taught a course about the top ten topics in travel health, most of which have health implications that touch US soil.

Here are some travel health topics that primary care providers should integrate into their practice.

1. Return of previously controlled disease

The top example in the US is the measles outbreak, which recently became the worst this country has seen in 25 years. Most cases are in unvaccinated people, and the outbreak originated abroad, likely in Israel or Ukraine. As Dirubbo points out, measles is still common in many parts of the world, especially in Europe, Asia, the Pacific, and Africa. Precision Vaccinations and the CDC  are top resources for PCP amidst outbreaks of vaccine-preventable diseases.

2. Vaccine shortages

Certain types of vaccines are necessary if you’re traveling abroad, and national vaccine shortages can affect your patients’ plans. The Immunization Action Coalition advises all international travelers to be up-to-date on all vaccines recommended in the US, and shortages can prevent this from happening.

3. Climate change

First and foremost, climate change has prompted an influx of natural disasters, such as tsunamis and hurricanes. Not only do these phenomena threaten lives, but they also cause mass migrations into new regions, which can strain healthcare systems. Therefore, before a trip, stress to your patients the importance of knowing where the local US embassy or consulate is, so they know where to go in an emergency. In addition, rising temperatures have expanded mosquito habitats, making protecting against mosquitoes even more important for travelers in parts of the world with life-threatening mosquito-borne illnesses, such as Dengue fever and Malaria.

4. Lack of awareness of travel insurance

Patients often think travel insurance is a waste of money, and while that can be true in some situations (like domestic trips), the cost of care can add up quickly during international travel. In addition, if you don’t have coverage, you might be less likely to seek the care you need to avoid paying for it, which can aggravate medical conditions. The cost can be even greater if you’re traveling in an area with fewer medical resources or on a cruise.

5. Antibiotic stewardship

Prescribing antibiotics as a preventative measure is a common travel health practice, but Dirubbo expressed concern that doing so is actually contributing to antibiotic resistance. PCPs who know the correct ways to prescribe antibiotics for travelers are a tremendous asset to the cause.

Dirubbo recommends disregarding the common American practice of telling patients to take an antibiotic at the first sign of traveler’s diarrhea. Instead, advise using Pepto-Bismol tablets, or the generic brand, and lots of hydration. Then, if the condition persists for a few days, they should only take one 500 mg dose of azithromycin.

In addition, PCPs should educate their traveling patients about what to do with their antibiotics should they not need them during the trip for which they were initially prescribed. Dirubbo’s advice? Tell them to keep the pills because their potency will last five years past the expiration date. (Studies have found there’s no scientific justification for expiration dates.) Simply throwing them out can result in more antibiotics in drinking water, which contributes to resistance.

Another masterful tip from Dirubbo: If you have a traveling patient with a layover in a country with universal healthcare, you might recommend they pick up medication at a health clinic at the airport. It’ll be one-third of the US price.

6. Teaching safety as a mindset

The top reason travelers die, according to Dirubbo, is not vaccine-preventable diseases or traveler’s diarrhea. Instead, it’s accidents. So it’s crucial for PCPs, who have existing, trusting relationships with patients, to stress that they should always be on the lookout for ways they can get hurt and to avoid taking risks.

Whether you’re equipped to talk to your patients about travel safety or not, they will go on trips and might not seek the appropriate medical care. Moreover, threats to the health and safety of international travelers affect not only individuals but communities abroad and at home. After all, travel health simply means keeping the world healthy, and your community is just one place inside it.