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Why Travel Medicine?

There are many advantages to consulting with a travel medicine specialist for basic preparation for healthy travel. They have many resources not available in most doctors' offices, and the most up-to-date and accurate information concerning health conditions around the world. They obtain bulletins from the World Health Organization, the Centers for Disease Control and other sources.

More than just a long list of immunizations, you will be advised according to your particular itinerary. Travel medicine doctors can walk you through immunization choices so that you do not get too many or too few of what you really need. They carry all the common immunizations as well as more unusual ones, including Tetanus/Diptheria, Polio, Hepatitis A & B, Meningococcal Meningitis, Yellow Fever, Japanese Encephalitis, Typhoid and Rabies. Fortunately, these diseases rarely infect travelers, especially when they are properly immunized.

Common problems can easily be prevented, such as Traveler's Diarrhea, jet lag, altitude illness, insect bites, food and water concerns. While they are not life threatening, they can cause major problems for the traveler. Being clear about prevention or treatment can make the difference between possibly being ill for 1-2 hours and being sick for several days. Specialists in travel medicine discuss every possible question or concern that you may have about staying healthy in the countries to which you are going, and can help you prepare a travel medical kit with medical supplies based on your itinerary. There is quite a difference between touring the countries of Southeast Asia in luxury hotels and going on a backpacking safari in Tanzania. Although you can prevent most of the problems that occur, should you still get ill abroad, names of reliable doctors in cities all around the world are available.

Travel Clinics at Home and Abroad

Common Medical Problems

People worry about serious medical problems abroad. However, the serious problems are fortunately unusual and are more often related to medical problems they would have encountered at home. In the most recent study done on the subject, S.W. Hargarten, M.D., M.P.H., studied the causes of death in the 1,200 people who died abroad in 1975. Fifty percent had heart attacks which we can assume they would have had at home. Over 20 percent were due to injuries, possibly preventable, and the rest had to do with medical diseases such as cancer, suicides and homicides. Interestingly, only one percent was due to the infectious diseases which frighten us the most. The majority of the deaths took place in Europe where most people travel.

The same author looked at Peace Corps deaths from 1962-1983. Although the Peace Corps volunteers were in developing countries, only 20 percent of the deaths were due to illness. The other 70 percent were due to accidents and 10 percent were due to suicides and homicides. Although we prepare for serious infectious diseases with a variety of immunizations, these are not the common problems.

Travel can be challenging to the human body; however, it can also provide an opportunity to learn more about our bodies, our health and the way we interact in new environments. There are unique stressors that come into play when traveling: fatigue and exhaustion, encountering new germs in food, water and the air, encountering endemic illnesses, and the emotional challenges of being away from home. If we know clearly what these challenges are before leaving, we can prepare for them and do well.

Let's look at some of the most common and easily treatable medical problems for travelers:

Traveler's Diarrhea

Most Travel Medicine doctors agree that this is the most important problem to prevent, or treat effectively. For our purposes, we will emphasize the treatment, assuming that most people know about basic precautions.

Recent research has shown that one dose of an appropriate antibiotic such as Cipro or Noroxin, combined with one two Immodium AD tablets, will effectively treat more than 90% of cases of traveler's diarrhea. If you do get symptoms of traveler's diarrhea, which may include watery or loose stools, fever, nausea, and malaise, immediately take the appropriate antibiotic with Immodium. It can limit the period of being sick to an hour or two, instead of being sick two to three days longer.

Jet Lag

People can feel disoriented, tired, and irritable for several days after a long journey. We recommend a number of strategies.

First, try to be rested before leaving home. All too often, we work hard and push ourselves to the brink prior to leaving, thinking we'll rest during the journey. It is better to leave rested and full of energy.

Second, it is important to sleep on the airplane on long journeys. Even if you are well rested before leaving home, it is important to maintain good health while you travel. A short-acting sleeping pill such as Ambien or Restoril is helpful if you cannot sleep easily.

Thirdly, be certain to drink plenty of water - eight to sixteen ounces per hour - while in the air.

Many travelers have depended successfully on No-Jet-Lag to help them feel fresh on arrival. It's a surprisingly effective, natural homeopathic product that addresses all the symptoms of jet lag, not just sleeplessness.

Upon arrival, become oriented to the local time and climate. Outdoor activity and exercise early on are quite beneficial. Melatonin 2-5 mg at night and/or a short-acting sleeping pill are also good strategies for a few days after arrival. Afternoon naps can help also. (For more information see our article Avoiding Jet Lag)

Common Ailments

One should prepare for a cold, sore throat, sinus infection, skin rash, urinary tract infection, vaginal infection, and mild stomach irritation, all of which can occur at home. Travelers should bring proper medications, or have access to good medical care abroad for prompt and familiar treatment.

Insect Bites


Insect bites can be prevented by using a good repellent. We recommend insect repellants containing at least 15 percent concentration of DEET. for the skin and Permethrin to spray on clothing and mosquito netting. Most small bites can be handled well with cortisone ointment which one would include in his or her medical kit. See our complete article on Insect Protection.

