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HealthHints

Health Tips for Travelers
Staying healthy and help when we don’t

April 2008 – Vol. 12, No. 4

Editors: Janet M. Pollard, MPH; and Carol A. Rice, Ph.D., R.N.

Whether you plan to travel across the state, across the nation, or across the ocean, planning ahead and being prepared are key to staying healthy and getting quality care when illness or injury is not avoided. The next four issues of the HealthHints newsletter will take you on a short tour of how you can strive to stay healthy during travel, as well as how and where to find help when you don’t. So, whether it’s for business or pleasure, be proactive in your planning…

Reduce health risks when traveling abroad.
Pack your bags (PDF) with preventative and prescription medications.
Prepare for and prevent complications on the move (PDF).
Gather information about climate and accommodations (PDF).

Health Issues Abroad: Reducing risks

If you plan to travel abroad, you can reduce the risk for negative health consequences and travel complications by getting appropriate vaccines, checking and/or supplementing your health insurance, registering your travels (in case of emergency), and following precautions to avoid food or water-borne illnesses.

Make Your First Trip…To the Doctor

One of the most important things to do if you are traveling abroad is to be sure you have the appropriate vaccines. There are three categories of vaccines (PDF):

Routine – These vaccines are necessary for protection from diseases that are still common in many parts of the world, even though they rarely occur in the U.S.¹
Recommended – These vaccines are recommended to protect travelers from illnesses present in other parts of the world and to prevent the importation of infectious diseases across international borders.¹
Required/Mandatory – These vaccines are required before entry into certain countries.¹ If you are required to have a yellow fever vaccine or meningococcal vaccine (Saudi Arabia),¹ you will also need an International Certificate of Vaccination and Prophylaxis.

Note: You may have to visit a travel medicine specialist or specific clinic (other than your doctor’s office) to receive the yellow fever vaccine. The certificate for yellow fever vaccine should be obtained and signed by an authorized health care provider at the time of inoculation. It is valid 10 days after receipt of the vaccine and is good for 10 years.^2,3

In addition to the International Certificate of Vaccination and Prophylaxis, you should carry with you:

a record of all vaccines, and
emergency medical data (e.g., information about prescription drugs and their uses, eye wear prescriptions, and information on any special conditions, such as diabetes, cardiovascular conditions, or allergies).

It is a good idea to make multiple copies of these records, leaving one with a close family member or friend at home, one in your suitcase (checked baggage), and one in your hand-carried baggage.⁴ You can obtain a passport-sized Traveler Clinic Record from the International Association for Medical Assistance for Travelers (IAMAT) to record this important information.

Ideally, set up your doctor’s appointment 4–6 weeks before your trip. “Most vaccines take time to become effective in your body, and some vaccines must be given in a series over a period of days or sometimes weeks. If it is less than 4 weeks before you leave, you should still see your doctor. You might still benefit from shots or medications and other information about how to protect yourself from illness and injury while traveling”¹ (e.g., preventative drugs against malaria may be prescribed depending on your destination; there is no vaccine to fight malaria).⁵

Health Coverage away from Home: Health policies & supplemental insurance

Gather information in regards to your health insurance and what it covers away from home. Health insurance is important for both domestic and international travel.⁶ Find out ahead of time how your health insurance handles medical care when you travel.⁷

