General Health Precautions:

More than 50 million people from industrialized nations travel to developing countries each year. Such trips can pose significant health hazards. Travelers who plan to visit developing or tropical countries, as well as those embarking on prolonged vacations or arduous treks should take a number of precautions.

Medical Preparation

A visit to the doctor is very important in preparing for travel to a developing nation. Since many doctors may find it hard to keep abreast of medical trends in foreign countries, a local travel clinic may be especially helpful. In addition, the Centers for Disease Control and Prevention maintains a Traveler's Health web site (wwwn.cdc.gov/travel). The site covers news about dangerous disease outbreaks around the world, safety guidelines, and detailed disease information about diseases of particular concerns to travelers.

• Travelers to developing countries should have a thorough check-up and prepare for any health situation at least 4 - 6 weeks before the trip. Be sure to make the appointment, even if this much advance preparation time is not possible.
• Take a brief summary of your medical history with you on your trip. This summary should include results of abnormal tests or electrocardiograms (EKGs) and a list of any drug allergies you have.
• Take along a list of medications you normally use, noting all trade and generic names as well as dosages. In addition, the doctor should give you a letter authorizing any necessary medications; this precaution will facilitate customs and security checks.
• If you wear contact lenses, ask your doctor about taking along ocular (eye) antibiotics.

Immunizations

The following are general guidelines for vaccinations for travelers: Travelers to developing countries should check with the U.S. Centers for Disease Control, U.S. State Department, or World Health Organization for the latest information on immunization requirements at their destinations. A visit to a travel clinic will also furnish this information. Studies indicate that multiple vaccines may be given at the same time to most adults, without significantly increasing adverse effects.

Routine vaccinations. Adults and children should make sure routine vaccinations are up-to-date. Travelers visiting developing countries may need booster doses. Depending on a person's age, immunization history, medical condition, and travel plans, recommended vaccinations may include:

• Tetanus-Diphtheria-Pertussis: Pertussis (whooping cough) has been added to the tetanus-diphtheria vaccine. The Infectious Diseases Society of America recommends this triple vaccine for infants, children, and adults. Infants and children are generally vaccinated against these three diseases, but until recently teens and adults did not receive whooping cough immunizations. Travelers who require tetanus boosters should check with their doctor about receiving the new DTaP vaccine.
• Hepatitis B: Hepatitis B vaccination is recommended for people traveling to countries with a high prevalence of hepatitis B. The hepatitis B vaccine is especially important for people who expect to have close or sexual contact with the local population. Blood transfusions and receiving tattoos are other common means of exposure to hepatitis B.
• Hepatitis A: Vaccination against hepatitis A is recommended for all travelers to developing countries.
• Haemophilus influenza b (Hib): Infections with the Hib bacteria can cause meningitis, pneumonia, and other potentially life-threatening diseases. Babies should receive 3 doses of Hib vaccine, usually at 2, 4, and 12 months of age. All children under 5 should receive this vaccine. Older children and adults who are immunocompromised, have no working spleen, or have sickle cell disease should also be vaccinated.
• Mumps: Infection with the virus that causes mumps can lead to severe complications, such as deafness or meningitis. The mumps vaccine is part of the MMR (measles-mumps-rubella) combined vaccine. Children should receive 2 doses, the first at 12 - 15 months and the second dose at least 28 days after the first, but usually by the age they enter school. Anyone who was born after 1956 and has not had these diseases should be vaccinated.
• Rubella: Rubella can cause birth defects if a pregnant woman becomes infected with the virus. The rubella vaccine is part of the MMR (measles-mumps-rubella) combined vaccine. Children should receive 2 doses, the first at 12 - 15 months and the second dose at least 28 days after the first, but usually by the age they enter school. Anyone who was born after 1956 and has not had these diseases should be vaccinated. Women should not become pregnant within 3 months of vaccination.
• Rotavirus: Rotavirus causes severe, sometimes life-threatening, diarrhea in babies and young children. Babies should receive 3 doses, the first by 12 weeks of age, the last by 32 weeks of age.
• Varicella (Chickenpox): The chickenpox vaccine is normally given to babies in 2 doses, one at 12 - 15 months and the second dose at least 3 months after the first, but usually by the age the enter school. Those older than 13 who were neither vaccinated nor had chickenpox should get 2 doses at least 28 days apart. A combined measles-mumps-rubella-varicella (MMRV) vaccine is available. The CDC reports, however, that fever and rash are more common with the MMRV vaccine than with separate administrations of the MMR and chickenpox vaccines.
• Polio: Polio still exists in parts of Asia and Africa. Babies should receive 2 doses of the vaccine, and a booster dose between the ages of 4 and 6 years. Adults who plan to travel to areas where polio still exists should check with their health care provider or travel clinic about the need for polio vaccination or booster. Since 2000, the only form of polio vaccine given in the United States is the inactivated vaccine.
• Pneumococcal Vaccine (PPV23): Pneumococcal disease can cause fatal pneumonia, and life-threatening blood infections and meningitis. Adults may benefit from the pneumococcal vaccine if they are aged 65 and older, have chronic heart or lung disease, are diabetic, or have certain conditions that compromise their immune systems (such as cancer or AIDS). Children over the age of 2 with the same immune-compromising conditions should also receive the vaccine. NOTE: A different pneumococcal vaccine is available for infants and toddlers (under 5 years of age). The PCV7 vaccine is currently a routine vaccination for the very young, and is not meant for use in adults and older children.
• Influenza: Upper respiratory infections are very common after foreign travel. The influenza vaccine may be recommended when traveling to any country during flu season, particularly if you are elderly or at risk for serious illness.

