International Travel Health

Becoming and Staying a Healthy International Traveler

It’s important to do certain pre-trip tasks before you travel overseas. Part of that pre-trip preparation, is knowing that the first thing you should pack is” common sense” when it comes to maintaining your health. Traveling internationally isn’t a vacation from your doctor’s orders, taking your prescribed medications, or following your doctor’s instructions on diet and exercise. Some of these pre-trip tasks need to be started almost from the moment you are planning your trip. Here is my top list for becoming and remaining a healthy international traveler.

I. The Importance of Getting a Physical Before International Travel

I can’t stress enough how important it is to get a physical exam before any international travel. You should always get a medical clearance from your primary physician before traveling to international destinations. This is especially true, if you have any pre-existing conditions or if you are an older traveler or if you are traveling with children. Additional precautions should be taken if you are traveling to third world countries, rural areas, for extended stays, or adventure type vacations.

II. Update Your Immunizations and Check Out the Health Advisories for Your Destination

Even if you are just taking a cruise to Cancun, Puerto Rico, or elsewhere — you need to make sure that your immunizations are updated. You also need to be absolutely aware of the health advisories for your international destination. Always be certain to be aware of the specific health precautions for your international destination, it could save your life. I’ve provided links below, for ease of information to the Center for Disease Control and the U.S. Department of State’s travel advisories.

III. Find Out If You Need a Vaccine or Booster Immunization

Immunizations obviously depend upon your destination. Additional considerations are:

How long you plan to stay
Your medical condition

If your trip is only a couple of months away, you should see your primary physician at least four to six weeks prior to your trip. However, truth be told, you probably should schedule this discussion about what immunizations you need at least four to six months to that trip. Why? Some immunizations require several injections spaced days, weeks or even months apart. In addition, you should make sure that you’ve had your primary vaccine series, such as:

Diphtheria
Measles
Mumps
Pertussis (aka Whooping Cough)
Polio
Rubella
Tetanus

Important Things to Ask Your Doctor:

Be sure to ask if you need a tetanus and diphtheria booster. (Since it’s recommended that with tetanus and diphtheria that a booster does of adult tetanus-diphtheria is given every ten years).
Be sure to ask if you need a polio booster. (If you haven’t had a polio booster as an adult, you may need this. This is especially true if you are traveling to Africa, Asia, the Middle East, India, and neighboring countries).
Be sure to ask if you need a measles vaccine booster. (This is important if you were born in 1957 or after).
Be sure to ask if you need an additional yellow fever vaccine. (This is important if you are traveling to Africa or South America).
Be sure to ask if you need any of the hepatitis vaccines. (Hepatitis A vaccine or immune globulin, is recommended anyone traveling outside of Japan, Australia, New Zealand, Northern and Western Europe, Canada, and the U.S). (Hepatitis B vaccine, is recommended if you are traveling to Southeast Asia, Africa, the Middle East, islands off the South and Western Pacific, and parts of Central and South America. It is also recommended if you will be on an extended stay or rural areas).
Be sure to ask if you need vaccination against typhoid. (Recommended if you are traveling to a third world country).
Be sure to ask if you need a meningococcal vaccine. (Recommended for travel to sub-Saharan Africa).
Be sure to ask if you need a vaccination against Japanese encephalitis. (Recommended if you’ve be staying long-term in Southeast Asia where this is a common disease).
Be sure to ask if you need a vaccination against rabies. (This is only recommended for long stays in third world countries).

Remember: Many international regulations command proof of yellow fever vaccinations and other vaccinations for travelers into certain countries. Make sure you carry your International Certificate of Vaccination as you travel outside of the U.S.

IV. Don’t Forget to Visit Your Dentist

Nothing can put a big damper on a long planned international vacation or business trip, than finding yourself with a horrible toothache or dental abscess. Imagine being at the beginning of a non-stop twelve hour flight to 7 sultans Hong Kong in a pressurized airplane, and developing a horrible toothache when you accidentally bit down on something and broke a tooth? Alternatively, imagine being in a third world country when you suddenly develop a dental abscess on a tooth, that was just slightly sore before you left? Neither of these or similar situations, are ones that should be a part of international travel. Have your cavities filled, poorly fitting dentures adjusted, and other dental work done before you go.