“Coverage is more often a problem for international travel.”⁸ “The Social Security Medicare Program does not provide coverage for hospital or medical costs outside the U.S.A.”⁶ “Some domestic insurance plans limit coverage for vaccinations and preventive drugs for international travel, even though some vaccinations are required for entry into certain countries.”⁸ Some insurance companies will pay for “reasonable” hospital costs abroad, but very few will cover medical evacuation, which can cost as much as $100,000. For this reason, consider purchasing a supplemental policy that guarantees medical payments and transport.⁷ Elements of care to consider when purchasing a supplemental policy may include emergency care, transportation for care, medical equipment and personnel transport, dental care, pre- or postnatal care, lost or stolen prescription drugs, and medical translators.⁸ If you have an underlying medical condition, research travel insurance companies carefully. Policies may vary considerably in their coverage of pre-existing conditions.⁸ Carry a copy of your insurance certificate, insurance policy card, claim forms, and any other contact details with other travel documents in your hand-carried luggage.^9,10 Also, realize that most domestic health insurance plans are not recognized outside the U. S. Instead, a cash deposit or payment in full may be required in some international hospitals and care facilities before care is provided.⁸ You will want to be informed about how to file your health insurance claim when away from home. For a listing of companies that provide traveler’s health insurance, see Medical Information for Americans Abroad or Seeking Health Care Abroad. Often, travel agents and tour operators can provide information about traveler’s health insurance⁹ as well.

Know Where to Go: Seeking quality medical services

When we become sick or injured while away from home, we often feel ill-prepared and ill-at-ease about where to turn for help. Before you set out on your next trip, know where to go in case you have an illness, injury, or other medical emergency. You can get this information from your doctor, local or state medical society, the International Association for Medical Assistance to Travelers, U.S. State Department’s Overseas Services, or private medicine clinic sources, like the International Society of Travel Medicine or the American Society of Tropical Medicine and Hygiene. You may also want to visit the state’s health department website for travel within the U.S.

If you forget to do your homework, most major credit card companies, as well as U.S. embassies and consulates, can steer you in the right direction. The Office of Overseas Citizen Services in the State Department’s Bureau of Consular Affairs may be reached for assistance with emergencies at 1-888-407-4747, if calling from the U.S. or Canada; or 202-501-4444, if calling from overseas.¹¹ “When in doubt or the timing is critical, consider going to a university hospital for help.”⁷ U.S. consulates or embassies can also help with the transfer of funds to a foreign country, if needed for medical care. Consulates and embassies do not provide medical advice.

Food & Water-borne Illness: Avoiding uncomfortable and dangerous illness

“Food and water are two of the most important considerations while traveling.”¹² The problem is that water and food can be contaminated with various parasites, bacteria, and viruses. Traveler’s diarrhea is the most common illness you are likely to experience while traveling. Characterized by loose stools and abdominal cramps, a vacation or business trip can quickly become agonizing with this common illness. Although it isn’t serious, traveler’s diarrhea is very unpleasant. More serious illnesses and diseases, however, can also result from food and water, including bacillary dysentery, giardiasis, cryptosporidosis, typhoid fever, hepatitis A, cholera, rotovirus, salmonellosis, and others.¹⁰

“A trip to a foreign country by no means guarantees gastrointestinal discomfort [or other food or waterborne illness]. But if you visit a place where the climate, social conditions, or sanitary standards and practices are different from yours at home, you have an increased risk of developing traveler’s diarrhea.”¹³

One of the biggest concerns with traveler’s diarrhea is the loss of fluids, leading to dehydration. To treat traveler’s diarrhea, using an oral rehydration solution (ORS) that contains specific proportions of water and salt is the best way to replenish lost fluids and electrolytes.¹³ Bottled ORS products are typically available in drugstores and pharmacies in most developed areas. Packets of powdered ORS are also available in most countries and should be labeled WHO-ORS. Be sure to make the solution with bottled or boiled water according to package directions. If premade ORS is unavailable, you can make your own solution with the following recipe (be sure to make it exactly as specified because inaccurate mixtures can cause harm rather than help):

½ teaspoon salt
½ teaspoon baking soda
2 tablespoons sugar or rice powder
¼ teaspoon potassium chloride (salt substitute)
1 liter safe drinking water.¹³

You or your child can drink small amounts of the solution throughout the day as a supplement to solid food or formula, as long as dehydration persists. If symptoms don’t improve, seek medical care right away. ORSs are intended only for urgent, short-term use.¹³ Traveler’s diarrhea usually resolves on its own, but several medications may help relieve symptoms, as well. Select the medications listed below to learn more about their specific uses and precautions for treating traveler’s diarrhea, and find out which ones are appropriate for you to carry on your next trip:

anti-motility agents (e.g., Imodium, Lomotil, etc.) (PDF),
bismuth subsalicylate (Pepto-Bismol) (PDF), and
antibiotics (PDF).

