TRAVEL HEALTH PRECAUTIONS

Millions of persons travel abroad each year, often to lesser-developed areas of the world. The risk of illness or injury while traveling is determined by many factors, including the health status of the traveler, geographic destination, duration of stay, activities engaged in while traveling, and preventive measures taken—including pretravel immunizations.

The most common causes of death of U.S. citizens abroad are due to cardiovascular disease (49%) and unintentional injury (22%), the latter being primarily from motor vehicle accidents and drowning. Death from infection or homicide (including terrorism) is uncommon. (Figure 1 details the percentages of all causes of death of travelers.)

The most common medical problem encountered by travelers to developing countries is traveler's diarrhea, with attack rates ranging from twenty to fifty percent. The cause is usually bacterial, most often enterotoxigenic Escherichia coli, though the etiology is unknown in twenty to fifty

Figure 1

percent of cases. Travelers are advised to avoid undercooked foods and untreated water. Self-treatment involving oral rehydration, loperamide (Imodium), and bismuth subsalicylate (Pepto-Bismol) is frequently recommended for those afflicted. Antiobiotics started at the onset of bacterial diarrhea may reduce the duration of symptoms. However, prompt medical attention is required in the case of bloody diarrhea, severe abdominal pain, dehydration, or fever above 101°F.

Assessment of immunization needs should begin at least two months before traveling. Basic immunizations for tetanus, diphtheria, mumps, measles, rubella, varicella, influenza, and pneumococcal infection may need to be updated. Immunization for diseases prevalent in certain geographic areas (most commonly these include cholera, hepatitis A, hepatitis B, Japanese encephalitis, meningococcal meningitis, poliomyelitis, rabies, and typhoid fever) should be looked into, as well as those that are required for entry in certain countries. Proof of yellow fever vaccination may be necessary for entry upon arrival from an endemic area, either directly or earlier in the trip, and Saudi Arabia requires meningitis vaccination during the Hajj pilgrimage to Mecca.

Malaria, found in subtropical areas, is prevented with oral antimalarial medication, along with the use of insect repellents and mosquito netting. Other travel health risks include altitude sickness (above 8,000 ft.), jet lag, venomous bites and stings, intestinal parasites, tuberculosis, and human immunodeficiency virus (HIV) infection.

Jeffrey W. Yatsu

Bibliography

Centers for Disease Control and Prevention (2000). CDC Health Information for International Travel 1999–2000. Available at http://www.cdc.gov/travel.html.

Rose, S. R. (1999). International Travel Health Guide, 1999 edition. Northampton, MA: Travel Medicine.

Thompson, R. F. (2000). Travel and Routine Immunizations, Milwaukee, WI: Shoreland.