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Travel to developing countries

Description

An in-depth report on travel-related health risks and how to prepare ahead of time to reduce these risks.

Alternative Names

Cholera; Dengue fever; Traveler's diarrhea; Malaria; Schistosomiasis; Typhoid; Yellow fever

Traveling with Health Problems

Diabetes

People with diabetes who do not require insulin injections do very well during international travel provided they monitor diet and exercise. Insulin-dependent patients should remember that if they are traveling eastward the first day is shortened, and they will need less insulin. Westward travel means a longer day, thus will require additional insulin. Patients who travel by aircraft and need to carry syringes or needles now require medical documents.

Heart and Lung Diseases

People with any serious medical conditions should check with their doctor before travel. Of note, cabin pressure in aircraft is also typically equal to about 5,000 - 8,000 feet above sea level. This can produce a 4% reduction of oxygen in the blood, which can affect patients with heart or lung problems.

Recommendations for Patients with Heart Risks. One study reported that over half the deaths that occurred in overseas travelers were due to heart disease. Generally, the following recommendations may be useful for travelers with a history of heart disease. Individual conditions vary, however, and any patient with heart disease, particularly a history of heart attack, should check with a doctor before traveling.

• If you have had an uncomplicated heart attack, wait 4 - 6 weeks before traveling. A 2-week wait is recommended after uncomplicated bypass surgery. There are no restrictions after angioplasty, assuming you are not experiencing chest pain.
• Implanted pacemakers and cardiac defibrillators can trigger metal detectors, so patients should have a card proving they have an implanted device and ask to be hand checked. Pacemaker patients should also carry an EKG taken with and without pacemaker activation. Defibrillators are found on board many commercial airlines. Patients should check to see if the airline trains their flight attendants on their use (rather than rely on traveling doctors, who may or may not be on board).
• Patients with a history or risk of heart disease might be advised to wear elastic compression stockings and take low-dose aspirin before long trips to prevent blood clots. They should also take ordinary precautions, including drinking fluids, taking frequent walks, and performing leg-lifts several times an hour.

Recommendations for Patients with Lung Disease. The following are some recommendations for patients with lung disease:

• For reasons of fuel economy, jets now fly higher and cabins are pressurized with up to 25% less oxygen than in the past. Patients with lung problems should consult their doctors about whether air travel might worsen their condition.
• People who require supplemental in-flight oxygen cannot supply their own and must make arrangements with the airline. This requires a prescription and the patient must call the air carrier at least 48 hours before the flight. Not all carriers supply in-flight oxygen and none supply oxygen on the ground. That must be arranged separately.

Pregnancy

Pregnancy alters a woman's immune system. Before traveling to any country with health risks, pregnant women should note the following:

• Avoid live vaccines, unless you plan to visit an area endemic for yellow fever. If you are in your first trimester, you should not receive any vaccines at all.
• Be sure you are immune to rubella (German measles) before taking a cruise. Outbreaks of have been reported on cruise ships; this normally harmless disease can cause fetal damage if a pregnant woman contracts it.
• Take strict precautions against mosquitoes if traveling to countries where malaria occurs. Pregnant women appear to be at higher risk for malaria than non-pregnant women.
• Use portable water filters instead of iodine tables for purifying water.

In considering air travel, pregnant women should consider the following:

• Avoid frequent air travel. Although the emissions during flight are generally considered safe, very slight radiation from cosmic rays occurs.
• To avoid hassles during airline travel, carry a letter from the doctor indicating the baby's due date. Most airlines prohibit women who are 35 or more weeks pregnant from flying internationally.
• Walk in the aisles during long flights to help prevent blood clots. Wear seat belts low around your hips in case of air turbulence.
• Try to avoid travel altogether if you are expecting multiple births, you have a history of preeclampsia (pregnancy-induced hypertension), or you are at high risk for other conditions such as circulatory problems.
• Radiation from airport security scanners is minimal. However, pregnant passengers may request a hand-wand search.

• Review Date: 1/23/2007
• Reviewed By: Harvey Simon, MD, Associate Professor of Medicine, Harvard Medical School; Physician, Massachusetts General Hospital

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