Before you leave for your trip, talk to your doctor about preventative strategies as well as appropriate medications to take with you so that you don’t have to buy diarrhea medications while traveling. Some of the drugs available abroad are unsafe and have been banned in the United States.¹³

Here are some tips from the Mayo Clinic to help you prevent traveler’s diarrhea, as well as other food and/or water-borne illness. Watch what you eat!

Stick to this “rule of thumb”: boil it, cook it, peel it, or forget it.
Don’t buy food from street vendors.
Avoid unpasteurized milk and dairy products, including ice cream.
Avoid raw or undercooked meat, fish, and shellfish.
Steer clear of moist food at room temperature, such as sauces and buffet offerings.
Eat foods that are well cooked and served hot.
Munch on dry foods—like breads—and high-sugar-content foods, such as jellies and syrups.
Stick to fruits and vegetables that you can peel yourself, such as bananas, oranges, and avocados. Stay away from salads and unpeelable fruits, such as grapes and berries.¹³

Don’t drink the water. When visiting high-risk countries:

Avoid unsterilized water—from tap, well, or stream. If you need to consume local water, boil it for 5–10 minutes.
Avoid ice cubes or fruit juices made with tap water.
Beware of sliced fruit that may have been washed in contaminated water.
Don’t swim in water that may be contaminated.
Keep your mouth closed while showering.
Feel free to drink canned or bottled drinks in their original containers—as long as you break the seals on the containers yourself. Wipe off any can or bottle before drinking or pouring.
Use bottled water to brush your teeth. Tie a colored ribbon around the bathroom faucet to remind yourself not to drink—or brush your teeth with—tap water.
Use bottled or boiled water to mix baby formula.
Order hot beverages, such as coffee or tea, and make sure they’re steaming hot.¹³

“If it’s not possible to buy bottled water or boil your water, bring some means to purify water. Consider a water-filter pump with a microstrainer filter that can filter out small microorganisms. Look in camping stores for a filter that’s certified by the National Science Foundation. Or chemically disinfect water with iodine or chlorine. Iodine tends to be more effective but is best reserved for short trips, as too much iodine can be harmful to your system. You can purchase iodine tablets or crystals at camping stores and pharmacies. Be sure to follow the directions.”¹³

In case of an emergency – register your travel

Consider registering any travel abroad with the U.S. Department of State. “Travel registration is a free service provided by the U.S. Government to U.S. citizens who are traveling to, or living in, a foreign country. Registration allows you to record information about your upcoming trip abroad that the Department of State can use to assist you in case of an emergency.” To register your travels, see the travel registration website.

Where to Find More Information: Important travel websites

The following information provides a brief overview of four important websites providing reliable information on travel and health. Visit these sites for further information about your destination.

Centers for Disease Control and Prevention (CDC) –
Start here with the link to destinations. View travel notices (PDF) (e.g., outbreak notices and health warnings) describing the level of risk for travelers to specific destinations and the recommended preventive measures to take at each level of risk. You will want to observe these notices for your destination to be sure there is no reason to postpone your travel and that you have taken all necessary precautions to avoid ill health. The CDC site also offers information regarding vaccines, diseases that may be contracted in that geographic region, mosquito and tick protection, safe food and water, illness and injury abroad, travel medicine clinics, and more.
Transportation Security Administration (TSA) –
Information on what you can and cannot take with you is found on the TSA site, including the 3-1-1 rule for packing items for air travel. Additionally, information for travel by cruise, railway, mass transit, and highway are included. You will also find help for traveling with children, as well as with a disability or medical condition.
U.S. Department of State –
The U.S. Department of State can help you register your travel (in case of an emergency) and make sure you have all appropriate documentation. Country-specific information, including health information, medical facilities, medical insurance, and embassy information are available for each country. Travel alerts and travel warnings can also be accessed at this site.
World Health Organization (WHO) –
The WHO site will inform you about what health precautions to take when traveling abroad, including environmental health risks (PDF) (e.g., altitude, heat, foodborne illness, etc.), vaccine-preventable diseases, and the potential risk for infectious diseases (PDF), injuries and violence (PDF) (e.g. road traffic, recreational waters, violence precautions), and more.

