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These materials are for your general information and are not a substitute for medical advice. You should contact your physician or other healthcare provider with any questions about your health, treatment, or care.

INTRODUCTION — More individuals are traveling internationally now than ever before. International travel can lead to wonderful new experiences and lasting memories. Unfortunately, this travel can also lead to health problems that range in severity from unpleasant to life-threatening.

Travel-related health problems arise from a variety of factors, including exposure to infectious organisms, the use of certain types of transportation, and participation in certain activities such as diving and high-altitude hiking during travel. Travel-related health problems can also arise from a worsening of preexisting medical conditions during travel.

Fortunately, most travel-related health problems can be prevented with a combination of pretravel planning, immunizations, and safety precautions during travel. It is important to consult your doctor as soon as you know the details of your trip. He or she will be able to provide immunizations, travel medications, and tips for staying healthy during your trip. A general overview of advice related to travel will be reviewed here. Immunizations for travel are discussed separately. (See "Patient information: Immunizations for travel").

OVERVIEW OF TRAVEL-RELATED HEALTH PROBLEMS — About 15 percent of travelers from developed countries experience health problems when they travel in developing countries for up to three months. In about one of every five affected travelers, the problems are serious enough to prevent the individual from working for two weeks.

Infections are a common travel-related health problem. The more common travel-related infections include diarrheal diseases and hepatitis. The most common ways in which travelers acquire infection are by consuming contaminated food and water and by having sex with infected individuals.

While patients worry about acquiring infections while traveling, other problems can arise. The most common causes of death in travelers from the United States, for example, are cardiovascular events, such as heart attack, and accidents.

PRETRAVEL EVALUATION — Individuals planning international travel should visit their doctor at least one month in advance to allow time for any necessary immunizations and special preparations. This visit provides an opportunity to discuss several important individual health issues: The presence of any medical conditions The regular use of medications The presence of any factors that weaken the immune system Pregnancy A history of allergy to any components used in making vaccines (eggs, gelatin, preservatives, or certain antibiotics)

The visit also provides an opportunity to discuss the specific details of travel, which are the basis for individualized travel-related medical advice: The duration of travel The season of travel The countries and regions that will be visited The planned activities during travel The place of residence during travel (for example, a modern hotel or a rural home or campground)

TRAVEL-RELATED MEDICAL ADVICE — Once your doctor has assessed your travel plans and your overall health, he or she can provide information about the health risks that you might encounter as well as advice for minimizing these risks.

Taking food and water precautions — Several different infections can be acquired by ingesting contaminated food and water, including infectious diarrhea (travelers' diarrhea), hepatitis A, and far less commonly, trichinellosis.

In areas where sanitation and personal hygiene are poor, food and water precautions are essential for reducing the risk of these infections. These precautions will be most effective when they are used on a daily basis.

Tap water that looks safe to drink can carry infection-causing organisms, but boiling this water can kill these organisms. You can reduce your risk of infection by following several water precautions: Do not drink or brush your teeth with unboiled tap water Do not drink beverages that contain ice made from unboiled tap water Drink only boiled tap water, drinks made from boiled tap water, carbonated beverages, beer, and wine While bottled water is safer than unboiled tap water, the source of the water and bottling conditions are not standardized; thus, other drinks are probably safer than locally bottled water

Food that looks safe to eat can also harbor infection-causing organisms. You can reduce your risk of infection by following several food precautions: Do not eat unpeeled fruit, and peel fruit yourself before eating it Do not eat raw vegetables Do not eat or drink unpasteurized dairy products Do not eat undercooked fish or shellfish (including seviche) or meat

Avoiding insect and arthropod bites — In certain areas of the world, insects (mosquitoes, flies, fleas, bugs, and lice) and arthropods (ticks and mites) can transmit a number of potentially serious infections. You can reduce your risk of infection by following several precautions on a daily basis: Whenever possible, avoid insect-infested and arthropod-infested areas Wear protective clothing, including long-sleeved shirts and pants Follow good personal hygiene Use insect and arthropod repellents Use mosquito netting over your bed Check your skin regularly and remove any insects or arthropods that you find Whenever possible, minimize the time spent outdoors after dark Take antimalarial drugs exactly as prescribed

Avoiding infection-causing organisms in open water, soil, and sand — Open water, soil, and sand can harbor infection-causing organisms in some areas of the world.

