Travel abroud precautionsBy BILL MCKELL,
Although travel can be a highly enriching experience, it can also present health dangers. When advising folks about their travel abroad, one needs to know their itinerary, because risk varies among and within countries.
Travelers should prepare for the unexpected and take at least an extra two-week supply of chronic medications, proof of vaccinations, prescriptions (including a letter on physician’s stationery if controlled or injectable meds are carried), and eyeglasses. Travelers with chronic health problems should take a summary of their current health status, including a recent EKG/EEG, if appropriate. One should determine in advance if their health insurance provides coverage abroad, Medicare and Medicaid do not. If one does not have coverage abroad, they might consider purchasing short-term travel health insurance.
Specific Advice for Potential Health Problems:
Accidents: Accidents are a leading cause of major health problems for travelers. Driving habits may differ from those in the U.S.
Altitude: Altitudes above 7,000 feet may cause acute mountain sickness (AMS) characterized by dizziness, headache, fatigue, chills and/or vomiting. More severe illness, characterized by extreme shortness of breath (high-altitude pulmonary edema) or extreme lethargy (high-altitude cerebral edema) may occur. Folks should acclimate to higher elevations prior to strenuous activity. Tobacco and alcohol should be avoided. Acetazolamide (Diamox) can be used to prevent AMS. Rest and further acclimatization may be all that is needed for mild symptoms. For more extreme symptoms, such as mental status changes or significant shortness of breath, the traveler must descend immediately.
Animal exposure: Rabies, for example, is endemic in many developing countries. Travelers should avoid petting or any contact with unfamiliar animals.
Medications: One reason why you were earlier advised to take your meds is that those purchased overseas may be counterfeit, ineffective, or even unsafe.
Sexually transmitted diseases (STDs): STDs are more prevalent and are more likely to be antibiotic resistant in many countries than in the U.S. 'Nuff said?
Sun exposure: In tropical countries, at high altitudes, and on snow and water, sun exposure can be more intense than expected. One should use a broad spectrum sunscreen (SPF at least 30 with UVA and UVB protection) and wear a wide-brimmed hat and sunglasses.
Swimming: Swimming areas (except in chlorinated pools) may have infection- causing “bugs” from sewer or land runoff. Feet should be covered. One should ask someone about the incidence of schistosomiasis (English-speaking natives will understand).
Arthropod-borne diseases: Arthropods (insects) are not only a source of bites, but they can transmit serious, potentially life-threatening diseases including malaria, yellow fever, dengue, Zika (mosquitoes), viral encephalitis (mosquitoes, ticks), and plague (fleas).Vaccines are available to protect against some of these (yellow fever, plague, tick-borne and Japanese encephalitis). Antibiotics may help avert others (malaria, typhus) and avoidance of exposure to the bug whenever possible is the primary means of preventing infection.
Minimize evening walks in the countryside, and wear light-colored, long-sleeved shirts and long pants.
Wear footwear at all times and always shake before putting it on (scorpions love warm, dark places).
Use insect repellant on exposed areas of the body (DEET) and clothing (permethrin).
Sleep in air-conditioned or well-screened rooms or under bed nets in areas where the above-mentioned diseases are present.
Prior to sleep, spray room/net with a permethrin spray.
Avoid perfumes, scented soaps and aftershave, especially in the evenings.
Malaria prophylaxis: Travelers visiting countries with malaria risk should take prophylactic medication. Which regime is recommended depends on the specific mosquito and resistance patterns in the area.
Diarrheal illnesses: Diarrhea is a frequent problem for Americans traveling abroad. To prevent diarrhea, avoid water and insufficiently cooked foods. Avoid food (other than commercially processed bread) that isn't boiled, steaming hot, washed, and peeled by the traveler. Avoid food from street vendors. Ice, unless made with safe water should not be taken in drinks – room temperature scotch sure beats no scotch! Safe beverages include:
Boiled water beverages – tea or coffee;
Canned/boxed fruit juices; and
Bottled/canned alcohol containing beverages.
Recommendations for water treatment include:
Heat water until vigorous boiling is achieved.
Use iodine tablets as directed. Use five drops of tincture of iodine per quart of water and wait 30 minutes.
Use chlorine dioxide tablets as directed. The amount of chlorine bleach depends on the chlorine concentration – 10 drops of 1 percent bleach, 2 drops of 4 percent-6 percent bleach, or 1 drop of 7 percent-10 percent bleach per quart of water.
Use a portable filter available at sporting goods stores or in their product catalogs.
Pepto-Bismol, two tabs four times a day for short periods has been shown to reduce the incidence of travelers' diarrhea. One should avoid this drug if he/she is on large doses of aspirin or on warfarin (Coumadin). Pepto-Bismol can cause black stools – don't panic in fear of GI bleeding. Treatment for diarrhea should begin with fluid replacement. One should avoid dairy products, alcohol, tea, and coffee. Imodium or Lomotil may decrease cramping and the number of stools, but do not alter the process causing the diarrhea – consider the option however - unresolved diarrhea while flying, on a bus, or driving a rental car and having no clue as to where the next rest stop may be! Medical evaluation may be needed if the diarrhea is very severe or persists despite self-treatment.
Vaccines: One's itinerary will determine what vaccines are recommended. Reactions consisting of pain, redness, and swelling at the injection site are not uncommon, and some will have low-grade fever, headache, and malaise. These minor reactions usually resolve within 48 hours and may be treated with aspirin or Tylenol.
Don't procrastinate, for one needs to receive vaccinations well before they travel – one to two months is often needed so that all regimens can be completed before leaving home and before exposure. A card listing all vaccines administered should be issued, including a yellow fever stamp.
Dr. William McKell is a Northsider.