- Specific itineraries dictates the specific immunization requirements, but often times business travel is arranged on short notice which may leave you with insufficient time to be properly immunized.
- If you are possibly traveling to high risk areas, consider getting travel immunizations, like yellow fever (keep your International Certificate of Vaccination for yellow fever current) and hepatitis A, hepatitis B, Typhoid, and update your routine vaccines at your earliest convenience so you are ready for trip on a short notice.
- Since some travel vaccinations are administered in 2-3 doses over several weeks, advance consultation with Travel health professional improves your chances of staying healthy during your travel.
- Your Travel physician can prescribe antibiotic self treatment for travelers’ diarrhea and discuss if taking prophylactic medications is advisable for you.
- Get your anti-malarial medications if you are traveling to a malaria endemic area. It is imperative that you take all of your medications exactly as prescribed. In addition to taking anti-malaria prophylaxis medication, you should wear protective clothing and use mosquito repellants containing 30-50% DEET.
- Get advice on Jet Lag as it decreases mental acuity and cause insomnia, and you may require a prescription medications to help you transition to new time zones at your destinations.
- Have your First aid kit ready and restock it after your trip. We carry many different kinds of First aid kits.
- Pack all medications and supplies in your carry-on luggage.
- Bring copies of your prescriptions.
- Know where to obtain emergency medical care abroad if you need it. Get a list of English speaking doctors, clinics and hospitals from your Travel health provider.
- Consider additional Medical and Evacuation insurance if required, check with your insurance as what kind of coverage you have while traveling abroad.
- Prepare for your business trip early to receive maximum vaccine protection and other health information to keep your trip healthy
Cruise travel is becoming much more popular as it provides a wonderful experience it poses certain health concerns as well because of large number of passengers and crew from various cultures and background and may be a potential source of communicable diseases.
Some major health risks with cruise ship travel:
Influenza: occurs among cruise ship passengers year-round all across the globe. As crowded conditions on the cruise ships increase person-to-person spread. Consider updating the flu vaccine before your trip and discuss with Travel physician regarding chemoprophylaxis in certain high risk situation.
Diarrhea/GI illness can be caused by many different types of bacteria and viruses. Norovirus is especially happens in outbreak situation as it is easily transmitted, has the ability to survive routine cleaning procedures and has been implicated in many cruise outbreaks. Good hand and personal hygiene helps to prevent this illness.
Legionnaires’ disease has caused pneumonia outbreaks on cruises in the past. Passengers typically develop symptoms upon completion of travel. Contaminated ships’ whirlpool spas and water supply systems are the most common sources.
Motion sickness, a common problem in travelers, usually causes mild to moderate discomfort but can be incapacitating in certain situations. Women and children ages 2-12 years are more prone to motion sickness and can present with abdominal discomfort, nausea, vomiting, dizziness and cold sweats. If you are susceptible to motion sickness talk to your travel physician take precautions to minimize your symptoms. Some helpful tips to avoid motion sickness include:
- Try to choose a cabin in the center of the boat, the center of the boat has less movement and decreases your chances of having motion sickness.
- If you know that you are susceptible to seasickness, consider using prophylactic medication. Talk to your physician which medication is right for you.
The options are:
- A Scopolamine patch (Transdermal) should be applied behind the ear at least 4 hours before departure and changed every 3 days as needed. You may experience dry mouth.
- Many antihistamines are effective for prevention of motion sickness. Dimenhydrinate (Dramamine) is available without a prescription and is safe in children over age 2 and pregnant women. For persons above 12 year of age and are non pregnant other options include Meclizine (Antivert) is available with and without prescription. It is taken once daily. Promethazine (Phenergan) is available by prescription. Some people use Pressure point bracelets but they have not been proven effective.
- Bring extra medication to cover unexpected trip delays.
- Pack all medications and supplies in your carry-on luggage.
- Bring copies of your prescriptions.
- Prepare or purchase a First Aid Kit.
- Bring an extra pair of prescription eyeglasses and extra contact lenses. Know your number or Carry copies of your eyewear prescriptions.
- Have a list of English speaking doctors, clinics and hospitals.
- Check with your insurance company about medical insurance policy coverage abroad. Confirm that it covers emergency evacuation and if required purchase supplemental medical insurance.
Students travel to different parts of the world even some time to remote areas. Whether you are spending a week, year or a semester abroad, taking precautions helps to prevent different forms of Tropical diseases, accidents and injuries. Most of the time studying abroad programs is generally planned long in advance. Please take this opportunity to get yourself ready for your and get proper immunizations depending upon your destination and get advice on how to stay safe while studying abroad. High school and college students traveling to a foreign country, who are unfamiliar with the language and culture, must be particularly vigilant in their daily activities and especially when engaging in financial transactions, accepting social invitations or entering into personal relationships. The culture and social values may be different then your home.
Some Helpful Tips:
- Schedule an appointment with a Travel physician to receive recommended travel vaccinations and update your routine immunizations.
- The recommendations regarding your safety and immunization depend on your itinerary, the length of your visit, your accommodations and whether you will be staying in urban or rural areas.
