Health: Considerations for travel
From the October 2015 issue of The Rotarian
In 1938, British travel writer Freya Stark observed: “To awaken quite alone in a strange town is one of the pleasantest sensations in the world. You are surrounded by adventure.” In many ways, travel is even more pleasant today than when Stark trekked across the Middle East almost a century ago. And when we plan a trip, we often focus solely on the most enchanting aspects – where we’ll go, what we’ll see. The person planning a safari to Africa or an elephant ride in Asia might stop to consider health precautions only a few weeks before departure, perhaps after reading something online or hearing a friend talk about a similar trip.
“You have no idea of what is in store for you,” Stark continued, “but you will, if you are wise and know the art of travel, let yourself go on the stream of the unknown.” But how can we open the door to new experiences while avoiding unnecessary risk?
Start by asking your doctor for your immunization records and checking with your insurance company to find out what vaccinations and travel medications are covered. The worst time to wonder about tetanus immunity is after a moped accident in a remote village. Get refills for all your medications, and let your doctor know where you’re headed. Be mindful of your pre-existing medical conditions, and plan for worst-case scenarios. Scan or photograph passports, vaccine records, and any other important health information, then email the images to yourself or upload them to an e-dropbox.
Next, address travel-specific recommendations. The U.S. Centers for Disease Control and Prevention (CDC) recommends that you get a travel consultation four to six weeks before leaving on an international trip. The CDC Travelers’ Health website has information about which vaccines you should have for which destinations. Think about what you plan to do on your trip; swimming in a river, getting a tattoo, or visiting an acupuncturist may raise your risk for certain illnesses. Volunteering at a hospital, a school, a prison, or an orphanage could increase risks for other diseases. Travelers with chronic medical conditions, meanwhile, might be vulnerable to air pollution, heat, or high altitude. Adventure travelers who camp, hike, or stay at open-air resorts or safari camps are at the greatest risk for vector-borne diseases.
Don’t neglect the basic precautions: Apply insect repellent. Wash your hands often with soap and water or an alcohol-based sanitizer. If the tap water isn’t safe, drink and brush your teeth only with bottled or filtered water; avoid beverages that may be blended with unsafe ice, water, or fruit; eat only cooked, hot foods; and don’t eat fruit that you haven’t peeled yourself. Avoid dairy products if you’re not sure they’re pasteurized, and don’t interact with stray animals.
If you’re like many people, you might worry most about getting sick during your trip. Diarrheal illnesses and malaria are indeed the most common ailments afflicting travelers. However, motor vehicle accidents are the most frequent cause of injury and death among healthy travelers abroad. In fact, you are 10 times more likely to die from injury than from infectious disease. We’re more inclined to take chances when on vacation, despite less familiar surroundings and new hazards. Use common sense: If a vehicle appears unsafe, or if a boat is overloaded and lacking life preservers, choose another method of transportation.
And consider what you might be eating. Two key vaccinations protect against foodborne illness: hepatitis A and typhoid. Because the hepatitis A virus can be acquired via unsafe food handling, the CDC recommends vaccination for anyone traveling to a less-developed part of the world, “even for travelers to urban areas, those who stay in luxury hotels, and those who are careful about what they drink and eat.” Typhoid vaccine protects against specific types of Salmonella bacteria, which can result in fever, headache, and abdominal pain. Many travelers who come down with gastrointestinal ailments often say that they “knew better,” but because they were staying in five-star accommodations or eating in fancy restaurants, they indulged in blended drinks, beef carpaccio, or raw salads. It’s also a good idea to have your doctor prescribe an appropriate antibiotic in case of traveler’s diarrhea.
Also keep in mind that dehydration strikes faster in hot climates. Carry a powdered sports drink mix that can be combined with safe water. Beverages that contain electrolytes can rehydrate faster than water alone. Use over-the-counter anti-diarrheal medications such as Imodium cautiously; they can postpone transit of problematic pathogens through the gut.
Mosquitoes are an exceptionally effective disease delivery method, transmitting malaria, yellow fever, dengue fever, Japanese encephalitis, chikungunya, and West Nile virus, among other things. Although you can be vaccinated against some of these ailments, for others, such as dengue, you must rely entirely on avoiding bites.
Half the world’s population is at risk of malaria, according to the World Health Organization. Prevention comes in the form of a pill, not a vaccine, and is available in daily or weekly doses. Travelers – even those who arrive back home feeling fine – must take the recommended post-travel doses, because the cardinal symptoms of fever, headache, and nausea typically appear 10 to 15 days after a bite from an infected mosquito. The medication you take after leaving an endemic region is still working to kill any parasites in your system and is crucial to prevent infection. If you’re tempted to stop your medication while traveling, perhaps because you have met locals who do not take anti-malaria pills, remember that people living in malaria-endemic regions may acquire a semi-immune status. If you are visiting from a non-malaria region, this does not hold true for you. Untreated malaria can be fatal.
Delays in therapy for any ailment can leave you susceptible to prolonged or more severe illness. If anything out of the ordinary occurs, even after you return home – a new rash, a worsening cough, cyclical fevers, loss of appetite, unrelenting fatigue, new headaches, joint pain, a bug bite that doesn’t heal – call a doctor or the local travel clinic.
Finally, know where to go before an emergency strikes. If you’re planning a trip to a foreign country, talk to people who live in the region or who have recently been there, and determine the location of the closest and safest medical facilities.
Acknowledging and preparing for risks lets us welcome the unexpected joys of travel without succumbing to preventable dangers. As even the fearless Freya Stark noted, when we’re “drooping and passive” with malaria and dysentery, we’re woefully unable to notice much else.
Shirley Stephenson is a nurse-practitioner and writer who works in infectious diseases and global health at an academic medical center in Chicago.