Travel Health

Precautions Along the Way

Traveling comes with a whole new set of things to think about. The following can help you stay healthy and enjoy your trip as much as possible.

Tips for flying

Flying is not always fun. But you can take steps to make it easier and to feel better during and after your flight.

• Pack anything that may cause problems at security—such as gels, liquids, sharp scissors, or pocket knives—in the luggage you plan to check. Leave lighters and matches at home. For an updated list of what is not allowed in carry-on luggage, see the Transportation Security Administration Web site at www.tsa.gov/travelers/airtravel/prohibited/permitted-prohibited-items.shtm.
• Wear roomy, comfortable shoes that slip on and off. These are easy to remove when you go through security at the airport. They will also be more comfortable if your feet swell on the plane.
• Take steps to prevent jet lag:
  • Drink lots of liquids and limit caffeine and alcohol. The dry air on airplanes makes it easy to get dehydrated. And caffeine and alcohol can make dehydration worse. Carry your own water to make sure you are getting enough.
  • Pack food in your carry-on bag. You may not get food on your flights or have time to eat between flights. If you pack your own food, you will be in control of what and when you eat.
  • Get up and walk around on the plane when possible. This is a good idea for anyone on a long flight, but it is especially important if you are at risk for blood clots.
  • Consider packing a neck pillow, eye cover, or earplugs to help you sleep on your flights. For longer trips, your doctor may be able to prescribe medicines to help you sleep better.
  • Change your sleep schedule to your new time zone. If you arrive at your destination during the day, try not to sleep until nighttime. This helps your body adjust better to your new time zone.

If you have a fear of flying, talk to your doctor. He or she may recommend medicines, hypnosis, or breathing, visualization, and relaxation exercises to help you feel less afraid.

Water and food safety

Contaminated water and food are the most common cause of illness in travelers. These illnesses range from an inconvenient case of travelers' diarrhea and the norovirus (Norwalk virus) seen on cruise ships to severe cholera.

Since it's difficult to know if tap water is properly treated, most doctors recommend avoiding tap water if there is any doubt. Safe beverages include drinks made with boiled water, such as tea and coffee. Otherwise, drink only canned or bottled carbonated beverages (including carbonated bottled water and soft drinks) and beer and wine. Ice should also be considered contaminated and should not be used in beverages. Dry the opening of wet cans or bottles before taking a drink. Remember not to brush your teeth with tap water.

Travelers to backcountry areas of North America should also take precautions with water. Even though the water in high mountain lakes looks sparkling clear, it may be contaminated with Giardia intestinalis, the parasite that causes giardiasis. Take simple precautions to avoid this illness, such as boiling the water.

Likewise, swimming in contaminated fresh water, such as ponds or rivers, can expose you to a variety of diseases. Even swimming pools with inadequate chlorination pose a risk. Talk to your doctor if you plan on doing recreational water sports—such as white-water rafting, adventure racing, or kayaking—in tropical and backcountry regions.

Take precautions with food by avoiding raw fruits (unless you wash and peel them yourself), raw vegetables, and raw or undercooked meat and seafood. Steaming hot, well-cooked food is usually the safest. Although tempting, don't eat food or drink from street vendors. Make sure dairy products have been pasteurized.

For more information, see the topic Food Poisoning and Safe Food Handling.

To prevent fungal or parasitic infections and injuries, do not go barefoot. Try to keep your feet as clean and dry as possible.

Although sea water is usually safe from disease, swimming or diving in sea water can still be dangerous. Avoid swimming or wading in sea water near a river, estuary, or other outlet from inland. In developing countries, sea water around big cities and other populated areas may not be safe. For more information, see the topic Marine Stings and Scrapes.

Insect-borne disease

Mosquitoes, flies, fleas, and ticks all spread disease, including malaria, Japanese encephalitis, Lyme disease, West Nile fever, South African tick-bite fever, yellow fever, and dengue fever.

Malaria is the insect-borne disease of most concern to travelers in tropical and subtropical regions. Although antimalarial medications kill the malaria parasite in the bloodstream, this protection is not complete and mosquito bites should be avoided. To ward off mosquitoes, travelers should take protective measures along with the antimalarial medication. Here are some tips:

• Use DEET or other insect repellents on your skin.
• Use flying insect spray in the room where you sleep.
• Wear light-colored and loose-fitting long pants and long-sleeved shirts, especially from dusk to dawn, when mosquitoes that spread malaria bite. Insect repellent applied to clothing is effective for longer than it may be on the skin.
• Permethrin or deltamethrin insecticide sprayed on bed nets will protect against mosquitoes for weeks to months.
• Mosquito coils can also help keep mosquitoes away.
• Home remedies like eating garlic, rubbing garlic on your skin, or taking vitamin B do not prevent bites.