Depending upon travel destination, some countries may require vaccinations against yellow fever, meningitis, typhoid, cholera, Japanese encephalitis, and rabies. Some of these diseases are covered in this report.

Other Preventive Recommendations

Tuberculosis: Travelers to areas with tuberculosis (TB) outbreaks should have skin tests before traveling; those with negative tests should have a repeat test 2 - 4 months after they return.

Malaria: Travelers to countries with malaria should take preventive drugs. Recommendations vary depending on destination, since resistance to different antimalaria drugs is widespread in some areas.

Immunocompromised Patients: Immunocompromised patients may need to take extra precautions in addition to the recommendations in this report. Patients with a compromised immune system should discuss their travel plans with their physician.

Pregnancy: Recommendations regarding vaccination and travel medications may be different for pregnant women, and should be discussed with a physician. Pregnant women should have vaccinations appropriate to their trimester. Not all vaccinations and preventive medications are appropriate during pregnancy.

Meningococcal vaccine: A vaccine against one of the types of the bacteria that causes meningitis is recommended for travelers to areas in which the disease is common, such as sub-Saharan Africa. This vaccine is also required by the Saudi Arabian government for all travelers to Mecca during Hajj. Two types of the vaccine, MPSV4 and MCV4, are available in the United States. Children aged 2 - 10, and adults over age 55, should receive the MPSV4 vaccine. Vaccination is also recommended for incoming college freshmen.

First Aid Kits and Other Supplies

First aid supplies for travelers should include:

• Sunblock (15 SPF or higher)
• Topical (skin) disinfectants
• Bandage materials
• Insect repellent
• Thermometer
• Any prescription drugs you take regularly
• Antifungal foot powder
• Hydrocortisone cream for rashes
• Loperamide (Imodium) for diarrhea
• Pepto-Bismol for diarrhea
• Devices or supplies to purify or filter water
• Nonprescription pain reliever

Note: Acetaminophen, the generic name for Tylenol, is known as paracetamol outside the United States.

Insurance

Travelers should remember to check what coverage their health insurance company offers for policyholders abroad. Medicare does not provide coverage outside the United States, but other insurers offer limited coverage overseas. Individual supplementary health insurance policies should cost no more than a few dollars a day for international travelers. Air ambulance insurance is also a wise investment that can be purchased through travel agencies before leaving the U.S. Additionally, you may want to take along the phone number and address of the U.S. Embassy or Consulate in your destination country, in case you need the name of a doctor to contact after you arrive. While abroad, you can obtain the location of your nearest U.S. Embassy or Consulate by calling 00 1 202-501-4444.

When You Return

If you develop any symptoms of illness upon your return to the United States, be sure to contact your doctor immediately. Let your doctor know where you have been, in addition to what symptoms you are experiencing.