Specific Advice for Potential Health Problems

Accidents. Accidents are a leading cause of major health problems for travelers. All types of motor vehicles are potential sources of accidents involving drivers, passengers, and pedestrians. Driving habits may differ from those in the United States, and drinking while driving is common. If the traveler is not comfortable or familiar with a particular type of vehicle at home (standard transmission, motorcycle, moped, etc), she or he is likely to be at increased risk from driving it while overseas.

Altitude. Altitudes above 10,000 feet may cause acute mountain sickness (AMS) characterized by dizziness, headache, fatigue, chills, and/or vomiting. More severe illness, characterized by extreme shortness of breath (high-altitude pulmonary edema) or extreme lethargy (high-altitude cerebral edema) may occur. Patients should acclimate to higher elevations prior to strenuous activity. Tobacco and alcohol use, if any, should be reduced. Acetazolamide (Diamox®) can be used to prevent AMS. Rest and further acclimatization may be all that is necessary for treatment of mild symptoms. If extreme symptoms, such as mental status changes, occur, the traveler must descend immediately

Animal exposure. Exposures to animals place travelers at risk for rabies as well as other less well-known zoonotic diseases. Rabies is endemic in many developing countries. Travelers should avoid petting or any contact with unfamiliar animals. Pre-exposure rabies prophylaxis may be indicated for travelers who make prolonged visits to highly endemic areas.

Medications. Check interactions for all drugs prescribed for travel with those the patient commonly takes. Antacids and antidiarrheal drugs frequently interfere with absorption of medications. Medications purchased overseas may be counterfeit and ineffective, or even unsafe.

Sexually transmitted infections. Sexually transmitted infections (STIs) are more prevalent and are more likely to be antibiotic resistant in many countries than they are in the United States. Latex condoms must be used with new sexual partners while overseas.

Sun exposure. In tropical countries, at high altitudes, and on snow or water, sun exposure can be more intense than expected. Travelers should use a broad spectrum sunscreen (SPF of at least 30 with UVA and UVB protection) and wear a wide-brimmed hat and sunglasses. Tetracyclines and ciprofloxacin, which are often recommended for travelers' diarrhea or malaria prophylaxis, can cause sun-induced rashes.

Swimming. Swimming areas (except in chlorinated pools) may have microbial contamination from sewer or land runoff. Travelers need to ask about schistosomiasis in the area, and if they become immersed in questionable sources of water, they should dry off vigorously and as rapidly as possible. Feet should be fully covered or protected if unsure of the bottom surface conditions.

Vaccinations. Travelers should be especially aware of yellow fever vaccination documentation requirements for all countries they are planning to visit, including airport layovers en route. International health regulations allow for avoiding vaccination if patients have a physician's letter documenting the medical contraindication to the vaccine. However, this may not be sufficient, especially at smaller border crossings. Sterility, efficacy, or content of vaccine cannot be guaranteed in some foreign countries, and protection may not be complete for at least 10 days after inoculation.[6]

Post travel. Patients should see their healthcare provider after returning from travel if any illness occurred during the trip. If any illness not easily explained occurs within 1 year after travel, include in the differential diagnosis possible travel-related exposure to an infectious agent with a prolonged incubation period. Consider appropriate post-travel testing for those who were in areas where the water is not safe, STIs are prevalent, or tuberculosis is common.