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This article originally appeared in Issue 6 of our magazine.
Warning! This article is meant to be a quick overview and not a detailed guide on health precautions while traveling. To learn more on how to defend against pathogens while abroad, consult a licensed medical professional or accredited healthcare agency.
Every few months, there seems to be some new infectious disease outbreak getting media attention, whether it's H1N1, Ebola, or the measles. The lingering question that always seems to be in the backs of people’s minds is “How safe am I?” The answer is that you’re only as safe as your level of knowledge in how to avoid these highly contagious diseases, and other situations that are potentially dangerous in general.
Although we may not be visiting countries where deadly diseases are endemic, risk of exposure and other accident-related situations may be unavoidable. Travel may be part of your career or something that only occurs for summer vacations, but it could still lead to an encounter with a lethal outcome. Whether you have a scuba diving accident without medical assistance nearby or a disease outbreak has occurred in your area, it’s important to know how to deal with the risks associated with travel.
If you’re in a location where a deadly disease outbreak is reported, what can you do to stay safe? Don’t say to yourself that you’ll just stay in the hotel room and order room service, take the first flight home, or avoid contact with people all together. What if that hotel room is on a cruise ship and you can’t leave? What if the airport is locked down and travel is impossible? Avoiding contact with people all together? Yeah, right. You need to get food and information somehow, don’t you? If someone you’re traveling with is becoming symptomatic with what you’re being told to avoid or has been injured in a freak accident, you need to know a safe protocol. We’ve consolidated important tips to put your mind at ease and provide you the resources that could save your life.
Knowledge: First and foremost, prevention is best handled through avoidance. Regularly updated travel safety bulletins are posted on the U.S. Department of State and the Centers for Disease Control and Prevention (CDC) websites. The CDC portal also has this information broken down by specific countries to include required or recommended vaccines for that country, current travel notices, recommended packing lists, and steps to take upon your return. You can also look up in what countries a specific disease may be occurring. Arm yourself with knowledge of a country’s infrastructure and potential dangers rather than digging your head in the sand and saying, “It would never happen to me.” The CDC publishes CDC Health Information for International Travel, commonly referred to as the Yellow Book. The World Health Organization (WHO) puts out a similar book titled International Travel and Health. These biannual publications can be purchased in hardback or digital versions through their websites and offer valuable information that travelers should take the time to digest.
Analysis: A realistic assessment of your general health and ability to travel should also be addressed. Diet and exercise create a healthy immune system, so practice those basics regularly. If you or someone you’re with is pregnant, young or old with a less-tolerant immune system, or whose overall health is weakened by a preexisting condition, all these factors should determine whether your travel is a wise decision — or should be postponed if it’s non-essential. It is recommended that you and anyone traveling with you visit their regular doctor at least four to eight weeks prior to departing. Get a thorough checkup and seek advice about possible risks, required or recommended vaccinations and boosters, and other considerations to make.
Coverage: If you have medical insurance, a careful evaluation of your travel coverage is necessary. Travel insurance alone might not cover medical issues, so if you have insurance of that type, review the policy’s stipulations. No matter if you are headed to Toronto or Timbuktu, consult your medical insurance company about travel exclusions. Even things such as a car accident or laceration requiring stitches may not automatically be covered when traveling abroad.
Learn what your plan offers as far as emergency evacuation, medical care abroad, network locations, preauthorization for treatment, coverage for those with underlying medical conditions, and what activities might be considered high-risk (such as mountain biking) and possibly not covered. You may want to upgrade your coverage during travel periods if you discover there are more exclusions than you are comfortable with. If you’re traveling on behalf of your company, abide by their policies and educate yourself on the care they offer their employees during emergencies on business trips.
Reconnaissance: Take the time to locate 24-hour, physician-backed emergency medical services near your region of travel. Also, finding U.S. embassies, consulates, and diplomatic missions located in your destination is a valuable commodity. Carry contact information (phone numbers and addresses) for these services with you during your travel. Leaving an itinerary listing where you’ll be during specific dates with someone at home, such as another family member, during your time abroad can also be a lifesaver. If you are stranded or unable to communicate during a certain portion of your trip, it will be easier to locate you and coordinate help.
