Travel Health

Online Travel Health Course : Online Travel Health Course An Online Course Presented by Student Health Services Health Education Texas A&M University Updated May 2007


Introduction : Introduction This course is designed to help you stay healthy when you travel and make informed decisions regarding immunizations. Schedule appointments with SHS Preventive Medicine as soon as you know you are traveling. Some vaccines take 2-6 months to complete the series. Please bring records of any previous immunizations with you to your appointment. If you follow preventive behaviors you can avoid most travel-related health and safety problems to ensure a wonderful trip.


Overview of the Course : Overview of the Course Food and water borne illnesses and precautions Insect borne illnesses and precautions Blood, body, and air precautions Treatment of common traveler’s ailments and when to seek medical care Specific vaccine-preventable diseases 10 tips for students Traveler’s health kit Before you go… Resources


Food and Water Borne Illnesses and Precautions : Food and Water Borne Illnesses and Precautions


Food and Water Borne Illnesses : Food and Water Borne Illnesses Hepatitis A Traveler’s Diarrhea Polio Typhoid Fever


Food Precautions in Developing Countries : Food Precautions in Developing Countries Avoid raw foods – salads, uncooked vegetables, unpasteurized milk and milk products such as cheese Eat only foods that have been cooked and are still hot or fruit that has been peeled by the traveler Reheat cooked food that has been standing for several hours at room temperature Avoid food and beverages obtained from street vendors


Food to Eat : Food to Eat Well-cooked meats, fish, veggies – served piping hot Rice, beans, and breads and other baked goods Fruits, nuts, veggies with thick skins or shells that you remove or peel yourself Canned foods are safe unless the can is dented, swollen, or hisses when being opened Take a multivitamin daily


Foods to Avoid : Foods to Avoid Fruit salad made with fruit you didn’t peel yourself Leafy green salads Food enhancers such as salsas Thin-skinned fruit (peaches) or non-peelable fruit (grapes) Raw or undercooked meat, fish, or shellfish – undercooked shellfish are carriers of Hepatitis A Unpasteurized dairy products such as white cheese, milk, and yogurt Food from street vendors Buffet foods unless you know they are fresh and have been kept hot


Water Precautions in Developing Countries : Water Precautions in Developing Countries Swimming Avoid beaches, lakes, or rivers that have been contaminated by human sewage or dog feces Avoid swallowing water while engaging in aquatic activities Chlorinated water can be considered safe if the water is properly maintained. However, avoid swallowing chlorinated swimming pool water. Avoid swimming with open cuts and abrasions Avoid wading or swimming in freshwater streams, canals, and lakes in schistosomiasis-endemic areas of the Caribbean, South America, Africa, and Asia


Water Precautions : Water Precautions Drinking – the following is safe to drink Beverages, such as tea and coffee, made with boiled water Canned or bottled beverages, including water, carbonated mineral water, and soft drinks Beer and wine


Hidden Drinking Dangers : Hidden Drinking Dangers Brushing your teeth or rinsing your contacts with faucet water Avoid ice, frozen beverages (the freezing process does not kill the organisms) Avoid fruit juice or lemonade from concentrate


Food and Water Borne Illnesses: Hepatitis A : Food and Water Borne Illnesses: Hepatitis A What is it? Viral infection of the liver spread by person-to-person contact or through contaminated food and water Symptoms range from mild, flu-like ailment to full-blown illness that can progress to jaundice and liver failure Fatigue is first sign of illness followed by nausea and lack of appetite Prevention Practice good personal hygiene and follow food and water precautions carefully Vaccine High Risk Areas South America, Africa, Central America, South and Southeast Asia, Middle East, and Indonesia Vaccine single dose at least 2 weeks before departure with a booster 6 months later


Food and Water Borne Illness: Traveler’s Diarrhea : Food and Water Borne Illness: Traveler’s Diarrhea What is it? Catch all term for illnesses including cholera, dysentery, and giardiasis that result from ingesting contaminated food or water Symptoms Loose stools, cramps, nausea More severe include bloody stools, dehydration, high fever, chills Prevention Strictly adhere to food and water precautions and by paying close attention to hygiene High Risk Areas Most developing countries in Africa, Central and South America, Asia, Middle East Intermediate risk areas include southern Europe and most of the Caribbean Treatment Prescription antibiotics filled before you leave the US; antimotility drugs such as imodium or pepto bismol; Replace fluids and electrolytes by eating salted crackers and drinking plenty of nonalcoholic, noncaffeinated beverages and soups Eat easy-to-digest foods such as bread, potatoes, tortillas, and rice