In countries in which schistosomiasis (a parasitic infection) is common, it is important to avoid swimming in fresh water. Even a brief exposure to infested water (for example, during rafting) can result in infection. In contrast, swimming in salt water or chlorinated water is safe in these countries.

Travelers should not walk barefoot or in open footwear on soil or sand that might be contaminated with dog or human feces. This exposure can lead to worm infections, including hookworm infection and strongyloidiasis.

Avoiding sexually transmitted diseases — Avoiding sexual contact with potentially infected individuals and practicing safe sex can reduce the risk of acquiring sexually transmitted disease during travel. The hepatitis B virus, the human immunodeficiency virus (HIV, the virus that causes AIDS), and the more common infections, gonorrhea and syphilis, are all transmitted by sexual contact. Therefore, safe sex precautions, especially the use of condoms, are particularly important when traveling.

Bringing along necessary medications — Some medications available in the United States are not available in other countries. Therefore, travelers who must take medication regularly should plan to bring enough medication with them for the duration of their trip. Travelers who must take medications daily should carry these medications on the plane with them instead of placing the medications in baggage that might become lost.

Avoiding accidents — Accidents, especially motor vehicle accidents, account for about 25 percent of deaths in American travelers. You can reduce the risk of accidents and the risk of injury or death if accidents occur by taking several precautions: Avoid driving at night Familiarize yourself with the local driving conditions Wear a seat belt at all times Avoid drinking alcoholic beverages and driving

Planning for tuberculosis testing — Travelers who will visit regions where tuberculosis (TB) is common may be advised to have a tuberculosis skin test before and after their trip. (See "Patient information: Skin testing for tuberculosis"). The results of this test convert from negative to positive in about 2 percent of travelers who spend an average of 23 weeks in such areas, indicating that they were exposed to the bacteria that cause TB. The risk is approximately doubled for traveling health care workers compared with other types of travelers.

ADVICE RELATED TO TYPE OF TRANSPORTATION — Travel-related health problems can be associated with the type of transportation used during travel.

Ships — The Centers for Disease Control and Prevention (CDC) inspects all cruise ships that dock at ports in the United States to be certain that these ships meet strict sanitation guidelines. Information about the past record of a specific cruise ship can be obtained from travel agents, state health departments, and the CDC.

Airplanes — Air travel can cause a variety of different health problems.

  Problems related to a lower-oxygen environment — Jet aircraft that fly at lower altitudes do not pressurize the cabin, and although jet aircraft that fly at higher altitudes pressurize the cabin, the pressure is still not as great as that on the ground. Under both conditions, the air in the cabin contains less oxygen than the air on the ground, which reduces the amount of oxygen in the blood.

Exposure to a lower-oxygen environment can lead to problems in individuals with certain medical conditions. Individuals who have chronic obstructive pulmonary disease (COPD) and heart conditions may experience symptoms when flying in jets and may need to use oxygen during flights.

A lower-oxygen environment can also be a problem for individuals who have recently experienced a heart attack while traveling. Such individuals can usually make a return flight home two to three weeks after the heart attack occurred, as long as a health care provider accompanies them.

  Ear and sinus symptoms — The change in air pressure during flight may cause ear and sinus symptoms for individuals with upper respiratory tract infections. These symptoms may include difficulty hearing and pain in the ears or sinuses. In most individuals, the symptoms can be relieved by taking decongestants.

  Blood clots — Sitting still during long flights may permit blood clots to form in individuals who have clotting disorders or vein conditions. Individuals with these conditions may be advised to take certain medications, to stretch frequently, and to wear compression stockings during long flights to reduce the risk of blood clots.

