Travel Medicine Precautions

Travel Medicine

• Primary care physicians are sources of health advice for international travelers.
• Destination-specific disease risks, travel and routine vaccines, chemoprophylaxis regimens, and self-treatment regimens for infectious and noninfectious illnesses need to be familiar to physicians.

Pre-Travel Health Advice

• Travelers need comprehensive medical advice and care before traveling, especially those traveling to lower-income regions.
• Instructions on obtaining medical care should be provided, and all travelers should carry a list of medications with dosages.
• Travelers with complex medical conditions or high-risk itineraries should consider supplemental medical insurance policies and medical evacuation insurance.

Air Travel Precautions

• The cabin pressure during long flights approximates 1800-2400 meters of altitude, which may exacerbate certain medical conditions.
• Prolonged immobility on long flights increases the risk of venous thromboembolism, especially in persons with predisposing conditions.
• Maintaining in-flight mobility, hydration, and using compression stockings may decrease this risk.

Insect-Borne Illnesses

• Prophylaxis against insect-borne diseases includes limiting unprotected exposure, habitat avoidance, and using physical barriers and insect repellents.
• A range of arthropod vectors can transmit diseases, including mosquitoes, ticks, mites, flies, lice, and fleas.
• Travelers to areas endemic for malaria or arthropod-borne viruses should be carefully instructed on ways to minimize mosquito bites.

Cruise Ship Travel

• Influenza, Legionella, and norovirus infections are particularly associated with cruise ship travel.
• All cruise ship travelers should receive influenza vaccine and be educated about respiratory hygiene and diarrhea management.

Motion Sickness

• Requesting interior cabins and considering medications for prophylaxis and treatment, such as anticholinergics and antihistamines, may help alleviate motion sickness.

Food and Water Safety

• Travelers to resource-limited areas should drink bottled water, carbonated soft drinks, and carbonated water to minimize the risk of water-borne illnesses.### Travel Health Risks
• Travelers should take precautions to avoid animal-borne diseases, such as rabies, by avoiding contact with stray dogs, feral animals, monkeys, and bats.
• Children are particularly at risk, and travelers should wash wounds with soap and water and seek medical care immediately if bitten.

Food and Water Safety

• When safe drinking water is not available, water can be disinfected by boiling, filtering, halogenation, or exposure to ultraviolet light.
• Ice cubes should not be used unless they are made from safe water.
• Food should be piping hot, thoroughly cooked, processed, packaged, and peeled, and street vendors should be avoided.

Vaccination

• Vaccines for travelers can be divided into three categories: required on the basis of international health regulations, recommended on the basis of risk at the destination, and routine as a preventive measure.
• The risk of vaccine-preventable illness in travelers depends on several factors, including medical conditions, destination, season, duration, and purpose of travel, and planned activities.
• Travelers with underlying medical conditions or those who plan to travel to a resource-limited country should ideally be evaluated by a clinician in advance.

Other Health Risks

• Travelers should take precautions to prevent road accidents, such as avoiding excessive use of alcohol, using seat belts and child safety seats, and avoiding travel by motorcycle or motor scooter.

• Altitude sickness can occur at lower altitudes, and travelers should ascend gradually, try to sleep at lower altitudes, and minimize alcohol consumption.

• Safe sex should be practiced to prevent sexually transmitted diseases, and travelers should be screened for such diseases on their return.

• Travelers should take precautions to prevent environmental illness, such as altitude sickness, and diving-related barotrauma.### Vaccination Recommendations for Travelers

• Vaccination recommendations for destination-specific immunization can be found at www.cdc.gov/travel.

• Live virus vaccines (e.g., yellow fever, varicella, zoster, measles-mumps-rubella) should be administered on the same day or 4 weeks apart.

• Avoid live vaccines in immunocompromised persons and pregnant women, although individual risk and benefit need to be assessed.

Yellow Fever Vaccination

• Yellow fever is a mosquito-borne disease endemic in parts of Africa and South America.
• The vaccine is a live attenuated virus, available only through registered clinics and sites (www.cdc.gov/travel/yellow-fever-vaccination-clinics/search.htm).
• Periodic shortages have occurred, and the only available vaccine in the United States is administered under an investigational new drug program.

Hepatitis A Vaccination

• Hepatitis A virus infection is common in developing countries and one of the most frequently acquired vaccine-preventable diseases.
• Vaccination is recommended for all nonimmune travelers, especially to Mexico and Central and South America.
• Two monovalent vaccines are available in the United States, and one bivalent vaccine is also available.

Traveler's Diarrhea and Extended-Spectrum β-Lactamase-Producing Enterobacteriaceae (ESBL-PE)

• Traveler's diarrhea is a significant risk for acquiring ESBL-PE.
• Vaccination against Hepatitis A and Typhoid fever can reduce the risk of traveler's diarrhea.

Meningococcal Infection

• A quadrivalent meningococcal conjugate vaccine is available in the United States.
• Vaccination is recommended for travelers to countries that are hyperendemic or epidemic for Neisseria meningitidis, especially during the dry season (December-June).

Rabies Prevention

• Rabies is enzootic in many countries, and preexposure vaccination should be considered for travelers at risk, such as those working with animals or traveling to rural areas for an extended period.
• Postexposure prophylaxis involves a series of injections and may not be available or reliable in resource-limited settings.

Japanese Encephalitis

• Japanese encephalitis is a mosquito-borne viral infection in Asia.
• Vaccination should be considered for individuals traveling in endemic countries during the regional transmission season, especially if rural travel is planned.

Typhoid Fever

• Typhoid fever is a water- and food-borne infection caused by Salmonella enterica serotype Typhi.
• Two typhoid vaccines are available: an injectable capsular polysaccharide Vi vaccine and an oral live attenuated vaccine.
• Vaccination is recommended for travelers to resource-limited areas, long-term travelers, and those traveling to southern Asia.

Cholera

• Cholera is a severe watery diarrhea that can be fatal.
• An oral cholera vaccine is available for travelers to areas where cholera is common.