Travel abroad information

All areas of the world have particular health risks. When you travel, it's important to know in advance what risks to expect at your destination. Taking the recommended precautions can help ensure a safe and healthy trip.


Health risks
Some health risks are common to most areas of the world, while others are limited to only a few. A first class hotel in an urban area of a developing country generally poses fewer health risks than one in a rural area, for example. The risk increases the longer you stay abroad. While you're traveling, you may be exposed to viruses, bacteria or parasites that cause infectious diseases if you:
consume contaminated food or water
are bitten by an infected insect or disease-carrying animal
bathe or swim in contaminated water
walk barefoot or sit on soil or sand containing parasites
contact contaminated blood or body fluids
breathe air contaminated with bacteria and viruses

Prevention tips
Become informed. Find out as much as possible about the region you plan to visit. Up-to-date, specific information about health risks around the world is readily available from the Centers for Disease Control and Prevention (CDC) through the Internet or by fax or phone. Information is also available on the Internet from the World Health Organization (WHO). For information about the general safety of a region, you can also contact the U.S. State Department.

It's also wise to learn about the medical care available at your destination. Your country's embassy or consulate in your destination area will have a list of hospitals and doctors. They can also help you obtain care if you can't do so for yourself. If you're pregnant, breastfeeding or have a diagnosed health condition, discuss travel plans with your doctor well ahead of time.

Before you leave, verify your health insurance coverage for traveling abroad. If treatment for medical emergencies abroad is not covered, consider purchasing a short-term health and emergency assistance policy that includes medical evacuation in the event of a serious illness or injury.

It's always wise to carry a written medical history with you, especially if you have a chronic medical condition. Be sure to list your medication allergies, and list the names and doses of all drugs, herbal supplements or vitamins you take. If you have any known change on an electrocardiogram (a recording of the electrical activity of your heart), ask your doctor for a copy of that electrocardiogram. If you have a medical condition that could require emergency care, itut your tetanus immunization status. If you ever need to supply your history to a doctor abroad, every bit of information you can provide will help you.

Consider HIV testing. Some countries now require HIV testing before entry, usually for travelers staying longer than one to three months. You may be able to use test results obtained before leaving your country, but some foreign countries may require testing upon arrival. Contact the consular officials of the country you will be visiting for further information.

Pack your prescription items. If you take any prescription medications, make sure you have more than enough to last throughout your trip. Carry the drugs in their original bottles along with copies of the prescriptions, including any generic names. To avoid unnecessary problems, carry a signed and dated statement from your doctor that includes a list of your major health problems and medications with dosages. This is especially important if your medication is unusual or contains a narcotic.

Do not pack any essential medications in luggage that could be lost or misplaced. If you're planning to be abroad for an extended period of time and will need a refill while you're gone, find out if the medication will be available locally or whether it can be shipped to you safely. Also, if you wear prescription glasses or contact lenses, be sure to take along an extra pair or the prescription.

Beware of contaminated food and water. Contaminated food and water can cause intestinal illnesses such as traveler's diarrhea, cholera, amoebiasis, giardiasis and intestinal worms. It can also cause typhoid fever, polio and hepatitis A. Before handling food or water, wash your hands thoroughly with soap and water or an antibacterial hand-washing solution.

Follow this simple rule if you have any doubts about a food's safety: "Boil it, cook it, peel it or forget it." While you're abroad, it's wise to avoid:

uncooked fruits and vegetables, unless you've peeled them yourself
unpasteurized dairy products
raw or undercooked meat, poultry, fish and eggs
foods prepared in advance that haven't been kept cold or very hot
foods purchased from street vendors
A special note of caution about fish: Fish can sometimes contain toxins, even when cooked. Avoid barracuda and puffer fish, which are often toxic. It's also smart to avoid tropical reef fish, red snapper, amberjack, grouper and sea bass, especially if the fish was caught in tropical reefs instead of the open ocean.

If you're unsure of the water safety (such as in areas where the water is not chlorinated or hygiene and sanitation are poor), drink only boiled water, beverages made from boiled water, canned or bottled carbonated beverages (including water and soft drinks), beer or wine. For babies who drink formula, buy prepared formula in cans. Otherwise, be sure to make formula with boiled water. Also avoid:

using ice cubes
drinking from unclean glasses and wet or dirty cans or bottles (Drink straight from the can or bottle after wiping it clean and dry.)
brushing your teeth in tap water
swallowing water while swimming or bathing
Remember, contaminated water may not look, smell or taste bad. Avoid drinking directly from lakes, rivers or other potentially contaminated water sources. Ensure water safety by boiling your water vigorously for one minute, filtering it or treating it with iodine or chlorine, which can be found in sporting goods stores or pharmacies. Carefully follow the package directions. Remember you must boil water at high altitudes longer because it reaches its boiling point sooner. Three minutes of vigorous boiling is recommended at altitudes higher than 6,562 feet or disinfection with iodine or chlorine after boiling for one minute. Because water filters have not been adequately studied for bacteria and virus removal, they're not recommended unless the water has first been boiled or chemically treated.