Food and Water Borne Illnesses: Polio : Food and Water Borne Illnesses: Polio What is it? An acute viral infection that involves the gastrointestinal tract and occasionally the central nervous system Symptoms Sudden fever, headache, sore throat, and vomiting Prevention Practice water and food precautions Vaccine High Risk Areas Developing countries in Africa, Asia, Eastern Europe, the Middle East, and the Caribbean Areas with inadequate sanitation and poor hygiene practices Vaccine If never vaccinated – full series of injected or oral polio vaccine requires 2 months to complete Previously received vaccine – one-time booster may be recommended, especially if traveling to developing countries


Food and Water Borne Illnesses: Typhoid Fever : Food and Water Borne Illnesses: Typhoid Fever What is it? Bacterial infection prevalent in countries with warm climates and poor sanitary conditions Acquired from contaminated food with an incubation period lasting 10-20 days Symptoms Flu-like symptoms and sometimes a rash If untreated, may progress to a more severe illness with ongoing high fevers and multiple organ involvement Prevention Vaccine Practice good food and water precautions High Risk Areas Indian Subcontinent and developing countries in Asia, Africa, the Caribbean, and Central and South America Vaccine oral series completed at least one week prior to departure; injection completed at least 2 weeks prior to departure


Insects Borne Illnesses : Insects Borne Illnesses


Illnesses from Insects : Illnesses from Insects Dengue fever Japanese encephalitis Malaria Yellow fever


Insect Borne Illness Precautions : Insect Borne Illness Precautions Insect repellents Most effective against mosquitoes, chiggers, ticks, fleas, and biting flies Must contain DEET Clothing Wear shoes, socks, long pants, and long-sleeved shirt if outdoors between dusk and dawn Insecticides permethrin is available for soaking or spraying clothing, window screens, bed netting, and other fabrics (never apply to skin)


Insect Borne Illness Precautions: Things to Do : Insect Borne Illness Precautions: Things to Do Take advantage of preventive medications and vaccines Learn about insect feeding habits in the region you are visiting Use unscented soaps, shampoos, and deodorants Cover as much skin as possible Wear shoes (not sandals) and socks Perform a full-body check for embedded insects every day


Insect Borne Illness Precautions:Things to Avoid : Insect Borne Illness Precautions: Things to Avoid Wearing cologne or scent Wearing jewelry or bright colors Walking with bare feet, especially at night or through tall grasses, brush, or forested areas Sitting directly on sand or ground


Insect Borne Illnesses: Dengue Fever : Insect Borne Illnesses: Dengue Fever What is it? Viral infection spread by mosquitoes Symptoms Sudden high fever, intense headache, body pain, and sore throat Headache can last up to 6 days followed by extreme fatigue and loss of appetite Measles-like rash near day 3 of the fever Prevention No vaccine Follow preventive measures against insect-borne disease, especially using repellent at all times of the day High Risk Areas Tropical regions of Africa, the Americas, Asia, the Caribbean, and the Pacific Islands


Insect Borne Illnesses: Japanese Encephalitis : Insect Borne Illnesses: Japanese Encephalitis What is it? a mosquito-borne flaviviral infection Symptoms Symptomless or appear as mild flu with headache, fever, nausea, and vomiting Rarely the illness progresses to inflammation of the brain, leading to paralysis or death Prevention Vaccine available Follow preventive measures against insect-borne disease High Risk Areas Rural and near-rural areas of the Far east, the Indian Subcontinent, and Southeast Asia Vaccine Not recommended for short stays; usually recommended for prolonged stays or frequent short stays in high risk areas 3-dose injection series requires at least 2 weeks to complete


