Facts and Details

TRAVELER’ S HEALTH TIPS AND CHECK LIST

in the hospital with malaria A consultant to the CDC told National Geographic Traveler magazine that nearly half of all visitors to developing countries get sick during a two-week trip.

Food and health standards in many countries are often below those of European or North American country. Dysentery, hepatitis, stomach parasites and malaria occur. It is is a good idea to make sure you are up to date with shots and are prepared for both travel-related and serious sicknesses.

Generally no vaccinations are required unless you entering from a country infected with yellow fever (usually in tropical Africa or South America) and then you need a yellow fever vaccination and documentation of it. It is a good idea to make sure you are up to date with your typhus, diphtheria and tetanus inoculations.

Try to get the new inoculations for food- and water-borne hepatitis A and blood-carried hepatitis B. The hepatitis B vaccination is worthwhile in case you have an accident and need blood transfusions. It may be worthwhile to get a vaccination for Japanese encephalitis, a mosquito-borne disease that is very rare but found in China, especially in the south.

Traveler doctors can tell you what shots and medications you need for specific countries. For information about travelers inoculations inquire first at your county, community or city clinic, or local university. Shots from these sources are generally much cheaper than those given at a hospital or from a private doctor. With inoculations, plan ahead. Some immunization require a series of shots that require more than a month to complete.

Websites and Resources on Health and Diseases: Centers for Disease Control and Prevention cdc.gov/DiseasesConditions ; Disease Pictures hardinmd.lib.uiowa.edu/pictures ; World Health Organization (WHO)statistics and data who.int/research ; World Health Organization (WHO) disease outbreak alert who.int/csr/disease ; Third World Traveler thirdworldtraveler.com/Disease/diseases ; Health Map healthmap.org ; Medline Plus medlineplus/healthtopics ; Merch Manuals (detailed info many diseases) merckmanuals.com/professional/index ; Health Images Directory healthline.com/directory/images

Travelers Inoculations

Make sure the inoculations are recorded on a valid International Vaccination Card and remember to bring the card when you travel. You may be required to show as evidence that you have been inoculated.

Some countries require that you show a health certificate upon arrival that shows you have had a yellow fever vaccination (valid for ten years). A record of a cholera immunization used to be required in some places but is generally not required in anymore.

Make sure you are up to date with your DTP (diphtheria, tetanus and pertussis), typhus, and typhoid shots. Also get inoculations for food- and water-borne hepatitis A and blood-carried hepatitis B. You may want to look into vaccinations for rabies, Japanese encephalitis, and meningitis. If you are heading to a tropical area look into the malaria situation there.

Some inoculations are administered in several doses given over several weeks or months so make sure that you take of getting them well in advance of your departure date.

It is better to seek help from a travel- and tropical-medicine specialist at a travel-health clinic than a regular doctor. Comprehensive list of travel clinics are found in the both the CDC and ISTM Web sites. Traveler doctors can tell you what shots and medications you need and alert you to problems in specific countries. Family doctors simply don’t have the time to be up to date on the latest risks and out breaks and new vaccinations and drugs. Seek help first from your county, community or city clinic. Then try a local university. Shots from these sources are generally much cheaper than those given at a hospital or from a private doctor or clinic.

Health Tips

Bring All Prescription Drugs and Medications you think you will need along with prescriptions with generic names rather than brand names (drug names vary widely from country to country). Always keep you prescription drugs in their original containers. You don’t want to raise any suspicions that you are carrying illegal drugs. Also keep in mind that some over-the-counter drugs in the country in which you are traveling are illegal your home country and you could get in trouble bringing them back.

If you take an important medication 1) make sure you don't forget to bring an adequate supply; 2) know where you can get refills if you lose your medication or it runs out; 3) know the generic names of your prescriptions in the country you are visiting; and 4) know the doses you need measured out in the metric system.

It is also a good idea to: 1) have the prescriptions handy when going through customs so that authorities can confirm that drugs are not illegal. 2) wear a medical bracelet if you have diabetes or a similar problem; and 3) keep you medications in your carry on baggage rather than check-in luggage.

Avoid buying medications locally. Many anti-malarials and antibiotics are counterfeits. Beware of drugs with similar names. For example: in Denmark Prazak is a high blood pressure medicine not an antidepressant like Prozac; in Germany Allegro is a headache medicine not an allergy medication like Allegra; and in Britain Amyben us a medicine for abnormal heart rhythm not a sleeping pill like Ambien.

If You Have a Medical Condition or Allergy wear your medical allergies bracelet. Some people carry their medical history with them at all times in the from of a wallet-size disc or USB drive. MedInforChips (www.medinfochip.com sells ☎877-872-3475) sells USB drives that contain prepared forms for information on allergies and medications, medical history, and doctor contacts.

If You Wear Glasses or contacts lenses make sure you bring an extra pair along plus some prescription sunglasses and a copy of your prescription.

Bring Your Own Supply of Sterile Hypodermic Needles as a preventative measure against diseases such as AIDS and some strains of hepatitis that can be transmitted by dirty needles.