Altitude Sickness

This is best described as being similar to a hangover which lasts, for most people, a day or two when reaching an altitude generally over 8,000 feet. Severe altitude illness or acute mountain sickness is a medical emergency and is rare, unless people are climbing rapidly to higher elevations. For mild cases one should avoid stimulants and alcohol. Allow the body to adjust to high elevations gradually and naturally. Drink plenty of liquids. Frequent urination shows the body is adjusting. If one has problems with sleeping, this may be a symptom of altitude sickness. Avoid taking a sedative, which will make the situation worse by slowing down the breathing. Diamox, which is a commonly used diuretic, helps the body adjust to mountain illness, and 125 mg twice a day or even just at night can help prevent the symptoms.

Remember, traveling is challenging. It is important to expect and plan for common problems. If and when they occur, you should be well prepared for them. If you are not adequately prepared, such problems can be inconvenient and troublesome.

Immunizations

When people think of traveling to developing countries, they often hesitate for fear of having to get many shots. There are destinations and travel itineraries where immunizations make sense, but often only a few immunizations are necessary due to the particular itinerary and mode of travel.

While the Centers for Disease Control and Prevention (CDC) provide general outlines of immunizations needed by a country, specific advice about which immunizations you may require is best found in consultation with a travel medicine doctor. A backpacker traveling the countryside in Southeast Asia needs different immunizations than someone staying in five-star hotels in the same countries.

The following is a summary of categories of immunizations to help you understand more about this subject, and is not meant to be a substitute for specific recommendations.

Updates on Childhood Shots

Experts suggest that people have a booster of tetanus/diphtheria immunization every 10 years. There is currently a high risk of diphtheria in the former Soviet Union.

Polio is almost absent in the Americas, Western Europe and much of the Pacific. However, it remains a danger in Africa, Eastern Europe and much of Asia. A one-time booster injection against Polio is recommended for travel to developing countries.

Adults born in or after 1957 should receive at least one dose of the measles, mumps and rubella inoculation unless there is a medical contraindication. Two doses are recommended for international travelers.

Poor Sanitation Conditions

Hepatitis A is the most commonly encountered serious infectious disease among travelers to developing countries. It is passed in the feces of a person who has Hepatitis A. If the traveler does not have control over the preparation and handling of food, it is a good idea to have a Hepatitis A shot. Previously, only the blood product, gamma globulin (immune globulin), was available. Now there are two new hepatitis A vaccines which give 100 percent protection. While one shot will give you a year's protection, a booster from six months to a year protects you for 10-20 years.

Typhoid Fever is also spread from those who have these bacteria in their system and it passes in their feces. This immunization is usually recommended when a person will be in parts of Africa, Asia and tropical South America for more than a few weeks, with travel to rural areas where hygiene is not good. This vaccine can be taken either as pills or an injection; both give 3-5 years protection. A well-tolerated immunization, it confers 50-70 percent protection.

Cholera is a disease associated with urban squalor and extreme poverty. It is unusual for travelers to use water supplies or food from such areas; therefore cholera is very rare among travelers. The cholera immunization, which is only 50 percent protective, lasts for a period of 8-12 weeks and has unpleasant side effects, is rarely recommended.

Viral Illnesses from Insects
Yellow Fever is a required immunization for travel in parts of tropical South America, Africa and certain other countries. A good immunization, effective for 10 years, it carries few side effects. Yellow Fever is basically a disease among monkeys. It is only in jungle areas that mosquitoes may bite monkeys and then humans, producing small, remote epidemics. Although this is rarely a disease encountered by travelers, there is a 60 percent fatality rate if a non-immunized person gets yellow fever.

Japanese Encephalitis is a virus carried by mosquitoes in the temperate areas of Asia and the Far East. Despite only 24 cases reported among travelers in the last 15 years, it is a serious illness and the immunization is recommended if staying in rural areas for several weeks where there is a high concentration of rice paddies and pigs. Pigs are the carriers of the virus and mosquitoes carry them from pigs to humans.

Other Serious Illnesses

Meningococcal Meningitis is a very serious disease which exists in epidemics across the so-called "meningitis belt" of Africa, below the Sahara in east and west Africa. These epidemics usually occur in winter and in crowded villages, but can occur in urban areas as well. Although reports of meningococcal meningitis among travelers to these areas are rare, this is an excellent immunization which provides three years protection with few side effects. It is also recommended for people trekking in rural areas of Nepal, and is required if going on the Haj to Saudi Arabia.

Rabies is a serious disease caused by animal bites, and is endemic through much of the developing world. Although there were only 10 cases from 1980-1992 reported among travelers, many times this immunization is recommended for adults, and especially children, who will be living in certain places in Asia, Africa and South America. This is a series of three immunizations, with the necessity for post-bite treatment as well. These are not painful shots in the abdomen as you may once have heard.

Hepatitis B is a potentially serious liver infection spread by a virus which is transmitted through blood products or sex. This immunization is recommended for healthcare workers, people who will be living in a local environment for some years, especially those who may be sexually active during their travels to parts of the world where Hepatitis B exists in a carrier state in the local population.

Some people may want every possible immunization, while others only want to protect themselves from diseases that present the highest degree of risk. A consultation with a travel medicine doctor can help you assess your options and decide what is appropriate for you.

John A. Horton, M.D., a general practitioner with a travel medicine subspecialty, has served with a flying doctor's service in Africa and taught and lectured on preventive medicine in Asia, Africa and North America. He co-founded World Travelers HealthCare with Edward S. Angelic, M.D., an internist who has been a consultant to international business travelers and tourists for 25 years.

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