General Travel Advice
Before Traveling
- Learn about potential problems and how to decrease risks
- Get appropriate immunizations and preventive medications.
- Learn about appropriate response to obvious exposure or illness.
- Learn about post-trip evaluation and response to illness.
Basic Recommendations
- Know your risk - some countries have higher risk than others
- Determine is antimalarials are required
- Begin recommended immunizations several months before departure
- Obtain address and phone number of the American Embassy in each country you visit (an excellent source for overseas physicians and hospitals)
- Develop a plan for illness or disability
- Ascertain if your health insurance covers illness abroad
- Carry adequate supplies for all required medications (including syringes if needed)
- Plan for adjusting medication schedule to new time zones
- Take an extra pair of glasses or lenses and lens solution, and your optical prescription
- Carry identification
- Take a basic first aid kit
Immunizations
- Know if immunizations are standard, required, or highly recommended
- Check with your health care provider about updating your immunizations (tetanus, measles, polio, etc.)
- Obtain immunizations required by individual countries (eg., Yellow Fever), or recommended due to itinerary and style of travel (Typhoid, Hep A/B, Rabies, Japanese Encephalitis, Meningococcus, etc.)
First Aid Travel Kit
Should include tweezers, needle, pocket knife, scissors, flashlight, band aids, sterile 4x4 gauze pads, adhesive tape, povidone-iodine solution for skin disinfection, antibiotic ointment, pain or fever medication (aspirin, acetaminophen, ibuprofen), antifungal cream, cortisone cream, and antihistamine tablets. Also should include insect repellents and insecticides, water purification tablets, sunblock, and medications for diarrhea and dehydration, and altitude and motion sickness.
Insect borne diseases (vector borne)
Many insect transmitted diseases are not prevented by vaccines or drugs. Some insect borne diseases like dengue fever are transmitted during the day, but malaria is transmitted from dusk until dawn. Avoid rural side trips if possible, leave rural areas before dusk, avoid still water ponds and lagoons, use insect repellants (30% or less non-absorbable formulation of N,N diethyl-m-toluamide, DEET is optimal), wear clothes that cover arms and legs, stay indoors in screened rooms from sunset until morning, spray rooms with pyrethrum-containing flying insect sprays, and sleep under bed nets. Take anti-malarial medication.
Food and Waterborne Disease (Traveler's Diarrhea)
It is optimal to drink water boiled for 10 minutes (add 5 minutes boiling time for each mile of altitude). Bottled carbonated beverages, beer, and wine are acceptable. Avoid ice, and use fresh straws and disposable cups if possible. Don't brush teeth or clean contacts in unboiled local water. Carry an immersion coil to boil water. Less preferable are iodine tablets or other water purification systems. Eat only well cooked food. Avoid salads, uncooked vegetables, creamy desserts, and food sold by street vendors. Make sure that milk, cheese, and other dairy products have been pasteurized. Eat only fruit that you peel yourself. Develop a plan with a physician for treatment of diarrhea. This may include bismuth subsalicylate (Pepto Bismol), an antibiotic such as ciprofloxacin, and an antimotility agent like loperamide (Imodium), a fluid/electrolyte solution like IAMAT Oral Rehydration Salts, and reporting to a physician if diarrhea contains blood or pus. If travel is short term and diarrhea is unacceptable, consider prophylaxis with bismuth subsalicylate or an antibiotic.
Motor Vehicle Accidents
In some areas motor vehicle accidents are the leading cause of medical problems among tourists. Avoid riding motorcycles or wear a helmet, don't drink and drive, avoid traveling in crowded buses, trucks and taxis, request rental cars with seat belts, and bring infant car seats.
Schistosomiasis and Other Diseases Transmitted by Skin Contact
Do not swim, bathe, or wade in fresh water, streams, lakes, or rivers where schistosomiasis is transmitted. If contact with such water occurs, immediately towel dry the skin. Inquire about jellyfish and other poisonous sea creatures. Wear protective clothing (long sleeves, and pants, socks, shoes). Do not walk barfooted.
AIDS/HIV, Hepatitis B, and Other STDs
Avoid contact with blood or body fluids of other individuals. Avoid injections. Practice safe sex, and always use condoms with spermaticides.
Heat and Sun Exposure
Avoid sun between 10am and 2pm, wear protective clothing/hats and sunglasses, drink lots of fluids, avoid alcohol, use air conditioning, and always use sunscreens and lip balms with UVA and UVB sun protective factor of at least 15.
Cold Exposure
Wear adequate clothing to protect from cold temperatures.
Altitude Sickness
Slow ascent is the cornerstone of prevention of altitude sickness (1,000 feet per day above 10,000 feet). The altitude at which the climber sleeps is critical. It is recommended that one should "climb high" and "sleep low". At high altitude the climber should not overexert, and should eat high carbohydrates, low fat, and avoid excessive salt. Acetazolamide (Diamox), when begun before rapid ascent and continued 1-2 days after arrival, aids in acclimatization.
Motion Sickness
Over-the-counter antihistamine tablets (Dramamine, Bonine) can help prevent motion sickness. Prescription products (Transderm Scop patches) are also available.
Jet Lag
Often jet lag is unavoidable. Recent studies suggest that exposure to as much sunlight as possible after arrival may reduce jet lag. Consider adopting the new time zone sleeping schedule as early as possible. The best strategy may be regular sleep, diet, exercise and avoidance of alcohol.
Pregnancy
Travel is not a problem for the healthy woman with a normal pregnancy. Live vaccines are avoided during pregnancy, while inactivated vaccines are generally thought to be safe. Flying need not be limited until the 36th week of pregnancy. Consult your obstetrician for more specific advice.
Appropriate response to illness after returning home
Make certain that you inform your health care provider that you have traveled recently, provide your itinerary, and discuss the diseases to which you may have been exposed. If you develop a fever during the two years after returning from a malarious area and there is no obvious cause for the fever, you must demand that malaria smears be done every 12 hours for 48 hours to rule out malaria.