Whether long trips increase the risk of blood clots in normal individuals is controversial. However, it is probably reasonable for all travelers to: Avoid dehydration by consuming plenty of fluids (non-alcoholic) Change positions in the seat; flex and unflex the knees and ankles, and avoid crossing the legs Move about every one to two hours on long flights Avoid constrictive clothing

  Motion sickness — Individuals who are prone to motion sickness should take medications before a flight to prevent this condition. Over the counter drugs work for most individuals; a doctor can write a prescription for stronger drugs, if necessary.

  Jet lag — Travelers who cross several time zones may experience jet lag. In general, it takes longer to recover from jet lag when flying west to east than when flying east to west. Although melatonin supplements have become popular for the self-treatment of jet lag, it is not yet known if melatonin is safe or effective.

ADVICE FOR INDIVIDUALS WITH SPECIFIC MEDICAL CONDITIONS — Additional travel considerations are necessary for pregnant women, individuals with HIV infection, and individuals with diabetes.

Pregnant women — Most women can travel safely during pregnancy, but the type of travel and the possible health hazards must be considered on an individual basis. Women who have had complicated pregnancies (premature delivery, miscarriage, toxemia, or other complications) should avoid extensive travel during subsequent pregnancies.

Pregnant women will not be able to receive certain travel immunizations and may not be able to take certain antibiotics during travel. However, pregnant women who travel to regions where malaria is common can and should take an antimalarial drug, which is safe during pregnancy.

Air travel does not have any known negative effects on a pregnant woman or the baby.

Individuals with HIV infection — HIV infection can pose several problems during travel. Individuals infected with HIV may not be allowed to enter some countries and should therefore check with consular offices when planning international travel. Individuals with HIV infection will not be able to receive certain travel immunizations. HIV-infected travelers should carry all of their needed medications with them and, before traveling, should try to locate adequate medical facilities in the planned destinations.

The risk of malaria is the same in individuals infected with HIV as in other individuals. However, certain other types of infections caused by opportunistic organisms (organisms that infect individuals with a weakened immune system) are more common in HIV-infected travelers. The risk of these infections is related to the severity of the immune deficiency in the individual, which is generally measured by the number of CD4 cells.

Individuals with HIV infection who travel to the European coast of the Mediterranean may acquire leishmaniasis. Other opportunistic infections that can occur in HIV-infected travelers include: protozoan infections (such as cryptosporidiosis), fungal infections (such as cryptococcosis and histoplasmosis), and bacterial pneumonia.

Individuals with diabetes — Travelers with diabetes who take insulin will need to adjust their insulin injection schedule with east-west travel. They should also wear a Medic Alert tag and carry syringes, medications, and snacks with them at all times.

ADVICE RELATED TO SPECIFIC EXPOSURES — Certain unusual activities and exposures during travel can cause health problems.

Scuba diving — Individuals who scuba dive while traveling should wait 12 to 48 hours (depending on the length of dives) before boarding a jet airplane. This measure is important for avoiding decompression sickness (also called "the bends").

High altitude exposure — Individuals who will be traveling to mountainous regions and other regions at high altitude should talk with their doctor about the prevention and treatment of high-altitude illnesses. These illnesses include mountain sickness, high-altitude pulmonary edema, and high-altitude cerebral edema.

Wilderness travel — Individuals who plan to travel to remote areas that are far from medical facilities should discuss precautionary measures with their doctor, especially if they will be exposed to extreme climates and physical exertion.

ADVICE FOR RETURNING TRAVELERS — Any patient experiencing symptoms, especially fever, diarrhea, or a rash, following the return from international travel should consult their physician.

WHERE TO GET MORE INFORMATION — Your doctor is the best resource for finding out important information related to your particular case. Not all travelers are alike, and it is important that your situation is evaluated by someone who knows you as a whole person.

A number of other sites on the internet have information for travelers. Information provided by the National Institutes of Health, national medical societies and some other well-established organizations are often reliable sources of information, although the frequency with which they are updated is variable. Centers for Disease Control and Prevention (CDC) travel page

      Toll-free: (800) 311-3435
World Health Organization page on International travel and health

National Library of Medicine

Infectious Diseases Society of America


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