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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

General Health Precautions

More than 50 million people from industrialized nations travel to developing countries each year. Such trips can pose significant health hazards. Travelers who plan to visit developing or tropical countries as well as those embarking on prolonged vacations or arduous treks should take a number of precautions.

Medical Preparation

A visit to the doctor is very important in preparing for travel to a developing nation. Since many doctors may have trouble keeping abreast of medical trends in foreign countries, a local travel clinic may be especially helpful.

• Travelers to developing countries should have a thorough check-up and prepare for any health contingency at least 4 - 6 weeks before the trip. Be sure to make an appointment, even if this much advance preparation time is not possible.
• Take a brief summary of your medical history with you on your trip, including the results of abnormal tests or EKGs and a list of drug allergies.
• Take along a list of medications you normally use, noting all trade and generic names as well as dosages. In addition, the doctor should give you a letter authorizing any necessary medications; this precaution will facilitate customs and security checks.
• If you wear contact lenses, consider taking along ocular antibiotics.

Immunizations and Preventive Drugs: General Guidelines

The following are some general guidelines for vaccinations and other preventive measures for travelers:

• Travelers to developing countries should check with the U.S. Centers for Disease Control, U.S. State Department, or World Health Organization for the latest information on immunization requirements for their destinations, or visit a travel clinic. Studies indicate that multiple vaccines may be given at the same time to most adults without significantly increasing adverse effects.
• Pertussis (whooping cough) has been added to the tetanus-diphtheria vaccine. The Infectious Diseases Society of America recommends this triple vaccine for infants, children, and adults. Infants and children are generally vaccinated against these three diseases, but until recently teens and adults did not receive pertussis (whooping cough) immunizations. Travelers who require tetanus boosters should check with their doctor about receiving the new Tdap shot.
• Adults and children should make sure routine vaccinations are up-to-date. Booster shots may be required for travelers to developing countries, even if they have completed the initial series. Depending on a person's age, immunization history, medical condition, and travel plans, recommended vaccinations may include tetanus-diphtheria-pertussis, hepatitis B, hepatitis A, haemophilus influenza B, mumps, rubella, rotavirus, varicella, polio, Streptococcus pneumoniae, and possibly yellow fever, typhoid, meningococcal meningitis, Japanese encephalitis, and rabies.
• Pregnant women should have vaccinations appropriate to their trimester. Not all vaccinations are appropriate during pregnancy.
• Older adults may not respond to a vaccination as quickly as younger people or may have a higher risk for toxic effects. They should check with their doctors.
• Upper respiratory infections are very common after foreign travel. The influenza vaccine may be recommended when traveling to any country during flu season, particularly if you are elderly or at risk for serious illness. Infants and children should have the haemophilus influenza type B (Hib) vaccine. Adults may need the pneumococcal vaccine.
• Travelers to areas with tuberculosis (TB) outbreaks should have skin tests before traveling; those with negative tests should have a repeat test 2 - 4 months after they return.
• Vaccination against hepatitis A is recommended for all travelers to developing countries. Hepatitis B vaccination is recommended for people traveling to countries with a high prevalence of hepatitis B. The hepatitis B vaccine is especially important for people who expect to have close or sexual contact with the local population. Some doctors may recommend that travelers, including infants and children, receive a combination hepatitis A and B vaccine.
• Travelers to countries with malaria should take preventive drugs.
• Some countries may require vaccinations against yellow fever, meningitis, polio, typhoid, cholera, Japanese encephalitis, and rabies under certain circumstances. Some of these are covered in this report.

First Aid Kits and Other Supplies

First aid supplies should include:

• Sunblock (15 SPF or higher)
• Topical disinfectants
• Bandage materials
• Insect repellent
• Thermometer
• Any prescription drugs regularly taken
• Antifungal foot powder
• Hydrocortisone cream for rashes
• Loperamide (Imodium) for diarrhea
• Pepto-Bismol for diarrhea
• Devices or supplies to purify or filter water
• Nonprescription pain reliever.

Note: Acetaminophen, the generic name for Tylenol, is known as paracetamol outside the United States.

Insurance

Travelers should remember to check what coverage their health insurance company offers for policyholders abroad. Medicare does not provide coverage outside the United States, but other insurers offer limited coverage overseas. Individual supplementary health insurance policies should cost no more than a few dollars a day for international travelers. Air ambulance insurance is also a wise investment that can be purchased through travel agencies before leaving the U.S. Additionally, you may want to take along the phone number and address of the U.S. Embassy or Consulate in your destination country in case you need the name of a doctor to contact after you arrive.

• 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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