How can I stay healthy on my trip?

Bushwhacking in Borneo? Trekking in Nepal? Cruising the Caribbean? Whether you tramp through the rain forest or bask on a love boat—travel presents new and different health concerns mostly unknown at home.

Preparing before you go is the best way to stay healthy while you're traveling. See a doctor at least 6 weeks before you leave so that you'll have time for immunizations that may need to be done in advance. Check with your doctor to see if there are medications or extra precautions that you should take. For example, people who have heart failure may need to take shorter flights with more stops to avoid long periods of sitting or they may need to adjust their medications.

Where can I get the best information?

Check the nearest health clinic for current recommendations for immunizations. In the United States, most state health clinics provide travel immunizations, some medications, and healthy travel tips. If your state health clinic does not give immunizations for travelers, ask for the name of a travel clinic near you.

To find general travel health information and details on current disease outbreaks around the world, see:

·                            Centers for Disease Control and Prevention (CDC) Web site at http://www.cdc.gov/travel/.

·                            World Health Organization (WHO) Web site at http://www.who.int/en/.

If you are booked on a cruise, check out your ship's sanitation inspection scores on the CDC Web site at http://www2.cdc.gov/nceh/vsp/vspmain.asp.

Find out where the best medical care can be found in the region you are visiting. The U.S. Department of State Web site—http://www.state.gov/travel/—lists every U.S. embassy worldwide and lists some doctors and medical facilities abroad.

Which immunizations and/or medications will I need?

Hepatitis A vaccine is recommended for most travelers to developing countries where the disease is prevalent. It is the most widely reported disease in returning travelers that can be prevented by a vaccine. ¹ The pneumococcal vaccine—which effectively prevents bacterial pneumonia—is recommended for everyone older than 65 and is especially important for travelers.

Make sure all routine immunizations are up to date for you and your children. These immunizations can protect you from diseases, such as polio, diptheria, measles, and rubella, which have been virtually wiped out in developed nations but are still prevalent in some developing countries.

The yellow fever vaccine is currently required for travelers who plan to visit countries in South America and Africa where the disease is active. Other immunizations may be needed depending on the area you are visiting, how long you will be there, and the purpose of your journey.

If you plan on visiting a malaria-risk area, ask about a prescription for antimalarial drugs.

What precautions should I take while I'm traveling?

Before you go, research local sanitation and other conditions so that you can take appropriate measures while you are traveling. Is the water safe to drink? Do insects, such as mosquitoes or ticks, carry disease? Is there air pollution? Will the altitude make you sick? Is it safe to swim in pools, lakes, or the ocean? Could you get heat exhaustion, sun stroke, or a sunburn?

Basic precautions, such as drinking bottled water or using insect repellent, can prevent some illnesses, ranging from an inconvenient bout of diarrhea to life-threatening malaria.

·                            Many underdeveloped countries do not have safe tap water. When visiting these areas, drink only beverages made with boiled water, such as tea and coffee; bottled water or carbonated beverages; or beer and wine.

·                            Don't eat raw vegetables, raw fruits (unless you peel them yourself), or raw or undercooked meat and seafood. Although sometimes tempting, avoid food or drink from street vendors.

·                            When visiting malaria-infected areas, use DEET insect repellent on exposed skin and flying insect spray in the room where you sleep. Wear long pants and long-sleeved shirts, especially from dusk to dawn. Likewise, protect against ticks when visiting areas where Lyme disease or Rocky Mountain spotted fever is present.

·                            Stay indoors during the hottest time of the day and use sunscreen when outdoors to prevent an uncomfortable sunburn and life-threatening heatstroke.

·                            Air pollution in some large cities can pose a serious threat to those with asthma or other respiratory conditions; these cities should be avoided when air quality is poor.

While disease presents a big risk, be aware also of potential sources of injury. Motor vehicle accidents are a leading cause of injury among travelers. ¹ Be familiar with local driving customs, road signs, and how to navigate unfamiliar traffic patterns, including driving on the left side of the road and using roundabouts or traffic circles. When possible, travel during daylight, and always use seat belts.

What if I become ill while I'm traveling?

"Montezuma's revenge," "Bali belly," "Tut's trots"—whatever you call it, diarrhea is the most common illness to strike travelers, especially in underdeveloped countries where food and water treatment is often lacking.

