Every year millions of Americans travel abroad. Many spend time in rural areas or developing countries, where the likelihood of contracting an infectious disease is higher. Throughout history, infectious diseases have spread through travel and mass migration. In this era of globalization, travel has become an even bigger factor in the spread of these diseases. In response, many medical facilities are establishing clinics that focus on international or geographic medicine. "Overall, it's becoming easier to travel just about anywhere in the world," says Abinash Virk, M.D., a specialist in infectious diseases and director of the Travel and Geographic Medicine Clinic at Mayo Clinic, Rochester, Minn. "As a result, more people are picking up rare or exotic diseases that you wouldn't expect to see in the United States. Therefore, it's important to see a physician who can recognize and treat these diseases and who understands geographic disease variations so that travelers can be educated on prevention." During the past decade, hundreds of travel clinics have been established across the United States. Services at such clinics vary widely — from vaccinations and informational handouts to overviews on infectious diseases. Some travel clinics are staffed by doctors trained in travel and tropical medicine and are better able to assess individuals returning to this country with diseases acquired outside the United States.
Causes of Travel And Health
Most deaths of travelers to other countries stem from traffic accidents or pre-existing conditions, such as cardiovascular disease — not from a disease picked up while abroad. Your risk of death from a motor vehicle accident is much higher in developing countries than in the United States. If you drive in a foreign country, use your defensive driving skills, especially at night, when most alcohol- and drug-related accidents occur. If you rent a vehicle, insist that it have seat belts. Inspect the vehicle to make sure the brakes, tires and lights are in good working order. Although infectious diseases account for nearly half of all illnesses and deaths among the inhabitants of many developing countries, your risk of catching one depends largely upon your itinerary and length of stay. Among the most common infectious diseases travelers incur are traveler's diarrhea and upper respiratory infections, such as the common cold. Only on occasion do epidemics, such as bubonic plague in India, diphtheria in Russia, and Ebola in parts of Africa, present a much more serious threat. Individuals who live in developing countries for months or years are at a higher risk of picking up infectious diseases than the typical tourist, who spends only a week or two abroad. "In addition to reviewing and addressing your general medical health prior to departure, it's important to take steps to minimize your risks of infectious diseases as well as the risks related to alcohol, accidents, sexually transmitted diseases, high altitude and deep-sea diving," Dr. Virk says.
Signs and Symptoms of Travel And Health
Preventive measures If you're headed for developing or tropical areas, obtain a consular information sheet from the Office of Overseas Citizens Services. These provide information on health and security conditions. Discuss your itinerary with your doctor at least 6 weeks before departure. This will allow time for immunity to develop after vaccinations are given. Some vaccinations are required for entry into certain areas. Others are optional. A review of your medical history, current diseases, medications and allergies also is a good idea. Department of State, Bureau of Consular Affairs, Office of Overseas Citizens Services
Time of year and length of visit will figure into your decisions on vaccinations and other preventive measures. If you plan to stay longer than 4 to 6 weeks in any country, plan to start your vaccinations about 6 months before leaving home because you may need the hepatitis B vaccination series, which can take as long as 6 months to complete. Give yourself plenty of time to update routine immunizations such as tetanus; measles, mumps and rubella; polio; and influenza. If you're traveling to places other than Canada, Australia, New Zealand, Japan and Western Europe, consider getting a hepatitis A immunization. If you're traveling to areas with a high prevalence of hepatitis B, such as Southeast Asia, Africa, the Middle East, some Pacific islands and the Amazon, ask your doctor well in advance about getting a hepatitis B vaccination. If your itinerary includes developing countries, consider a typhoid vaccination in addition to a hepatitis A immunization, especially if you're planning to be there for more than 3 weeks, are planning to backpack or are an adventurous eater. If you're heading for certain areas of South America or Africa, you may need to be immunized against yellow fever. If you're staying more than a couple of weeks in certain parts of Southeast Asia, your doctor may recommend vaccination against Japanese encephalitis, especially during certain seasons or if you plan to stay in rural areas or participate in significant outdoor activity. The vaccination is a series of three doses given over a period of a month, and has to be completed at least 10 days before departure. Once again, planning ahead is extremely important. Rabies is pervasive worldwide, especially in developing countries. It's fatal unless you receive prompt treatment or have taken preventive steps prior to departure. The Centers for Disease Control and Prevention has guidelines for the use of a pre-exposure vaccine against rabies. In areas where rabies is present, don't pet dogs, cats or other domesticated animals and avoid contact with wild animals. If an animal bites you, especially in an unprovoked attack, consider it a medical emergency and seek medical care immediately. Over the last decade the number of cases of malaria entering the United States, Canada and Europe has increased. Malaria is a serious disease and is still extremely common in a number of countries. If you're visiting parts of Africa, Asia, South America, Mexico or Central America, you can protect yourself against malaria by taking chloroquine phosphate (Aralen), mefloquine (Lariam) or another antimalarial drug, depending on the area you are planning to visit. Check with your doctor or your local travel clinic to learn the current recommendations for preventive treatment. You usually need to begin taking your antimalarial medication 1 to 2 weeks before leaving. Don't take the anti-malarial drug Lariam if you have active depression or a recent history of depression, a generalized anxiety disorder, psychosis, schizophrenia or other major psychiatric disorders, or a history of convulsions. If you take Lariam and psychiatric symptoms such as acute anxiety, depression, restlessness or confusion occur, immediately stop using the drug and substitute alternate medication. Mosquitoes and other insects spread many travel-related illnesses. Repellents that contain DEET with a concentration of 25 percent to 35 percent are among the most effective and are safe for adults and children. Apply insect repellent only to exposed skin and wash it off as soon as possible. You can get additional protection from insects by wearing Permethrin-coated clothing and using bed nets. Mosquito repellents: To DEET or not to DEET?
Other dangers may not be readily apparent. Swimming in contaminated water may result in skin, eye, ear, intestinal tract and internal infections. "You want to think twice before you jump into a lake or other body of water, no matter how inviting it looks," Dr. Virk says. Generally only pools that contain chlorinated water should be considered safe for swimming. Overall, salt water is safer than fresh water, although jellyfish and other stinging or biting creatures can be a hazard. Avoid beaches that could be contaminated with sewage or animal feces. Counseling on sexually transmitted diseases is appropriate for individuals who practice risky behaviors while traveling. Studies suggest a low rate of condom use among travelers and ignorance in many foreign countries about the risks of human immunodeficiency virus (HIV) infection.
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Medical Content Last Updated on 07/12/2008
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