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Health Perils in Paradise?
Some of the world's most spectacular destinations are also home to some of the world's nastiest bugs. Yellow fever, malaria, and even polio can strike international travelers. Protect yourself by learning which vaccines or health precautions are advised for your destination. To give vaccines time to take effect, see your doctor or travel clinic four to six weeks before your trip.
If you're planning an African safari, you may need a polio booster. This debilitating disease is still active in many parts of Africa and Asia. The germs can be spread through food, water, and contact with an infected person. Even if you received a polio vaccine as a child, you may need a booster to make sure you're protected against all three types of the virus.
Yellow Fever Vaccine
Along the border of Argentina and Brazil, Iguazu Falls attracts visitors from all over the world. Unfortunately, it also attracts mosquitoes that carry the yellow fever virus. Yellow fever occurs in parts of South and Central America, as well as tropical Africa, and it can be life-threatening. Vaccination is required to visit certain countries, with a booster shot needed after 10 years. Avoiding mosquito bites is important, too.
Typhoid Fever Vaccine
Typhoid fever is a life-threatening infection common in the developing world. It's caused by bacteria found in contaminated food or drink. Several hundred Americans get typhoid fever every year -- most while visiting Asia, South America, or Africa. The CDC recommends the typhoid vaccine at least one to two weeks before travel to these regions. If you've had the vaccine in the past, ask if you need a booster.
Before planning any adventure travel, make sure you're up to date on your tetanus shot. Tetanus infections often result from skin injuries, including frostbite, burns, or punctures. The culprit is a bacterium that occurs in all parts of the world. Tetanus can be fatal. Booster shots are recommended every 10 years.
Hepatitis A Vaccine
One of the great pleasures of international travel is trying a variety of exotic cuisines. Unfortunately, contaminated food or water can spread infections, including hepatitis A. This viral infection, which causes inflammation of the liver, is common throughout the developing world. If you were not vaccinated as a child, ask your doctor about getting the vaccine series before venturing abroad.
Hepatitis B Vaccine
The hepatitis B virus also causes liver inflammation, but is spread through blood or other body fluids infected with the virus rather than food. Many chronically infected people carry the virus in Africa, Southeast Asia, the Middle East, Pacific Islands, Caribbean Islands, and the Amazon River basin. The CDC recommends the hepatitis B vaccine for all travelers to these areas, especially adventure travelers, missionaries, Peace Corps volunteers, and military personnel.
Rabies is found on all continents, except Antarctica, and is spread through the bite of an infected animal. Street dogs in Africa, Asia, and South America pose the greatest risk to travelers, followed by monkeys living among the temples of Asia. Without treatment, rabies is fatal. A three-dose vaccine is available, though it doesn't eliminate the need for treatment after a bite. It buys you time to reach medical care, and cuts the doses needed.
If you get an annual flu vaccine, factor your travel plans into the timing of your vaccine. In the Southern Hemisphere, flu epidemics are most common from April through September. So families planning a summer vacation in Australia, for example, should make sure they are vaccinated before departing.
Malaria is a life-threatening disease carried by mosquitoes. It is most common in sub-Saharan Africa, but also occurs in parts of South Asia and South America. Travelers should ask their doctor about the pros and cons of preventive antimalarial medications. Other strategies include using mosquito repellents (30% - 50% DEET for adults), wearing long sleeves and pants outdoors, and sleeping under insecticide-treated mosquito nets.
Dengue Fever Precautions
In travelers returning from the Caribbean, South Central Asia, and Central America, dengue fever is the most common cause of fever. Recently, small numbers of the mosquito-borne illness have been reported in Key West, Fla. While most cases are mild, some people develop dengue hemorrhagic fever, which can be fatal. There is no vaccine, but travelers can reduce their risk by protecting against mosquito bites.
Tuberculosis (TB) is more common in Asia and sub-Saharan Africa, although it is found throughout the world. The infection is spread when a contagious person coughs. Travelers who spend time working or volunteering in hospitals, prisons, or homeless shelters have a higher risk of exposure to TB. If you feel you may have been exposed, it's important to get a skin test. Prompt treatment is the key to avoiding complications.
Sleeping on the beach may sound romantic … until you consider the infected sand flies. Their bites can spread a disease called leishmaniasis. The most common type, found in parts of the Middle East, Asia, Africa, and South America, causes skin sores and ulcers. A less common form affects internal systems and causes life-threatening disease. To avoid bites, stay indoors from dusk to dawn. Wear long-sleeved shirts, pants, and socks. Bug spray and bed nets can also help.