Travelers' diarrhea typically begins abruptly with watery stools, vomiting, cramping, and low fever. Most doctors recommend taking only clear liquids for the first 24 to 48 hours. Watch for signs of dehydration, such as dry mouth and dark-colored urine. If possible, drink rehydration drinks to replace lost fluids and electrolytes. Most cases of travelers' diarrhea resolve within 1 to 3 days without medical treatment, but see a doctor if diarrhea doesn't subside or if you have high fever, blood or pus in your stools, or signs of dehydration.

If you become seriously ill while traveling, your country's embassy or consulate can help you find medical care. If you become ill with a fever or flulike illness while traveling in malaria-risk areas, seek medical attention immediately.

Should I see a doctor when I return?

If you became ill with a fever or flulike illness while traveling or up to 1 year after returning home, you should see your doctor. Tell your doctor the regions you visited and about any exposure to disease. Many diseases do not show up immediately, and some can take weeks to months to develop. Up to 90% of travelers who get malaria do not become ill until after they return home. ²

In addition to fever, the returned traveler should be aware of other symptoms. See your doctor if you have persistent or intermittent diarrhea, a skin rash or sores, jaundice (typically most noticeable when the whites of the eyes appear yellow), unexplained weight loss, or fatigue.

If you have been healthy during your trip and feel well when you return home, you probably don't need to see a doctor.

Frequently Asked Questions

Before You Go

Preparing for a journey takes planning and time. Proper planning is the best way to stay healthy during your trip. See a doctor at least 6 weeks before you go so that you'll have time for immunizations and other health precautions you may need to take in advance. There are several factors to consider in preparing for a trip.

Your individual health needs

If you have any chronic diseases or other health concerns, such as birth control or allergies, see your doctor. You may need to adjust your itinerary to accommodate your health needs. For example, if you have heart failure or a history of blood clots, you may need to take shorter flights with more stops to avoid long periods of sitting. If you have asthma, chronic obstructive pulmonary disease (COPD), or other lung diseases, you may need to avoid stays in polluted cities or at high altitudes.

Evaluate whether you will be physically able to meet the rigors of your particular trip. Most travel, even if you are going on a professionally led tour, typically demands more physical effort than is required at home. Boost your fitness by starting an exercise program, such as fitness walking, in advance.

If you have health problems, carry a letter from you doctor describing your conditions, a list of your routine medications including their generic names, and written prescriptions for refills if you will be gone long. People with heart conditions should travel with a copy of their most recent electrocardiogram (EKG, ECG) for comparison should you have chest pain or other symptoms. If you have diabetes, you can take precautions to prevent problems while traveling.

If you are pregnant, talk to your doctor before making any travel decisions. If you decide to travel, take some general precautions while traveling, such as notifying the airline of your condition before you fly and taking occasional walks while on a long flight to increase the blood circulation in your legs (good advice for all travelers).

Leave your prescription medications in the original containers, and pack them in a waterproof container in your carryon luggage. Take extra amounts of your routine medications packed in checked luggage in case of theft or loss.

Many doctors recommend that you take a first aid kit with items such as pain relievers, sunscreen, moleskin, antifungal and antibacterial ointments, and antidiarrheal medications, especially if you will be traveling to areas where modern medical care is not readily available.

Potential health risks

Preparing for health risks is especially important if you are visiting developing countries, such as those in most parts of Africa and Asia and many parts of South and Central America, where expert medical care may not be readily available. Click here to see vaccine recommendations and health precautions for the region you will be visiting.

Before you go, you should be aware of any needed immunizations or medications, disease outbreaks, food and water precautions, and any other preventive measures to take. Check your local or state health clinic at least 6 weeks before traveling so that you'll have time for immunizations and other health precautions that may need to done in advance. Most of these clinics can give immunizations and prescriptions for antimalarial drugs. If not, ask to be referred to a clinic that specializes in travel health.

Make sure all of your routine immunizations are up to date for you and your children. These immunizations can protect you from diseases such as polio, diptheria, measles, and rubella that have been virtually wiped out in developed nations but are still prevalent in some developing countries. If you will be traveling to a country where these infections are still common, check your immunity status. Some adults have not received all of these vaccines (especially measles, mumps, and rubella) and may be susceptible unless they have had the disease. Tetanus immunization should be updated before traveling if you haven't received one in the last 10 years.

See recommended routine immunizations for:

·                            General adult population.

·                            Adults with medical conditions, including pregnancy.

For more information, see the topic Immunizations.

