Travel can be one of the most rewarding experiences, but can also be dangerous if you are not prepared. Your body is not used to the germs in other parts of the world and the last thing you would want is to get sick on your trip, or worse return home with a serious medical condition such as malaria. During the year and half I worked as the clinical director for an epidemiology practice I became a travel expert and would like to share my “how to survive travel guide.” Preparing for your trip and travel consult Step 1) Make a detailed list of all the locations you will be traveling to, including layover airports. The reason why it is important to consider layover airports is because if you are traveling to an airport that requires a yellow card for yellow fever vaccine, you can be stopped by airport officials. Step 2) Get a copy of your most up to date vaccines. If your primary care doctor does not have them, try the college or high school you went to. Step 3) Do your homework. The CDC is a wonderful resource and provides lists of the vaccines and medications you will need for the specific destinations you are going to.

When traveling you can come across unexpected damgers like poorly handed food, contaminted water, and insects that carry diseases. The following tips can help keep you safe while traveling. Water Safety Do not drink tap water. Drink bottled water or water that was boiled for 3 mins. Brush your teeth with bottled water Make sure the bottled water is from a reputable source Food Safety Cooked foods are the best foods No fresh cut fruits or raw vegetables if going to Asia, Africa, South America, and parts of Europe and Australia. Fruits should have a peel on them such as banana, oranges, pineapple. All vegetables should be cooked. Make sure milk, yogurt, and ice cream say “pasteurized” on the label No raw fish Stay away from street vendors Eat hot foods hot and cold foods cold Insect repellent Insects carry a variety of diseases from malaria, yellow fever, Japanese encephalitis so insect repellent is extremely important 15% DEET repellant is preferred, make sure to apply in areas where veins and arteries are easy to access such as wrists, neck, behind the knees, ankles. Cover up, wear long pants and full sleeve shirts when possible, applying deet repellent only to exposed areas such as wrists and neck

Make sure you are up to date on your routine vaccines such as MMR, Polio, Meningitis, Varicella, TDAP, and Influenza. Travel specific vaccines (often not covered by health insurance) are listed below. Hep A: protects against contaminated food and water. 2 doses, 6 months apart good for 10 years Hep B: protects against blood and body fluids. Most medical workers and this with high risk sexual activity will 3 doses, given at 1, 2, 6 months good for 20 years Typhoid: protects against contaminated food and water. The oral pills will last 5 years, but are a live vaccine meaning you can have side effects from them such as fever, chills, weakness 1 dose lasts for 2 years Yellow Fever: protects against yellow fever, which is transmitted by insect bites. Only needed if traveling to parts of Africa and South America, will be required to show documentation of vaccine when entering/ leaving the country. Is a live vaccine meaning some will have flu like side effects such as fever, chills, weakness. 1 dose, good for 10 years Japanese Encephalitis: protects against JE, which is transmitted by insect bites. Only needed if you are traveling to Asia 3 doses, good for 1 year Rabivert: protects against rabies from animal bites, however if you are bitten you will still need 3 more doses within 24hours to be effective.

If you followed the food and water safety , but still got sick you should take the following steps: Step 1) contact medical provider to decide which medication is appropriate and if you need to be seen at a medical clinic. Imodium should be the first drug you reach for when having moderate diarrhea (<3 bowel movements per day, for less than 2 days) Azithromycin (aka the Z-pack), is an antibiotic that given if you are traveling to Asia. Take if you have diarrhea plus a fever, diarrhea plus vomiting, >3 bowel movements, or if symptoms are lasting >2 days. Ciprofloxoin is an antibiotic given if you are traveling to South America, Europe, Africa, Australia, Middle east. Take if you have diarrhea plus a fever, diarrhea plus vomiting, >3 bowel movements, or if symptoms are lasting >2 days. Step 2) Hydrate: try to drink at least 8 cups of water per day. Gatorade or pedialyte are helpful for restoring lost electrolytes. If unable to keep fluids down, go to medical clinic to prevent dehydration. Step 3) Follow a bland diet such as bananas, rice, dry toast, crackers, plain chicken or fish. Avoid spicy and acidic foods, alcohol, and caffeine that can further upset your stomach.

Feeling sick? If you return from your trip and are not feeling well you should see an infectious disease specialist. Parasite infections are rare, but occur and it is imperative that you get them treated as quickly as possible. Parasite infections such as GI worms can present themselves with symptoms of fatigue, diarrhea , vomiting, constipation, bloating, weight loss or gain, weakness, vision changes, headache, body aches, skin rashes. Infectious disease, gastrologist, or tropical medicine specialists are best at treating such conditions. Possible tests for parasites include stool samples, CT scan, blood work for eosinophils and antibodies made against the parasite. Stool samples often miss the parasite on the first try and may require multiple attempts. Finish your vaccines Many travelers get the first or second dose of a vaccine, but do not complete the series before the trip. Make sure you finish you vaccine series once you return from your trip. Example: Hep A is a 2 dose vaccine. One dose can be effectively given before the trip, but will only last for 6 months, the second vaccine given 6 months later will last for 10 years.