Travelers should see a physician before leaving for a trip if they are going to developing countries,they are visiting sites that are not on the usual tourist routes or traveling to high altitudes, they have chronic diseases that could be affected by travel,or they are visiting countries that require vaccinations before they allow travelers to enter the country.
The goal of a pre-travel medical evaluation is to help travelers protect themselves against (1) common diseases that may be mild but that will disrupt their trip and (2) less common diseases that may be serious or even fatal. All travelers need to be up to date on routine vaccines they would normally get if they were not traveling. For example, an annual influenza vaccination (flu shot) is recommended if traveling during influenza season. Travelers should also be up to date on tetanus vaccines. If a tetanus booster is needed, a physician may elect to use the Tdap vaccine that also provides continuing protect against adult pertussis. No immunizations are required for re-entry into the United States after travel. Some countries require you to provide an International Certificate of Vaccination or Prophylaxis prior to allowing border entry from certain countries, even if you are only stopping there to change planes, whether you are traveling to your destination or coming home.
What diseases occur in travelers, and how can disease be prevented?
They can pick up infectious diseases from contaminated food or water, from insect bites, animal bites, or from other people. Immunizations, medications, and simple precautions can reduce or eliminate the risk of many of these travel-related infections. While infectious disease is the most common concern for travelers, it is important to remember that the most common cause of death in travelers is motor-vehicle accidents. Be sure to look both ways before crossing the street, review traffic laws (especially in countries where people drive on the opposite side of the road), don’t get in a car with a driver who is drunk, and use seat belts and infant/child car seats if available both at home and when traveling.
Traveler’s diarrhea is the most common medical complaint in travelers, occurring in up to 50% of travelers to developing countries. It occurs when infectious organisms are inadvertently ingested by travelers, resulting in one to five days of loose stools. The stools are often watery and may be accompanied by abdominal cramps. Although not fatal, traveler’s diarrhea can cause dehydration, vomiting, low-grade fever, and discomfort to the point that some travelers have to change their itineraries. It is important to note that traveler’s diarrhea is not associated with bloody stools, severe abdominal pain, or high fever. These symptoms are suggestive of more serious conditions and should prompt medical attention.
Traveler’s diarrhea is spread when bacteria or other infectious agents such as viruses are ingested. Traveler’s diarrhea is most often spread through contaminated food or water, or by putting contaminated hands in the mouth. Even small amounts of contamination can cause infection. Although bacteria are the most common cause of traveler’s diarrhea, there have been outbreaks of diarrhea on cruise ships caused by viruses known as noroviruses. Noroviruses spread readily from person to person.
Travelers can get diarrhea in most areas of the world, but some countries pose a higher risk. High-risk areas include most of Asia, the Middle East, Africa, and Central and South America. Risk is increased if the traveler is adventurous with his or her diet, eats foods from street vendors, or travels to areas off the usual tourist routes.
may help prevent or shorten the duration of traveler’s diarrhea. All travelers should wash their hands often and understand basic food and water precautions (see “What is safe to eat and drink while traveling?”). However, it has been shown that even well-informed travelers often choose to eat foods that pose an increased risk of traveler’s diarrhea. Therefore, travelers at risk should carry in their first-aid kit an antimotility agent such as loperamide (Imodium; Kaopectate II; Imodium A-D; Maalox Anti-Diarrheal Caplets; Pepto Diarrhea Cont) and start taking it if they get symptoms. Bismuth subsalicylate (Pepto-Bismol) is also helpful.
Because bacteria are developing resistance to many antibiotics, many older antibiotics do not work, and those prescribed currently may not be effective in the future. Antibiotics also have risks of their own and do not protect against viruses or parasites; therefore, routine prophylactic antibiotics are not recommended for most travelers. However, many physicians recommend that travelers carry along an antibiotic to take in case they get diarrhea. Fluoroquinolones, such as ciprofloxacin, levofloxacin, ofloxacin, or norfloxacin, are the most commonly prescribed antibiotic; azithromycin (Zithromax, Zmax) or rifaximin (Xifaxan) are alternatives. If an antimotility agent (a drug that reduces gastrointestinal motility) and an antibiotic are started at the first sign of diarrhea, symptoms may be shortened to only a few hours instead of a few days.