Tag Archives: international travel

International Travel Tips

Over-the-Counter Medications and Supplies:

  • Antacid
  • Antibacterial handwash
  • Anti-constipation (Dulcolax)
  • Anti-diarrheal (Imodium AD or Pepto-Bismol)
  • Anti-fungal (Monostat)-female travelers
  • Antihistamine (Benadryl)
  • Anti-inflammatory (ibuprofen)
  • Aspirin or other analgesic (pain-killer)
  • Bandages and antibiotic ointment
  • Cold tablets
  • Decongestant (Sudafed)
  • Hydrocortisone cream 0.5% t0 1%
  • Thermometer

Prescription Medications:

  • Sufficient supply of all your usual medications for a week beyond the duration of your trip, including antibiotics, oral contraceptives, etc. (leave a list of medications taken on your trip at home, preferably on an Internet-accessible computer)

Medical Alert Bracelet or Wallet Card:

  • For allergies, or a serious health condition

Other Considerations:

  • Waterproof Sunscreen with SPF 15 or higher
  • Insect repellant with 20% DEET
  • Extra pair of glasses or contact lenses

Special Medical Supplies:

  • Syringes for diabetics
  • Epinephrine (EpiPen) for serious allergy problems
  • Syrup of Ipecac if traveling with children (induce vomiting, if poisoned)

“TO DRINK OR NOT TO DRINK”

Unsafe Beverages:

  • Water or ice from hotel sinks, restaurants, and public restrooms
  • Unprocessed or chemically untreated water
  • Beverages from glasses with moisture on them
  • Carbonated drinks that are served with ice
  • Bottled water without a manufacturer’s seal
  • Raw milk

Do not use tap water to brush your teeth!

Safe Beverages:

  • Boiled or otherwise purified water
  • Internationally known brands of bottled water or carbonated drinks (without ice)

“TO EAT OR NOT TO EAT”

Unsafe Foods:

  • Foods that are not fully cooked
  • Foods prepared far in advance of eating
  • Foods made with eggs, mayonnaise, chicken, creams, or custards
  • Raw or partially cooked meats, fish, or shellfish
  • Foods served on dinnerware that is wet from washing
  • Fresh fruits and vegetables with broken skins or that you cannot peel yourself
  • Foods purchased from street vendors

Safe Foods:

  • Thoroughly cooked foods that are served hot
  • Fresh fruits or vegetables with intact skins
  • Foods that are packaged or canned
  • Rice, beans, or grains that are freshly cooked
  • Bread and other baked goods 

Getting Around Safely

Motor vehicle accidents are the leading cause of death of travelers to developing countries. Travelers involved in these accidents are also at risk for contracting serious illnesses through foreign medical system blood transfusions and injections (AIDS, hepatitis B/C).

  • Avoid overcrowded public vehicles.
  • Do not drive after dark (especially in rural areas).
  • Do not drive motorcycles (14 times more risky per mile traveled).
  • Wear a seatbelt.

Fresh Water

Slow-moving fresh water rivers, lakes, and streams in many developing countries should be enjoyed from a safe distance. It is common for these waters to be infested with parasites that are capable of penetrating the unbroken skin and causing serious illness.

If contact is unavoidable, towel dry vigorously  to reduce the risk of a parasite entering the skin, especially the feet.

High Altitude

Altitude sickness can have serious consequences and can even be fatal.

  • Make your ascent gradually, allowing time for adaptation on the way up.
  • Drink plenty of fluids.
  • Avoid overexertion (out of proportion to your physical condition and fitness level).
  • Avoid sedatives, aspirin, codeine, and alcohol.
  • Consider using acetazolamide (Diamox) preventively.

Asian Travel: Carry TamiFlu?

May 2006

Tamiflu (oseltamivir phosphate) is effective against most strains of influenza virus A and B.  This includes the Asian avian influenza (AAI), Type A H5N1 strain. This virus has been confirmed to have infected a number of people, with a substantial risk of death. Many were young, healthy individuals (as with the 1918 Spanish influenza pandemic).

Tamiflu can speed recovery by 1-2 days, and markedly reduces serious flu complications, such as secondary bacterial pneumonia.

To be effective Tamiflu must be taken within 48 hours of first symptoms: abrupt, high fever; cough/congestion; severe muscle aches; headache. There is no human vaccine available for the H5N1 strain, although work on a potential vaccine is ongoing.

So far, most of the AAI flu cases occurred by direct contact with infected poultry – chickens or ducks – or environmental surfaces contaminated by their feces/excretions. But, the concern that the bird Type A H5N1 strain could genetically mingle with more traditional human flu viruses, allowing it to become a lethal human flu strain, spreading human-to-human, is real; so real that countries have placed orders to stockpile millions of doses of Tamiflu. The Infectious Diseases Society of America has recommended that the U.S. stock 150 million doses.

