Travel and Health

The bags are packed and you have your tickets. You're ready to go. But successful traveling is healthy traveling and all it takes is a bit of planning.

Predeparture checklist:

• Take care of routine dental and medical check-ups before departure.
• Leave plenty of time to get your vaccinations before you set off. Some of them may require an initial shot followed by a booster. Have your doctor record all your vaccinations and take the certificate on the trip with you. For some countries, no immunizations are necessary, but the further off the beaten track you go, the more important it is to take precautions.
• Don't let an accident to your glasses, contact lenses or dentures ruin your holiday. Always take a spare.
• If you take medication, take enough to last your entire trip. As an extra precaution, take part of the packaging showing the generic rather than the brand name, which will make getting replacements easier. To avoid any problems, it's also wise to have a letter from your doctor with you to prove you legally use the medication. Diabetics should be aware that there are now new regulations on air travel that affect them. Call the airline for specifics. (Read about "Diabetes")
• Check your health insurance. Health coverage doesn't always travel with you. Some policies may also exclude "dangerous activities" such as scuba diving, motorcycling or trekking. Check with your travel agent for recommendations on travel insurance policies. (Read about "Health Insurance Terms Glossary")

If you are flying, current security concerns can make it difficult, if not impossible, to carry some things in your carry-on. You should contact your airline before you even start to pack, so that you are aware of the restrictions and can avoid problems at the airport.

Avoiding jet lag

Here are a few tips from the American Academy of Family Physicians:

• Drink plenty of water, during and after the flight to avoid dehydration (Read about "Dehydration")
• Don't drink lots of alcohol or take unnecessary medication while in flight
• Avoid overeating
• Sleep well before the flight (Read about "Sleep")
• Exercise while on the plane. Walk around the cabin to get the blood circulating in your feet and legs. Try stretching in your seat as well. (Read about "Deep Vein Thrombosis")

Tummy trouble

According to the Centers for Disease Control and Prevention (CDC), care in what you eat and drink while traveling abroad may be the most important health rule. Remember: boil it, cook it, peel it or forget it. Eat only food that has been thoroughly cooked and is still hot or fruit you've peeled yourself. (Read about "Food Safety") CDC says in areas where hygiene and sanitation are inadequate, all sorts of germs can be present. (Read about "Microorganisms") Travelers should avoid:

• salads
• undercooked vegetables
• unpasteurized milk and dairy products such as cheese
• raw meat and shellfish

If in doubt, the number one rule is DON'T DRINK THE WATER, and that includes ice. Always assume the worst when it comes to drinking water and plan accordingly.

• Don't use water direct from the tap.
• Sterilize water by boiling it vigorously for at least five minutes.
• When drinking bottled water or canned drinks clean the area of the bottle or can which will be in contact with your mouth.
• Use only sterilized water for brushing your teeth, cleaning any cuts or cleaning contact lenses.
• CDC says chemical disinfectants such as iodine or chlorine may be used successfully, but you must read and follow the manufacturer's instructions carefully.

CDC makes no recommendations on portable filters saying they have no independent test results showing if they are effective or not. Diarrhea (Read about "Diarrhea") is a common travelers' complaint, sometimes associated with changes in water and food. CDC says, while rarely life threatening, diarrhea can last up to a week and may be more serious in children. CDC says diarrhea sufferers should drink plenty of safe fluids to avoid dehydration. Some diarrhea however is caused by seriously contaminated food or water. That can be much more dangerous and life threatening. Consulting with a doctor should occur if the diarrhea lasts more than a few days or if it is severe or bloody. Fever and chills or being unable to ingest fluids are other danger signs that call for a doctor's attention.

Cruise lines have been vexed by noroviruses. (Read about "Noroviruses") Noroviruses are significant causes of sporadic and epidemic gastrointestinal disease in the United States, not just on cruise ships. (Read about "Digestive System") The Centers for Disease Control and Prevention (CDC) say over 180,000 cases occur annually. Noroviruses include Norwalk virus, Norwalk-like viruses and caliciviruses.