In the last few years, a link has been established between a disease of cattle found in Europe called bovine spongiform encephalopathy (mad cow disease) and a fatal disease in humans known as new variant Creutzfeldt-Jakob disease. Thanks to various preventive measures, the risk of mad cow disease spreading to humans is now thought to be extremely small (possibly less than one case per 10 billion servings of beef). To completely eliminate the risk, you may want to avoid beef and beef products while traveling in Europe. To reduce the risk, choose solid pieces of muscle meat rather than products such as burgers and sausages.

Avoid insect bites. Insects -- including some ticks, mosquitoes, flies, fleas, lice and mites -- can be infected with viruses, bacteria or parasites. When transmitted to you through a bite, these organisms can cause illnesses such as malaria, yellow fever, dengue fever, river blindness, sleeping sickness, Lyme disease and the plague. To avoid being bitten, take the following precautions:

If disease-carrying insects are present, remain in screened-in areas. This is especially important during the evening and nighttime hours, when mosquitoes are most prevalent.

Wear loosely fitting clothing that covers as much of your body as possible, preferably including long sleeves and pants. Light-colored clothing is best in tick-infested areas because you may be more likely to spot a tick before it attaches to your skin. Always tuck the bottom of your pant legs into your socks. Don't forget your shoes, but avoid sandals or shoes with open toes or heels.

If you must be in areas where there are ticks, walk on the center of trails and avoid grassy and marshy areas. After outdoor activities, do a complete body, scalp and clothing check for ticks and other insects. Pets should also be examined before coming inside.

Sleep under mosquito netting that is tucked under the mattress.

Always empty any containers of standing water to avoid breeding mosquitoes.

Apply an insect repellent containing permethrin to clothing, mosquito netting and camping gear. When used as directed, it will repel insects for several weeks.

Apply insect repellent containing DEET to any exposed areas of skin. Be sure to follow the manufacturer's directions -- a 10 to 35 percent formula repellent is recommended for adults.

Even for children, products containing DEET are the most effective insect repellents. The safety of DEET does not appear to be related to the concentration in the repellent. There are no studies on skin absorption of DEET in children, but studies of similar substances suggest that absorption through the skin would not differ after age 2 months. Currently, 30 percent DEET is the maximum concentration recommended for infants and children over age 2 months. Keep insect repellent out of reach of children at all times.

The best approach is to use the lowest concentration of DEET effective for the amount of time spent outside:
30-percent DEET protects for six hours
24-percent protects for five hours
20-percent protects for four hours
6.65-percent protects for two hours
4.75-percent protects for an hour and a half

Check with your doctor before using any insect repellent on a child younger than age 2 months or if you're pregnant or breastfeeding.

Spray flying insect repellent in living and sleeping areas.
Avoid unsafe swimming and bathing. Water for bathing and swimming may contain parasites, bacterium or sea life that can cause injury or infection. Schistosomiasis, for example, is a serious parasitic infection contracted in contaminated fresh water in certain regions of the world. Other parasites and bacteria may be present in water contaminated by sewage or animal waste. Ocean water is usually free of parasites, but may harbor stinging or biting fish, coral, shellfish, sea anemones or jellyfish. To avoid illness or injury in the water, consider the following suggestions:

Avoid fresh water bathing or swimming in areas where parasites may be present.
Use chlorinated swimming pools.
Heat bath water for at least five minutes at 150°F (65.5°C) or keep it in a storage tank for at least 48 hours before use. (If heating water to 150°F, be sure to cool it to a comfortable temperature to avoid scalding.)
Wear shoes, aqua socks or sandals while wading or swimming in the ocean.
Don't swim or wade in the water if you have cuts or scrapes on your exposed skin.
If you're exposed to water that may be contaminated, vigorously towel dry the exposed area as soon as possible.
Avoid contaminated soil. In some areas, the soil and sand may be contaminated with parasites. When in these areas, always wear shoes and don't sit directly on the ground.