- If you will be staying for long the recommendations may also include some vaccines which you may not require in short stays like Rabies , Japanese encephalitis
- Students frequently travel on a low budget and may make money saving decisions that put them at risk. Taking a few precautions may decrease these risks.
- Consume only hot foods at buffets and avoid food from street vendors.
- Wash hands and use hand sanitizers frequently.
- Use DEET lotion and pre-treated bed netting if you are in malaria risk areas.
- Have accommodations with window screens; otherwise keep windows closed.
- Have accommodations with safety doors and window locks.
- Use common sense when you are out and dealing with anyone.
- Always keep your identification with you.
- Register with the consulate on your arrival
- If you’re traveling from your place of residence, always inform someone about your destinations and plan.
- Travelers whose itineraries will take them to altitude above 6,000-8,000 ft are at risk of altitude sickness. Altitude sickness is the result of traveling to a high altitude faster than the body can adapt to the new altitude.
- You can be exposed by flying, driving or climbing to high altitude
- Travelers with underlying chronic problems especially lung and heart problems may be at increased risk.
- The altitude sickness ranges from a mild disorder to a life threatening neurological disease. Symptoms develop as oxygen supply decreases.
- The altitude sickness can be a mild Acute mountain sickness characterized by a throbbing headache, nausea and dizziness or it can be a complicated leading to High-altitude pulmonary edema (HAPE) and High-altitude cerebral edema (HACE)
A Few Key Points:
- Learn early symptoms of altitude sickness and be willing to admit that you have them.
- Climb slowly and limit your ascent to 2,500 – 3,000 feet daily.
- Never ascend to sleep at higher altitude, If possible, descend to a lower altitude for sleep.
- If acute mountain sickness is suspected, do not climb further until symptoms resolve.
- Never climb alone.
- If more serious symptoms develop, such as confusion or an unsteady gait, descend immediately.
- Discuss with a Travel Clinic Physician if you should take medication to prevent and treat Altitude sickness.
- Scuba divers can face risks of serious complications including ear barotraumas, decompression sickness and arterial gas embolism.
- Diving abroad may be more hazardous as compared to US.
- Follow established diving principles to avoid serious illnesses, which can be fatal.
- Avoid high altitude activities for 24 hours after diving, including air travel and mountain climbing, in order to decrease the risk of decompression illness.
- Dive conservatively and stay well within your limits.
- Dive only with a reputable diving outfit.
Some helpful tips:
- If you are planning to become pregnant consider preconception immunization to prevent diseases and transmission of diseases to offspring.
- Since most of pregnancies are unplanned, consider maintaining current immunizations.
- If you receive any live vaccine (MMR, Yellow Fever) defer pregnancy for at least 28 days.
- If you are not immune to varicella or rubella, consider getting these vaccines in post partum period.
- Healthy pregnant women may be safe to travel to most destinations but consider postponing your trip if you are traveling to a malaria or yellow fever endemic area.
- If you have to travel, the best time to travel is in the second trimester (especially18-24 weeks)
- If you develop diarrhea, use rehydration salt and talk to your travel physician before travel about getting prophylactic antibiotics and anti-diarrheal medications.
- Commercial air travel poses no special risks to a healthy pregnant woman or her baby. Lowered cabin air pressure, airport metal detectors and cosmic radiation during routine flights will not harm you or your baby. Check with the airline before booking a flight. Some airlines may require a physician’s written permission to travel. Walk every half hour during flight and flex your ankles frequently to prevent deep venous Thrombosis, Pregnant women are more susceptible to blood clots. Fasten the safety belt under your abdomen across the top of your thighs. Drink plenty of fluids. Low humidity in the cabin increases the risk of dehydration.
- Bring a first aid kit containing medications approved by your physician for use during pregnancy.
- Get a list of English speaking doctors, clinics and hospitals at your travel destination.
- Evaluate your U.S. medical insurance policy coverage abroad. Verify that it covers emergency evacuation. Purchase supplemental insurance if necessary.
- Consult with your physician before making any travel decisions.
- Schedule a consult with Travel Health professional early to discuss travel recommendations and receive vaccines which are safe during pregnancy.
Potential Contraindications to International Travel
Some Obstetric Risk Factors:
History of miscarriage, incompetent cervix, history of ectopic pregnancy or premature labor, Multiple gestations, threatened abortion, fetal growth abnormalities, history of toxemia with pregnancy, high risk pregnancy.
Some General Risk Factors:
History of thromboembolic disease, pulmonary hypertension, severe asthma, valvular heart disease (NYHA III or IV), cardiomyoplathy, severe hemoglobinopathies.
Potential Hazardous Destinations:
High altitude, Endemic areas for life threatening food or insect borne diseases, resistant malaria areas, yellow fever endemic areas.
Malaria and Pregnancy
Malaria during pregnancy can very risky not only for mother but also for baby. It is best to avoid malaria areas but if you have to travel, discuss with your Travel physician which type of prophylaxis is right for you. Try to stay indoors, use protective clothing pre treated with permetharin, use mosquito nets and use repellents like DEET (30-50%) to exposed skin. Use precautions while using DEET and wash off when back indoors.