Ticks inhabit many regions, including Europe, Canada, and the United States, and carry many diseases, including Lyme disease, Rocky Mountain spotted fever, tularemia, ehrlichiosis, relapsing fever, Colorado tick fever, South African tick-bite fever, and babesiosis. Although it is rare for travelers to contract diseases from ticks, many of these diseases are serious. For information on how to prevent tick bites, see the Prevention section of the topic Tick Bites.

Sun and heat exposure

Many travelers underestimate the sun's strength and overestimate the amount of protection their sunscreens offer. This can add up to at least an uncomfortable sunburn and, at worst, life-threatening heatstroke.

To avoid these complications:

• Stay out of the sun during the middle of the day, when ultraviolet light (UV) is greatest.
• Apply sunscreen blocks for both UVA and UVB rays with a sun protection factor (SPF) of at least 15. Use liberally on areas of the body not protected by clothing and reapply frequently, especially during midday and when you're swimming or sweating. For more information, see the topic Sunburn.
• Wear UV-protective sunglasses.
• Wear a broad-brimmed hat, long pants, and loose-fitting, long-sleeved shirts.
• Watch for signs of dehydration, most importantly little and/or dark-colored urine.
• Limit exertion and drink plenty of fluids. If possible, use rehydration drinks to replace lost fluids and electrolytes.

Accidents

Although disease presents a big risk while traveling, you should also be aware of potential sources of injury. Shoddy roads, poor driver training, and crowded roadways often make driving in other countries an unwanted adventure. Motor vehicle accidents are a leading cause of injury among travelers. Be familiar with local driving customs, road signs, and how to navigate unfamiliar traffic patterns, including driving on the left side of the road and using roundabouts or traffic circles. If possible, travel during daylight, and always use seat belts. If you are hiring a driver (such as in a taxi), don't hesitate to ask the driver to slow down or drive more carefully if you feel unsafe. When riding motorcycles or bicycles, wear helmets and protective clothing.

Take care around dogs and other animals. Dogs in developing countries are often not tame and may bite. Rabies is more common in tropical and subtropical regions. If bitten by an animal, wash the bite with soap and water and seek medical attention immediately.

Most wounds sustained in developing countries carry a higher risk of becoming infected. If you get even a minor wound, clean the wound as soon as possible with large amounts of warm water and soap. Apply antibiotic ointment and a bandage. But it is good to know that in some people, antibiotic ointments (such as Neosporin) can cause an allergic reaction that looks just like a wound infection that is getting worse.

If you haven't had a tetanus shot in 5 years, a booster dose is recommended following an animal bite or an injury that results in a break in the skin.

Altitude

Altitude sickness poses a threat to anyone traveling over 1,500 meters, or about 5,000 feet. Initial symptoms may feel like a hangover, with a headache, fatigue, loss of appetite, nausea, and vomiting. If symptoms become worse or include confusion, an unsteady gait (ataxia), or faintness, a traveler must go to a low altitude as fast as possible to avoid death. To avoid getting altitude sickness:

• Do not fly directly from low altitudes to high altitudes. Try to schedule at least a 1-day stopover at an in-between altitude. Examples of high-altitude cities are Cuzco, Peru; La Paz, Bolivia; and Lhasa, Tibet. After arrival, avoid overexertion, large meals, and alcohol.
• When trekking, climb gradually to high altitudes, allowing for periods of adaptation.
• If you have heart or lung disease or anemia, ask your doctor's advice before deciding to travel to a high altitude.
• Medications such as acetazolamide (AK-Zol, Diamox) or dexamethasone (Decadron), may be prescribed by your doctor along with instructions on how to use them.
• Eat a lot of carbohydrate. This includes breads, cereals, grains, and pasta.

For more information, see the topic Altitude Sickness.

Scuba diving safety

Safety is an important part of scuba diving. You will learn all about safety in your scuba diving certification class. If you plan to get certified while traveling, find an experienced, certified teacher that you feel comfortable with. Several organizations, including the Professional Association of Diving Instructors (PADI) and the National Association of Underwater Instructors (NAUI), certify instructors and dive shops all over the world.

There are many important safety precautions for divers. If you are a new diver, it is best to go with an experienced guide, also called a dive master. Most accidents and problems occur when divers ignore the rules and push their limits. Some general diving rules include:

• Only dive if you feel comfortable.
• Use equipment that you are familiar with and that is in good repair.
• Know what to do if something goes wrong.
• Always dive with a buddy.
• Go down and come up slowly. Do not hold your breath.
• Know and follow recommended depths and time limits.
• Allow enough time between your last dive and your flight home.

Motion sickness

People can feel sick from the motion of cars, planes, trains, boats, or ships. Once you start to feel sick, it can be hard to feel better until the motion has stopped. If you know you get motion sickness, pack medicines to prevent it. There are both prescription and over-the-counter medicines for motion sickness. For more information, see the topic Motion Sickness.

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Author:	Monica Rhodes	Last Updated: May 2, 2007
Medical Review:	Wajeeh E. Nasser, MD - Family Medicine W. David Colby IV, MSc, MD, FRCPC - Infectious Disease
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