To prevent illness while traveling, it is good preventative strategy to have a pre-travel evaluation with one’s primary care physician. He or she can advise upon many conditions that are present and how best to avoid complications that traveling add to their respective risks. A list of potential exposures based on the itinerary can help organize immunizations/vaccinations to preemptively counter the endemic diseases along the trip and at the destination.
A list of all current conditions and current medications should be compiled. For the medications, include the generic names, since brand names may be unrecognized abroad.
A past medical history and a list of allergies is part of the pre-travel evaluation, as is a list of immunizations and the dates of administration.
Ingestion of Contaminated Food and Drink
Travelers diarrhea, the most common illness, affecting almost 40% of those traveling from a resource-rich to a resource-poor region, is typically caused by ingesting any one of many bacterial, viral, and parasitic organisms. Avoiding open-air food establishments and keeping to factory-sealed bottles of beverages can limit exposure.
Standing and walking should be done at least every 1-2 hours to discourage thrombus formation in the legs. Jets do not pressurize cabins to sea level, so that cardiopulmonary compromise may require pre-trip planning for oxygen supplementation. In those with respiratory infections, decongestants will help prevent ascent or descent pain in the eustachian tubes. Jet lag should account for the time of re-equilibration with one’s circadian rhythm, typically one day for each time zone crossed. Some immunocompromise and fatigue from disruption of the sleep/wake cycle can be anticipated. For this reason, in west-to-east travel, melatonin should be taken on the evening of arrival and for 5 days after; in east-to-west travel, seeking morning light and avoiding sun exposure in the afternoons for a few days will ease the re-acclimation. Diabetics should discuss alterations in their insulin requirements due to jumped time zones and sporadic meals.
The CDC has information on which specific cruise ships meet sanitation standards. Hand-washing should be frequent. Scuba divers should wait 1-2 days before flying to avoid decompression sickness (“the bends”).
The biggest risk in traveling to remote locations (ocean travel, jungle expeditions, desert travel) is the lack of a timely response to medical emergencies that can arise. One must take into account present medical conditions that would rely on a timely intervention should it be necessary. Even surprises (e.g., appendicitis on the tundra) can cause death that otherwise could be treated easily.
Vaccines needed will depend on the destination. However, the following are commonly administered:
- Yellow fever (Africa, Central and South America)
- Typhoid (Asia, Africa, Latin America)
- Hepatitis A
- Japanese encephalitis (Asia)
- Polio (Pakistan and Afghanistan)
- Tetanus, diphtheria
- Hepatitis B
An egg allergy should be reported before getting any immunizations. Also, some vaccines require more than one dose, so the time needed for a full course completion before embarking should be taken into account.