Sign Up: Travelers can also register with the U.S. Department of State and companies such as International SOS, an organization that provides medical assistance, international healthcare, and security services. This registration can allow you to record information about your trip so you can receive travel alerts during your stay or a representative can contact and assist you in an emergency.
Backups: If you are dependent on medications, packing extra for your trip is advisable. You never know if these medications are available at your destination or if they could be tainted. Many organizations recommend carrying a medical kit. The contents of these kits vary depending on the destination and individual needs, and may require authorization from a physician (and other parties) if certain prescription medication or other specialty items must be carried, such as syringes. The WHO provides a list of recommended contents by visiting www.who.int/ith/precautions/medical_kit/en/.
Though Ebola is a prime example of the devastation of infectious disease, it’s certainly not the most likely infection to be contracted — at least if you’re not going to West Africa. What are the diseases you should be most concerned about when traveling? These statistics change constantly, and new diseases come on the horizon every year. New strains of influenza and tuberculosis are always being discovered and could be resistant to any current vaccinations you may have received.
And then there are those that have been around for a long time and haven’t gone away despite the scientific and medical communities’ best efforts. In the United States, 36,000 people die from the flu every year. Around the world, HIV and AIDS are still some of the most deadly infections, killing 1.5 million people in 2012. Even diseases such as polio, which has essentially been eradicated in the United States, are still prevalent in other countries. Traveler’s diarrhea, usually contracted through contaminated water and poor hygiene, is extremely common in developing countries as well. Vector-borne diseases (those transmitted to people by blood-sucking buggers like insects and arachnids) such as dengue, malaria, and chikungunya continue to wreak havoc, but can be mitigated through the methods discussed elsewhere in this story.
So, good hygiene and knowledge are your two best methods of prevention. Read the tips in this story, do some research before hopping on a plane or vessel, and take common-sense precautions while abroad.
Hygiene: This factor is of utmost importance, especially when traveling. Regularly washing your hands can mean the difference between getting sick and having a safe trip. Be conscientious of how your own health may affect others; cover your mouth when you cough or sneeze. Hand sanitizer with a 60-percent or greater alcohol content is another great carry item if soap and water is unavailable. Thinking of going outside? Particularly in tropical areas where insects carry infectious diseases like malaria, wearing insect repellant is imperative. Keeping windows closed or well screened can also prevent insect bites.
Food and Water: Low health standards for water and dining establishments may also be inherent to your area of travel. The CDC has country-specific tips for your destination that pertain to food and water standards. In developing countries, drinking bottled water or other carbonated drinks in cans or bottles may be preferable to drinking anything from the tap or fountain drinks with ice. Brushing teeth with bottled water is also advisable over tap water. Make sure any food you eat is well cooked. Any fruits or vegetables should be washed in clean water or peeled before eating. Eating salads as well as consuming unpasteurized dairy products is often discouraged. Do not eat what is frequently referred to as “bush meat.” It can often be wild animals such as bats or monkeys that are notorious disease carriers, regardless of how well they’re cooked. Food from street vendors is also not a good idea.
Risk Management: As always, pay attention to local customs and laws, and be respectful. Taking risks such as drinking too much alcohol also increases your willingness to engage in risky behavior. Become educated about your travel destination’s infrastructure and problems that you may encounter. For instance, all cabs may look alike, but some may not be legitimate and could result in robberies or worse. Familiarizing yourself with reliable transportation methods as well as staying in a reputable hotel in a safe area are considerations that are overlooked all too often.
Seek Aid: If you or a member of your party becomes sick or injured while traveling, see a doctor right away. How sick should you be before you go? Exhibiting flu-like symptoms, persistent diarrhea, urinary problems, vomiting, jaundice, genital infections, or skin rashes are obvious warning signs. If the nature of the injury causes an open wound, clean it immediately to reduce the risk of infection and seek qualified medical help. Assume and treat these situations as if they’re an emergency.
