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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
use the Internet to find general travel health information. Just make sure that the
information is up-to-date and from a reliable source. See the following websites before you travel:
Vaccines that may be recommended include those for:
If you plan to visit an area where malaria is common, start taking medicine ahead of time to prevent malaria infection.
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
you become seriously ill while traveling, your country's embassy or consulate
can help you find medical care. If you become ill with a fever or flu-like
illness while traveling in malaria-risk areas, get medical help right
Diarrhea is the most common illness to strike travelers. Most cases of traveler's diarrhea get
better in 1 to 3 days without treatment. But see a doctor if diarrhea lasts
longer than 7 days, or if you have a high
fever, blood or mucus in your diarrhea, or signs of dehydration.
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:
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.
Learning about healthy travel:
Staying healthy while you're traveling:
Health Tools help you make wise health decisions or take action to improve your health.
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 so you'll have time to get vaccines or make other health preparations.
use the Internet to find general travel health information. Just make sure the
information is up-to-date and from a reliable source. See the following websites before you travel:
Check with the
nearest travel health clinic, your regional health department, your doctor, or one of the websites listed above to see what kind of
vaccines you should get. In the United States, most state health clinics can give
you travel vaccines, some medicines, and healthy travel tips.
See your doctor or go to a clinic several months before your trip, or as soon as you can. Some vaccines need to be given in more than
one dose. For example, if you need protection from hepatitis A, you'll need two doses of hepatitis A vaccine spaced at least 6 months apart.
You may need vaccines to protect against:
immunizations may be needed depending on the area you are visiting, how long
you will be there, and the purpose of your journey. For example, if you will be
trekking in rural Asia for a month or longer, you may need a vaccine for Japanese encephalitis(What is a PDF document?).1
A vaccine for traveler's diarrhea and
cholera, called Dukoral, has been approved in Canada
and Europe. But it is not available in the United States.
To learn more, see the topic
Ask about a prescription
for antimalarial drugs if you will be visiting an area that has
malaria. This includes large
areas of Central and South America, Haiti and the Dominican Republic, Africa,
the Indian subcontinent, East Asia, Southeast Asia, the Middle East, and many
South Pacific islands.
You may need to take one of several different preventive
medicines, depending on the type of malaria parasite in that part of the world.
These medicines need to be taken daily during your travels and for a specified
time after you return. It is important to take all the tablets you were given.
This may mean taking antimalarial tablets for several weeks after you get home.
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.
Traveling comes with a
whole new set of things to think about. The following can help you stay healthy
and enjoy your trip as much as possible.
Flying isn't always fun. But you can take steps to
make it easier and to feel better during and after your flight.
If you have a fear of flying, talk to your doctor. He or
she may recommend medicines, hypnosis, or
relaxation exercises to help you feel less
Contaminated water and food are the most common cause of illness in
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
To learn more, see the topic
Food Poisoning and Safe Food Handling.
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. For more information, see the topic
Marine Stings and Scrapes.
Mosquitoes, flies, fleas,
and ticks all spread disease. These diseases include malaria, Lyme disease,
West Nile fever,
yellow fever, and dengue fever.
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. For
information on how to prevent tick bites, see the
Here are some tips that can help you avoid mosquitoes and other insects:
Do not use home remedies like eating garlic, rubbing garlic on your
skin, or taking vitamin B. They do not prevent bites.
Many travelers underestimate the sun's strength and overestimate the
amount of protection their sunscreen offers. This can add up to at least an
uncomfortable sunburn and, at worst, life-threatening
Steps you can take to protect yourself from the sun include using sunscreen, wearing a hat, and drinking plenty of fluids.
disease is a big risk while you are traveling, you should also be aware
of the risk of injury.
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.
Altitude sickness happens when you can't get enough
oxygen from the air at high altitudes. This causes symptoms such as a headache
and loss of appetite. The best treatment for altitude sickness is to go to a lower altitude. But if you have mild symptoms, you may be able to stay at the higher altitude and let your body get used to it.
Steps to prevent altitude sickness include eating breads, grains, and pasta and not flying directly from low altitudes to high altitudes. You may also be able to take medicine to prevent altitude sickness.
