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Travel Medicine 101
Are you prepared to hit the road?

As international travel becomes more common, travellers are exposed to a variety of health risks in unfamiliar environments. Whether planning a business trip, a family vacation or a honeymoon, thinking ahead can reduce the risk.

First, it is a good idea to take along a first aid kit. Buy a pre-made version or put one together at home. If you have prescription medication, carry a sufficient supply in hand luggage. Be aware that some countries require a doctor’s letter certifying that medications or other medical items such as syringes are necessary for your personal use. You must also obtain travel insurance. The extra cost for insurance is minimal compared to the potential expense from unforeseen illness abroad.

If you will be travelling to a developing country, plan to visit a travel medicine clinic or a physician at least four to six weeks before you leave. This allows adequate time for any necessary immunizations before travel. A travel medicine professional will consider the specific risks involved during travel and at the destination, and suggest appropriate precautions.

Will I need special immunizations before I travel?

Immunizations help prevent serious diseases. Along with the routine immunizations most people receive as children, a yearly flu shot can help protect against several strains of influenza. For travel to areas where sanitary conditions are poor, typhoid and hepatitis A vaccinations are recommended. Specific requirements also exist for travel to certain parts of the world. For instance, proof of yellow fever vaccination is mandatory for entry into some countries in sub-Saharan Africa and South America. For specific and up-to-date information, visit a travel clinic.

What is malaria?

Malaria is a common and life-threatening disease in many tropical countries. It is caused by a parasite spread to humans by mosquitoes. Untreated malaria can lead to serious complications in the liver, kidneys and lungs.

What are the symptoms of malaria infection?

Symptoms include fever, chills, headache, muscle aches, weakness, vomiting, cough, diarrhea and abdominal pain. As the disease progresses, organ failure may result. Any traveller who has visited a malaria-endemic area and has a fever should seek immediate medical attention. Consider the combination of symptoms to be malaria until proven otherwise and treat it as a medical emergency. Malaria can present itself symptomatically up to two months after returning home. Diagnosis is made using blood tests that detect the malaria parasite.

Can I prevent malaria infection?

Unfortunately, there is no vaccine to protect against malaria. Certain actions are key in keeping yourself safe in areas where malaria is common. The species of mosquito that transmits malaria bites at night. Avoid outdoor activities after dusk and wear long-sleeved shirts and pants if you must be outdoors between dusk and dawn. An insect repellant containing DEET should be used regularly in areas where malaria is a possibility. DEET is safe for use in pregnant and breastfeeding women. If you are using a DEET-containing insect repellant on children, apply it sparingly and less frequently. Always follow the directions on the repellent. Mosquito nets, especially when treated with repellant, offer a great way to prevent mosquito bites during sleep.

Medications do exist for malaria prevention, although no medication can protect you completely. The right medication depends on the travel destination, individual risk and other existing medical conditions. A travel medicine specialist can help you decide on the best medication for a particular situation. Medication must be started before arrival in the malaria-endemic area, sometimes up to a week in advance. It must also be taken for a period of time after your return. The importance of taking malaria prophylaxis medications as prescribed cannot be overstated. The effects of malaria can be serious.

What is traveller’s diarrhea?

Traveller's diarrhea is an illness that affects visitors to developing countries and other tourist destinations. It is the most common health problem encountered by travellers. It is caused by an infectious agent (bacteria, parasite or virus) usually picked up by consuming contaminated food or drink.

Symptoms, which range in severity, include nausea, vomiting, fever and stomach cramps in addition to diarrhea. The illness usually resolves on its own but can be a nuisance and can ruin an otherwise pleasant trip.

Can traveller’s diarrhea be prevented?

Simple steps can reduce the risk. Avoid high-risk foods, including foods containing raw eggs or raw seafood. Stay away from raw vegetables and fruits that can't easily be cleaned, such as grapes and raspberries. Fruits and vegetables that can be peeled are safe. Food sold by street vendors can also be risky, since their food handling and storage practices may be questionable. Make certain food has been cooked thoroughly and is still hot when served. Avoid ice unless it has been made with purified water. Drinking water and water used for brushing teeth should be purified, disinfected with chlorine or iodine tablets or boiled. Otherwise, drink bottled water. Sewage-contaminated beaches and swimming pools can be another potential source of infection. Hand washing is essential in preventing the spread of disease-causing germs. If clean water is not available, waterless alcohol-based antiseptic hand rinses are a convenient alternative.

Several other diseases can be acquired from contaminated food and beverages, including hepatitis A and typhoid fever. The precautions mentioned above also reduce the risk of other food or waterborne illnesses.

What if I get traveller’s diarrhea?

A major concern with traveler’s diarrhea is the risk of dehydration. As soon as diarrhea develops, consume extra fluids. If diarrhea persists, oral rehydration salt solutions may help. Oral rehydration salts are often sold in developing countries. Simply add clean water according to the directions. An effective over the counter (OTC) medication for traveller’s diarrhea is loperamide (Imodium™).

As previously mentioned, traveller’s diarrhea usually resolves without medical assistance. Still, seek help if there is fever, repeated vomiting, blood in the stools or if diarrhea lasts more than three days.

Other points to remember

During your trip remember that road safety is still important. Wear helmets on bicycles and motorbikes, wear safety belts in vehicles and try not to travel at night on unfamiliar roads. Leave animals alone. They may look cute but animal bites and scratches can transmit rabies, most especially in developing and low-income countries. Don't forget the sun. The sun can be more intense at mid-day, over water, snow or high altitude. Minimize damage from the sun by using sunscreen regularly.

Where can I get more information?

Your pharmacist and family physician are good places to start. In addition, several good web sites exist. Visit www.travelhealth.gc.ca for useful travel information and links to travel medicine clinics in Canada. At www.cdc.gov/travel you can find health information on specific destinations. The World Health Organization travel medicine website includes a comprehensive online guide for international travel medicine.