Travel Health Information
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 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
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.
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 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.
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 travelers 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 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.