What Every (Safe) Traveler Should Know

Hello fellow traveler,

Here lives the collective safety wisdom gathered during my pre-travel preparations by picking the brains of those much more medically savvy than I.

Un-cited facts and information can be attributed to the San Francisco Department of Public Health — where I believe I long overstayed my appointment to sponge up as much information as possible.

Sections are short, to the point, and contain essentials. Below is a table of contents so you can skip to your topic of interest. Otherwise if this is all new to you, like it was to me, I’d recommend getting comfy and spend possibly your most important pre-travel half hour as you digest this lifesaving information that every traveler should know.

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The Skinny on Food and Water Saftey
On-the-Go Medical Safety Tips
Avoiding Jet Lag
Handling Altitude Sickness
Preventing/Treating Rabies
Cures for Motion Sickness
The 101 on Malaria
How to Disappoint a Mosquito
Beating the 50/50 Chance of Travelers’ Diarrhea
A Chart of Vaccines and Vaccine Preventable Diseases

The Skinny on Food and Water Safety

Contaminated food and water are a major source of disease for travelers. Harmful bacteria, viruses, protozoa, and parasites love to reside in fresh fruits, veggies and liquids. The key to eating in a foreign country is to remember that YOU are in control of your foods before they enter your body.

I admit, I don’t abide by the wisdom below at all times. Sometimes there is a food cart with a heavenly scent that’s just too tempting to ensure it meets all the safety requirements. At those times, I like to let my 6th sense be the judge or step back and watch the chef in action to derive if he cares to clean his hands after handling money or pick his nose. To each is his own.

Regardless of your bravery, it’s important to know best practices to avoid common diseases that are easily transferred through food and water.

Eating Like a Local and Avoid the Runs

The more foods are cooked, the better. At least as far as killing bacteria goes. Start with foods served too hot to eat immediately. No harm and recleaning your utensils before sticking them in your mouth. Canned foods are fine if the can is undamaged. Amazon Prime now has a Prime Pantry service that guarantees I can have cans of my favorite organic beans waiting at my next destination. That way I’ll at least have something safe to fill my belly with.

Foods to Be Cautions With In a New Country:

Raw Foods
Salads, uncooked fruits and vegetables, all dairy products
Cold sauces such as mayonnaise, chutneys or salsas, which are usually raw, made by hand, and may sit for hours without refrigeration
Food and beverages from street vendors or market stalls
Cooked food that has been allowed to sit for several hours at room temperature (unless reheated until steaming hot in the center)

Proper Water Safety Can Prevent 80% of All Diseases!

Waterborne diseases are no joke. In developing countries four-fifths of the various illnesses are caused by water-borne diseases.

The only kind of water you should be drinking to avoid the list above can be broken down into three categories that I’ll refer to as BBD:

Boiled – e.g. coffee, tea, etc. You could also boil water yourself, say… straight from an elephants watering hole and drink it with no worries [link to youtube video].
Bottled – Commercially sealed, e.g. bottled water, carbonated drinks, beer, wine, etc.
Disinfected water are the only kinds of water you should drink if you want to avoid the above list.

Water to avoid:

Tap water and anything made with tap water. Avoid brushing and rinsing your toothbrush or contacts in tap water.
Ice (unless made from BBD water).
Liquids in unsealed containers
Wet cans or bottles (the water on them may be contaminated)

The Best Water Disinfected Methods:
Instead of buying water in plastic bottles (which are rarely recycled in the developing world) you can reduce waste and increase your self-reliance by using proven water disinfection techniques.

Heat
Bacteria, viruses, protozoa, cysts, and parasites are killed within seconds by boiling water. Any water brought to a boil for a full minute (3 minutes at altitudes higher than 5000 ft) will be disinfected. If you’re traveling with access to electricity, you can bring a portable electric immersion heating coil to heat water and beverages in a cup.
Ultravoilet “Pen” – My Personal Fave
UV light rays are used by many municipal water systems—recently available in a highly portable, hand-held, USB rechargeable unit (Steri-Pen® by Hydro-Phonton Inc.). Within a few minutes, these pens use UV rays to kill bacteria, viruses, and protozoa (including Cryptosporidium) with no chemical taste or odor. Cloudy water or particulate matter block UV light from reaching the microbes and must be filtered first.
Filters
Most portable water filters do not remove viruses so I (or the ITC) wouldn’t recommend them for developing countries unless the water will also be boiled or UV-irradiated. A hybrid technology is also available that uses a 0.1 micron filter to remove bacteria, protozoa and cysts, plus an EPA-certified electrostatic charge mechanism to remove viruses. Costs about $115 for the basic system – XLE®. The benefit is there is no wait time, the downside is it tastes like odor and is a bit bulkier than other methods.