V. Plan Ahead With Medications

Suddenly finding out that your international stay has been extended and running out of a needed prescription, could be a giant headache when you travel abroad. Prevent this from happening to you by packing more of your medications than you need and get prescriptions filled before you go. Make sure, that your medications are in their original pharmacy bottles, clearly labeled and that they match your name. Having unidentified pills or pills in your companions name in your possession, can cause problems with airport security in the U.S.

Prescription services being what they are today in the U.S. — Some companies having stringent rules about only filling the prescription every 21 days, etc. can cause additional problems. Be aware that there are exceptions to this rule and that your physician can intervene, should the prescription insurance overseers become unbending about their rules and regulations. Also, remember that if you are taking a prescription narcotic, it is important to obtain a letter of authorization from your doctor on his letterhead.

Travel Health for Disease Prevention
VI. Travelers Diarrhea the Most Common Travel Health Issue

One of your biggest concerns in any international destination is the absolute possibility of having some sort of stomach upset. Fifty percent of all travellers develop traveler’s diarrhea. Here are some ways to reduce your risk:

Only eat foods that are well cooked and served hot;
Only drink bottled water, sodas, beer or wine served in their original containers;
Coffee and tea that has been boiled is also a safe choice;
Avoid salad bars;
Avoid buffets;
Avoid raw or uncooked fruits and vegetables that you haven’t cleaned yourself with bottled water;
Avoid raw or undercooked meats;
Avoid dairy foods;
Never drink tap water or use ice cubes;

Finally, make sure you carry, not only anti-diarrhea over-the-counter medications, but obtain a prescription from your primary physician for an antibiotic. Many physicians will prescribe a limited amount of such medication as a precaution once they understand why you might need it.

VII. Other Common International Traveler Ailments

Other concerns in maintaining international traveler health are the following ailments:

Motion Sickness – The bad news is that motion sickness can strike anyone, anywhere on any type of transportation and of course, it’s not fun. However, the good news is that motion sickness can be prevented by:

Taking over-the-counter Dramamine, Marezine, or Bonine — thirty to sixty minutes before getting on-board;
Getting plenty of fresh air. This means on-board a plane, direct the air vent at your face. This means on a train take a seat near a window and face forward. This means in a car, drive or sit in the front passenger seat.
If you already know you have problems with motion sickness, talk to your doctor.

Heat Exhaustion – In the summer and in hot climates heat exhaustion is always a very real possibility for travelers. To prevent this:

Pace yourself;
Plan regular breaks in the shade or inside an air-conditioned building;
Carry water;
Don’t overeat;
Drink liquids frequently;
Avoid alcohol;
Wear lightweight clothing;
Wear light colored clothing;
Wear a hat;
If you are feeling weak, dizzy, nauseated — get out of the sun immediately.

Blisters – International travel is not time to break in a new pair of shoes! However, even your most comfortable shoes can sometimes be a reminder to:

Pack more than one pair of comfortable shoes;
Wear socks dusted with talcum powder or foot powder;
Use foot inserts.

Altitude Sickness – Higher altitudes can cause altitude sickness even in healthy adults and children. Symptoms of altitude sickness are: Headaches, shortness of breath, fatigue, nausea, and difficulty sleeping. Prevention of altitude sickness includes:

Pace yourself, going slowly, especially after altitudes of 9,000 feet;
Rest for 24 hours after arriving;
If out of breath or tired, slow down!;
Don’t climb more than 3,000 feet in any one day below 12,000 feet;
After 12,000 feet, don’t climb more than 1,000 feet per day;
When climbing, always sleep at the lower altitude;
Don’t use alcohol;
Don’t smoke;
Get a prescription for actazolamide (Diamox) or other such medication prior to the trip from your doctor. This may prevent or lessen symptoms.

VIII. Pack Your Medical History Summary

One item not to forget, just in case you should have a medical emergency, is a copy of your medical history. This is especially true, if you have a history of heart problems or have a pacemaker. Also, obtain and pack a copy of a recent ECG.