Insect Borne Illnesses: Malaria : Insect Borne Illnesses: Malaria What is it? Mosquito spread illness Occasionally, transmission occurs by blood transfusion, organ transplantation, needle-sharing, or congenitally from mother to fetus Symptoms Occur as soon as a week or more than a year after infection Fever, chills, sweating, nausea, muscle aches, and headache Prevention Follow preventive measures against insect-borne disease Preventive medication Chloroquine – started 1 to 2 weeks before travel and continued for 4 weeks Mefloquine – recommended in areas of cholorquine resistance; started 1 to 2 weeks before travel and continued for 4 weeks Malarone – started 1 day before travel and continued for 1 week Doxycycline – recommended in areas of cholorquine and mefolquine resistance or for people who can’t take Malarone; started 1 to 2 days before travel and continued for 4 weeks High Risk Areas Sub-Saharan Africa, Central and South America, Southeast Asia, India, the Middle East, Haiti, and the islands of the South Pacific


Insect Borne Illnesses: Yellow Fever : Insect Borne Illnesses: Yellow Fever What is it? Named for characteristic jaundice that results from viral invasion of the liver cells Spread from infected mosquitoes Symptoms Sudden headache, fever and exhaustion Illness ranges in severity from an influenza-like syndrome to severe hepatitis and hemorrhagic fever Prevention Vaccine Follow preventive measures against insect-borne disease High Risk Areas sub-Saharan Africa and tropical South America Vaccine All travelers age > 9 months who are traveling to yellow-fever endemic areas of South America and Sub-Saharan Africa should be vaccinated Single injection given at least 10 days before your departure date; effective for 10 years


Blood, Body, and Air Precautions : Blood, Body, and Air Precautions


Blood, Body, and Air Precautions : Blood, Body, and Air Precautions Hepatitis B Rabies Sexual contact Skin problems Tetanus


Blood, Body, and Air Illnesses:Hepatitis B : Blood, Body, and Air Illnesses: Hepatitis B What is it? Liver infection spread by contact with blood; usually through contaminated needles, razors, or medical and dental instruments Can also be spread through sexual contact, blood transfusion, or wound contamination Symptoms Nausea, fatigue, jaundice, loss of appetite usually begin 3-4 months after infection Prevention Vaccine Taking precautions to avoid infected blood and other body fluids High Risk Areas all of Africa; Southeast Asia, including China, Korea, Indonesia, and the Philippines; the Middle East, except Israel; South and Western Pacific islands; the interior Amazon River basin; and certain parts of the Caribbean (Haiti and the Dominican Republic) Vaccine Series of 3 injections over a 6-month period


Blood, Body, and Air Illnesses:Rabies : Blood, Body, and Air Illnesses: Rabies What is it? Spread by contact with the saliva of infected dogs, cats, bats, raccoons, skunks, foxes or other animals Virus that travels from site of entry to the brain Symptoms Usually none during incubation period of less than a week to more than a year Early symptoms are flu-like accompanied by itching or irritation at the site of entry Later symptoms include sensitivity to light, sound, and touch, and will have severe throat spasms when trying to drink water followed by dementia, convulsions, paralysis, and death Prevention Avoid animals while traveling Vaccine Clean bite immediately by scrubbing vigorously with soap and water, alcohol or povidone iodine High Risk Areas Found on all continents except Antarctica Endemic in Afghanistan, Bangladesh, Brazil, Bolivia, China, Colombia, Ecuador, El Salvador, Guatemala, Haiti, India, Indonesia, Mexico, Myanmar (Burma), Nepal, Pakistan, Peru, the Philippines, Sri Lanka, Thailand, Vietnam, and Yemen found in dogs in many of the other countries of Africa, Asia, and Central and South America Vaccine Pre-exposure vaccine consists of 3 injections over a 3-4 week period Post-exposure vaccine also available regardless if you have had the pre-exposure vaccine


Blood, Body, and Air Illnesses:Sexual Contact : Blood, Body, and Air Illnesses: Sexual Contact Sexual contact with new or casual partners can lead to numerous sexually transmitted infections and should be avoided Prevention Use condoms to reduce, not eliminate, your risk Bring a supply of high-quality latex condoms with you; do not rely on the safety standards of other countries Condoms do not entirely eliminate the risk of HIV transmission Abstain from all forms of sexual contact