Hepatitis A vaccine is recommended for most travelers to developing countries where the disease is prevalent. It is the most widely reported disease in return travelers that can be prevented by a vaccine. You can help protect yourself from hepatitis A while traveling by taking basic precautions such as boiling your drinking water, making sure food is well-cooked, and eating only raw fruits and vegetables that you have washed and peeled.

The pneumococcal vaccine, which lowers the risk of complications that can result from bacterial pneumonia, is recommended for everyone older than 65 and is especially important for travelers. Adults may not have received these newly developed vaccines, although many children have as part of the nationwide standard immunization program.

The yellow fever vaccine is currently required for travelers who plan to visit countries in South America and Africa where the disease is active.

Additional immunizations may be needed depending on the area you are visiting, how long you will be there, and the purpose of your journey. For example, trekkers to parts of rural China during the summer and autumn months may need the vaccine for Japanese encephalitis. The cholera vaccine is no longer recommended because it was found ineffective.

Ask about a prescription for antimalarial drugs if you will be visiting a an area that has malaria. Malaria-risk areas of the world include large areas of Central and South America, Hispaniola (Haiti and the Dominican Republic), Africa, the Indian subcontinent, Southeast Asia, the Middle East, and many South Pacific islands. You may need to take one of several different preventive medications depending upon the type of mosquito inhabiting that part of the world. These medications need to be taken daily during your travels and for a specified time after return.

To find general travel health information and details on current disease outbreaks around the world, see:

·                            Centers for Disease Control and Prevention (CDC) Web site at http://www.cdc.gov/travel/.

·                            World Health Organization (WHO) Web site at http://www.who.int/en/.

Sanitation inspection scores for cruise ships are reported on the CDC Web site at http://www2.cdc.gov/nceh/vsp/vspmain.asp.

Medical care in developing countries can be below standard. Before you go, get the addresses and phone numbers of embassies and consulates in the areas you will be visiting. If you get sick, these offices can help you find medical care. For a complete list of embassies and consulates, see the U.S. Department of State Web site at http://www.state.gov/travel/. You can also obtain lists of local doctors and medical clinics.

Precautions Along the Way

Traveling, especially in developing countries, comes with a whole new set of considerations. You will need to change some everyday routines that you take for granted at home, like drinking a glass of tap water, and protect against some hazards, such as malaria-carrying mosquitoes, that may not exist at home. Click here to see vaccine recommendations and health precautions for the region you will be visiting. Following are some general precautions to take while traveling.

Water and food safety

Contaminated water and food are the most common cause of illness in travelers. These illnesses range from an inconvenient case of travelers' diarrhea to 24-hour stomach flu, from the Norwalk-like virus seen on cruise ships to severe cholera.

Since it's difficult to know if tap water is properly treated, most doctors recommend avoiding tap water if there is any doubt. Safe beverages include drinks made with boiled water, such as tea and coffee; canned or bottled carbonated beverages, including carbonated bottled water and soft drinks; beer and wine. Ice should also be considered contaminated and should not be used in beverages. Dry the opening of wet cans or bottles before taking a drink. Remember not to brush your teeth with tap water.

Travelers to back country areas of North America should also take precautions with water. Even though the water in high mountain lakes looks sparkling clear, it may be contaminated with Giardia intestinalis, the parasite that causes giardiasis. Take simple precautions to avoid this illness.

Likewise, swimming in contaminated fresh water, such as ponds or rivers, can expose you to a variety of diseases. Even swimming pools with inadequate chlorination pose a risk. Talk to your doctor if you plan on doing recreational water sports—such as whitewater rafting, adventure racing, or kayaking—in tropical and back country regions.

Take precautions with food by avoiding raw vegetables and fruits (unless you wash and peel them yourself), and raw or undercooked meat and seafood. Steaming hot, well-cooked food is usually the safest. Although tempting, don't eat food or drink from street vendors. Make sure dairy products have been pasteurized.

For more information, see the topic Food Poisoning and Safe Food Handling.

To prevent fungal or parasitic infections and injuries, do not go barefoot. Try to keep your feet as clean and dry as possible.

While sea water is usually safe from disease, swimming or diving in sea water can be still dangerous. For more information, see the topic Marine Stings and Scrapes.

Insect-borne disease

Mosquitoes, flies, fleas, and ticks all spread disease, including malaria, Japanese encephalitis, Lyme disease, West Nile fever, South African tick-bite fever, yellow fever, and dengue fever.

