Travel Health

Overview

How can you stay healthy on your trip?

The best way to stay healthy on your trip is to plan before you go. If you are planning to travel to another country, see a doctor several months before you leave so you will have time for vaccines (immunizations) that you may need to get ahead of time.

Also ask your doctor if there are medicines or extra safety steps that you should take. For example, if you have asthma, you may have to avoid stays in polluted cities. Or someone visiting the tropics may need to take medicine to prevent malaria.

What precautions should you take while you travel?

Before you go, learn about the places you plan to visit. For example, find out if the water is safe to drink or if you need to worry about malaria.

Basic safety can prevent some problems:

• Developing countries may not have safe tap water. When visiting these places, drink only beverages made with boiled water, such as tea and coffee. Canned or bottled carbonated drinks are usually a safe choice. Don't use ice if you don't know what kind of water was used to make it.
• Do not eat raw vegetables, raw fruits, or raw or undercooked meat and seafood.
• In areas where mosquito-borne illnesses are found, use DEET insect repellent. Wear long pants and long-sleeved shirts, especially from dusk to dawn. Use mosquito netting to protect yourself from bites while you sleep.
• Motor vehicle accidents are a leading cause of injury among travelers. If you drive, be sure to learn the custom and rules. If you use hired drivers (such as in a taxi), don't be afraid to ask your driver to slow down or to drive more carefully. Use seat belts if possible.

What if you get sick while you are traveling?

If you become seriously ill while traveling, your country's embassy or consulate can help you find medical care. For a complete list of embassies and consulates, see the U.S. Department of State website at www.usembassy.gov. You can also get the contacts for local doctors and medical clinics. If you become ill with a fever or flu-like illness while traveling, seek medical attention immediately.

Should you see a doctor when you return?

If you were healthy during your trip and you feel well when you return home, you probably don't need to see a doctor.

See your doctor when you get home if either of the following occurs:

• You were sick with a fever or severe flu-like illness while traveling.
• You develop these symptoms within 6 months of coming home.

Tell your doctor the places you visited and whether you think you may have gotten a disease. Many diseases don't show up right away. And some can take weeks or months to develop.

Before You Go

Proper planning is the best way to stay healthy during your trip. This takes time. You'll want to gather both travel and health information, and think about your special needs.

• See a doctor several months before you go.

  This will help make sure you have time to get vaccines or make other health preparations.

• Think about the type of shape you're in.

  Most travel, even if you are going on a guided tour, typically demands more physical effort than is required at home. Boost your fitness by starting an exercise program, such as fitness walking, in advance.

• Make a first aid kit.

  Include items such as pain relievers, sunscreen, insect repellent, moleskin, antifungal and antibacterial ointments, medicine for motion sickness, and antidiarrheal medicines.

• If you have health insurance, find out how your insurance works outside of the United States.

  If your insurance company doesn't cover you in other countries, you may want to think about buying travel health insurance. Use the Internet to search for "travel insurance compare" to get websites that help you compare types of travel insurance.

Getting the information you need

• Use the Internet to find travel health information. Try these websites:
  • www.cdc.gov/travel. This website is for the Centers for Disease Control and Prevention (CDC).
  • www.who.int/ith/en. This website lists information from the World Health Organization (WHO) on travel, required immunizations, and disease outbreaks.
• Find out where you can get the best medical care in the region you are visiting. See the U.S. State Department's website at www.usembassy.gov. It lists every U.S. embassy worldwide. It also lists some doctors and medical facilities in those countries.
• Take along the phone numbers and addresses of embassies in the areas you will visit. They can help you find a doctor or hospital. Find out if your insurance company will cover you. You may want to get special travel health insurance.
• If you are taking a cruise, you can find your ship's health record on this website: www.cdc.gov/nceh/vsp.

Getting needed vaccines

Depending on where you're visiting and how long you'll be there, you may need vaccines to protect against childhood infections, tetanus, or other diseases. Check with the nearest travel health clinic, your regional health department, your doctor, or the U.S. Centers for Disease Control and Prevention website (www.cdc.gov/travel) to see which vaccines you need.

Personal health needs

If you have any chronic diseases or other health concerns, such as birth control or allergies, see your doctor. You may need to take other steps or make adjustments in your travel plans.

• Carry important medical paperwork.
  • A letter from your doctor describing your conditions
  • A list of your routine medicines including their generic names
  • Written prescriptions for refills if you will be gone long
• Leave your prescription medicines in the original containers.

  Your name must match the name on the bottle. Pack them in a waterproof container in your carry-on luggage. Take extra amounts of your routine medicines packed in checked luggage in case of theft or loss.

• Travel with a copy of your most recent electrocardiogram (EKG, ECG) if you have a heart condition.

  This will help with a comparison in case you have chest pain or other symptoms.

• Take precautions to prevent problems while traveling if you have diabetes.

  For example, wear a medical identification tag and take extra medicine with you.