The accessibility of medical attention may also be hampered by your situation. If you are on a flight or cruise ship, tell a crewmember as soon as possible and do not refuse a request to wear a surgical mask to cover your mouth and nose if instructed to do so — other lives may potentially be at risk. Remember, the longer you just wait and hope for the best, the worse your condition may get, and it may begin to affect people around you. Don’t be cavalier with your health. The sooner you act, the better your chances are.
Stay Calm: If you’ve received word of a disease outbreak in your area, panic is the purveyor of bad judgment. For instance, a malaria outbreak is a serious situation; however, malaria is spread through mosquito bites and is not airborne or contagious through direct human contact. Therefore, basic precautions — long clothing, insect repellent, staying indoors, etc. — are the best ways to deal with this type of problem until you leave the affected area.
Outbreak Defense: For diseases that are highly contagious, such as Ebola, your ability to remain safe is contingent on several things. “The first thing you should do upon hearing news of an infectious disease outbreak is to verify it. There’s a lot of fiction out there and not a lot of fact,” says Dr. Robert Quigley, regional medical director and senior vice president of medical assistance for International SOS. “Learn about the mode of transmission and learn what you need to do to mitigate your risk. If it’s a serious enough outbreak, you’ve got to decide what you need to do to get out of town. Companies should have plans in place to protect and support their workforce, and they can be adapted to wherever the location might be and whatever the incident might be.”
“At this moment in time Ebola is only transmitted by contact with an infected individual’s bodily fluids, whether they’re dead or alive,” Quigley adds. “Bodily fluids include sweat, stool, saliva, blood, and vomit. Ebola is robust and can survive on surfaces, so it’s possible you could put your hand down on a surface an infected individual had previously touched, even as long as 48 hours earlier, and then you put your hands in your mouth and you could get infected that way. Whether it’s Ebola or not, always practice universal precautions of hygiene and wash your hands when you visit public places, don’t put your hands in your mouth, and cover your mouth when you sneeze. We tend to take for granted what’s getting people into trouble.”
Infected?: If you feel you’ve come in contact with Ebola or any other disease that is also dangerous and/or easily communicable, the first thing you should do is report it to your local public health department so it can be managed. That organization will direct you where to go, because not all hospitals are equipped to deal with all diseases and conditions. “That first phone call is critical, because if you are symptomatic and have been to West Africa or exposed to someone who has been there where the disease is prevalent, if you go into a communal area you could spread the disease,” says Quigley. “From that first phone call there needs to be a response plan that would limit the likelihood that you would expose anyone else. That would be orchestrated by the local department of health. The CDC may not have a lot of jurisdiction or presence in your location, but you may have to make an overseas phone call as well and report your condition. You would want to have access to our healthcare system so they could support you and manage your complications, since there are no specific medications for a condition like Ebola.”
Not all travel-related diseases are exotic by nature. Some of them are quite common and can be avoided with some forethought and care. Here is a list of the top five conditions you’re most likely to contract while abroad, according to the Global Infectious Diseases and Epidemiology Network.
When you return home, do not assume you or anyone in your traveling party is now in the clear. Many diseases have incubation periods that could last indefinitely, so if you become sick upon your return you may have become infected with an illness that didn’t manifest symptoms during your trip. If you begin feeling sick upon your return, immediately seek medical attention and give your doctor full disclosure on where you were, for how long, and what you did, no matter how embarrassing it might be. The only way to determine and treat what you might have is to be honest.
If you have spent more than three months traveling in a developing country, the WHO recommends scheduling a medical examination. Travelers who suffer from a chronic disease such as heart problems or diabetes should also be seen for a thorough checkup to avoid any additional complications after returning from a trip.
Be conscientious about your health and don’t become complacent, hoping any ill effects will just go away by themselves. Time is of the essence. Be prepared, be alert, and be educated. Your best offense is a good defense.