Malaria is the insect-borne disease of most concern to travelers in tropical and subtropical regions. While antimalarial medications kill the malaria parasite in the bloodstream, this protection is not complete and mosquito bites should be avoided. To ward off mosquitoes, travelers should take protective measures along with antimalarial medication. Here are some tips:

·                            Use DEET or Bayrepel insect repellent on clothes and exposed skin, but not on the eyelids or lips. Always wash your hands after applying. Repeat every 3 to 4 hours, especially in hot and humid climates. Dosage should not exceed manufacturer's recommendations, especially for young children. Be aware that DEET can damage some fabrics.

·                            Use flying insect spray in the room where you sleep.

·                            Wear light-colored and loose-fitting long pants and long-sleeved shirts, especially from dusk to dawn, when mosquitoes that spread malaria bite. Insect repellent applied to clothing is effective for longer than it may be on the skin.

·                            Permethrin or deltamethrin insecticide sprayed on bed nets will protect against mosquitoes for weeks to months.

·                            Mosquito coils can also help fend off mosquitoes.

·                            Home remedies like eating or rubbing garlic on your skin or taking vitamin B do not prevent bites.

Ticks inhabit many regions, including Europe, Canada and the United States, and carry many diseases, including Lyme disease, Rocky Mountain spotted fever, tularemia, ehrlichiosis, relapsing fever, Colorado tick fever, South African tick-bite fever, and babesiosis. While it is rare for travelers to contract diseases from ticks, many of these diseases are serious. For information on how to prevent tick bites, see the Prevention section of the topic Tick Bites.

Sun and heat exposure

Many travelers underestimate the sun's strength and overestimate the amount of protection their sunscreen offers. This can add up to at least an uncomfortable sunburn and, at worst, heat exhaustion and life-threatening heatstroke.

To avoid these complications:

·                            Stay out of the sun during the middle of the day, when ultraviolet light (UV) is greatest.

·                            Apply sunscreen blocks for both UVA and UVB rays with a sun protection factor (SPF) of at least 15. Use liberally on areas of the body not protected by clothing and reapply frequently, especially during midday, and when you're swimming or sweating. For more information, see the topic Sunburn.

·                            Wear UV-protective sunglasses.

·                            Wear a broad-brimmed hat, loose-fitting, long-sleeved shirts, and long pants.

·                            Watch for signs of dehydration, most importantly scant and/or dark-colored urine.

·                            Limit exertion and drink plenty of fluids, if possible, rehydration drinks, to replace lost fluids and electrolytes.

Accidents

While disease presents a big risk while traveling, you should also be aware of potential sources of injury. Shoddy roads, poor driver training, and crowded roadways often make driving in other countries an unwanted adventure. Motor vehicle accidents are a leading cause of injury among travelers. Be familiar with local driving customs, road signs, and how to navigate unfamiliar traffic patterns, including driving on the left side of the road and using roundabouts or traffic circles. If possible, travel during daylight, and always use seat belts and, when riding motorcycles or bicycles, wear helmets.

Take care around dogs and other animals. Dogs in developing countries are often not tame and may bite. Rabies is more common in tropical and subtropical regions. If bitten by an animal, seek medical attention immediately.

Most wounds sustained in developing countries carry a higher risk of becoming infected. If you get even a minor wound, clean the wound as soon as possible with large amounts of warm water and soap. Apply antibiotic ointment and a bandage.

If you haven't had a tetanus shot in 5 years, a booster dose is recommended following an animal bite or an injury that results in a break in the skin.

Altitude

High altitude sickness poses a threat to anyone traveling over 1,500 meters, or about 5,000 feet. Initial symptoms may feel like a hangover with headache, fatigue, loss of appetite, nausea, and vomiting. If symptoms worsen or include confusion, an unsteady gait (ataxia), or faintness, a traveler must go to a low altitude as fast as possible to avoid death. To avoid getting high altitude sickness:

·                            Do not fly directly from low altitude to high altitudes. Try to schedule at least a 1-day stopover at an in-between altitude. Examples of high-altitude cities are Cuzco, Peru; La Paz, Bolivia; and Lhasa, Tibet. After arrival, avoid overexertion, large meals, and alcohol.

·                            When trekking, climb gradually to high altitudes, allowing for periods of adaptation.

·                            If you have heart or lung disease, or anemia, ask your doctor's advice before deciding to travel to a high altitude.

·                            Medications, such as acetazolamide (AK-Zol, Diamox) and dexamethasone (Decadrone) may be prescribed by your doctor with instructions on usage.