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:
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.
Traveler's diarrhea is the most common illness when traveling. Most cases get better
within 1 to 3 days without medical treatment.
Most doctors recommend trying to keep to your normal diet as much as
possible. If you are vomiting, this may be hard. Try drinking clear liquids.
Watch for signs of
dehydration, such as a dry mouth and dark-colored
urine. If possible, drink
rehydration drinks to replace lost fluids and
electrolytes. Before you go, buy dry packets of oral rehydration mix at a
See a doctor if diarrhea doesn't
subside or if you have a high fever, blood or
mucus in your stools, or signs of
dehydration. Watch closely for
signs of dehydration in children, because children with
diarrhea can quickly become seriously dehydrated.
Your doctor may be able to give you antibiotics to take if you get diarrhea. But some antibiotics can be dangerous if you have bloody diarrhea. Make sure you talk to a doctor before you take antibiotics for bloody diarrhea. And don't take antibiotics to prevent diarrhea.
medicines, such as those containing bismuth (examples include Bismatrol and Pepto-Bismol) or Imodium A-D (nonprescription) and Lomotil (prescription),
give relief from cramping and frequent stools. But you shouldn't take them if
you have a fever or blood or
mucus in your stools.
See a doctor right away if you have bloody diarrhea.
To learn more, see the topic Traveler's Diarrhea.
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. For example, 90% of travelers who
get malaria don't become ill until after they return home.2
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:
The CDC's Travelers' Health Web site provides health
information for the traveler. The Web site provides information on
immunizations that are needed for travel to various areas of the world. It also
provides information for safe travel, including traveling with children and
with people who have special needs. Information about current outbreaks of
disease in the world is also provided. The CDC is the leading federal agency
for protecting U.S. citizens' health and safety by providing credible health
information and health promotion.
Fischer M, et al. (2010). Japanese encephalitis vaccines: Recommendations of the Advisory Committee on Immunization Practices (ACIP).
MMWR, 59(01): 1–27. Also available online: http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5901a1.htm.
Spira AM (2003). Assessment of travellers who return
home ill. Lancet, 361(9367): 1459–1469.
Other Works Consulted
Centers for Disease Control and Prevention (2012).
CDC Health Information for International Travel 2012: The Yellow Book. New York: Oxford University Press. Also available online: http://wwwnc.cdc.gov/travel/page/yellowbook-2012-home.htm.
Advice for travelers (2012). Treatment Guidelines From The Medical Letter, 10(118): 45–56.
Basnyat B, Ericsson CD (2012). Travel medicine. In PS Auerbach,
ed., Wilderness Medicine, 6th ed., pp. 1694–1709.
Philadelphia: Mosby Elsevier.
Centers for Disease Control and Prevention (2010). Yellow fever vaccine: Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR, 59(RR–7): 1–27.. Also available online: http://www.cdc.gov/mmwr/pdf/rr/rr5907.pdf.
Committee to Advise on Tropical Medicine and Travel (2005). Statement on personal protective measures to prevent arthropod bites. Canada Communicable Disease Report, 31: 1–20. Available online at http://www.phac-aspc.gc.ca/publicat/ccdr-rmtc/05vol31/asc-dcc-4/.
Hill DR, et al. (2006). The practice of travel
medicine: Guidelines by the Infectious Diseases Society of America.
Clinical Infectious Diseases, 43(12):
Kanzaria HK, Hsia RY (2012). Mosquitoes and mosquito-borne
diseases. In PS Auerbach, ed., Wilderness Medicine, 6th
ed., pp. 883–900. Philadelphia: Mosby Elsevier.
Keystone JS, Kozarsky PE (2012). Health recommendations for
international travel. In DL Longo et al., eds., Harrison's Principles of Internal Medicine, 18th ed., vol. 1, pp. 1042–1051. New
Weller PF (2009). Health advice for international travelers. In EG Nabel, ed., ACP Medicine, Clinical Essentials, chap. 7. Hamilton, ON: BC Decker.
October 14, 2013
E. Gregory Thompson, MD - Internal Medicine & W. David Colby IV, MSc, MD, FRCPC - Infectious Disease
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