Noroviruses cause gastroenteritis, an inflammation of the gastrointestinal tract. (Read about "Gastroenteritis") The acute gastrointestinal illness, which can resolve within two days, results in symptoms that can include:

• vomiting
• diarrhea (Read about "Diarrhea")
• nausea
• abdominal cramps
• headache
• low-grade fever

Like all viral infections, noroviruses are not affected by treatment with antibiotics. (Read about "Antibiotics") However, as with any illness causing diarrhea and vomiting, a big concern with norovirus infection is dehydration. (Read about "Dehydration")

Travel diseases

There are some specific diseases that are more common in other parts of the world. Many are considered fairly rare but a traveler should be aware of them and their symptoms. Some of these diseases include:

• Chikungunya - Chikungunya virus is transmitted to people by mosquitoes. The most common symptoms of chikungunya virus infection are fever and joint pain. Other symptoms may include headache, muscle pain, joint swelling, or rash. Outbreaks have occurred in countries in Africa, Asia, Europe, and the Indian and Pacific Oceans. In late 2013, chikungunya virus was found for the first time in the Americas on islands in the Caribbean. There is no vaccine to prevent or medicine to treat chikungunya virus infection. Travelers can protect themselves by preventing mosquito bites. When traveling to countries with chikungunya virus, use insect repellent, wear long sleeves and pants, and stay in places with air conditioning or that use window and door screens.

• Dengue - Dengue fever is an infectious disease carried by mosquitoes and caused by any of four related dengue viruses. This disease used to be called "break-bone" fever because it sometimes causes severe joint and muscle pain that feels like bones are breaking, hence the name. Health experts have known about dengue fever for more than 200 years. (Read about "Dengue Fever")

  Dengue fever is found mostly in tropical and subtropical areas, but is starting to move northward. The National Institute of Allergy and Infectious Diseases (NIAID) says it has surfaced along the U.S.-Mexico border and in the commonwealth of Puerto Rico. There was also an outbreak in 2001 in Hawaii.

  Most people infected with a dengue virus have no symptoms or a mild fever, according to NIAID. Those who do get sick sometimes experience minor bleeding, such as from the nose or gums, and frequently develop a high fever, severe headache, pain behind the eyes and in joints and muscles, and a rash. Sometimes the disease leads to leakage of blood plasma out of the circulatory system and into tissues, causing blood pressure to drop. The Centers for Disease Control and Prevention (CDC) say this condition often can be reversed by giving patients fluids and electrolytes. With proper treatment, case fatality rates for severe dengue are low. If left untreated, however, the person may become unresponsive, slip into a coma and possibly die. Early diagnosis and treatment of dengue are critical to preventing shock and death.

• Ebola - Ebola hemorrhagic fever is a severe and often deadly disease affecting humans and primates. (Read about "Ebola") The virus can be transmitted in several ways, according to CDC:
  • direct contact with blood or secretions of infected person
  • exposure through contact with objects, like needles, that have been contaminated with infected secretions
  • infected animals

  The onset of Ebola is abrupt and characterized by the following symptoms:

  • fever
  • headache
  • joint and muscle aches
  • sore throat
  • weakness
  • diarrhea (Read about "Diarrhea")
  • vomiting
  • stomach pain
  • rash (Read about "Skin Rash")
  • red eyes
  • hiccups
  • internal and external bleeding (Read about "Gastrointestinal Bleeding")

  While laboratory tests (Read about "Laboratory Testing") can help diagnose Ebola within a few days of the onset of symptoms, there is no proven and tested treatment for Ebola at this time. Patients receive supportive therapy, which includes balancing fluids and electrolytes, maintaining oxygen status and blood pressure and treating any complicating infections.

• Hepatitis E - Hepatitis E is spread through food or water contaminated by feces from an infected person. The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) says this disease is uncommon in the United States. This is, however, a common cause of acute hepatitis in underdeveloped areas of the world and travelers to these areas can acquire this form of hepatitis. International travelers are most at risk. (Read about "Hepatitis E")
• Malaria - Malaria is a serious and sometimes fatal disease caused by a parasite. Humans get malaria from the bite of an infected mosquito. The parasites go from the mosquito's mouth into the person's blood, traveling to the liver where they grow and multiply in the liver's cells. (Read about "The Liver") Malaria occurs in over 100 countries and territories. The World Health Organization estimated that 300-500 million cases of malaria occur yearly and more than one million people die from the disease. Symptoms of malaria include:
  • fever
  • shaking chills
  • headache
  • muscle aches
  • tiredness
  • nausea
  • vomiting
  • diarrhea (Read about "Diarrhea")

  Malaria may cause anemia and jaundice (Read about "Jaundice" "Anemia") because of the loss of red blood cells, according to CDC. A blood test (Read about "Laboratory Testing") can confirm a diagnosis of malaria and the disease can be cured with prescription drugs.