IX. Air Travel Hazards

While air travel is one of the fastest and safest ways to travel, it also puts you at certain health risks while traveling. Here are some suggestions for preventing them:

Blood clots and leg swelling- Sitting for long periods of time in a cramped airplane will cause fluid to accumulate in the soft tissues of your legs. This can cause a life-threatening complication of a blood clot (thrombophlebitis). To prevent this:

Stand up and stretch periodically;
Take a walk up and down the isle every hour or so;
Flex your ankles;
Press your feet against the floor or seat in front of you;
Wear support hose if you are already prone to swelling;
Wiggle and move your toes and feet periodically;

Dehydration – To prevent dehydration on the plane, drink plenty of liquids (water and fruit juices). Also, avoid alcohol and caffeine during flight.
Ear Pain – Some people have trouble with ear pain during ascent or decent. To avoid this:

Take a deep breath and hold for a few seconds;
Slowly exhale part of the air while pursing your lips;
With lips closed tight, gently blow remaining air out;
Then breathe normally;
Some people find that yawning, chewing gum; and swallowing also helps;

Jet Lag – We all know about this travel hazard and it’s difficult to avoid if you are crossing several time zones. The best possible thing to do is drink plenty of fluids, eat lightly, and remember to pace yourself once at your destination to accommodate jet lag.

X. International Traveler’s First-Aid Kit

Packing a travel first aid kit can help you treat yourself and any fellow travelers for minor medical emergencies. Here is a list of basic supplies:

Antacids
Antibacterial cream
Antidiarrheal medication
Adhesive tape
Antihistamine
Benadryl
Bandages
Calamine
Decongestant
Deet (if traveling to mosquito infested location)
Laxative
Over-the-Counter heartburn or acid reflux medicine
Over-the-Counter motion sickness medications
Anti-itch cream
Second pair of prescription glasses if you have them, if not your eyeglasses prescription
Sunscreen
Thermometer
Tweezers

XI. Safe Food and Water While Visiting Abroad

One of the most healthy travel tips to remind everyone of, is to take proper food and water precautions once you arrive at your destination. Just use your common sense. If you follow the guidelines listed above in VI. Travelers Diarrhea — You shouldn’t encounter any problems with safe food and water.

XII. Health Advice for Specific Pre-existing Illnesses

Travelers with Asthma Should:

Avoid not having enough medication overseas (make sure you have extra medication both in your baggage and carry-on). Be aware that reduced oxygen levels on the plane can affect asthma. You should always seek permission to use nebulisers and make a request for oxygen prior to the flight should your asthma condition be severe;
Not choose to visit highly polluted destinations unless you consult your physician first. Climatic conditions of cold will also cause issues. Seek advice from your doctor as to how to handle a full asthma attack abroad and if you should take steriods with you;
Not go scuba diving;
Not travel during an asthma flare-up;
Avoid excessive physical activity for the first couple of days;
Pack a spacer and inhaler in addition to the nebulisers;
Think about using of a peak flow meter to monitor your asthma;
Be up-to-date on your flu shots;
Remember over-exertion can cause asthma to flare up;
Remember that high altitudes may change the effectiveness of your inhalers.

Travelers With COPD Should:

Avoid overly ambitions trip schedules;
Avoid traveling when not feeling well or having a chest infection;
Always have travel health insurance;
Always request airline oxygen when making reservations;
Keep antibiotics on your person (in case of a chest infection);
Avoid destinations with high altitudes and air pollution;
Pack extra medication in checked luggage and always have medication in your carry-on;
Consult your physician before making airline reservations;
Make sure your flu shots are up-to-date;
Avoid carrying heavy luggage long distances (get help);
Make sure you leave yourself plenty of time and avoid rushing at the airport;
Drink lots of non-alcoholic drinks;
Not scuba dive.

Travelers with Diabetes Should:

Not travel without travel health insurance;
Drink alcohol while traveling;
Have medication both in hand luggage and in checked luggage (Type 1 diabetics);
Pack both sugar and carbohydrate foods in hand luggage(particularly true for those with Type 1 diabetes);
If injection dependent, be sure to get a copy of your medical history and a letter on your doctor’s stationary, explaining why you need to carry syringes in your hand luggage;
Wear a medic alert bracelet or necklace;
Be sure to take an ample supply of medications, testing strips, syringes and pens in your carry on luggage. Don’t risk packing them in your checked luggage;
Make sure your traveling companion knows what to do if you have a diabetic problem;
Pre-order diabetic meals on long air flights;
Talk to your doctor prior to traveling about managing your diabetes when crossing several time zones and any changes in medication timing;
Keep your insulin in a cool, dark place, and wrapped in wet cloths in very hot climates;

Travelers Who Have Had a Previous Heart Attack Should:

