Summer Travel Health Advice

SARS. Lyme disease. West Nile virus. With the smorgasbord of exotic bugs seemingly waiting to get us, is it safe to travel this summer?

The answer is a resounding yes, say travel health experts. With proper planning and precautions, the 7 in 10 Americans hitting the roads and skies this summer can help ensure a healthy vacation for their families.

Here is some travel health advice, straight from the experts.

Be Proactive

"Think about health in advance of your trip," advises Bradley Connor, MD, a travel health specialist at Weill Medical College of Cornell University and president of the International Society of Travel Medicine (ISTM).

"If you have a chronic health problem, get a checkup before you leave," he says. And find out as much as you can in advance about destination-specific health risks. The ISTM as well as the CDC and the World Health Organization (WHO) offer up-to-date information.

Pack a Travel Health Kit

Expect the unexpected, warns Connor. He tells all his patients to pack a travel health kit, equipped with the following:

• An anti-inflammatory drug such as ibuprofen or naproxen
• Anti-diarrhea medication such as Imodium, available over-the-counter
• Motion sickness medication -- also available over-the-counter
• Band-Aids
• Antiseptic cream
• Drugs for stomach upset

If you wear glasses, pack a spare pair. Mosquito or other bug repellents may also be advisable.

And if you take any prescription drugs, be sure to bring along enough for the entire trip, he says. If you're flying, always place the medication in your carry-on luggage in case your baggage is lost.

A Shot in the Arm

About 30 million Americans go abroad each year, some 8 million of whom visit developing countries where the risk of tropical and infectious diseases is high, notes Connor. And many of them fail to follow basic travel health advice.

"The good news is most of these diseases are preventable, but the bad news is most people fail to take steps to protect themselves."

He should know. Connor is co-author of a new survey showing that 4 in 10 Americans traveling to areas with high rates of malaria fail to carry antimalarial drugs. And although the majority of travelers said they believe vaccines are effective for prevention, only 1 in 3 was immunized against tetanus, fewer than 3 in 10 had received hepatitis A shots, and just 1 in 10 was vaccinated against yellow fever.

"Ensure you have all the right vaccinations and medications before you leave," he says.

Consider a Flu Shot

Flu shots are now recommended for all people traveling to developing nations, in a group, or on a cruise, says David O. Freedman, MD, travel health specialist at the University of Alabama at Birmingham.

In addition to warding off the aches and misery of influenza, a flu shot may also help avoid an unnecessary scare -- or being pulled over by immigration officials who suspect you have SARS, he says.

"The symptoms of influenza and SARS are very similar," Freedman notes. "Until we have a good mechanism in place to rapidly identify SARS, the only sensible approach is to cast a wide net. If people have symptoms that mimic those of SARS, they will need to be isolated until we can clear them."

Wash Your Hands -- Again, and Again, and Again

"If there is one message we want to say over and over, it is, "Wash your hands," says Isabelle Nuttall, MD, an infectious disease specialist at WHO headquarters in Geneva. Good hygiene is the first line of defense against any viral or bacterial ailment, be it the common cold or the potentially deadly severe acute respiratory syndrome.

Following the correct technique is important, the experts say. If you're in a public restroom with a towel dispenser, first pull down the paper so you have a clean sheet waiting with which to dry off. Then run the hot water and vigorously scrub for at least 15 seconds, making sure to get all the nooks and crannies -- the folds of your hands as well as cuticles and fingernails that can trap dirt and germs. If the washbasin has foot pedal, be sure to use it.

A simple trick, they add, is to say the alphabet to yourself while washing -- by the time you reach the letter "Z," your 15 seconds will have elapsed.

If the washroom has an electric hand-dryer rather than a paper dispenser, use your elbow to turn it on.

When should you wash? Before you prepare or eat food; treat a cut or wound; tend to someone who is sick, or insert or remove contact lenses. And, of course, you should wash after you go to the bathroom; handle uncooked foods, particularly raw meat, poultry or fish; change a diaper; blow your nose, cough or sneeze; handle garbage; tend to someone who is sick or injured, or handle an animal or animal waste.

Drink and Eat Sensibly

Travelers' diarrhea throws a wrench into more vacations than any other disease, striking an estimated 10 million travelers each year, says David Shlim, MD, medical director of Jackson Hole Travel and Tropical Medicine in Wyoming. High- risk destinations: Mexico, Latin America, Africa, the Middle East, and Asia.

To minimize risk, follow this standard travel health advice:

• Drink only bottled or boiled water.
• Eat well cooked, rather than raw or undercooked meat and seafood.
• Avoid any foods or beverages purchased from street vendors or establishments with unhygienic conditions.
• Avoid eating raw fruits and vegetables unless you peel them yourself.
• Don't put ice in your drinks.

But no matter how closely you follow this advice, you may still come down with travelers' diarrhea, says Shlim, who believes restaurant food preparation is the culprit. "Some restaurants may use the same cutting board for raw vegetables and meat, for example. Or they may rinse vegetables in dirty tap water."

His advice: Eat only freshly served foods that were cooked at high heat. "Lasagna and casseroles are risky because they are often cooked earlier, leaving plenty of time for organisms to grow."

Shlim also advises going to a doctor in advance of your trip and asking him or her for a course of antibiotics. Taken as soon as diarrhea strikes, the drugs can usually shorten the illness from several days to several hours.

Move Around, Drink Plenty of Fluids

Sitting in a cramped position for long periods -- whether in an airplane, car, or a bus -- can lead to an increased risk of potentially deadly blood clots, warns Wolfgang Schobersberger, MD, professor of intensive care medicine at the University of Innsbruck in Austria.

To minimize risk, drink plenty of non-alcoholic fluids and frequently move your legs, he says. Taking frequent, deep breaths can also improve circulation.

Those at moderate risk should also wear compression stockings, sometimes called support hose, he says. And those at high risk should ask their doctor about an injection of heparin immediately before the trip, which will provide protection for about 12 hours, he says.

Your risk for blood clots increases if you are age 60 or older, have heart disease, a family history of blood clots, varicose veins, obesity, cancer, are pregnant or recently had a baby, or have had recent surgery.

Don't Get Bitten

Mosquitoes are not just pesky pests: They can carry West Nile disease, dengue fever, even malaria. Ticks spread Lyme disease. But a few simple precautions can minimize your risk of getting bitten this summer, the experts say.

Among their travel health advice:

• Stay indoors at dawn and dusk and in the evening, when mosquitoes are most active.
• Wear long-sleeved shirts, long pants, and hats. Shirts should be tucked in.
• Tuck your pants into your socks and wear boots, not sandals.
• Inspect yourself and your clothing for ticks, both during outdoor activity and at the end of the day. Prompt removal of attached ticks can prevent some infections.
• Consider using an insect repellent: Most experts recommend repellents containing DEET on skin and permethrin-containing repellents on clothing, shoes, bed nets, and camping gear. But these ingredients can be toxic, so be sure to follow the instructions carefully.

Leave Fear -- and Masks -- at Home

Do not let fear of SARS ruin your summer vacation, Freedman says.

And even though designer masks are popping up in some airports, Freedman advises against them.

"They probably don't do a whole lot of good and may even facilitate the spread of germs," he says. Typically, masks bought in stories do not have a tight fit, he explains. Plus, they get easily soiled, so you may inadvertently spread germs when taking them off. Finally, the pore size is insufficient to catch viruses or bacteria, Freedman says.

"SARS may dominate the headlines, but there's no reason it should dominate your trip."

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