Travel Health Information

Water
In areas with poor sanitation, only the following beverages should be considered safe to drink: boiled water, hot beverages such as coffee or tea (made with boiling water), canned or bottled carbonated beverages, beer, and wine. Ice may be made from unsafe water and should be avoided. It is safer to drink from a can or bottle than to drink from a container that is not known to be clean and dry. However, water on the surface of a can or bottle may also be contaminated; therefore, the area of a can or bottle that will touch the mouth should be wiped clean and dry.

Food
Food should be selected with care. Any raw food could be contaminated, particularly in areas of poor sanitation. Foods of particular concern include salads, uncooked vegetables and fruit, unpasteurized milk and milk products, raw meat, and shellfish. If you peel fruit yourself, it is generally safe. Food that has been cooked and is still hot is generally safe.

Some fish are not guaranteed to be safe even when cooked because of the presence of toxins in their flesh. Tropical reef fish, red snapper, amberjack, grouper, and sea bass can sometimes be toxic at unpredictable times if they are caught on tropical reefs rather than open ocean. The barracuda and puffer fish are often toxic, and should generally not be eaten. Highest risk areas include the islands of the West Indies and the tropical Pacific and Indian Oceans.

Traveler's Diarrhea
The typical symptoms of traveler's diarrhea (TD) are diarrhea, nausea, bloating, urgency, and malaise. 50% of all tourists contract TD and it usually lasts from 3 to 7 days. It is rarely life threatening. An effective over-the-counter medication to prevent TD is Pepto-Bismol. Some common antibiotics used to treat TD are Cipro, Doxycycline, and Bactrim. The Center for Disease Control does not recommend the use of antibiotics to prevent TD because they can cause additional problems themselves. The best way to prevent TD is by paying meticulous attention to choice of food and beverage. Iced drinks and non-carbonated bottled fluids made from water of uncertain quality should be avoided. Dairy products can aggravate diarrhea in some people and should be avoided.

Most episodes of TD resolve in a few days. As with all diseases, it is best to consult a physician rather than attempt self-medication, especially for pregnant women and children. Travelers should seek medical help if diarrhea is severe, bloody, or does not resolve within a few days, or it if it accompanied by fever and chills, or if the traveler is unable to keep fluids intake up and becomes dehydrated.

Malaria
Malaria is caused by a parasite transmitted from person to person by the bite of an infected Anopheles mosquito. These mosquitoes are present in almost all countries in the tropics and subtropics. Anopheles mosquitoes bite during nighttime hours, from dusk to dawn. Therefore, anti-malarial drugs are recommended for travelers who will have exposure during evening and nighttime hours in malaria risk areas.

Symptoms
of malaria include fever, chills, headache, muscle ache, and malaise. Early stages of malaria may resemble the onset of the flu. Travelers who become ill with a fever during or after travel in a malaria risk area should seek prompt medical attention and inform their physician of their recent travel history. Neither the traveler nor the physician should assume the traveler has the flu or some other disease without doing a laboratory test to determine if the symptoms are caused by malaria. Malaria can often be prevented by the use of anti-malarial drugs and the use of personal protection measures against mosquito bites. The risk of malaria depends on the traveler’s itinerary, the duration of travel, and where the traveler will spend the evenings and nights. Despite preventive measures, travelers can still contract malaria. Symptoms can develop as early as 6-8 days after being bitten by an infected mosquito or as late as several months after departure from a malarious area and after anti-malarial drugs are discontinued. Malaria can be treated effectively in its early stages, but delaying treatment can have serious consequences.

Hepatitis A
Hepatitis A is an interracially transmitted viral disease. It is found throughout the developing world but occurs infrequently in developed countries such as the U.S. In developing countries, Hepatitis A virus (HAV) is usually acquired during childhood, frequently with little or no symptoms or just a mild infection. Transmission may occur by direct person-to-person contact; from contaminated water, ice, or shellfish harvested from sewage-contaminated water; or from fruits, vegetables, or other foods which are eaten uncooked, but which may become contaminated during handling. Hepatitis A virus is inactivated by boiling or cooking to 85* C (1 minute); cooked foods may serve as vehicles for disease if they are contaminated after cooking. Hepatitis A vaccine or immune globulin (IG) is recommended for all susceptible travelers to countries with intermediate or high rates of HAV infection. Vaccination with the age-appropriate dose of Hepatitis A vaccine for children 2 yeas of age and older, adolescents, and adults is preferred for those who plan to travel repeatedly or to reside for long periods of time in intermediate or high risk areas.