Wherever your travels take you, you will want to be prepared with appropriate documentation and information to reduce your risks for illness and injury. Visit these sites as well as the continued series on Health Tips for Travelers (PDF) to gather the information you need for healthy, enjoyable travel.

This document is meant for educational purposes only and is not intended to replace the advice of your doctor or other health care provider.

References:

Centers for Disease Control and Prevention (2007). Vaccinations [on-line]. Retrieved February 21, 2008. From http://wwwn.cdc.gov/travel/contentVaccinations.aspx.
Centers for Disease Control and Prevention (2007). Questions and answers about travelers’ health [on-line]. Retrieved February 20, 2008. From http://wwwn.cdc.gov/travel/contentFAQ.aspx.
World Health Organization (2007). Vaccine-preventable diseases and vaccines [on-line]. In International travel and health 2007. Retrieved February 20, 2008. From http://www.who.int/ith/chapter%206.pdf.
Centers for Disease Control and Prevention (2007). Podcast: The three P’s of safe and healthy travel [on-line]. Retrieved February 21, 2008. From http://www2a.cdc.gov/podcasts/player.asp?f=7952.
Centers for Disease Control and Prevention (2007). Prevention of specific infectious diseases [on-line]. In Health Information for International Travel 2008. Atlanta: US Department of Health and Human Services, 2007. Retrieved February 20, 2008. From http://wwwn.cdc.gov/travel/yellowBookCh4-Malaria.aspx.
U.S. Department of State (2008). Medical information for Americans abroad [on-line]. Retrieved February 21, 2008. From http://travel.state.gov/travel/tips/brochures/brochures_1215.html.
Mayo Clinic (2006). International travel: Staying healthy far from home [on-line]. Retrieved February 21, 2008. From http://mayoclinic.com/health/vaccines/HQ00760.
Merck and Company (2007). Travel and health: Merck manual home edition [on-line]. Retrieved February 22, 2008. From http://www.merck.com/mmhe/print/sec25/ch303/ch303b.html.
World Health Organization (2007). Health risks and precautions, general considerations [on-line]. In International travel and health 2007. Retrieved February 20, 2008. From http://www.emro.who.int/sudan/media/pdf/Health%20Risks%20
and%20Precautions_general%20considerations%20chapter%201.pdf.
Centers for Disease Control and Prevention (2007). Pre- and post-travel general health recommendations [on-line]. In Health Information for International Travel 2008. Atlanta: US Department of Health and Human Services, 2007. Retrieved February 20, 2008. From http://wwwn.cdc.gov/travel/yellowBookCh2-FoodWaterRisks.aspx.
U.S. Department of State (2008). Tips for traveling abroad [on-line]. Retrieved February 21, 2008. From http://travel.state.gov/travel/tips/tips_1232.html.
University of Maryland Medical Center (2007). Travel medicine: Guide for the adventurous traveler [on-line]. Retrieved February 20, 2008. From http://www.umm.edu/travel/guide.htm.
Mayo Clinic (2007). Traveler’s diarrhea [on-line]. Retrieved February 20, 2008. From http://www.mayoclinic.com/health/travelers-diarrhea/DS00318.
Centers for Disease Control and Prevention (20060. Travelers’ diarrhea [on-line]. Retrieved February 21, 2008. From http://www.cdc.gov/ncidod/dbmd/diseaseinfo/travelersdiarrhea_g.htm.

Health Tips for Travelers Staying healthy and help when we don’t