Avoid overly ambitious travel schedules;
Avoid extra-strenuous activities if you are not used to them;
Avoid high altitudes;
Avoid traveling too soon after a heart attack;
Avoid climbing too many stairs too fast;
Book assistance at airports, hotels, etc. if necessary;
Only use luggage with wheels;
Travel by land or sea if you possibly can;
Be cautious in hot or very cold weather;
Be aware of the symptoms of a heart attack or stroke. At first symptom, seek immediate health care;
Not drive for more than four hours at a time;
Avoid heat exhaustion;
Limit alcohol;
If you have a pacemaker, be sure to have your physician check the battery before you go;

Travelers With Inflammatory Bowel Disease Should:

Not travel when not feeling well;
Not travel if you are having a flare up of the disease;
Avoid risky foods and known food triggers;
Ask your physician about any precautionary prescriptions for travel flare-ups;
Seek medical attention early if you feel unwell or develop a fever;
Practice safe food and drink precautions (above) at all times;

Pregnant Travelers Should:

Not fly too close to the birth date;
Not fly too close to the particular airline’s pregnancy cut-off date;
Not fly to countries with high rates of diseases;
Not travel to remote or rural areas where medical help is not readily available;
Not travel to high altitudes;
Avoid countries with poor or substandard health care;
Avoid travel during the first fifteen weeks of pregnancy;
Avoid travel after thirty weeks of pregnancy;
Consider, if you are traveling to a country where malaria is a risk, talk to your physician before traveling;
Likewise, discuss the risks of certain vaccinations to your pregnancy;
Wear travel socks on airlines;
Drink plenty of fluids on planes;
Be aware that flying increases risks of radiation;
Avoid dehydration;
Avoid heat-exhaustion;

XIII. Mosquito Protection When Traveling Abroad

International travel to countries where mosquito borne illnesses exposes you to such illnesses as:

Malaria
Dengue fever
West Nile Virus
Yellow Fever
Hepatitis
Hemorrhagic Fever
Japanese Encephalitis

Without doing into great detail, none of these illnesses are ones that anyone would want to contract and some of them are life threatening. The only real way that you can prevent them is to eliminate your exposure to this insect. This means:

Use of insect repellents such as DEET
Wearing protective clothing;
Wearing insecticide (permethrin) clothing;
Use of mosquito netting

XIV. Health Issues When Traveling With Children

Traveling abroad with children and insuring that they are healthy before, during, and after the trip is very important. Today, many children are traveling with their parents overseas. The main thing is to try to make your trip as safe and hassle free as possible. Some suggestions are:

Be as prepared as possible for all minor ailments and emergencies;
Be aware of how to treat coughs, colds, diarrhea, and vomiting and know when to call for help;
Be extra careful to watch out for sunburn;
Make sure that all land transportation used has seat belts;
In tropical and humid climates, make sure to keep all cuts, scrapes, and abrasions clean, covered with antibacterial cream, and bandaged;
Remember that children are more prone to diarrhea;
Talk to your physician if you are traveling to an area where malaria is a concern;
Make sure that they have all vaccinations necessary for your destination;
Be extra careful in swimming pools and other swimming sites when traveling abroad.

XV. Health Issues When Traveling With the Elderly

There are certain special precautions and considerations when traveling abroad to rural or remote destinations. Among these are:

Understand that travel to these locations carries extra risks of disease;
Exposure to livestock and wild animals makes rabies an added risk;
Medical care may be difficult, even obtaining simple first aid and medications;
You have an increased risk for mosquito and other insect borne illnesses;
Water sources may be very unsafe and bottled water not available;
Food can be contaminated. Some cultures use human waste as fertilizers;
Rural road travel carries a greater risk of accidents and death;
You need to carry a much better supplied first aid kit than normally recommended for international travel;
You need to pack mosquito repellent, clothing, and netting. Don’t expect to buy it there;
For your own safety and health, do not travel roads at night.

XVII. Make It Your Business to Know Where Medical Care Will Be Available

Make it your business to know where medical care will be available at your destination. Download a list of names, addresses, and telephone numbers of recommended English speaking doctors, clinics, and hospitals near your destination.

XVIII. Deciding on International Traveler’s Health Insurance

One key thing to do in pre-trip planning is to check with your current health insurance carrier to see what (if any) travel-related medical expenses your policy covers.

Additionally, anyone travelling overseas should consider purchasing international travel health insurance. Keep in mind:

The older the traveler, the harder it will be to get adequate travel insurance. If you are over 75, and have a history of long-term illnesses such as diabetes or heart disease, you especially need travel insurance. Purchasing such travel insurance is important and every effort should be made to do so.