• Avoid stays in polluted cities or at high altitudes if you have asthma, chronic obstructive pulmonary disease (COPD), or other lung diseases.
• Talk to your doctor before making any travel decisions if you are pregnant.

  If you decide to travel, take some general precautions while traveling, such as notifying the airline of your condition before you fly. Consider wearing compression stockings and taking a few walks while on a long flight to increase the blood circulation in your legs. (Taking walks is good advice for all travelers.)

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Precautions Along the Way

Tips for flying

Flying isn't always fun. But you can take steps to make it easier and to feel better during and after your flight.

• Pack in your checked bags anything that may cause problems at security.

  Examples include gels, liquids, sharp scissors, or pocket knives. See the Transportation Security Administration website at www.tsa.gov/travel for an updated list of what isn't allowed in carry-on luggage.

• Wear roomy, comfortable shoes that slip on and off.

  These are easy to remove when you go through security at the airport. They will also be more comfortable if your feet swell on the plane.

• Walk around the plane every 1 to 2 hours during flights to prevent dangerous blood clots during long periods of travel.

  Sitting still slows down the blood flow in your legs and raises your blood clot risk. Consider wearing compression stockings.

• Take steps to prevent jet lag.

  Examples include drinking plenty of liquids and changing your sleep schedule to the new time zone.

If you have a fear of flying, talk to your doctor. The doctor may recommend medicines; hypnosis; or breathing, visualization, and relaxation exercises to help you feel less afraid.

Water and food safety

Contaminated water and food are the most common cause of illness in travelers.

• Don't drink tap water if it may not have been properly treated.
• Don't brush your teeth with tap water.
• Drink beverages made with boiled water, such as tea and coffee.

  Canned or bottled carbonated beverages (including bottled water and soft drinks), beer, and wine are also usually safe.

• Don't accept ice in drinks.

  It may be contaminated.

• Dry the opening of wet cans or bottles before taking a drink.
• Avoid raw fruits (unless you wash and peel them yourself), raw vegetables, and raw or undercooked meat and seafood.
• Try to eat steaming hot, well-cooked food.
• Don't get foods or drinks from street vendors.
• Make sure dairy products have been pasteurized.

Taking the above precautions with food can help prevent infections, like tapeworm.

Travelers to backcountry areas of North America should also take precautions with water. Even though the water in high mountain lakes looks sparkling clear, it may be contaminated with Giardia intestinalis, the parasite that causes giardiasis. Take simple precautions to avoid this illness, such as boiling the water.

Swimming and water sports

Swimming in contaminated fresh water, such as ponds or rivers, can expose you to diseases. Even swimming pools with inadequate chlorination pose a risk. Talk to your doctor if you plan on doing recreational water sports—such as white-water rafting, adventure racing, or kayaking—in tropical and backcountry regions.

To prevent fungal or parasitic infections and injuries, do not go barefoot. Try to keep your feet as clean and dry as possible.

Although sea water is usually safe from disease, swimming or diving in sea water can still be dangerous. Avoid swimming or wading in sea water near a river, estuary, or other outlet from inland. Swimming when you have an open cut or sore can also increase your risk of getting an infection. In developing countries, sea water around big cities and other populated areas may not be safe.

Insect-borne disease

Mosquitoes, flies, fleas, and ticks all spread disease such as malaria, Lyme disease, and West Nile fever.

Malaria is the insect-borne disease of most concern to travelers in tropical and subtropical regions. Although antimalarial medicines kill the malaria parasite in the bloodstream, this protection isn't complete. Take protective measures along with taking antimalarial medicine.

Ticks inhabit many regions, including Europe, Canada, and the United States. Although it is rare for travelers to contract diseases from ticks, some of the diseases are serious.

Here are some tips that can help you avoid mosquitoes and other insects.

• Use DEET or other insect repellents on your skin.
• Sleep under a bed net to prevent insects from biting you while you sleep.

  Permethrin or deltamethrin insecticide sprayed on bed nets will protect against mosquitoes for weeks to months.

• Use mosquito coils.

  The smoke from these slow-burning coils repels mosquitoes.

• Wear light-colored and loose-fitting long pants and long-sleeved shirts.

  This is especially important from dusk to dawn, when mosquitoes that spread malaria and other diseases bite. Insect repellent applied to clothing is effective for longer than it may be on the skin.

• Do not use home remedies like eating garlic, rubbing garlic on your skin, or taking vitamin B.

  They do not prevent bites.

Sun and heat exposure

Many travelers underestimate the sun's strength and overestimate the amount of protection their sunscreen offers. This may cause an uncomfortable sunburn and other skin damage.

