Vaccinations and Other Precautions
-- By Chris Ott
© 2000, RPK&A, Inc.
OK, so maybe you won't come down with giardiasis, cyclosporiasis, onchocerciasis, or leishmaniasis. Maybe you'll be spared the unpleasantness of tuberculosis, shigellosis, even cryptosporidiosis. And perhaps you don't have to worry about leptospirosis, coccidioidomycosis, or histoplasmosis. But how do you really know?
The world we inhabit is not exactly a sanitary place, and in fact it's home to a variety of microorganisms that are just waiting for the chance to smack your immune system around a bit. Worse, the danger isn't just in "exotic" places; even in some of world's more manicured countries, you can pick up things like Lyme disease, rabies, hantavirus, mad cow disease, or that old favorite, the Plague. So what are you, in your bright-eyed state of wanderlust, supposed to do?
Other than the immunizations you've probably already had, there's no one-size-fits all approach. Fortunately, it's pretty easy to check the travel requirements and advisories for the specific places you may be dropping in on, and that's the first step. See "Where to Go for More Information" at the end of this article for details.
Once you know what (if anything) you need, it's a good idea to start as early as you can. That's because not every clinic stocks obscure vaccines. Some immunizations also require multiple doses spaced out over a period of weeks or months, and some vaccines can't be given at the same time as others.
You don't need any particular immunizations at all to visit some countries, but a common requirement for the tropics is a certificate for vaccination against yellow fever (a sometimes-fatal, mosquito-borne infection). Although not usually required, it may also be a good idea to bring records of your other immunizations, or at least to be familiar with what you've had and when. Rural Russia, for instance, might not be a good place to have to remember when you had your last tetanus shot (they're usually recommended every 10 years).
Remember, also, to bring an adequate supply of any medications or equipment you might need. Sometimes you may even be advised to bring your own supplies, like syringes, if you're traveling to a region where they may be unavailable or (maybe even worse) considered reusable. If you do this, however, it's a good idea to bring along a letter about them from a health care provider--sometimes border guards who find syringes think you're carrying drug paraphernalia.
Be sure to bring any other necessary paperwork too. If you have insurance, check to see if it covers you where you're traveling, and what the procedure is if you need to get care. You may have to pay for medical care yourself or wait to get reimbursed until after you get back.
Food, Bugs, and Other Hazards
According to the U.S. Centers for Disease Control, food and waterborne diseases are the number one cause of illness in travelers, so it's prudent to take precautions.
To deal safely with thirst, drink only canned or bottled drinks, or beverages like tea or coffee, for which the water has been boiled. You can purify water yourself by boiling it, or (more conveniently) with filters and dissolvable tablets available from travel or camping stores. If you can, avoid ice--freezing doesn't kill what might be found in contaminated water.
Cooked food that's still hot is generally safe, but it's smart to be wary of street vendors; conditions may be less than immaculate, and it may be difficult for them to keep food hot. You can also peel fruits that may have been washed in contaminated water, and try to avoid raw or uncooked foods, including salads if the vegetables may have been washed in suspicious water. Wash your own hands.
If you have special dietary requirements or preferences, remember that some foods (like, say, vegetables) may be difficult to find in some countries. And, since even the best precautions sometimes fail--sometimes even in countries with good sanitation--it's also a good idea to bring a small stash of over-the-counter diarrhea medication and other hygienic aids. (I once had to ask our group's guide if there was, um, a bathroom somewhere nearby. He helpfully suggested, "Well, if you catch bus number 183 and transfer at the park to the number 62…")
If you're going somewhere where insect-borne diseases like malaria occur, it's a good idea to wear protective clothing (comfortable long-sleeved shirts and pants) and insect repellant. Speaking of which, if you're traveling to these areas, be ready on board the plane for disinsection: the quick (if slightly unnerving) spraying of an insecticide inside the cabin to take care of any tiny stowaways.
It's also important to remember that not every travel-health danger is microscopic. Vehicular accidents--both for passengers and pedestrians--are one of the leading causes of travel injuries, so keep an eye on those careening Ladas. Crime is also a problem for travelers everywhere from Turkmenistan to Texas.
So there are some precautions to take on trips abroad, but another danger is going too far. Maybe one of the worst things you can come down with while traveling is a case of hypochondriasis: "morbid concern about one's health, especially when accompanied by delusions of physical disease." Buen viaje.
Where to Go for More Information
- HTH CityHealth Profiles contain information about notable hospitals, pharmacies and emergency numbers in more than 500 destinations. In addition they include information from the Centers from Disease Control on vaccination requirements.
- Travel warnings and consular information sheets from the U.S. State Department provide general information about each country in the world, as well as details on medical entry requirements, the availability of medical care and facilities, and safety information. They're available online at: http://travel.state.gov/travel_warnings.html
- The U.S. CDC maintains a site with more detailed health information at http://www.cdc.gov/travel/destinat.htm, including information about everything from current outbreaks to the health inspections of specific cruise ships. You can also get travel-health information from the CDC for special circumstances--such as if you have disabilities or are pregnant or HIV-positive--at http://www.cdc.gov/travel/spec_needs.htm. Also be sure to check HTH's Special Needs Travel Health Center.
- The World Health Organization offers a comprehensive, country-by-country list of required immunizations (and even recommended medications, like the most effective anti-malarial drugs for a particular region) at http://www.who.int/ith/english/country.htm.
- For more details on food- and waterborne illnesses that cause everything from diarrhea to mad cow disease, see the CDC's "Safe Food and Water" recommendations at http://www.cdc.gov/travel/foodwater.htm and the article Avoiding Travelers' Diarrhea.
- In addition to the online resources mentioned here, check the CDC's 225-page manual Health Information for International Travel, available electronically for free at http://www.cdc.gov/travel/reference.htm.
- Canadian citizens may want to check "Information for Travellers" (http://www.hc-sc.gc.ca/hpb/lcdc/osh/pub_e.html), a site maintained by Health Canada. Many other countries provide travel recommendations specifically for their citizens as well.
Berkow, Robert, MD, ed. 1997. The Merck Manual of Medical Information: Home Edition. New York: Pocket Books.
Centers for Disease Control and Prevention. Health Information for International Travel 1999-2000. Atlanta: U.S. Department of Health and Human Services.