• Respiratory diseases - Respiratory diseases including severe acute respiratory syndrome (SARS) and bird flu are concerns in several parts of the world. (Read about "SARS" "Animal & Insect Borne Diseases")
• Typhoid fever - Typhoid fever is a life-threatening illness caused by the bacterium Salmonella Typhi. CDC says there are about 400 cases of the disease in the United States each year. Seventy percent of them are acquired while traveling internationally. About 12.5 million people are affected by typhoid fever each year around the globe. People with typhoid fever carry the bacteria (Read about "Microorganisms") in their bloodstream and intestinal tract, according to CDC. You can get the illness if you eat food or drink beverages that have been handled by someone who is shedding the bacteria. You can also contract the illness if sewage contaminated with S. Typhi bacteria gets into the water you use for drinking or washing food. Typhoid fever is most common in the developing world. CDC recommends you take precautions if you plan to travel to Asia, Africa or Latin America. People with typhoid fever may have some of the following symptoms, according to CDC:
  • fever
  • stomach pains
  • headache
  • loss of appetite
  • possible rash of flat, rose-colored spots (Read about "Skin Rash")

  The only way to know for sure if you have typhoid fever is to have samples of blood or stool tested for S. Typhi. Antibiotics (Read about "Antibiotics") are usually used to treat people with typhoid fever. Ampicillin, trimethoprim-sulfamethoxazole and ciprofloxacin are the three most commonly prescribed antibiotics. People undergoing treatment usually begin to feel better within two or three days. CDC says death from typhoid fever is rare when treatment is given promptly. People who have fever for weeks or months could die from complications of the infection. You can protect yourself from typhoid fever in two ways, according to CDC:

  • avoid risky foods and drinks
  • get vaccinated

  If you are traveling to a country where typhoid is common, you should discuss your vaccination options with a physician. Keep in mind that you will need to complete your vaccination at least one week before you travel so that the vaccine has time to take effect. Typhoid vaccines last only several years.

• Yellow fever - Yellow fever is a viral disease transmitted between humans by mosquitoes, according to CDC. It occurs only in Africa and South America and is a very rare cause of illness among travelers. Most countries do have regulations and requirements for yellow fever vaccination that must be met before entering the country. Adults and children over nine months are allowed to take the vaccine. A single dose confers immunity lasting ten years or more.
• Zika virus - Zika virus is mainly spread to people through mosquito bites. (Read about "Insect Bites") The most common symptoms of Zika virus disease are fever, rash, joint pain, and conjunctivitis. (Read about "Zika Virus")

Other diseases travelers should be aware of include West Nile virus, trichinosis, shigellosis, Cryptosporidiosis, Giardiasis and plague. (Read about "West Nile Virus" "Trichinosis" "Shigellosis" "Cryptosporidiosis" "Giardiasis" "Biological Health Threats")

Travel and pregnancy concerns

Pregnant women have some extra concerns while traveling especially to areas where emergency medical care may not be available. CDC advises pregnant women to consult with their doctor before making any travel decisions. (Read about "Healthy Pregnancy") If a pregnant woman has decided to travel, a number of issues need to be considered prior to her departure. For instance, a pregnant woman should be advised to travel with at least one companion; she should also be advised that, during her pregnancy, her level of comfort might be adversely affected by traveling. Here are some specific things to think about from CDC:

• Make sure, before traveling, that your health insurance is valid while abroad and during pregnancy and that the policy covers a newborn should delivery take place. Also, a supplemental travel insurance policy and a prepaid medical evacuation insurance policy should be obtained, though most might not cover pregnancy-related problems.
• Check medical facilities where you are going. For a woman in the last trimester, medical facilities should be able to manage complications of pregnancy, toxemia and cesarean sections. (Read about "Stages of Pregnancy")
• Determine beforehand whether prenatal care (Read about "Prenatal Care") will be required abroad and, if so, who will provide it. The pregnant traveler should also make sure prenatal visits requiring specific timing are not missed.

Symptoms that indicate the need for immediate medical attention are bleeding, passing tissue or clots, abdominal pain or cramps, contractions, ruptured membranes, excessive leg swelling, headaches or visual problems.

Before traveling a pregnant woman should consult her doctor about any other concerns she or the doctor may have.

Related Information:

    Motion Sickness

    Pregnancy and Nutrition

    Hepatitis A

    Hepatitis B

    Hepatitis C

    Tuberculosis

    Mad Cow Disease

    Encephalitis and Meningitis

    Immunizations

    Animal & Insect Borne Diseases

    Insect Bites

    Bed Bugs