Avoid potentially dangerous animals. Avoid contact with all domestic and wild animals -- especially if you're traveling in an area where rabies is common. If you're bitten, thoroughly cleanse the area with soap and water and seek treatment promptly. If there is any possibility the animal has rabies, you'll need a rabies vaccination. If you were vaccinated before your trip, you'll still need a new vaccination, just less vaccine.

In some areas, you'll need to be careful of snake and scorpion bites. Wear fully enclosed boots or shoes, especially at night. Before getting dressed, carefully examine your clothes for any hidden snakes, scorpions or insects.

Drive and walk with care. Traffic accidents are the major cause of death for travelers. If you plan to drive in a foreign country, learn the traffic laws ahead of time. Drive defensively and avoid excessive speed. Always wear a seat belt or, if on a motorcycle, a helmet. If you're tired, don't get behind the wheel, and never drink and drive. It's also a good idea to avoid driving at night whenever possible.

While walking, use caution at all times. Be aware of what's going on around you, obey pedestrian rules, and use designated walkways.

Be aware of altitude risks. When traveling in high altitudes, especially those above 6,000 to 8,000 feet, altitude illness is possible. The risk of developing altitude illness seems to be genetically determined. Even travelers in optimal health may be affected. Early symptoms of altitude illness, which may include headache, tiredness, nausea or vomiting, usually begin six to 12 hours after you reach a high altitude. If you develop these symptoms and they seem to persist, seek medical treatment to help prevent serious illness.

If you're planning high-altitude travel, learn about the symptoms and treatment of altitude illness before you go. If you have a chronic health condition, have experienced altitude illness in the past, or are older, pregnant or traveling with children, discuss your travel plans with your doctor.


Traveler's diarrhea
Unfortunately, up to 50 percent of travelers are affected by diarrhea, which can significantly disrupt a long-awaited vacation. Traveler's diarrhea is caused by eating contaminated food or drinking water containing bacteria, viruses or parasites.
To prevent traveler's diarrhea, follow the recommendations outlined above for safe food and water handling. The CDC does not recommend the routine use of preventive antibiotics. They may be appropriate, however, for special travel situations or medical conditions, such as if your immune system is suppressed or you're on long-term steroid therapy. Antibiotics will not prevent diarrhea caused by viruses or parasites. They should be used with safe food and water, not in place of general safety precautions. Your doctor may recommend bismuth subsalicylate (Pepto-Bismol, for example) to help prevent traveler's diarrhea, but, again, it should be used with safe food and water and should not be taken for more than three weeks. Keep in mind that bismuth subsalicylate is not appropriate for everyone, such as people who have an aspirin allergy, kidney insufficiency or gout, or those who take certain medications (such as anticoagulants). It's also not recommended for pregnant women, children under age 3 or anyone under age 19 who's at risk for Reye's syndrome.

Signs/symptoms
Symptoms of traveler's diarrhea may include:

loose or watery stools, usually four to five a day
abdominal cramps
nausea and occasionally vomiting
bloating
fever
general feeling of discomfort
Symptoms of traveler's diarrhea usually last three to four days. A few people may experience symptoms for more than one week, and even fewer have symptoms for more than a month.

Treatment
To treat most cases of diarrhea, all you need to do is drink available (and safe) clear fluids. However, using an oral rehydration solution may be best because it also replaces salts lost through the diarrhea. The World Health Organization has its own solution called oral rehydration salts (ORS), which can be purchased in stores or pharmacies in many countries. Follow package instructions, being careful not to mix the solution with contaminated water.

Antibiotics may be prescribed for three to five days, especially if youryone.

Your doctor may recommend antidiarrheal medications such as diphenoxylate (Lomotil) or loperamide (Imodium) to help treat a simple case of traveler's diarrhea. Do not take these medications if you have a high fever, blood in your stool or diarrhea that lasts longer than 48 hours. Also, do not give these medications to children younger than age 2. If you're pregnant or breastfeeding, discuss the use of any antidiarrheal medications with your doctor or the baby's doctor before you travel.

Seek medical attention as soon as possible if your diarrhea lasts more than a few days, you're concerned about dehydration, or you develop:

severe diarrhea
blood or mucus in the stool
a fever and shaking chills

Post-travel illness
If you contract an infectious illness while traveling, you'll typically become ill during the trip or within six weeks of your return home. However, with some infectious diseases, you may not become ill until several months later. If you become ill within one year of a trip abroad, remind your doctor of your travel history.