Visiting Friends & Family
Non-US born citizens or non-residential persons who are visiting friends and family in a developing country or returning to their home country may be at a higher risk than tourists for becoming ill.
You may not be aware that your naturally acquired immunity to life-threatening diseases, like malaria, decreases with time spent away from your birth country.
Infectious diseases, such as typhoid fever, malaria, tuberculosis and hepatitis A are more common in persons visiting friends and family as compared to other groups of international travelers for several reasons because they tend to have longer trips and travel to higher risk destinations. They stay in private homes where it may be more difficult to adhere to safety precautions.
This group needs extra precaution and should talk to the travel physicians for proper advice on immunization and prevention of other travel diseases like malaria, diarrhea as well as other diseases endemic in their native countries.
There is a common saying that there are two types of travel “travel first class or travel with children”. Traveling with children brings extra excitement and additional challenges. According to new law all Children need their own passport. The person applying for the passport must demonstrate that both parents consent to the issuance of a passport to the child or that the applying parent has the sole authority to obtain a passport. Any child departing the United States with only one parent, a guardian, grandparents or other adults, must have written and notarized permission from both birth parents and legal guardians to enter different countries.
Update routine immunizations and administer travel related vaccines. Consult with a travel physician regarding recommendation on different immunization, Consider rabies vaccine if you are traveling to developing countries and planning a prolonged stay. Rabies is transmitted through the saliva of infected animals. Children are more likely to approach stray animals and may not report being bitten.
Mosquito borne illnesses especially Malaria is a serious disease, especially in children. While complete protection against malaria and other mosquito borne illnesses like dengue cannot be guaranteed, avoiding mosquito bites and taking preventive medications greatly reduces the risk especially against malaria. Discuss with your travel physician which medication is most appropriate for your child.
Missionaries have greater health risks as they typically travel to:
- remote locations
- stay for longer periods of time
- closer contact with local populations
- stay with locals most of the time
Get yourself ready for the mission
- See your physician and dentist before your travel.
- Talk to the adviser who has already visited your destination.
- Attend the mission’s seminar before the trip.
- Schedule an appointment with a Travel physician as soon as your mission destination is finalized.
- Update your routine immunizations
- Recommended travel vaccinations will depend on your age, health status, destination, itinerary and length of stay.
- As Hepatitis A and Typhoid are transmitted from food and water, these are generally recommended for most destinations, along with others like Hepatitis B, Yellow Fever, Rabies, Japanese Encephalitis and others depending upon your destination.
- If you are traveling to a Malaria endemic area, you will need prophylactic medication.
General safety advice
- “Boil it, cook it, peel it, or forget it”.
- Avoid mosquito and other insect bites by using DEET repellants
- Use Permetharin treated clothing.
- Sleep under a permetharin treated net.
- Try to stay indoors between dusk and dawn.
- Use caution with eating local food and drinking local water, which may cause diarrhea.
- Have a First Aid Kit
- Bring sufficient supplies of prescribed medications and pack them in your carry-on luggage. Medical care abroad may not be as adequate as in the US.
- Check with your mission office to ensure proper insurance and evacuation plans.
- Get a list of qualified English speaking physicians abroad from your travel health physician.
Travel for Adoption
Over the past decade, the number of international adoptions has increased tremendously. The majority of these children are adopted from Asia, Eastern Europe, Central America and the Caribbean.
As a consequence of inadequate medical care, these children may be infected with different diseases like Tuberculosis, Hepatitis, parasitic infections and other diseases including communicable diseases. Adopting a baby from a developing country carries increased health risks for your entire family. These can be minimized by following safety precautions.
Before your trip not only update your immunizations, obtain proper travel vaccines according to your itinerary but update the household immunizations as well as they may be exposed to any communicable disease from the adopted child. Please visit the section on general precautions for safety.
Try to get the health records of the adopted child and circumstances the child was living in and have the child complete medical checkup on arrival to the US.
Chronically Ill Traveler
Travelers with chronic illness, such as diabetes or emphysema add challenges to their travel. Advance planning is the key to a successful trip. Consult with your primary physician and specialists well in advance of your trip to discuss how travel may affect your condition. Discuss how to handle emergencies and have written plans. Travel Clinic physician can help coordinate your care for chronic diseases.
Please take the copies of recent EKG, laboratory and x-ray results on your trip. Have the names and telephone and fax numbers of all of your treating physicians. Schedule an appointment with a Travel physician as soon as you know your travel plans. You may need additional health and travel shots and some of the travel immunizations may be contraindicated, especially if you are immunocompromised.
Try to have extra medication with you in case you are unexpectedly delayed on your trip. Pack all medications and supplies in your carry-on luggage and bring copies of your prescriptions. Bring a first aid kit packed with over the counter medications approved by your physician. The medication you take may not available outside US and if available may not meet US standards. Consider purchasing medical evacuation insurance.