Before
traveling, you should visit your doctor. Discuss your
travel plans and personal health to determine any
precautions, which vaccines you may need, and to be
sure you have an ample supply of any prescription
medications.
Vaccinations
and Travel
- Have you scheduled a visit to your doctor or a travel
medicine provider?
- Ideally, set up one up 4 to 6 weeks before your
trip.
- Most vaccines take time to become effective in your
body and some vaccines must be given in a series over
a period of days or sometimes weeks.
- If it is less than 4 weeks before you leave, you
should still see your doctor. You might still benefit
from shots or medications and other information about
how to protect yourself from illness and injury while
traveling.
- Are you aware of which types of vaccinations you
or those traveling with you may need?
Vaccines for travel are divided into three categories:
routine, recommended, and required. While your doctor
will tell you which ones you should have, it's best
to be aware of them ahead of time.
Routine Vaccinations
Be sure that you and your family are up to date on
your routine vaccinations. These vaccines are necessary
for protection from diseases that are still common
in many parts of the world even though they rarely
occur in the United States and Western Europe.
Recommended Vaccinations
These vaccines are recommended to protect travelers
from illnesses present in parts of the world and to
prevent the importation of infectious diseases across
international borders. Which vaccinations you need
depends on a number of factors including your destination,
whether you will be spending time in rural areas,
the season of the year you are traveling, your age,
health status, and previous immunizations.
Required Vaccinations
The only vaccine required by International Health
Regulations is yellow fever vaccination for travel
to certain countries in sub-Saharan Africa and tropical
South America. If you are traveling to the Caribbean
from sub-Saharan Africa or tropical South America,
there may be Yellow Fever vaccine entry requirements.
Please check in advance.
Seeking Health Care Abroad
In addition to ensuring that all necessary travel
documents are complete before departure, travelers
should learn what medical services their health insurance
will cover overseas, as well as any policy exclusions.
While some major health insurance carriers in the
United States may provide coverage for emergencies
that occur while traveling, most do not cover medical
expenses due to exacerbations of pre-existing medical
conditions while abroad. It is also important to know
the insurance company's policy for "out-of-network"
services, pre-authorization requirements, and need
for a second opinion before obtaining treatment. Travelers
should carry claim forms and a copy of their insurance
policy card, if their insurance policy does provide
coverage abroad. (note to U.S. residents - The Social
Security Medicare program does not provide coverage
for medical costs outside the United States). Furthermore,
very few health insurance companies cover the cost
of medical evacuation, which can vary widely, ranging
from a few thousand dollars to over US$100,000, depending
on the circumstances. Travelers who will be away for
an extended period of time, who have underlying illnesses,
or who are participating in activities entailing risk
for injury, are encouraged to consider a supplemental
health insurance policy that provides guaranteed medical
payments, assistance via a 24-hour physician-backed
support center, and emergency medical transport, including
repatriation.
Injuries
Motor vehicle crashes are a leading cause of injury
among travelers. Protect yourself from motor vehicle
injuries: avoid drinking and driving; wear your safety
belt and place children in age-appropriate restraints
in the back seat; follow the local customs and laws
regarding pedestrian safety and vehicle speed; obey
the rules of the road; and use helmets on bikes, motorcycles,
and motor bikes. Avoid boarding an overloaded bus
or mini-bus. Where possible, hire a local driver.
Food
To avoid illness, travelers should be advised to select
food with care. All raw food is subject to contamination.
Particularly in areas where hygiene and sanitation
are inadequate, the traveler should be advised to
avoid salads, uncooked vegetables, and unpasteurized
milk and milk products such as cheese, and to eat
only food that has been cooked and is still hot or
fruit that has been washed in clean water and then
peeled by the traveler personally. Undercooked and
raw meat, fish, and shellfish can carry various intestinal
pathogens. Cooked food that has been allowed to stand
for several hours at ambient temperature can provide
a fertile medium for bacterial growth and should be
thoroughly reheated before serving. Consumption of
food and beverages obtained from street vendors has
been associated with an increased risk of illness.
The easiest way to guarantee a safe food source for
an infant <6 months of age is to have the infant
breastfeed. If the infant has already been weaned
from the breast, formula prepared from commercial
powder and boiled water is the safest and most practical
food.
Cholera cases have occurred in people who ate crab
brought back from Latin America by travelers. Travelers
should be advised not to bring perishable seafood
with them when they return to the United States from
high-risk areas. Moreover, travelers may assume incorrectly
that food and water aboard commercial aircraft are
safe. Food and water may be obtained in the country
of departure, where items may be contaminated.
Water
Swimming
A variety of infections (e.g., skin, ear, eye, respiratory,
neurologic, and diarrheal infections) have been linked
to wading or swimming in the ocean, freshwater lakes
and rivers, and swimming pools, particularly if the
swimmer's head is submerged. Water may be contaminated
by other people and from sewage, animal wastes, and
wastewater run-off. Diarrhea and other serious waterborne
infections can be spread when disease-causing organisms
from human or animal feces are introduced into the
water. Travelers who swim should be advised to avoid
beaches that may be contaminated with human sewage
or dog feces.
