Global travel: Advance planning can prevent illness By Mayo Clinic staff
More people are traveling overseas each year for social, recreational, business and humanitarian purposes. At the same time, it's becoming easier and cheaper to visit developing countries and rural areas of the world once considered inaccessible to the average tourist.
As a result, such travelers are exposed to a greater number of health risks and contagious diseases in unfamiliar environments. Yet taking simple precautions before departure and while abroad can go a long way toward minimizing the risks.
Risks range from minor colds to more serious diseases
Your risk of infection depends largely on where you go and how long you stay. Of course, if you live in a developing country for months or years, you're more likely to pick up an infectious disease than you are if you spend only a week or two abroad.
Among the most common infectious diseases travelers contract are diarrhea and upper respiratory infections such as the common cold or bronchitis. However, a number of other diseases, such as mosquito-borne malaria and yellow fever, are becoming more of a concern as it becomes easier for travelers to visit disease-endemic areas. Rest assured that only on rare occasions do epidemics such as bubonic plague in India and diphtheria in Russia present a much more widespread threat. And you can take steps to prevent many such diseases.
Seek medical care and vaccinations weeks to months in advance
If you're planning to travel abroad, allocate time before your trip to:
Assess what vaccinations you need If you're headed for developing or tropical areas, obtain a consular information sheet from the State Department's Office of Overseas Citizens Services or visit the Centers for Disease Control and Prevention's Web site. Determine whether vaccines are recommended or even mandatory for the countries you plan to visit.
Allow time for immunity to develop Give yourself plenty of time to update routine immunizations such as tetanus, pneumococcal, polio, influenza, and measles-mumps-rubella — diseases that may still be prevalent in some places around the world. Seeing your doctor for a review of your medical history, current diseases, medications and allergies also is a good idea. Consider seeing a travel medicine specialist.
Then consider the time of year and length of your visit when deciding on other vaccinations and preventive measures. Discuss your itinerary with your doctor at least six weeks before departure. Some vaccines require several weeks for immunity to develop, while others may require more than one dose of the vaccine for full protection.
Vaccines for foreign travel
Introduction
Diphtheria, tetanus
Polio
Measles
Yellow fever
Hepatitis A
Hepatitis B
Rabies
Encephalitis
Typhoid
Meningococcal
Influenza, pneumococcal
In addition to making sure you've had your primary vaccine series, the World Health Organization (WHO), the Centers for Disease Control and Prevention (CDC) and other organizations recommend that you consider several additional vaccines if you'll be traveling outside the United States.
Click on the tabs to the left to read about these vaccines.
Diphtheria — recommended for travel to Russia and the independent countries of the former Soviet Union, and parts of Africa, Asia, Eastern Europe, and Central and South America.
Tetanus — recommended for all adults, as the disease can occur anywhere in the world.
A booster dose of adult tetanus-diphtheria vaccine is recommended every 10 years.
Recommended for travel in parts of Africa, Asia and the Middle East — especially in Afghanistan, India, Pakistan, Nigeria and Niger.
For those never vaccinated and depending on time available for departure, two doses of vaccine administered four to eight weeks apart are recommended, with a third dose six to 12 months after the second. For those with prior polio immunization, a single lifetime booster dose should suffice.
Recommended for travelers born in 1957 or after. Measles remains a common disease in many countries of the world, including some developed countries in Europe and Asia.
Recommended, and in some cases required, for travel in sub-Saharan Africa and tropical South America.
Consult with the State Department's Bureau of Consular Affairs to determine whether your destination country requires proof of vaccination.
If you're not immunized and you contract the disease, your chance of dying from it is greater than one in five.
A booster dose is recommended every 10 years.
Recommended for travelers to all areas except Japan, Australia, New Zealand, Canada, Northern and Western Europe.
Two doses needed: one initial dose and another dose six months later.
Recommended if you're staying in areas with high rates of hepatitis B, particularly if you'll have daily physical contact, sexual contact or both with the local population.
Areas with high rates of hepatitis B include Southeast Asia, Africa, the Middle East, islands of the South and West Pacific, Mexico, Central America and the Amazon region of South America.
Three doses needed: one initial dose, and subsequent doses at one and six months later.
Recommended if you're traveling to developing countries, especially if you'll be spending extensive time outdoors at night in rural areas. Infected dogs and other terrestrial animals are more likely to be present in such areas. Also at risk are animal handlers, campers, biologists and spelunkers.
This disease is fatal unless you've received the vaccine or receive prompt treatment, which may be difficult.
Countries of concern include Brazil, Bolivia, Colombia, Ecuador, El Salvador, Guatemala, India, Mexico, Nepal, Peru, the Philippines, Sri Lanka, Thailand and Vietnam. Also found in dogs in most countries in Africa, Asia and Central and South America.
Japanese encephalitis — recommended if you're staying longer than two weeks in certain parts of China, India and Southeast Asia.
Tick-borne encephalitis — recommended for Russia and Eastern and Central Europe.
Encephalitis is of particular concern if you'll be:
Staying in rural areas
Visiting during seasons when mosquitoes or ticks are prevalent
Three doses needed over a one-month time period. Must be completed at least 10 days before departure for immunity to develop.