• Protect yourself from the sun by using sunscreen and wearing a hat and sunglasses.
• Take steps to prevent heat-related illness, such as heat exhaustion or heatstroke.
  • Before you travel to a hot environment, improve your ability to handle heat. Start by exercising for a short time in the heat. Then for the next 2 to 3 weeks, slowly increase the time you exercise in the heat.
  • If you are not used to the heat, limit your time outside in the hottest part of the day.
  • Drink plenty of water.
  • Do not drink alcohol. It increases your risk for dehydration.
  • Know if you take medicines that may make heat-related illness more likely. If you take medicines regularly, ask your doctor for advice about hot-weather activity and your risk for heat-related illness.

Injuries and other concerns

Although disease is a big risk while you are traveling, you should also be aware of the risk of injury and other concerns.

• Take precautions to help avoid motor vehicle accidents.

  They are a leading cause of injury among travelers. Bad roads, poor driver training, and crowded roadways can make driving dangerous in other countries.

  • Learn local driving customs and road signs.
  • Try to travel during daylight.
  • Always use seat belts.
  • Ask taxi drivers or other hired drivers to slow down or drive more carefully if you feel unsafe.
  • Wear helmets and protective clothing when riding motorcycles or bicycles.
• Understand the risks associated with animal bites.

  Take care around dogs and other animals. Dogs in developing countries may bite, and rabies is a concern. If you are bitten by an animal, wash the bite with clean water and seek medical attention immediately.

• Be prepared to treat minor wounds.

  Most wounds sustained in developing countries carry a higher risk of becoming infected.

  • If you get even a minor wound, clean it as soon as possible with large amounts of warm, clean water.
  • Apply a thin layer of petroleum jelly, such as Vaseline, and a bandage.
• If you haven't had a tetanus shot in 10 years, you should get a booster dose before you leave on your trip.

  But if you don't get a tetanus shot before you leave, you should get one after an animal bite or an injury that results in a break in the skin.

• If you know that you get motion sickness, pack medicines to prevent it.

  The motion of cars, planes, trains, boats, or ships can make some people sick.

• When air quality is poor, avoid the area or stay indoors as much as possible.

  Air pollution can pose a serious threat to those with asthma or other respiratory conditions.

• Practice safer sex and use condoms to prevent infections.

  Sexual activity can lead to sexually transmitted infections.

Altitude

Altitude sickness occurs when you cannot get enough oxygen from the air at high altitudes.

It happens most often when people who are not used to high altitudes go quickly from lower altitudes to 8,000 ft or higher. When you go too high too fast, your body cannot adjust.

Altitude sickness can range from mild to life-threatening. With good planning, such as ascending slowly or taking certain medicines, it is often preventable.

Scuba diving safety

You will learn about safety in your scuba diving certification class. If you plan to get certified while traveling, find an experienced, certified teacher that you feel comfortable with. Several groups, including the Professional Association of Diving Instructors (PADI) and the National Association of Underwater Instructors (NAUI), certify instructors and dive shops all over the world.

If you are a new diver, it is best to go with an experienced guide, also called a dive master. Most accidents and problems occur when divers ignore the rules and push their limits. Here are some general diving rules.

• Only dive if you feel comfortable.
• Use equipment that you are familiar with and that is in good repair.
• Know what to do if something goes wrong.
• Always dive with a buddy.
• Go down and come up slowly.

  Don't hold your breath.

• Know and follow recommended depths and time limits.
• Allow enough time between your last dive and your flight home.

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What to Do if You Get Ill

Serious illness

If you become seriously ill while traveling, your country's embassy or consulate can help you find medical care. For a complete list of embassies and consulates, see the U.S. Department of State website at www.usembassy.gov. You can also get the contacts for local doctors and medical clinics. If you become ill with a fever or flu-like illness while traveling, seek medical attention immediately.

Diarrhea

Traveler's diarrhea is loose, watery bowel movements you can get when you travel. It also can cause vomiting and belly cramps.

This kind of diarrhea is usually caused by bacteria. But sometimes it is caused by a parasite or virus.

Most people get it when they eat undercooked, raw, or contaminated foods. You can also get it if you drink contaminated water or if you drink something that has contaminated ice cubes in it.

In some cases, new foods can cause diarrhea. In other cases, the stress and anxiety of travel can cause it.

Traveler's diarrhea usually isn't serious. Most of the time, bowel movements return to normal quickly. The most important thing is to prevent dehydration. Make sure to drink a lot of fluids.

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Post-Travel Care

If you have been healthy during your trip and feel well when you return home, you don't need to see a doctor. But if you've been ill, especially while traveling to regions where disease is prevalent, you need to see a doctor.

Many diseases don't show up right away. Some take weeks to months to develop.

See your doctor when you get home if either of the following occurs:

• You were sick with a fever or severe flu-like illness while traveling.
• You develop these symptoms within 6 months of coming home.

Tell your doctor the regions you visited and about any exposure to disease.

It's important to be aware of other symptoms besides a fever. See your doctor if you have:

• Diarrhea that won't go away or that keeps coming back.
• A skin rash or sores.
• Jaundice (typically most noticeable when the whites of the eyes appear yellow).
• Unexplained weight loss.
• Shortness of breath.
• Fatigue.