Updated: Nov 6, 2019
Updated: Sep 8, 2019
International travel is fairly common, some travel for work, some for pleasure. The ease of getting around has made the world smaller and remote areas are now more accessible. This has led to an increased awareness of travel related health issues.
Fortunately, with a little planning you can minimize or avoid travel related illness. This is a huge topic to cover and we will aim to highlight the main components of this topic.
The key to staying healthy while traveling is assessing the risks your specific travel risks and what you will be exposed to. There are locations around the globe where access to medical care will be limited or none at all. Even an emergency evacuation can take a significant amount of time. It is important to plan accordingly.
Risks of encountering local disease need to be assessed as well, so that appropriate decision about vaccines and other measures can be addressed.
The key questions to ask prior to travel:
1- Type of travel - vacation or business
2- Accommodations - luxury or backpacking
3- Urban or rural travel - Rural travel often poses greater risks
4- Activities - jungle trekking, alpine expedition, water sports etc.
5- Length of trip
Unfortunately few people have pre-travel evaluations or seek advice for travel to high risk areas. Further, many doctors are not aware of the appropriate pre-travel measures. Here are a few things that may be helpful while planning your trip.
Before You Embark On Your Trip
It is always a good idea to touch base with your doctor to address any underlying medical conditions, allergies to foods and or medications.
The duration and location of your trip can help estimate the risk of exposure to endemic diseases. Understandably, the risk to your health is drastically different if you are staying at an all inclusive high end resort versus trekking in remote areas.
If you are on any medications, make sure you have enough for the duration of your trip as these may not be available where you are going. Depending on what you are doing, you may also want to consider travel insurance.
The type of vaccines needed depends on where you plan to travel. Here a list of the more common vaccines needed for travel. They are broken down into “routine” and “recommended.”
Routine vaccines are those such as measles/mumps/rubella (MMR), diphtheria/pertussis/tetanus etc. Most people have had these and just need to make sure a booster is not needed.
Hepatitis A is recommended for all people traveling to areas with a high risk of infection from food or water.
Hepatitis B is recommended for all unvaccinated persons traveling to countries with high levels of endemic hepatitis B transmission, especially if there is a risk of exposure to blood or body fluids such as in the case of medical volunteers.
Typhoid vaccine is recommended for travelers going to areas where it is endemic. The vaccine is not 100% effective and you still need to use good judgement about what you eat and drink.
Yellow fever is recommended for those traveling to areas where there is a risk of exposure to this virus, mostly Africa and South America. It is important to note that some countries require proof of this vaccination for entry.
Rabies is recommended for travelers spending a lot of time outdoors, especially in rural areas. Children are considered higher risk because they may play with animals and not report scratches or bites. Rabies is a deadly disease.
Vaccines are a proven method to protect your health.
During your trip
Food and Water Borne Illness
This is probably the most common cause of travel related illness. You need to be careful and use good judgment. Common issues caused by contaminated food or water include travelers diarrhea and hepatitis A.
Keep in mind that parasitic infections can also be acquired this way. Avoid tap water in high risk areas. This includes ice made from tap water and raw foods rinsed with tap water (fruits, vegetables). Boiled, treated, or bottled water are the best options.
Carbonated beverages, beer, wine, and drinks made with boiled water are safe. Produce that needs to be peeled is relatively safe for consumption. Food should be cooked well. Obviously, unpasteurized dairy products and undercooked fish or meat should be avoided.
Wash your hands often with soap and for at least 15 seconds, especially before meals.
Traveling to areas known to have malaria, dengue, chikungunya, Zika, and other vector-borne diseases requires extra measures to prevent mosquito bites. These same measures are also generally effective for reducing risks of bites from sand flies, ticks, and other insects.
You should be aware of mosquito feeding times:
- Malaria, Japanese encephalitis, West Nile virus - dusk and dawn
- Dengue, Chikungunya, Zika, yellow fever - during the daytime
You are not going to spend your entire vacation indoors and it is impossible to avoid being outside during these times. Protect yourself by wearing clothing that reduces the amount of exposed skin. Use insect repellent with 30-50% DEET.
Picaridin (available in 7-15% concentrations) is an option also. Picaridin may be less effective against mosquitos that transmit malaria. Treating your clothes with insecticides is an option.
We have treated our clothing (and our kids) with insecticides purchased online. This has worked really well for us and is much more affordable than buying clothing that has been pre treated. If you are in an endemic area, use bed nets treated with permethrin.
Know about the specific risks before entering any body of water. This should include depth, temperature, currents, endemic diseases etc. For example, if you are in an area known to have schistosomiasis, avoid swimming! Even short exposures to infested water is enough for transmission. The more you know about the specific risks the safer you will be.
To avoid animal bites and serious disease, do not handle or pet wild animals. If you are bitten or scratched, wash the wound with soap and water and seek immediate medical attention.
Don’t feed wild animals!
This is dangerous and there are real health risks from animal bites and scratches, including rabies. Rabies is nearly ALWAYS fatal once symptoms develop.
Motor vehicle crashes are a leading cause of injury for travelers. Protect yourself by taking the following measures:
-Don’t drive while intoxicated
-Wear a seatbelt when in a car
-Follow local traffic laws
-Wear a helmet when you ride bikes, motorcycles etc.
-Avoid riding in overloaded vehicles
-Avoid driving at night
When you get back home
Travel related illness can manifest days to weeks after you come home from your trip. If you are not feeling well after a trip abroad, make an appointment to see your doctor and tell her where you were, how long you were there, what you did and what you ate.
If you traveled to known malaria risk areas and develop a fever or flu like symptoms when you return home, seek prompt medical attention. Malaria is a serious disease.
More and more people are catching the travel bug (no pun intended). This puts us all at risk of exposure to endemic diseases and environmental factors associated with travel.
Prior to travel, seek medical advice and evaluate the risk for adverse outcomes depending on your medical conditions, the itinerary, anticipated activities, and potential exposures.
Plan ahead, be prepared.
For Part 2 click here.
Please remember that medical information provided by us must be considered an educational service only. This blog should not be relied upon as medical judgement and does not replace your physician’s independent judgement. This is NOT medical advice. Please seek the advice of your physician.