TRAVEL MEDICINE - HEALTHY HINTS

Pre-Travel Plans

Pre-travel health consultation
The time to visit your health professional is when you start to make your travel plans. You need to gather health-risk information about the countries you will visit, update your immunizations, and get recommendations on medications for illness prevention and treatment. If the trip involves many countries or extensive stays, you should be getting your health consultation 3-5 months before you plan to leave.

Health-risk information
The health risk factors vary greatly from country to country and change from time to time. Some areas are endemic for certain diseases such as malaria. Sometimes there are epidemics of other contagious diseases in certain areas. The University Health Services Manoa provides up to date country-by-country travel advisory information.

Immunizations
A review of your health and immunization records will determine if and what type of immunizations you need. Specific recommendations will also depend on which countries are on your itinerary. Some of the common immunizations include:

Polio (basic series of 3) - Booster once as an adult

Tetanus/Diphtheria (basic series of 3) - Booster every 10 years. Optional addition of Pertussis to this vaccine is recommended once as an adult.

Yellow Fever - Certificate valid for 10 years

Typhoid Fever - Injectable Typhim, booster every 2 yrs; or Oral Typhoid tablets, taken every other day x 4; booster every 5 years

Hepatitis A - Two shots six month apart.

Hepatitis B - Series of three shots; may be combined with Hepatitis A

Tuberculosis - You should have a tuberculin skin test within the 12 months before your departure. If you are “negative,” repeat after you return home. If you already have a “positive” test, a chest X-ray is recommended.

Meningococcal meningitis - One shot. Required for certain areas, recommended for others.

Malaria - Malaria is endemic in many parts of the world. The illness is transmitted by mosquito bites. There are several different medications that may be used for malaria prophylaxis.

  1. Mefloquine (Lariam): Take one tablet eack week starting one week before your departure, and take weekly throughout your stay. Continue to take weekly for 4 weeks after leaving the area of risk.
  2. Malarone: Take one tablet each day starting two days before departure, then take daily until one week after leaving the area of risk.
  3. Doxycycline: Take one tablet each day throughout your stay in the area of risk and continue for four weeks after leaving the area.

If you had many mosquito bites while traveling through malarious areas, see your doctor on your return home. You may need additional antimalarial medicine to completely eradicate all forms of malaria parasites.

Don't rely solely on your medications to prevent malaria. The mosquitoes usually feed between dusk and dawn. Stay in well-screened areas. Sleep under mosquito netting. Wear clothing that covers arrns and legs in the evening, Apply insect repellent to exposed areas of skin and thin clothing. The most effective repellents contain N,N diethyl-meta-toluamide (DEET).

If you suffer any illness with fever after your return home, be sure to tell your doctor that you have been in a malarious area. Antimalarial medications are not always 100% effective. Symptoms of malaria may begin anywhere from 8 days to 1 year after exposure.

Primaquine is an anti-malarial tablet which can be taken after leaving a malarious area, to prevent occurrence of relapsing malaria caused by Plasmodium vivax or Plasmodium ovale parasites.

Mefloquine, Malarone, and Doxycycline work well against P. falciparum and P. malariae malaria but only primaquine will eradicate P. vivax and P. ovale parasites in their dominant stage in the liver. If you are bitten by mosquitoes during your travel in malarious areas, see your doctor on your return home. He/she will probably order a blood test for G-6- PD deficiency* first, then prescribe 2 weeks of Primaquine tablets.

Common side effects: Usually none. However, nausea, abdominal discomfort, headache, visual disturbance, and itching can occur. More serious side effects include low white cell counts, anemia, and methemoglobinemia. The drug should be stopped immediately if marked darkening of the urine or sudden fall in white cell or red cell counts occurs.

* Some people have an inherited deficiency of G-6-PD (glucose-6-phosphate dehydrogenase) and have a tendency to develop hemolytic anemia while taking primaquine.

Back to Top

Special Medical Problems

Consult your private physician for advice. You may want to get a note from your doctor regarding your specific medical problems, your current condition and treatments. Be sure to take along enough of your regular prescribed medications, as you may not be able to obtain the same medication overseas.

