When traveling outside the United States, you should always be prepared for the unexpected. The physicians at Capital Center for Travel and Tropical Medicine can prescribe appropriate medications to take with you to help avoid and treat disease.
Malaria is a life threatening disease that is transmitted by infected mosquitoes. Travelers can avoid infection by repelling mosquitoes and using preventative medicines.
You can repel mosquitoes by the following methods
• Use insect repellent containing 30-50% DEET on all exposed skin except eyes, lips and open wounds.
• Pre-treat clothes, netting and shoes with permethrin, which also repels mosquitoes.
• Wear long pants tucked into pants when hiking and long sleeve shirts tucked into your pants.
• Avoid scented products such as perfumes and deodorants.
• Try to remain indoors between dusk and dawn when mosquitoes are most active.
Your physician will prescribe anti-malarial medicines which are taken before, during and after your trip. It is extremely important to take these medications as prescribed.
Before you travel, see your travel medicine provider. They will review your specific itinerary and determine the risk of malaria exposure.
The most common health related issue to afflict the traveler is diarrhea. Typically caused by the ingestion of bacteria or their toxin byproducts, viruses and parasites after swallowing germs during mealtime or from contaminated hand to mouth contact.
When traveling to a developing country be aware of the filtration system. Here are a few tips.
• Boiling water for 3 minutes is a safe way to disinfect the water
• Drink bottled water and juices.
• Use bottled or boiled water to brush your teeth
• Avoid milk and dairy products which may be unpasteurized
• Do not use ice made from local tap water
• Ask your physician about the use of iodine tablets to disinfect the water.
• Eat only fruits with thick skin that you have personally peeled
• Do not eat raw or undercooked meat, seafood or vegetables
• Avoid salads (washed with contaminated water)
• Do not eat food from street vendors
• Wash hands with soap before eating
Rehydration is the key if you should contract traveler's diarrhea. If you have several watery stools with abdominal cramps you have likely contracted traveler's diarrhea. You should drink fluids (bottled juices and water as well as broths made from boiled water). If possible try and purchase oral rehydration salts known as Pedialyte or Gatorade. If overseas and are unable to purchase these products you can make your own rehydrating solution. Mix together 1 tsp salt and 8 tsp sugar in 1 quart of clean (bottled or boiled) water.
Over the counter medication, i.e. Imodium AD can be taken with caution only if you do not have a fever or bloody stools. Be careful, we do not want to trap the offending agent or chemical in your body so only use Imodium if you are having trouble keeping up with what is coming out of you. If you have no relief from Imodium AD, you should consider taking an antibiotic prescribed by your physician.
Please wash your hands frequently to prevent infecting others.
Ticks are one of the leading carriers of diseases to humans, whether from the tick bite itself or from the organisms in the tick's saliva transmitted through the bite.
The following are simple measures a traveler can take to help prevent a tick bite:
• Avoid grassy areas and shrubs where ticks may be lying in wait.
• Wear light colored clothing so ticks can be easily seen, and brush them off
• Tuck your pants into boots or socks
• Apply insect repellant to the clothing but not to the skin, specifically the brands designed to repel ticks.
• At the end of the day do a "tick check" on yourself
Unfortunately, many people think they know how to remove ticks, but the most common tick-removal methods result in increasing the chances of infection. The best way to remove a tick is to use a small pair of tweezers. Using the tweezers, carefully flip the tick onto its back. Grab the tick firmly (but not too tight as to cause it to rupture) with the tweezers as close to the skin as possible. Apply gentle pulling until the tick comes free. Twisting and turning the tick can cause the head and mouthpiece to break off increasing the chance of infection.
Once the tick is removed, you may rinse it down the sink or flush it down a toilet. Consider keeping it in a tightly closed jar or taped to a piece of paper to help the doctor in managing your condition should you become ill from the tick bite.
Cruise Ship Sanitation
The CDC (United States Centers for Disease Control and Prevention) conducts sanitation inspections of all passenger cruise ships arriving at ports under control of the United States. These inspections are held to decrease the possibility of disease outbreaks caused by contaminated food or water on board cruise ship. Ships are rated on the following items to determine if they meet CDC's sanitation standards:
• Food Preparation
• Potential contamination of food
• Personal cleanliness of food handlers
• General cleanliness and repair
The inspection program is based on World Health Organization guidelines.
A summary of cruise ship sanitation inspections and/or a copy of the last inspection report of a specified ship is available from the Office of Chief, Sanitation and Vector Control Activity, Quarantine Division, 1015 North America Way, Room 107, Miami, Florida 33132.
Altitude sickness can affect 25% of adults going higher than 5000 feet. Eight percent of those symptomatic will develop more serious disease resulting in possible brain swelling and/or heart failure. Initial symptoms may mimic more common problems such as migraine headaches, dehydration, exhaustion, viral infections, or bronchitis.
Travelers have options to decrease risk. Slower ascent facilitates acclimatization. Reduced activity upon arrival and appropriate high carbohydrate diet are helpful, as well as limited alcohol usage. Acetazolamide (Diamox) is the drug of choice to accelerate acclimatization and decrease susceptibility to altitude sickness. It is gentle, yet very effective when started twice or three times per day the day before ascent and continued until descent. Acetazolamide acts as a mild diuretic and also adjusts the chemistry of the body promoting adequate breathing patterns' and fluid balance. Acetazolamide is contraindicated in persons with sulfa allergy. Dexamethasone and Nifedipine are helpful in select situations.
Mild altitude sickness may be treated with analgesics, diamox, or dexamethasone. The mildly symptomatic person should rest and not go any higher until symptoms resolve. If there is no improvement in a few days, or the symptoms worsen, it becomes imperative to descend to lower elevation, and use oxygen in conjunction with further treatment to save the person's life.
Sexually Transmitted Disease
Be aware of risk of infection if you should decide to be sexually active abroad. Particularly, risk of HIV and other sexually transmitted diseases such as gonorrhea, Chlamydia, Herpes simplex, syphilis, HBV, etc. may be much higher than here in the U.S. Responsible behavior and use of condoms and alcohol will decrease but not eliminate all risk. Avoid illicit drugs. Abstinence is the only preferably reliable safe behavior. There is increased antibiotic resistance in some of these infections in Asia and Africa. It is important to let your health care provider know of your travel history, should you develop illness upon return home.
20-50% of travel-related deaths are caused by accidents, trauma and injuries. Avoid nighttime driving in rural areas. Use seat belts and infant/child car seats. Avoid use of alcohol while driving or engaging in water sports. Use flotation devices or life jackets. Use helmets when riding bikes, horses, or mopeds. Avoid politically unstable areas.