Make Sure Your Health Insurance is valid overseas and promises to airlift you to the nearest high-quality medical facility or to your home country. If it isn’t or doesn’t you may want to consider purchasing a traveler’s health insurance that will cover you during the duration of your trip.

Always Get the Best Medical Care Available . Before you go try to find out which medical facilities the Peace Corps, the U.S. State Department and the United Nations uses. Once you are in a country get the names and numbers of reputable doctors and clinic from a top end hotel. Some of these have in house nurses and doctors that are on call 24 hours a day. The consular services section of the American Embassy can suggest preferred physicians and facilities.

Avoid Blood Transfusions and Risky Treatments . In some countries blood may be tainted with the AIDS virus, hepatitis B or C, or another disease. Transfusions are generally only necessary in situation of massive hemorrhaging such as during and after severe trauma, gynecologic and obstetric emergencies or gastrointestinal bleeding. If you need a transfusion, if possible, make sure can wait until you get to a good hospital. In many cases a colloid or crystalloid plasma can be used instead of blood.

If You Have a Fever seek medical attention immediately. You could have malaria or some other serious illness that requires immediate medical attention.

Drinks Lots of Water and Wash Regularly . Use bottled water even when brushing your teeth. Keep your hands clean by washing with soap or a liquid sanitizer like Purell.

To Avoid Bacterial Infections in hot and humid climates wear loose-fitting garments, wash frequently with antibacterial soaps and change into clean, dry clothing after washing.

To Avoid Fungal Skin Infections such as athlete's foot, jock itch and ringworm don't wear damp shoes or clothing and apply anti-fungal power to areas prone to sweating.

In Case of an Accident don't move the victim. If the victim is losing blood or has broken bones moving him may do more ham than good. Victims with spinal or neck injuries may suffer paralysis or death.

In Case of Bleeding apply pressure or a tourniquet to the area of bleeding.

In Case of Shock keep the victim, warm and covered.

For Jet Lag some people take melatonin before embarking on a long trip. Doctors sometimes say the body needs one day of recover for every time zone crossed.

Health Stuff to Bring

Medical allergies bracelet

Sunscreen rated SDF 15 or better.

Chapstick and sun protection for lips

Sunglasses

Water Purification Tablets or Two percent tincture of iodine (5 to 10 drops per liter)

Insect Repellant with at least 30 percent DEET

Medications

Oral Rehydration Salts (restores essential body nutrients deprived by severe diarrhea)

Throat lozenges, nasal spray and cough medications

Digital thermometer

List of your medical conditions, allergies, medications and dosages.

Calamine lotion for itching

Vitamin pills, calcium tablets.

Women should bring tampons, sanitary napkins and birth control pills of they need them.

First Aid Kit

Band Aids, bandages and tape of various sizes and shapes

Moleskin (for blisters)

Gauze Pads

Gauze Roll

Eye Wash

Tweezers, scissors, needles

Safety Pins

Topical Antibiotic

Hand Sanitizer

Butterfly bandages (for cuts that need stitches).

Sterile disposable syringes

Antiseptic and antibacterial cream (to prevent infections from cuts and scrapes)

Over the Counter Medications

Pain and fever reliever (Aspirin, Panadol, Tylenol or Advil)

Antihistamine such as Benadryl (useful as a decongestant, allergy medicine and relief from insect bites and stings)

Aspirin or other headache remedy

Fiber tablets (constipation)

Laxative

Kaolin preparations such as Pepto-Bismol, Lomotil or Immodium (for relief from diarrhea and nausea)

Loperarride tablets (diarrhea)

Motion-sickness remedy

Oil of cloves (toothache)

Antacid tablets

Acetaminophen tablets (fever)

Ibuprofen tablets (muscle pain)

Anesthetic/antiseptic spray

Hydrocortisone cream (skin irritation)

Antifungal cream (athletes foot)

Antibiotic ointment (skin infections)

By Prescription

Antimalarial pills

Antibiotics (e.g. penicillin or tetracycline, Ciprofloxican, for general and urinary infection, diarrhea. Doxycycline for traveler; diarrhea, consult a doctor about specific prescriptions);

Sleep medications

Antihistamines (motion sickness or allergic reaction)

Antibiotic eyedrops

Water Precautions

Street restaurant Exercise caution with water. Tap water should be regarded with suspicion. If you have any doubts don't drink it unless it is treated first. Drink bottled water and use it to brush your teeth and avoid containers such as glasses or bowls may have contained contaminated water. Clean water is sometimes hard to get in rural areas. If you go to such a place make sure to bring a large supply of clean water with you. If nothing else is available tap water that is very hot to the touch is usually safe.

Bottled water is not always trustworthy. Make sure the cap is sealed shut and buy the water at places regarded as trustworthy, such as a supermarket, not on the streets or in a kiosk.. Generally safer are carbonated bottled water bottled or canned carbonated beverages, coffee or tea made with boiled water, beer or wine, or water boiled for five minutes (longer at high altitudes) or chemically treated (iodine is better than chlorine). It is also a good idea to wash your hands with soap before and after you eat.

