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Reason2Go ● Health Infor- mation for Travelers ● Spring

2017

Health Risks and Precau- tions for International

Travelers

General Considerations The number of people traveling internationally in-

creases every year. International tourist arrivals in the

year 2015 reached 1 billion, with arrivals expected to

reach 1.6 billion by 2025. Over half the arrivals were for

leisure and holidays, with business, religious pilgrim-

ages, and family visits cited as other major reasons peo-

ple travel.

International travel can pose serious health risks to trav-

elers, depending on the destination country, the nature

and characteristics of the trip, and the traveler’s physical

condition and overall health. Travelers might be ex-

posed to sudden and significant changes in altitude, hu-

midity, microbes, and temperature. Also, serious health

risks can arise in areas where clean water is unavailable,

sanitation and hygiene are inadequate, and medical ser-

vices are not well-developed.

All people planning travel should know the po-

tential hazards of the countries they are travel-

ing to and learn how to minimize their risk of

acquiring diseases. Forward planning, preven- tive measures, and careful precautions can sub-

stantially reduce the risks of adverse health con-

sequences.

The medical profession and the travel industry are an

important source of help and advice for travelers, how-

ever, it is the responsibility of the traveler to seek out

information on travel-related risks, understand the fac-

tors involved, and take the necessary precautions.

Travel-related Risks The following are key factors in determining the risks to

which travelers may be exposed:

• destination and mode of transportation

• purpose, duration, and season of travel

• standards of accommodation and food hygiene

• behavior and health of the traveler

Destinations where accommodation, hygiene, sanita-

tion, medical care, and water quality are of a high stand-

ard pose relatively few serious risks for the health of

travelers, unless there is a pre-existing illness. This also

applies to travelers visiting most major cities and tourist

centers and staying in quality accommodations, such as

a conference center or a resort.

In contrast, destinations where accommodation is of

poor quality, hygiene and sanitation are inadequate,

medical services do not exist, and clean water is una-

vailable may pose serious risks for the health of travel-

ers. Exposure to insects, infectious agents, and contam-

inated food and water, makes travel in many remote re-

gions particularly hazardous. Travelers who venture

into remote areas should take stringent precautions to

avoid illness, including receiving vaccinations and tak-

ing antimalarial medications.

The purpose, season, and duration of the visit, the mode

of transportation, and the lifestyle and overall health of

the traveler are also important in determining the likeli-

hood of exposure to infectious agents.

Medical Consultation Before Travel Travelers intending to visit a destination in a developing

country should consult a travel medicine clinic or a phy-

sician at least 4-8 weeks before the journey, and prefer-

ably earlier for long-term travel or travel to remote ar-

eas. Last minute travelers should also consult a clinic or

physician.

A medical consultation is needed to determine the need

for vaccinations and antimalarial medication, as well as

any other medication the traveler may require. Medical

advisors base their recommendations on an assessment

of risk for the individual traveler as well as any associ-

ated public health.

Malaria: A Serious Health Risk for Travelers Each year an estimated 8 million North Americans

travel to countries where malaria is common. Transmit-

ted by the bite of an infected mosquito, malaria is a se-

rious and potentially fatal infectious disease that is char-

acterized by headaches, fever, chills, and sweating.

Malaria occurs mostly in poor tropical and

subtropical areas of the world. In many of the countries affected by malaria, it is a leading

cause of illness and death. In areas with high

transmission, the most vulnerable groups are young children, who have not developed im-

munity to malaria yet, and pregnant women, whose immunity has been decreased by preg-

nancy. (Centers for Disease Control and

Prevention)

According to the Centers for Disease Control, malaria

can usually be prevented if travelers to tropical and sub-

tropical regions follow these preventive steps:

First, inform yourself about the risk of acquiring malaria

in the region of the world where you plan to travel. Ma-

laria exists throughout the tropics, but it is most preva-

lent in sub-Saharan Africa. Malaria hotspots change

constantly, so check with a travel medicine specialist or

the Centers for Disease Control for the latest develop-

ments before you travel.

Second, take measures to prevent mosquito bites, partic-

ularly between dusk and dawn. Always sleep in a well-

screened room, preferably under a mosquito net that has

been treated with insecticide. During the evening, wear

long pants and long-sleeved shirts, and apply an insect

repellent that contains DEET.

Finally, consult your physician or a travel medicine spe-

cialist several weeks prior to departure for advice on tak-

ing antimalarial drugs. Prophylaxis drugs need to be

taken continuously, beginning before travel commences

and continuing through up to four weeks after leaving

malaria-endemic areas.

Even if you take antimalarial pills, it is still possible to

get malaria, so seek medical treatment promptly if you

experience flu-like symptoms and are in or have re-

cently visited an area where malaria is present. For more

information on malaria prevention and other travel

health issues, check out the Centers for Disease Control

on the Internet at www.cdc.gov/travel.

Malaria Worldwide • 3.3 billion people (half the world’s population) live

in areas at risk for malaria transmission.

• 35 countries (30 in sub-Saharan Africa and 5 in Asia)

account for 98% of global malaria deaths.