Accidentally swallowing small amounts of fecally contaminated
water can cause illness. Travelers should be warned
to try to avoid swallowing water while engaging in
aquatic activities. Generally, for infectious disease
prevention, pools that contain chlorinated water can
be considered safe places to swim if the disinfectant
levels and pH are properly maintained. However, some
organisms (e.g., Cryptosporidium, Giardia, hepatitis
A, and Norovirus) have moderate to very high resistance
to chlorine levels commonly found in chlorinated swimming
pools, so travelers also should avoid swallowing chlorinated
swimming pool water. All travelers who have diarrhea
should refrain from swimming to avoid contaminating
recreational water.
Travelers should be advised to avoid swimming or wading
with open cuts or abrasions that might serve as entry
points for pathogens. In certain areas, fatal primary
amebic meningoencephalitis has occurred after swimming
in warm freshwater lakes or rivers, thermally polluted
areas around industrial complexes, and hot springs,
so travelers should avoid submerging the head and
should wear nose plugs when entering untreated water
to prevent water getting up the nose. Travelers should
also be advised to avoid wading or swimming in freshwater
streams, canals, and lakes in schistosomiasis-endemic
areas of the Caribbean, South America, Africa, and
Asia.
Drinking
Water that has been adequately chlorinated according
to the minimum recommended water treatment standards
used in the United States will afford substantial
protection against viral and bacterial waterborne
diseases. However, chlorine treatment alone, as used
in the routine disinfection of water, may not kill
some enteric viruses and the parasitic organisms that
cause giardiasis, amebiasis, and cryptosporidiosis.
In areas where chlorinated tap water is not available
or where hygiene and sanitation are poor, travelers
should be advised that only the following may be safe
to drink:
* Beverages, such as tea and coffee, made with boiled
water.
* Canned or bottled beverages, including water, carbonated
mineral water, and soft drinks.
* Beer and wine.
Where water might be contaminated, travelers should
be advised that ice should also be considered contaminated
and should not be used in beverages. If ice has been
in contact with containers used for drinking, travelers
should be advised to clean the containers thoroughly,
preferably with soap and hot water, after the ice
has been discarded.
It is safer to drink a beverage directly from the
can or bottle than from a questionable container.
However, water on the outside of beverage cans or
bottles may also be contaminated. Therefore, travelers
should be advised to dry wet cans or bottles before
they are opened and to wipe clean surfaces with which
the mouth will have direct contact. Where water may
be contaminated, travelers should be advised to avoid
brushing their teeth with tap water.
Travelers' Health Kit
The purpose of a Travel Kit is twofold: to allow the
traveler to take care of minor health problems as
they occur and to treat exacerbations of pre-existing
medical conditions. A variety of health kits is available
commercially and may even be purchased over the internet;
however, similar kits can be assembled at home. The
specific contents of the health kit are based on destination,
duration of travel, type of travel, and the traveler's
pre-existing medical conditions. Basic items that
should be included are listed below.
Medications
* Personal prescription medications (copies of all
prescriptions, including the generic names for medications,
and a note from the prescribing physician on letterhead
stationary for controlled substances and injectable
medications should be carried)
* Antimalarial medications, if applicable
* Antidiarrheal medication (e.g., bismuth subsalicylate,
loperamide)
* Antibiotic for self-treatment of moderate to severe
diarrhea
* Antihistamine
* Decongestant, alone or in combination with antihistamine
* Antimotion sickness medication
* Acetaminophen, aspirin, ibuprofen, or other medication
for pain or fever
* Mild laxative
* Cough suppressant/expectorant
* Throat lozenges
* Antacid
* Antifungal and antibacterial ointments or creams
* 1% hydrocortisone cream
* Epinephrine auto-injector (e.g., EpiPen), especially
if history of severe allergic reaction. Also available
in smaller-dose package for children.
Other Important Items
* Insect repellent containing DEET (up to 50%)
* Sunscreen (preferably SPF 15 or greater)
* Aloe gel for sunburns
* Digital thermometer
* Oral rehydration solution packets
* Basic first-aid items (adhesive bandages, gauze,
ace wrap, antiseptic, tweezers, scissors, cotton-tipped
applicators)
* Antibacterial hand wipes or alcohol-based hand sanitizer
* Moleskin for blisters
* Lubricating eye drops (e.g., Natural Tears)
* First Aid Quick Reference card
Other items that may be useful in certain circumstances
* Mild sedative (e.g., zolpidem) or other sleep aid
* Anti-anxiety medication
* High-altitude preventive medication
* Water purification tablets
* Commercial suture/syringe kits (to be used by local
health-care provider. These items will also require
a letter from the prescribing physician on letterhead
stationary)
* Latex condoms
* Address and phone numbers of area hospitals or clinics