The concern is for an influenza pandemic – multiple, concurrent continental epidemics worldwide. The 1918 Spanish influenza pandemic caused 25 million deaths in 6 months. The pre-condition for that pandemic as well as the one predicted to occur soon in the upcoming years (by the Asian A H5N1 strain or other flu virus) is an immunologically novel influenza virus for humans, with no immunity experience from prior illness with the specific flu virus strain or closely related prior flu virus strains or from influenza vaccines used in prior years. In other words, with an epidemic from a viral strain to which people are immunologically naked, 2.2 million deaths in the U.S. are predicted. Worldwide the toll would be unimaginable.

Although the Centers for Disease Control (CDC) has not yet issued a travel advisory for the general public, these facts should at least prompt consideration for carrying a supply (5 day treatment course) of Tamiflu by individuals traveling or residing in countries where  human or bird cases have occurred (and possibly contiguous nations, as well):

 

Animal Cases
Since December 2003, avian influenza A (H5N1) infections in poultry or wild birds have been reported in the following countries:
Africa: Europe & Eurasia:
Burkina Faso Albania
Cameroon Austria
Cote D’Ivoire Azerbaijan*
Djibouti* Bosnia & Herzegovina (H5)
Egypt* Bulgaria
Niger Croatia
Nigeria Cyprus
Sudan Czech Republic
East Asia & The Pacific: Denmark
Cambodia** France (H5)
China* Germany
Georgia Greece
Hong Kong (SARPRC) Hungary
Indonesia* Italy
Japan Poland
Laos Romania
Malaysia Russia
Mongolia Serbia & Montenegro
Thailand** Slovakia
Vietnam** Slovenia (H5)
Near East: Sweden
Afghanistan Switzerland
Egypt Turkey*
Iran Ukraine
Iraq (H5)* United Kingdom
Israel
Jordan
Pakistan
South Asia:
Burma (Myanmar)
India
Kazakhstan
*human cases
**most cases human
For additional information about these reports, visit theWorld Organization for Animal Health Web site.Updated May 30, 2006

Availability of the drug locally cannot be relied upon and it must be started immediately upon becoming ill or after credible exposure (as an illness preventive strategy). Older flu drugs, amantidine and rimantidine, are not effective against this strain. Relenza (zanamivir) is effective, but cannot be used in those less than 12 years old or in those with respiratory disease (asthma, COPD, etc.).

Officials at the CDC and the World Health Organization (WHO) believe that the H5N1 Type A strain has become endemic to the birds in the affected regions and that human infections will continue. They feel it is possible this strain will evolve into a deadly human pathogen (once there is human-to-human transmission possible).

Asian Avian Flu Preparations

  • Regional Destination Disease Activity Information: update yourself: http://www.cdc.gov/flu/avian/index.htm
  • Asian Avian Flu Kit:
    • thermometer
    • alcohol-based hand rub for hand hygiene
    • Tamiflu 75mg twice daily x 5 days
    • In-Country Healthcare Resources: identify pre-travel
    • Medical Evacuation Health Insurance
  • During Travel
    • Avoid direct contact with poultry/fowl – live or dead.
    • Avoid poultry farms and bird markets.
    • Avoid handling surfaces contaminated with poultry feces/excretions.
    • Perform careful, frequent hand cleansing.
    • Thoroughly cook all poultry products – heat kills flu virus.
    • If you become sick abroad, contact U.S. consulate to locate medical services.
  • After Travel
    • If you become ill within 10 days of return, immediately notify your physician or a travel medicine/infectious diseases specialist, emphasizing the specifics of your recent travel.

 

Edward R. Rensimer, MD, FACP

Director, IMC

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

Food and Beverage Safety

Food and Beverage Safety

“TO DRINK OR NOT TO DRINK”

Unsafe Beverages:

  • Water and ice from hotel sinks, restaurants and public restrooms
  • Unprocessed or chemically untreated water
  • Beverages from glasses with moisture on them
  • Carbonated drinks that are served with ice
  • Bottled water without a manufacturer’s seal
  • Raw milk

ATTENTION: Do not use tap water to brush your teeth

Safe Beverages:

  • Boiled or otherwise purified water
  • Internationally known brands of bottled water or carbonated drinks (without ice)

“TO EAT OR NOT TO EAT”

Unsafe Foods:

  • Foods that are not fully cooked
  • Foods prepared far in advance of eating
  • Foods made with eggs, mayonnaise, chicken, creams or custards
  • Raw or partially cooked meats, fish, or shellfish
  • Foods served on dinnerware that is wet from washing
  • Fresh fruits and vegetables with broken skins or that you cannot peel yourself
  • Foods purchased from street vendors

Safe Foods:

  • Thoroughly cooked foods that are served hot
  • Fresh fruits or vegetables with intact skins
  • Foods that are packaged or canned
  • Rice, beans, or grains that are freshly cooked
  • Bread and other baked goods

 

BIOTERRORISM: FUTURE

Republished from the December 2001 issue of Texas Healthcare Houston magazineRepublished from the December 2001 issue of Texas Healthcare Houston magazineRepublished from the December 2001 issue of Texas Healthcare Houston magazineRepublished from the December 2001 issue of Texas Healthcare Houston magazineRepublished from the December 2001 issue of Texas Healthcare Houston magazineRepublished from the December 2001 issue of Texas Healthcare Houston magazine