As for water purification tablets, iodine kills bacteria, dysentery amebas and giardia parasites. It is safe for short term. Long term use is dangerous to pregnant women and people who have thyroid problems. Chlorine kills amebas and giardia. Water filtration systems don't remove all pathogens. They can not be considered safe for removing all infectious agents although they remove a lot of them. A heating coil is useful for heating water.

Iodine tablets are available from camping stores and tincture of iodine is available from pharmacies. Double the dose of iodine in cloudy water and try to warm up water that is very cold so the chemicals dissolves. The water is usually safe to drink about a half hour after the chemicals have been added.

Food Precautions

Street bakery Also exercise caution with food. Many visitors have stomach- and bowel-related problems. Some get stomach parasites. Avoid salads, dodgy seafood or meat, drinks with ice, diluted fruit juice, unpasteurized milk and milk products such as cheese, cold meats, raw vegetables, street food and uncooked food.

Never eat anything raw. Some kinds of shellfish and fish are particularly risky. Peel vegetables and fruit. Try to eat at reputable restaurants. Make sure meals are hot and recently prepared, preferably right in front of you. Don't eat anything that looks questionable or looks as if it had been sitting around for a while.

Keep your hands clean by washing with soap or a liquid sanitizer like Purell. Many people worried about hygiene bring their own utensils or chopsticks or carry swabs and packets of alcohol to wipe off utensils, chopsticks and rims of glasses in restaurant.

Avoiding Insects

For protection from insects use an insect repellant with at 30 percent DEET (some people recommend 95 to 100 percent), wear long pants and long sleeve shirts, treated with "Coulston's Duranon Tick, spray, and sleep under an insecticide-impregnated insect netting. Periodically check your body for ticks. If a tick penetrates your skin, remove the entire tick with tweezers or a tick removal kit by grasping the head and slowly backing it out.

Disease-carrying mosquitos, like most mosquitos, generally bite at night between dusk and dawn, and are particularly fierce around sunset. An exception to this rule are mosquito that carries dengue fever. They generally bite in the day. Mosquitos generally go for the lower extremities of the body. People with a high skin temperature and high moisture-transpiration rates sometimes attract more mosquitos.

The best way to avoid disease-carrying mosquitos and insects is avoid the places where the diseases are known to exist. The Center of Disease Control can provide information on countries and regions where diseases are found. Rural areas are generally more risky than urban areas. Local people can often provide information on specific risky places in their area.

The best way to avoid mosquitos is to: 1) stay inside when they are most active (in the late afternoon, early evening, and early morning); 2) sleep under a mosquito net (tucked under the mattress and treated with an insecticide); 3) cover as much of your body with clothing as possible, wearing long sleeve, light-colored, loose-fitting clothing; 4) use a repellant and your skin and a toxicant on your clothing; and 5) stay in hotels that are well-screened or air-conditioned, if screens are insufficient ask for mosquito netting. Fans and mosquito coils are also effective in keeping mosquitos away. Sandals should be avoid and pants should be tucked into socks in places with lots of ticks. White or light clothing makes ticks easier to spot.

Many Africans who live malaria-endemic areas use nets but still get the disease. Many people in hot countries don't like them because the keep out the breeze.

DEET and Permethrin

Use a DEET insect repellents on your skin. DEET is a strong chemical that interferes with the tiny sensory hairs and pits in the antenna and body it uses to detect carbon dioxide.. DEET is toxic if ingested; stings eyes severely; and can blister the skin in high concentrations. Repellents with 30 to 35 percent DEET are good. They the usually only last for around five hours. Higher concentrations, such a 95 percent to 100 percent, don’t add any more protection but they last longer. Aerosol insecticides and mosquito coils help to clear rooms but they sometimes contain DDT. Non-DEET repellants generally work 1½ hours or less.

The Centers for Disease Control and Prevention recommend products containing DEET, picaridin, IR3535 and the oil of lemon eucalyptus. They say put some on you clothes for greater protection. If you wear sun screen, apply the insect repellant on top of it.

Use a spray or repellent with Permethrin or Permanone (such as Coulston's Duranon Tick Repellent) on your clothes, shoes, tents, camping gear and bed netting. Permethrin often maintains its potency through ten or more washing. It bonds tightly with cotton fabric and It is effective enough to knock out a mosquito by the time sticks its probe through the cloth and it aims it towards the victims skin.

Some people are turned off by the odor of DEET and the chemical os not suited for all ages. Alternatives include the chemical Picaridin and the plant-based oil of lemon eucalyptus.

Image Source: Centers for Disease Control and Prevention cdc.gov/DiseasesConditions except street food pictures: by Perrechon

Text Sources: CDC Health Information for International Travel, U.S. Department of Health and Human Services; National Geographic, New York Times, Washington Post, Los Angeles Times, Times of London, The New Yorker, Time, Newsweek, Reuters, AP, Lonely Planet Guides, Compton’s Encyclopedia and various books and other publications.

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© 2009 Jeffrey Hays

Last updated March 2011