Blood, Body, and Air Illnesses:Skin Problems : Blood, Body, and Air Illnesses: Skin Problems Can result from contact with people, plants, insects, or animals Prevention Avoid poisonous plants or animals Stop using products you suspect are causing a rash Prevent blisters by wearing clean, soft, cotton socks and sturdy comfortable shoes Clean minor cuts or abrasions thoroughly by scrubbing gently with soap and boiled, bottled or purified water or povidone iodine solution; coat with antibiotic ointment Bring antifungal skin cream, ointment, or powder to aid in treating fungal infections


Blood, Body, and Air Illnesses:Tetanus : Blood, Body, and Air Illnesses: Tetanus What is it? Organisms found in dust and soil worldwide, especially where there is animal waste Infect a wound or other damaged tissue and create toxins that affect the nervous system Symptoms Muscle rigidity and spasms, usually starting with “lockjaw” Severe cases can be fatal Prevention Vaccine Cover all open cuts and abrasions with appropriate dressings Vaccine <7 = 4 doses of DTaP given over 12-18 month period >7 and unimmunized adults = 3 doses of Td over a 7-12 month period Booster every 10 years


Specific Vaccine Preventable Diseases : Specific Vaccine Preventable Diseases


Routine Immunizations : Routine Immunizations Childhood immunizations Measles, mumps, rubella (MMR) Diptheria, tetanus, pertussis (DTP or DTaP) Polio Booster DTP/DTaP every ten years Polio if traveling to area where polio still occurs


Required Immunizations : Required Immunizations Yellow fever – some countries may require proof of vaccination; check with specific country you are visiting Cholera – some local governments may require


Special Considerations : Special Considerations Meningococcal meningitis - spread between people by direct contact or through inhalation of bacteria. Vaccine is recommended for travel to countries where outbreaks or epidemics have occurred.


10 Tips for Students : 10 Tips for Students


Slide37 : Make sure you have a signed valid passport and visas and fill in the emergency information page of your passport Read the consular information sheets (and public announcements or travel warnings) for the countries you plan to visit Leave copies of your itinerary, passport data page, and visas with family or friends at home. Make sure you have insurance that will cover your emergency medical needs (including medical evacuation) while you are overseas


Slide38 : Familiarize yourself with local laws and customs of the countries to which you are traveling. You are subject to their laws when in a foreign country. Do no leave your luggage unattended in public areas and never accept packages from strangers. While abroad, avoid using illicit drugs or drinking excessive amounts of alcoholic beverages, and associating with people who do. Do not become a target for thieves by wearing conspicuous clothing and expensive jewelry and do not carry excessive amounts of cash or unnecessary credit cards.


Slide39 : Deal only with authorized agents when you exchange money to avoid violating local laws. When overseas, avoid demonstrations and other situations that may become unruly or where anti-American sentiments may be expressed.


Traveler’s Health Kit : Traveler’s Health Kit


Include the following in a health kit when traveling: : Include the following in a health kit when traveling: Band aids Rubbing alcohol Sunscreen and sunburn ointment Anti-diarrhea medication Gauze and adhesive tape Antibacterial ointment Pain reliever Regular medications Contraceptives Feminine hygiene products Hand sanitizer Water purification tablets Salt tablets Skin moisturizer Insect repellent Malaria prophylaxis Antihistamine Throat lozenges Digital thermometer Latex condoms


Before You Go… : Before You Go…


Slide43 : Get a physical and dental check-up especially if you will be gone at a time when you would normally schedule these appointments and/or you will be in a developing country. Take special precautions when preparing for and managing medical conditions like allergies or diabetes while overseas. Take enough prescription medication to last throughout your time abroad. Take a supply of disposable syringes if you are diabetic or have another medical condition. Wear a tag or bracelet or carry a card to identify conditions such as diabetes, asthma, mild epilepsy, or allergy. Get immunizations even if they are not required by the host country.


Resources : Resources


Slide45 : US Department of State – http://travel.state.gov Centers for Disease Control and Prevention – http://www.cdc.gov/travel World Health Organization – http://www.who.int/en/ TAMU Study Abroad Office – http://studyabroad.tamu.edu/health.asp Student Health Services – http://shs.tamu.edu/


HAVE A SAFE AND HEALTHY TRIP! : HAVE A SAFE AND HEALTHY TRIP!