Recommended if you're staying three weeks or more on the Indian subcontinent, in developing countries in Asia, Africa, Central and South America, and other areas where food and water precautions are suggested, particularly if you have adventurous eating habits.
Four oral doses at 48-hour intervals needed or one injection administered at least two weeks before departure.
Recommended if you're traveling to certain countries in sub-Saharan Africa. Epidemics have occurred within the last 10 years in Saudi Arabia, Burkina Faso and in parts of the savannah areas extending from Mali east to Ethiopia. Immunization is required for travelers to Mecca during the hajj.
Consider getting vaccinated especially if you're traveling during the dry season of December through June, when the disease peaks. Also consider vaccination if you'll have prolonged contact with the local population, as the disease spreads through the exchange of respiratory and throat secretions, such as with coughing and kissing.
One injection needed at least two weeks before departure.
Recommended for travel during the flu season in the Northern and Southern hemispheres, or if you plan to travel in the tropics anytime. These are separate vaccines — which can be administered at the same time or separately — but the groups at risk of these diseases largely overlap.
Consider getting vaccinated especially if you:
Are age 65 or older
Have a chronic illness, such as diabetes, heart disease, lung disease or kidney disease
Go in good health Take care of routine dental and medical matters before you go, too. Get that root canal or annual physical. Health care overseas may not meet U.S. health standards and can be expensive and difficult to arrange. Obtain medical clearance to travel if need be.
Arm yourself against potentially dangerous mosquitoes
Malaria, a mosquito-borne illness, is a leading cause of death in developing countries worldwide, occurring in 300 million to 500 million people each year. In the United States about 1,200 cases are diagnosed annually, primarily in Americans who travel abroad and immigrants who return from sub-Saharan Africa, the Indian subcontinent and other high-risk areas.
Although malaria can be fatal if untreated, the disease is largely preventable if you have access to medications and take precautions to avoid being bitten by mosquitoes when traveling in parts of Africa, Southeast Asia, South America, Mexico or Central America — particularly the warmer tropical and subtropical areas where mosquitoes thrive. To protect yourself when traveling to such areas:
Take antimalarial drugs before you go. No vaccine for malaria exists, but you can protect yourself by taking prescription drugs such as mefloquine (Lariam), chloroquine phosphate (Aralen) or atovaquone-proguanil (Malarone). Take these drugs beginning two days to two weeks before departure. The choice of drug will depend on your itinerary.
Pack and use insect repellents that contain DEET as an active ingredient.
Minimize skin exposure. Pack and wear long-sleeved shirts and long pants, preferably in light colors.
Spray your clothing with permethrin insecticide spray.
Doing your homework before you go can help you avoid later hassle or illness. To prepare:
Check your health insurance policy. Understand what kind of coverage you have should a medical emergency arise outside the United States. Although some insurance companies will pay for "reasonable" hospital costs abroad, very few will pay for medical evacuation to the United States. Some companies also require travelers to notify them upon admission to a hospital. To avoid such complications, you might consider purchasing a supplemental policy that provides guaranteed medical payments and medical transport.
Consider counseling on sexually transmitted diseases. This is especially appropriate for individuals who practice risky sexual behavior while traveling. Studies suggest a low rate of condom use among travelers and ignorance in many foreign countries about the risks of human immunodeficiency virus (HIV) infection.
Identify medical care in the areas you plan to visit. Take with you a list of recommended hospitals and English-speaking doctors at your intended destinations. Your doctor, local or state medical society, the International Association for Medical Assistance to Travellers or the State Department's Office of Overseas Citizens Services can help you develop your list.
Bring documentation from your doctor. Carry a signed and dated statement from your doctor indicating your health history and required medication dosages if necessary. This provides foreign medical personnel with critical information in case of an emergency.
Pack extra supplies of prescription medicines. Divide additional supplies among carry-on bags and checked luggage in case of loss or theft. If possibly, carry your medications in their original labeled prescription bottles. Also consider bringing an extra prescription from your doctor.
Take a basic first-aid kit. Include pain relievers, nasal decongestants, antibiotic ointment, anti-diarrheal medication and bandages. Also pack sunscreen, extra prescription eyewear and motion sickness medication if applicable. These items may be expensive or hard to find in foreign countries.
Use common sense while abroad
Think twice about activities you wouldn't hesitate to do back home. For example, eat carefully. Well-cooked food is usually safest. Avoid eating foods from street vendors, unpasteurized dairy products and raw or uncooked seafood. Drink water only from commercially sealed bottles.
After the trip: Be alert for signs of illness
Watch for illness in the first 12 weeks. Travelers who acquire viral, bacterial or parasitic infections overseas usually show symptoms and become ill within that period of time. However, be aware that some diseases, such as malaria, may not cause symptoms until six months to a year later, and may occur even if you took preventive medication.
If you get sick, tell your doctor where you've been traveling within the past year. If the illness continues or the diagnosis remains unclear, consider consulting a doctor who specializes in geographic medicine.
Whether you're traveling abroad for business or pleasure, the keys to avoiding illness are preparation and common sense. Take a few simple precautions before you leave and make wise choices during your trip to help keep it a healthy experience.
