General Travel Guidelines

Basic Recommendations

  • Know your risk; some countries have higher risk than others.
  • Determine if anti-malarials are required.
  • Begin recommended immunizations several months before departure.
  • Obtain address and telephone number of the American Embassy in each country you visit; included in State Department Advisory (excellent source for overseas physicians and hospitals.)
  • Develop a plan for illness or disability.
  • Ascertain if health insurance covers illness abroad.
  • Carry adequate supplies of all required medications (including syringes, if needed.)
  • Plan for adjusting medication schedule to new time zones.
  • Take an extra pair of glasses or lenses and lens solution, and optical prescription.
  • Carry identification.
  • Take a basic first aid kit.

Immunizations: May be standard, required, or highly recommended

  • Check with your physician about updating standard immunizations (tetanus, measles, polio, and others.)
  • Obtain immunizations required by individual countries (yellow fever), or recommended because of itinerary and style of travel (typhoid, hepatitis A and B, rabies, Japanese encephalitis, meningococcus, and others.)

First Aid/Travel Kit

May include tweezers, needle, pocket knife, scissors, flashlight, bandaids, sterile 4x4 gauze pads, adhesive tape, povidone-iodine solution for skin disinfection, antibiotic ointment, pain/fever medication (aspirin, acetaminophen, ibuprofen), antifungal cream, cortisone cream, and antihistamine tablets. Also should include insect repellents and insecticides, water purification tablets, sunblock, and medications for diarrhea/dehydration, and altitude and motion sickness as described below.

Take Appropriate Precautions

Insect borne diseases (Vector borne): Many insect-transmitted diseases are not prevented by vaccines or drugs.

  • Some insect-borne dseases like dengue fever are transmitted during the day, but malaria is transmitted from dusk until dawn.
  • Avoid rural side trips if possible.
  • Leave rural areas before dusk.
  • Avoid still water ponds and lagoons.
  • Use insect repellents (a 35% non-absorbable formulation of N,N diethyl-m-toluamide, DEET (Ultrathon, 3M), is optimal), wear clothes that cover arms and legs, spray clothing with permethrin (Permanone), stay indoors in screened rooms fro msunset until morning, spray rooms with pyrethrum-containing flying-insect sprays, and sleep under permethrin-impregnated bed nets.
  • TAKE ANTI-MALARIA MEDICATION.

Food and water borne diseases (Travelers' Diarrhea):

  • It is optimal to drink water boiled for 10 minutes. For each mile of altitude add 5 minutes to boiling. Bottled carbonated beverages, beer, and wine are acceptable. Avoid ice, and use fresh straws and disposable cups, if possible. Don't brush teeth or clean contacts in unboiled local water. Carry immersion coil to boil water. Less preferable are iodine tablets or other water purification systems.
  • Eat only well cooked food. Avoid salads, other uncooked vegetables, creamy desserts, and food sold by street vendors. Make sure that milk, cheese, and other dairy products have been pasteurized. Eat only fruits that you peel yourself.
  • Develop a plan with a physician for treatment of diarrhea. This may include bismuth subsalicylate (Pepto-Bismol), an antibiotic such as ciprofloxacin, an antimotility agent like loperamide (Imodium), a fluid/electrolyte solution like IAMAT Oral Rehydration Salts, and reporting to a physician if diarrhea contains blood or pus. If travel is short term and diarrhea is unacceptable, consider prophylaxis with bismuth subsalicylate or an antibiotic.

Motor vehicle accidents: In some areas, motor vehicle accidents are the leading cause of medical problems among tourists.

  • Avoid riding motorcycles or wear a helmet.
  • Don't drink and drive.
  • Avoid traveling on crowded buses, trucks or taxis.
  • Request rental cars with seat belts and bring infant car seats.

Diseases transmitted by contact with skin:

  • DO NOT SWIM, BATHE, OR WADE IN FRESH WATER, STREAMS, LAKES, OR RIVERS WHERE SCHISTOSOMIASIS IS TRANSMITTED. If contact with such water occurs, immediately towel dry.
  • Inquire about jellyfish and other poisonous sea creatures.
  • Wear protective clothing (long sleeves and pants, socks, shoes.) Do not walk barefoot.

AIDS/HIV, Hepatitis B, and other sexually transmitted diseases:

  • Avoid contact with blood, or body fluids of other individuals.
  • Avoid injections.
  • Practice safe sex. Always use condoms with spermacides.

Heat and sun exposure:

  • Avoid sun between 10 a.m. and 2 p.m.
  • Wear protective clothing/hats and sunglases.
  • Drink lots of fluids, but avoid alcohol.
  • Use air-conditioning.
  • Always use sunscreens and lip balms with UVA/UVB sun protective factor of at least 8.

Cold Exposure:

  • Bring adequate clothing.

Altitude sickness: Slow ascent is the cornerstone of prevention of altitude sickness; 1000 feet per day above 10,000 feet.

  • The altitude at which the climber sleeps is critical. It is recommended that one should climb "high" and sleep "low".
  • At high altitude, the climber should not overexert, and should eat a high carbohydrate, low-fat diet, and avoid excessive salt.
  • Acetazolamid (Diamox) when begun before rapid ascent and continued for 1-2 days after arrival aids in acclimatization.
  • Dexamethasone decreases the symptoms of altitude sickness, but does not enhance acclimatization. A recent study suggests that nifedipine may be useful in preventing altitude sickness.

Motion sickness: This can generally be prevented with over the counter antihistamine tablets. (Dramamine, Bonine) or with prescription products (Transderm Scop patches.)

Jet Lag: This may be unavoidable. Recent studies suggest that exposure to as much sunlight as possible after arrival may reduce jet lag. Consider adopting the new time zone sleeping schedule as early as possible. The best strategy may be regular sleep, diet, exercise, and avoidance of alcohol.

Radiation: The Chernobyl Nuclear accident resulted in the largest release of radiation ever recorded affecting the Ukraine, Belarus, and Russia. Travelers should avoid controlled areas and long term travelers should investigate local conditions prior to residence. Travelers should drink bottled water, avoid wild or uncontrolled food stuffs. Young children, babies, nursing infants and pregnant women are at greatest risk.

Poisonous snakes: Most bites are a result of handling or harassing. Less than half the bites contain venom, but medical attention should be sought.

  • Use mosquito nets, protective clothes and snake out clothes and boots in the morning.
  • Scorpions are painful, but seldom dangerous except to small children.

Pregnancy: Travel is not a problem for the healthy woman with a normal pregnancy.

  • If possible, administration of live vaccines is avoided during pregnancy, while inactivated vaccines are generally thought to be safe.
  • Because the long term effects of antimalarials have not been adequately evaluated, the world wide spread of chloroquine resistant P. falciparum has made chemoprophylaxis for women in the childbearing years often difficult.
  • Flying is generally not limited until the 36th week. The obstetrician should be consulted.

Appropriate response to illness after returning home:

  • Make certain that you inform your health care provider that you have traveled recently and provide the itinerary, and share your knowledge of the diseases to which you may have been exposed.
  • If you develop a fever during the next two years after returning from a malarious area, and there is no obvious cause for the fever, you must demand that malaria smears be done every 12 hours for 48 hours to rule out malaria.