Lymphatic filariasis is caused by a tiny, parasitic worm that spreads through bites. It affects millions in Asia, Africa, and the Western Pacific, and a fraction go on to develop elephantiasis. In the Americas, the disease occurs in Haiti, the Dominican Republic, Guyana, and Brazil. Short-term travelers are at low risk, but it's prudent avoid mosquito bites: use repellent, wear long sleeves and pants, and sleep under a mosquito net.
Bedbugs are not choosy about their accommodations -- they check into hostels and five-star resorts across the globe. They cause itchy red bites on the face, neck, arms, hands, or other body parts -- but these marks can take up to 14 days to appear. To detect an infestation more quickly, look for tiny bugs in the folds of mattresses or sheets, rust-colored spots on the mattress, and a sweet musty odor.
Preventing Travelers' Diarrhea
Travelers' diarrhea is the top travel-related illness, affecting up to half of international travelers. People visiting Latin America, the Middle East, Africa, and Asia, are the most at risk. It's rarely dangerous and almost always goes away on its own. Still, you can take steps to prevent it -- steps that also help prevent more serious diarrheal illnesses such as cholera. The CDC recommends avoiding tap water, food sold by street vendors, raw or undercooked meats and seafood, and unpeeled fruits and veggies.
What About Fruits and Veggies?
With a few precautions, you can enjoy fruits and vegetables while abroad. Avoid raw fruits and veggies, unless you can peel them yourself. A good rule of thumb: boil it, cook it, peel it, or leave it. Also be wary of salads that may have been washed in tap water or smoothies made with non-purified ice.
"Don't drink the water" may be a mantra of international travelers, but there are actually several ways to make local water safe. The most reliable method is to boil it vigorously for a minute. When this isn't possible, you can disinfect water with iodine tablets, but this may not kill all types of parasites. You can also use a portable water filter. If you choose to buy bottled water, make sure the bottles come from a trusted source.
Antibiotics for Diarrhea
Despite all your precautions, there's still a chance you may get travelers' diarrhea. If you're heading to an area where this is likely, you may want to ask your doctor about bringing antibiotics. Cases of moderate to severe traveler's diarrhea can be treated with a course of antibiotics. If diarrhea persists after taking antibiotics, it's important to get tested for possible parasitic infections.
Adventures in extremely hot and humid climates can put travelers at risk for dehydration. The risk is even greater if you develop traveler's diarrhea. Signs of dehydration include sunken eyes, dry mucous membranes, and urinating less. Sports drinks can help you stay hydrated if you're well, but they are not suitable when you have diarrhea. In that case, you should sip an oral rehydration solution.
Few things take the fun out of a beach vacation like red, peeling skin. Besides being painful, UV rays and sunburn can lead to premature aging and an increased risk of skin cancer. Protect yourself with a broad spectrum sunscreen that blocks UVA and UVB rays. Doctors also recommend staying inside or in the shade between 10 a.m. and 4 p.m., even on cloudy days.
Precautions During Pregnancy
Being pregnant doesn't put travel off limits, but you should take some precautions. The CDC recommends steering clear of any country where malaria is present. Following food and water safety guidelines is even more important, because the consequences of a food-borne illness could be more severe. And if you're in your third trimester, make sure you will be near a medical facility than can handle premature labor and/or birth.
Precautions for Young Children
The best way to protect infants against food and waterborne illnesses is to breastfeed while traveling. If this isn't possible, be sure to make formula with water that has been boiled sufficiently or bottled. When babies or young children develop diarrhea, they can become dehydrated quickly and may need medical attention. Children are also more vulnerable to complications if they become infected with malaria and other infections.
First Aid Kit for Travelers
You can purchase a travel first aid kit or make your own. The contents should include disposable gloves, adhesive bandages of various sizes, gauze, antiseptic, cotton swaps, scissors, elastic bandage wraps for strains, antifungal and antibacterial creams, anti-itch cream, aloe gel, saline eye drops, and a first-aid quick reference card. You should also include any medications you take regularly in their original containers, along with copies of your prescriptions.
Travel and Evacuation Insurance
Before your trip, check with your health insurance provider to find out which services are covered abroad. You may want to buy supplemental insurance to pay for medical expenses during your travels. Evacuation insurance is a special policy that will cover the cost of an air ambulance. This is particularly important for travelers to areas with limited medical facilities.
More Reading on Travel and Health
Reviewed by Varnada Karriem-Norwood, MD on Tuesday, November 29, 2011
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