Traveler's Diarrhea
Prevention and Treatment

1. Most of the microorganisms that cause traveler's diarrhea can be found in the local water supply if it is not adequately treated. Drink only bottled water or water that has been boiled for 10 minutes. Beverages from cans and bottles are OK, as well as beverages made from boiled water (coffee, tea). Do not use ice in your drinks!

2. Avoid raw salads and unpeeled fruits.

3. Avoid room temperature sauces and foods. Hot foods should be eaten hot.

4. If you develop diarrhea, you can do the following:

  • with minor diarrhea (1-3 loose stools only), take only liquids for 24 hours. (See Oral Rehydration Solution below.)
  • with multiple watery stools, take 2 tablets of PeptoBismol 4 times a day or other antidiarrheal medication prescribed by your doctor such as Lomotil or Imodium.
  • If the diarrhea does not stop within a day or two, or if you have fever, severe abdominal cramps, or bloody stools, consult a doctor for additional treatment.

5. Oral Rehydration Solutions comparable to that recommended by the World Health Organization are:

  • 8 ounces of apple/orange/other fruit juice; add a pinch of table salt.
  • 8 ounces of water, add a pinch of salt, 1 tablespoon of sugar or 1 teaspoon of honey, and 1/4 teaspoon of baking soda if available.
  • Use of a recommended packaged solution mix.
6. If you continue to have gastrointestinal symptoms after your return home, see your doctor to check for intestinal parasites and other pathogens.

Back to Top

Unavoidable Traveling Conditions

Minor conditions that might be unavoidable but could be minimized

Plane ride stiffness.
Exercise 5 minutes every hour while sitting in your seat. Both isometric and isotonic exercises can be done to stretch and relax muscle groups in your body.

Jet lag.
Adjust to the new time zone as soon as possible. Two to three days before your departure, adjust your sleep pattern a few hours earlier or later depending on your direction of travel. Eat and drink lightly during your trip; limit intake of caffeine and alcoholic beverages. Upon your arrival, follow the local time schedule immediately. Expose yourself to outdoor light to acclimatize quickly.

Sore feet and muscles.
These are preventable if you plan activities compatible with your physical condition and tolerance. Allow for adequate rest periods during the day. Make sure you have well-fitting and comfortable walking shoes.

Motion sickness.
If you are prone to motion sickness, take along a motion sickness remedy and follow directions.

Sunburn.
Wear sunscreen preparations whenever you plan outside activities, especially in tropical areas, the seashore, or high altitude places. If you get a sunburn, apply cold compresses and moisturizing creams or lotions to the burned areas. You can also take 2-3 aspirins every 4 hours for discomfort.

Minor cuts/Insects bites.
Minor cuts should be washed, kept clean, and lightly covered. An antiseptic/ antibiotic ointment or cream could be applied. Apply cold compresses to insect bites. Most insect bites are minor annoyances, but if you have a history of severe allergy to certain insects, you should consult your doctor about a bite treatment kit to take along with you. Wear protective clothing, use insect repellents and mosquito nets when appropriate.

The common cold.
If you are in good general health and do not allow yourself to be over-stressed during your travels, you minimize your chances of getting a cold. If you get a cold, rest, fluids, and some symptomatic medications will help. You may consider getting a "flu shot" if you will be travelling during the influenza season.

Back to Top

Travel Kit

Here are suggested items to include in your travel kit. These will vary depending on your destination, activities, and length of stay.

Bandaids
Thermometer
Extra glasses or contact lens
Sunglasses
Skin lotion for minor bums and irritation
Sunscreen
Insect Repellent
Foot powder
Analgesic
Antiseptic
Laxative or stool softener
Common cold remedies
Medication for motion sickness
Medication for diarrhea/upset stomach
Contraceptives /condoms
Oral rehydration mix
Water purification tablets

Back to Top

For additional information, check http://wwwn.cdc.gov/travel/destinationList.aspx


Last Updated: 03.01.2008