Travel Medicine

Travel Medicine

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Medical Author: Mary Nettleman, MD, MS
Coauthor: Kara Jacobs, MPH
Medical Editor: Melissa Conrad Stöppler, MD

• Why should travelers see a physician before they leave?
• What diseases occur in travelers, and how can disease be prevented?
• Traveler's diarrhea
• Malaria
• Meningococcal meningitis
• Yellow fever
• Hepatitis A
• Typhoid fever
• Polio
• Cholera
• What about diseases for which there is no vaccine or preventive medication?
• What is safe to eat and drink while traveling?
• What can I do to avoid insect bites?
• What should be in my first aid kit?
• What are the medical concerns with jet lag?
• What if I have a medical condition or chronic disease?
• What if I'm pregnant?
• What about traveling with children?
• Where can I find additional information?

Why should travelers see a physician before they leave?

Travelers should see a physician before leaving for a trip if they are going to developing countries, going off the usual tourist routes, or if they have chronic diseases that could be affected by travel. Travelers should protect themselves against common diseases that may be mild but that will disrupt their trip as well as protecting themselves against less common diseases that may be serious or even fatal. Some foreign countries require certain vaccinations before they will allow the traveler to enter the country. All travelers need to be up to date on routine vaccines they would normally get if they were not traveling (for example, an annual influenza vaccination if indicated). No vaccinations are required for re-entry into the United States for foreign travelers.

What diseases occur in travelers, and how can disease be prevented?

Travelers can pick up infections from contaminated food or water, from insect bites, animal bites, or from other people. Vaccinations, medications, and simple precautions can reduce or eliminate the risk of many of these travel-related infections. While infections are the most common problem for travelers, it is important to remember that the most common cause of death in travelers is motor vehicle accidents. Be sure to look both ways before crossing the street, don't get in the car if the driver is drunk, and use seatbelts if available both at home and when traveling.

This review will only cover diseases commonly encountered by travelers or those for which vaccinations are recommended. For a more complete discussion, please refer to the CDC travel medicine Web site (http://www.cdc.gov).

Traveler's diarrhea

Traveler's diarrhea is the most common medical complaint in travelers. It occurs when infectious organisms are ingested by travelers, resulting in one to five days of loose stools. The stools are often watery and may be accompanied by abdominal cramps. Up to half of travelers to developing countries will get traveler's diarrhea. Although not fatal, traveler's diarrhea can cause dehydration, vomiting, low-grade fever, and discomfort to the point that some travelers have to change their itinerary. It is important to note that traveler's diarrhea is not associated with bloody stools, severe abdominal pain, or high fever. These symptoms are suggestive of more serious conditions and should prompt medical attention.

Traveler's diarrhea is spread when bacteria or other infectious agents are ingested. It can be spread through contaminated food or water, or by putting contaminated hands in the mouth. Even small amounts of contamination can cause disease.

Travelers can get diarrhea in most areas of the world, but some countries pose a higher risk. High risk areas include most of Asia, the Middle East, Africa, and Central and South America. Risk is increased if the traveler is adventurous with his or her diet, eats from street vendors, or travelers to areas off the usual tourist routes.

Protective measures may help prevent or shorten the duration of traveler's diarrhea. All travelers should wash their hands often and understand basic food and water precautions (see below). However, it has been shown that many people will still choose to eat foods that pose an increased risk of traveler's diarrhea. Therefore, travelers at risk should carry along an antimotility agent such as loperamide and start taking it if they get symptoms. Bismuth subsalicylate is also helpful.

Many physicians also recommend that travelers carry along an antibiotic to take in case they get diarrhea. Fluoroquinolones, azithromycin, or rifaximin are those that are often used. Because organisms are developing resistance, many of the older antibiotics do not work well. If an antimotility agent and an antibiotic are started at the first sign of diarrhea, symptoms may be shortened to only a few hours instead of a few days. In rare cases, physicians might prescribe daily antibiotics or daily bismuth subsalicylate to prevent diarrhea, but this is not needed for most travelers. Affected people should stay hydrated. Pregnant women and children need special advice because many of these drugs are not appropriate for them.