• The World Health Organization estimates that in

2018, malaria caused 350-500 million clinical epi-

sodes of malaria.

• An estimated 863,000 malaria deaths occur every

year, most of them children.

• 89% of malaria deaths occur in Africa.

• Malaria is the fifth cause of death from infectious

diseases worldwide (after respiratory infections,

HIV/AIDS, diarrheal diseases, and tuberculosis).

• Malaria is the second leading cause of death from in-

fectious diseases in Africa, after HIV/AIDS.

Source: (Centers for Disease Control and Prevention)

Preventive Options for Serious Travel Health Issues

Medical Kit and Personal Items

Travelers should always carry a medical kit, particularly

to destinations where there may be significant health

risks, including developing countries where local avail-

ability of medications cannot be guaranteed.

The medical kit should include basic medicines to treat

common ailments, first aid items, and any other special

items, such as syringes and needles, that might be

needed for a pre-existing medical condition. It is also

important to bring a signed statement from a physician

certifying that the traveler requires specific medication

or items for a medical condition.

Travelers should also carry personal items in sufficient

quantity for the length of the visit, unless their availabil-

ity is assured at the travel destination. Such items might

include toothpaste, supplies and solutions for contact

lenses, skin care items, and other items for personal hy-

giene.

The Centers for Disease Control and Prevention recom-

mends travelers carry the following items for a basic

medical kit:

First aid items • Adhesive bandages, multiple sizes

• Adhesive tape

• Antibacterial hand wipes or an alcohol-based hand sanitizer containing at least 60% alcohol

• Antifungal and antibacterial ointments

• Antihistamine

• Anti-itch cream for insect bites and stings

• Antiseptic wound cleanser

• Cotton swabs

• Digital thermometer

• Disposable gloves

• Elastic bandage wrap for sprains and strains

• First aid quick reference card

• Insect repellent

• Medication for pain or fever, such as Aceta- minophen, Aspirin, or Ibuprofen

• Moleskin for blisters

• Oral rehydration salts

• Saline eye drops

• Scissors, safety pins, and tweezers

• Sterile dressing

Other important items The following items might be necessary depending on

the destination, trip duration, and individual needs:

• Antibiotic for self-treatment of diarrhea

• Antidiarrheal medication

• Antifungal powder

• Antimalarial medication

• Anti-motion sickness medication

• Epinephrine auto-injector (such as an EpiPen) for severe allergic reactions

• Extra pair of contacts or prescription glasses

• Medication for high-altitude sickness

• Medications taken on a regular basis at home

• Mild laxative

• Mild sleep aid or anti-anxiety medication

• Sterile syringes and needles

• Sunscreen

• Water purification tablets

Contact card Travelers should carry the name and contact details for

their physician, together with information about any

medical conditions, treatments, and medications, in-

cluding generic drug names and doses. The contact card

should also include contact information for a family

member still in the traveler’s home country and the

home embassy or consulate in the destination country.

Insurance for Travelers International travelers should be aware that medical care

abroad is often only available at private medical facili-

ties and can be extremely expensive. In places where

high-quality medical care is not readily available, trav-

elers might need to be repatriated in the event of an ac-

cident or illness. Repatriation of the body can be costly

and difficult to arrange if death occurs abroad.

Travelers are advised to seek information about possible

reciprocal health-care agreements between the country

of residence and the destination country, and to obtain

special traveler’s health insurance for destinations

where health risks are significant and medical care is ex-

pensive and not readily available.

Travel health insurance should include coverage for

changes to the itinerary, emergency repatriation for

health reasons, medical care in case of illness or acci-

dent, hospitalization, and repatriation of the body in case

of death.

Some countries now require proof of adequate health in-

surance as a condition of entry. Travelers should be fa-

miliar with the procedures to obtain medical assistance

if needed while abroad, and should carry a copy of the

insurance certificate, along with other important travel

documents, in their carry-on luggage.

Traveler’s Checklist When preparing for an international trip, travelers can

use the following checklist as a guide:

 Determine local conditions ✓ Risks related to the destination (urban, rural, or

remote)

✓ Type of accommodation (resort, local hotel, or camping)

✓ Length of stay ✓ Altitude ✓ Regional conflicts ✓ Standards of hygiene and sanitation ✓ Availability and quality of medical facilities

 Arrange a medical consultation ✓ Visit a physician or travel clinic 4-8 weeks prior

to departure

✓ Receive required and recommended vaccina- tions

✓ Determine malaria risk and plan for prevention of mosquito bites; obtain antimalarial drugs,

mosquito net, and insect repellent

 Establish a plan for food hygiene ✓ Eat only thoroughly cooked food and drink only

bottled water or packaged drinks

✓ Boil, filter, or disinfect water if bottled water will not be available

 Assemble a suitable medical kit ✓ Include items for basic first aid and items spe-

cific to the destination and the traveler’s per-

sonal needs

✓ Obtain prescription medications

 Subscribe to travel medical insurance ✓ Look for insurance that covers changes in itin-

erary, medical care, hospitalization, as well as

repatriation.