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Disaster Preparation/Safe Travel

Disasters, natural or otherwise, create substantial problems with medical/health implications:

  1. Water Supply: disrupted
  2. Increased free-standing water
  3. Unburied, decaying corpses
  4. Shelter unavailable (from sun, rain, heat)
  5. Food supply: questionable availability/quality
  6. Crime: social, law enforcement disruption
  7. Communications: disruption of any reliable connection to others except by satellite-based systems
  8. Medication shortage

In the weeks and months post-disaster, social and disease-related problems will occur. Most of these will remain localized in the areas of physical destruction, although mosquito-borne disease incidence and risk will almost certainly increase in adjacent areas downwind: malaria, Japanese encephalitis, dengue, West Nile virus, Yellow fever, etc. (depending on which infectious agents are endemic to the area).

To be properly prepared, travelers should well consider the following:

  1. Bottled water: Although physically cumbersome, carrying water for short trips makes the most sense. Foreign-bottled water may not be up to acceptable standards of purity. With relief efforts underway, US-produced bottled water may be available from emergency support organizations. Consider a personal H2O purification device (filtration/sterilization) or H2O sterilization chemicals (iodine, etc.).
    Note: Do not brush teeth with local water and avoid bathing in it.
  2. Food: Take prepackaged, easily preserved dry foods – “Power Bars”, grain-based snacks (granola, etc.), dried fruit, heat resistant candy, etc.
    Note: If you can procure packaged food from relief organizations while there, you probably can rely on its safety.
  3. Shelter: Consider taking mosquito netting and a sleeping mat/bag.
  4. Medications:
    1. Antimalarials: Are a must. In ordinary circumstances, highly dangerous, resistant malaria is fairly limited in incidence in endemic areas. As time goes by, the density of infected mosquitoes will increase with the increase of free-standing water, large number of homeless people serving as a reservoir for malaria incubation, and a lack of antimalarial medications for prevention and treatment locally.
    2. Travel Medicine Kits: Medications to address,
      1. Nausea
      2. Diarrhea
      3. Pain – moderate and severe
      4. Fever
      5. Wound cleansing
      6. Bandages
      7. Anti-inflammatory
      8. Decongestant
      9. Sunscreen
      10. Antibiotics: Antibiotics directed,
      11. Bacterial Gastroenteritis (dysentery)
      12. Respiratory Infection
      13. Soft Tissue Infection (from skin trauma)
      14. It can be assumed that medications will be unavailable and that access to medical expertise will be marginal. In addition, with an illness evolving, ability to arrange means of travel quickly to obtain medical evaluation or evacuation may not be practical.
      15. DEET Insect Repellent (skin)
      16. Permethrin Insecticide (used on clothing)
  5. Immunizations:
    1. Hepatitis A
    2. Hepatitis B
    3. Typhoid
    4. Influenza
    5. Polio
    6. Japanese encephalitis
    7. Rabies
    8. Routine: Tetanus/diphtheria, Tdap; pneumonia
      Note: There is no cholera vaccine available in the U.S., and the vaccine currently available elsewhere is not highly effective.
  6. Personal items:
    1. Toilet paper
    2. Soap
    3. Toothpaste
    4. Female menstrual products
    5. Sunglasses / extra reading glasses
    6. Tape recorder
    7. Digital camera (with spare batteries)
    8. Digital phone (with charger)
    9. Camping knife
    10. Personal digital assistant (and batteries)
    11. Global Positioning System device
    12. Footwear (suited for uneven terrain, demanding activity)
    13. H2O purification device (filtration/sterilization)
    14. Whistle; strobe light; flashlight
    15. Multi-purpose tool (cutting)
  7. Crime: Notify your embassy of your arrival and planned itinerary, with updates en route. Also, provide this information to others at home as much as possible through e-mail. Have copies of travel documents (passport, visa, credit cards, and any other important identifying and contact information) in a secured website with password available to trusted individuals. Maintain the highest level of awareness and suspicion, and practice prudent avoidance of travel in high-risk areas, particularly after-hours.
  8. Diseases expected to increase, specifically:
    1. Malaria
    2. Dengue fever
    3. Bacterial dysentery: cholera, typhoid fever, E. coli, Campylobacter
    4. Other dysentery: giardiasis, amebiasis, norovirus
    5. Respiratory infections: influenza, pneumonia
    6. Soft tissue infections: staphylococcal and streptococcal – especially boils and impetigo
    7. Viral: hepatitis A, hepatitis B
      Note: To learn more about these diseases, please see the table at the end of this document.
  9. Personal Medical Conditions: Be sure to carry adequate supplies of medications (at least a month’s amount) for pre-existing problems: diabetes, high blood pressure, heart diseases, etc.
    Note: List meds, dosages, etc. on your website for access while abroad along with other vital personal medical information that would be critical to foreign care providers in an emergency.
  10. Medical insurance: Coverage for medical evacuation/transport, medical care, and repatriation of remains
  11. Identification bracelet or necklace/dogtag:
    1. Name
    2. Website
    3. Cell phone numbers (of your contacts)
    4. Nationality
    5. Passport number
    6. Religion
  12. Leave a hair sample at home in a dry container for DNA analysis, if needed, and place on your computer/internet location where to find that sample.

Conclusion: Some of these items may not be relevant to a specific trip. Many must be handled by the traveler. Many medical supplies and treatments should be available at a travel medicine specialty clinic.

Edward R. Rensimer, MD, FACP

Director, IMC

Summary of Common Travel/Disaster-Related Illnesses Transmission, Prevention & Treatment

Disease Transmission Available Prevention Treatment
Amebiasis (Diarrhea) Food, Water Low-risk ingestion Antibiotics
Campylobacter Food, Water Low-risk ingestion Antibiotics
Cholera (Vibrio) (Diarrhea) Food, Water Low-risk ingestion Antibiotics/Supportive
Dengue (virus) Mosquitos Vector barriers Supportive
E. coli (Diarrhea) Food, Water Low-risk ingestion Supportive +/- Antibiotics
Giardia (Diarrhea) Food, Water Low-risk ingestion Antibiotics
Influenza (virus) Respiratory VaccineAntiviral medications Antiviral Medications
Malaria Mosquitos Antimalarial Medications Antimalarial Medications
Norovirus Pneumonia (pneumococcal) Respiratory Vaccine Antibiotics
Soft Tissue Infection (MRSA Cellulites) Skin Contact Topical Antibiotics Antibiotics
Typhoid (salmonella) Food, Water Low-risk ingestion Antibiotics
Vibrio vulnificus (Diarrhea/Soft Tissue) Seafood, Water Avoid contaminated sea water/food Antibiotics/Surgery/Supportive
Viral Hepatitis A Food, Water Gamma GlobulinVaccineLow-risk ingestion Supportive
Viral Hepatitis B Intimate ContactBody Fluids Safe SexAvoid Body FluidsVaccine Antiviral MedicationsHepatitis B Antibody
West Nile Virus Mosquitos Vector Barriers Supportive