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Staying Healthy On The Road Falguni Shah, M.D. International travel is undertaken by increasing numbers of people for professional, social, recreational and humanitarian purposes and this trend looks set to continue. In 2003, there were 694 million visits across international borders, and a total of $514 billion was spent during these trips, indicating the huge investment made in travel. Travelers are exposed to a variety of pathogens during their stay in a foreign land that are rarely encountered at home. Studies show that almost 50 percent of travelers returning to the U.S. from the tropics experience health problems related to their travel. The risk of infection depends on the degree of endemicity (prevalence in a particular region or people) in the area visited, the duration of the stay, the individual behavior and the preventive measures taken. Most risks can be minimized by suitable precautions taken before, during and after travel. Some of the illnesses experienced by international travelers are: 1. Traveler’s diarrhea (TD): TD is the most common illness affecting travelers to high risk countries with poor sanitation infrastructure like Asia, the Middle East, Africa, Central and South America, and some Caribbean islands. It is characterized by fairly abrupt onset of loose watery stools, with abdominal cramps and rectal urgency, resulting from microbial contamination of ingested food and water. TD is usually self-limited and lasts 3-4 days, but persistent symptoms leading to dehydration and requiring IV Fluid and antibiotic treatment can occur in a small percentage of travelers.
2. Hepatitis A: Hepatitis A is a viral infection of the liver that results in fever, anorexia, and nausea followed by jaundice, which may turn into an acute fulminant illness or run a prolonged and relapsing course. It is the most common vaccine-preventable infection acquired during travel to high risk areas such as Asia, South and Central America and the Caribbean. The hepatitis A vaccine is recommended for travelers to areas of high endemicity, and Immune Globulin is available for patients who are allergic to the vaccine or have less than four weeks before the start of their travel. A primary series of two doses of the vaccine given six months apart is believed to confer immunity for at least 15 years.
4. Malaria: Malaria is caused by protozoan infection transmitted to humans by the bite of an infected mosquito. It is a major public health problem in areas of Central and South America, the Dominican Republic, Haiti, Africa, Asia (including the Indian subcontinent), Eastern Europe and the South Pacific. The illness is characterized by fever with chills, anemia and jaundice and, when severe, can lead to seizures, kidney failure, coma and death. Personal protection measures include remaining in screened areas, using protective clothing, bed nets, and DEET containing body sprays. A vaccine is not available for the prevention of this illness but preventive medications, taken well in advance of travel and continued through the duration of travel followed by ingestion for the recommended period after return, can prevent the infection. Different medications are available depending on the traveler’s underlying medical problems, age and tolerability
5. Yellow fever: Yellow fever is a viral disease that is transmitted to humans through the bite of infected mosquitoes. Illness ranges in severity from an influenza-like syndrome to severe hepatitis and hemorrhagic fever. The case fatality rate in children is reported to be more than 20 percent. The disease is most prevalent in some parts of Central and South America and West Africa. This illness is preventable with a relatively safe and effective live vaccine. Some countries in Africa mandate a certificate of YF vaccination from all entering travelers; others may waive the requirement for travelers coming from nonendemic areas and staying in the country for less than 2 weeks. 6. Japanese Encephalitis: JE, yet another mosquito-borne viral infection, is the leading cause of childhood encephalitis in Asia. Most infections are asymptomatic, but when encephalitis develops, the case fatality rate is 30 percent and neuropsychiatric symptoms are reported in 50 percent of survivors. The recommended immunization series with an inactivated vaccine is three doses on days 0, 7, and 30. Some other infectious illnesses I didn’t mention that could be acquired as a result of travel to an endemic area include but are not limited to: Dengue fever, African Sleeping Sickness, Measles, and parasitic infections like Amebiasis, Cryptosporidiosis and Schistosomiasis. All of the illnesses above can be prevented either by vaccines, by preventive medications or by personal protective measures. Ideally, the initial consultation with a Travel Medicine specialist for your family should occur at least six weeks before departure to allow time for booster immunizations, and assessment of any adverse reactions from the vaccines or medications. The pretravel visit should minimize health risks specific to the journey, give you the capability to handle most minor medical problems, and allow you to identify when to seek local care during the trip or on return. A travel specialist is able to customize your prevention package before travel to assure you of a safe, healthy and fun vacation!!!
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Risk of TD can be minimized by carefully selecting food and beverage consumption. Eat foods that are freshly cooked and served piping hot, and avoid uncooked food or foods washed in local water, like salads. Other risky foods include undercooked meat and seafood and raw fruits and vegetables. Safe beverages include those that are bottled and sealed or carbonated Water should be boiled for at least 1 full minute before it is considered safe to drink. Iodine and chlorine tablets are also available in pharmacies for use to treat local drinking water. 
3. Typhoid fever: TF is an acute, life-threatening febrile illness caused by bacterium Salmonella enterica Typhi. Approximately 400 cases of TF, mostly among travelers, are reported to the Centers for Disease Control each year. The hallmark of typhoid infection is persistent high fevers. Other symptoms include headache, anorexia and enlargement of the spleen. It is acquired through ingestion of contaminated food or drink. Although not 100 percent effective, vaccination against this illness is available in the form of an injectable vaccine or an oral vaccine in children age>6 years of age. 
Falguni Shah MD, is a board-certified physician in Pediatrics and Pediatric Infectious Diseases. She specializes in the treatment of a variety of infectious illnesses and is the Medical Director of the Division of Pediatric Infectious Diseases and Travel and Adoption Medicine at Saint Barnabas Medical Center. It is located at the Saint Barnabas Ambulatory Care Center.