What To Do if You Get Ill

If you become seriously ill while traveling, your country's embassy or consulate can help you find medical care. For a complete list of embassies and consulates, see the U.S. Department of State Web site at http://www.state.gov/travel/. You can also obtain the contacts for local doctors and medical clinics. If you become ill with a fever or flulike illness while traveling, seek medical attention immediately.

Travelers' diarrhea is the most common illness when on the road. It typically begins abruptly with watery stools, vomiting, cramping, and low fever. Most doctors recommend taking only clear liquids for the first 24 to 48 hours. Watch for signs of dehydration, such as dry mouth and dark-colored urine. If possible, drink rehydration drinks to replace lost fluids and electrolytes. Before you go, buy dry packets of oral rehydration mix at a drugstore.

The nonprescription remedy bismuth subsalicylate (Pepto-Bismol, Bismatrol, or Bismed) has been shown to decrease the duration and severity of diarrhea by about 60% in several placebo-controlled studies. ³ For diarrhea, take 1 fluid ounce or two tablets every 30 minutes for up to eight doses in a 24-hour period, which can be repeated. It should not be taken for more than 3 weeks and should not be used by people who use aspirin products. Pepto-Bismol has several side effects, including causing your tongue and stool to turn black, and should not be taken by people who should not take aspirin, such as people who have gout or those younger than 20. Read the label directions carefully before taking. If diarrhea persists more than 48 hours, travelers should be evaluated by a doctor.

Antidiarrheal medications, such as Imodium A-D (nonprescription) and Lomotil (prescription), offer relief from cramping and frequent stools. However, you should not take them if you have a fever or blood or pus in your stools. Be aware that they can cause a serious complication called toxic megacolon, in which the colon swells to many times its normal size.

Most cases of travelers' diarrhea resolve within 1 to 3 days without medical treatment. See a doctor if diarrhea doesn't subside or you have high fever, blood or pus in your stools, or signs of dehydration. Watch closely for signs of dehydration in children, because with diarrhea they can quickly become seriously dehydrated.

If you are traveling to an area where modern medical care is not readily available, your doctor may give you antibiotics to take in case of diarrhea. Ciprofloxacin (Cipro) or ofloxacin (Floxin) can be taken at the onset of diarrhea to reduce the number of days you have it. However, some bacteria that cause diarrhea have developed resistance to some of these antibiotics and others, including ciprofloxacin, ofloxacin, trimethoprim-sulfamethoxazole, and doxycycline. This may limit how well these antibiotics work. ⁴

Because antibiotics can increase a traveler's susceptibility to resistant bacteria and provide no protection against either viruses or parasites, they should not be taken as a preventive; only take them if symptoms develop.

For more information, see the topics Food Poisoning and Safe Food Handling, Giardiasis, Diarrhea, Age 11 and Younger, and Diarrhea, Age 12 and Older.

Post-Travel Care

Most travelers return home in good health with a few souvenirs and lasting memories. But if you've been ill, especially while traveling to regions where disease is prevalent or developed symptoms after you returned, you may have brought more than just handicrafts home with you.

Many diseases do not show up immediately; some take weeks to months to develop. For example, 90% of travelers who get malaria do not become ill until after they return home. ² If you become ill with a fever or flulike illness while traveling or up to 1 year after returning home, see your doctor. Tell your doctor the regions you visited and about any exposure to disease.

In addition to fever, the returned traveler should be aware of other symptoms. You should see your doctor if you have persistent or intermittent diarrhea, a skin rash or sores, jaundice (typically most noticeable when the whites of the eyes appear yellow), unexplained weight loss, shortness of breath, or fatigue.

If you have been healthy during your trip and feel well when you return home, you probably don't need to see a doctor.

Other Places To Get Help

Organizations

Related Information

·                            Diarrhea, Age 11 and Younger

·                            Diarrhea, Age 12 and Older

·                            Food Poisoning and Safe Food Handling

·                            Hepatitis A

·                            Malaria

·                            Sunburn

·                            Tick Bites

References

Citations

1.       Spira AM (2003). Preparing the traveller. Lancet, 361: 1368–1381.

2.       Spira AM (2003). Assessment of travellers who return home ill. Lancet, 361: 1459–1469.

3.       Centers for Disease Control and Prevention (2000). Health Information for International Travel 1999–2000, Atlanta, GA: Department of Health and Human Services.

4.       Weller PF (2001). Health advice for international travelers. Scientific American Medicine, vol. 1, Clinical Essentials, chap. 7. New York: WebMD.