On the Go Medical Safety

I’m traveling from Bangkok to Chiang Mai as I write this with a 15 pound backpack (laptop included). Needless to say, I prefer to travel light. But there some medical essentials that have made their way into my extremely picky pack.

See what’s inside my backpack.

I would recommend travelers include a personal medical kit. The peace of mind and convenience alone is worth the extra 2 pounds. Contents vary based on destination, activities planned, and access to medical supplies and treatment facilities. So here are suggestions on commonly needed items:

Insect repellent
Sunscreen
Acetaminophen, ibuprofen
Oral rehydration packets
Stomach acid medications (antacids, ulcer tablets)
Anti-diarrhea agents
Condoms / birth control – just bring it

Prescription Medications

Bring all your usual medications. To avoid issues with customs officials, keep medications in their original containers. Additional, travel-specific prescription medications may include:

Malaria prevention medication
An antibiotic for stand-by treatment of travelers’ diarrhea
Acetazolamide to prevent altitude illness
An antibiotic to treat bladder infection
An antifungal to treat yeast infection
Scopolamin to treat motion sickness
Epinephrin to treat life-threatening allergic reactions
Emergency contraception

Basic First Aid Kit

Tweezers and scissors
Adhesive bandages, gauze pads and adhesive tape
Wound closure strips (Steri-Strips)
Thermometer
Antibiotic ointment
Antiseptic solution (Betadine® or Iodine)

If you’re concerned about sterility of medical supplies in developing countries, bring your own sterile needles, syringes, suture kit, and cannula for IV fluids. To avoid issues with airport officials, kids with syringes, needles, or other sharp objects should include a document endorsing their use for medical purposes.

Pre-packaged first aid and suture/syringe kits are handy to carry. Here’s an example of a quality adventure travel kit.

If You Need Medical Care

Know how to contact the embassy or consulate in the countries you plan to visit. They can be of help in locating appropriate medical services if needed.

Pack a list of the generic names of your medications, a list of letter from your physician describing your existing medical problems, and phone, fax and email contact information for your personal physician.

Join IAMAT (International Association for Medical Assistance to Travelers), membership is free. IAMAT lists professional qualified physicians, clinics, and hospitals in 125+ countries.

Contact your health insurer about overseas coverage. Your Medicare or US health insurance won’t be accepted in other countries; so expect to pay cash for services. However, some of your costs may be reimbursable upon your return.

Consider buying a short-term travel health insurance policy that covers your trip, and includes medical evacuation coverage. A number of companies offer these services and can found with a simple Google search.

Handling Altitude Sickness

Altitude illness is a response to the lower levels of oxygen found at high altitudes. Mountain sickness is common at elevations over 6,000 feet, even though serious altitude illness does not usually occur below 9,000 feet above sea level.

The faster the ascent, the more likely that altitude illness ill occur. Some people adjust to high elevation more quickly than others, for reasons that are not will understood. Acclimatization (adjustment) generally takes 1 – 4 days at a given altitude.

Symptoms of Altitude Illness

Mountain sickness consists of throbbing headaches, fatigue, lack of appetites, nausea, and disturbed sleep, all of which can range from mild to quite severe. Many people liken it to the feeling of an alcohol hangover. There may be decreased urination. Symptoms begin during the first 48 hours after arriving at altitude and, untreated, will last from 1-5 days.

About 10% of those with untreated mountain sickness will progress to high altitude cerebral edema (brain swelling), which is an emergency and must be addressed immediately. Symptoms include vomiting, sever headache, unsteady gait, and altered consciousness, and can progress to coma and death.

High altitude pulmonary edema (lung fluid) can occur 2 – 4 days after reaching altitude. Certain individuals are more susceptible than other, based on genetic factors. It begins with a dry cough and decreased exercise tolerance, then progresses to shortness of breath, air hunger, and unusually rapid heartbeat. If severe, it can be fatal in a few hours.

Treating Altitude Illness

Descent is the mainstay of treatment. The general rule is to descend rapidly to below the altitude at which symptoms begin.

In extreme circumstances, treatment with oxygen and/or a series of one-hour stays inside a pressurized air (hyperbaric) body-tent can be life-saving. However, descent is ultimately still required.

After descent, symptoms tend to improve rapidly, but full recovery may take several days or more.

3 Rules that Will Save Your Altitude Sick Self

If you feel unwell at altitude, assume it is due to altitude illness until proven otherwise.
Never go higher when you have altitude illness symptoms.
If you are getting worse, go down at once.

Preventing Altitude Illness

The key to avoiding altitude illness is to ascend gradually to give your body time to adapt, and pay careful attention to symptoms.

Avoid overexertion
Avoid ascending abruptly to sleeping elevation > 9,000 feet
Sleep 1-2 nights at 6,000-9,000 feet before going higher
Above 9,000 feet, increase you sleeping elevation < 1,500 feet per night,. If you must increase sleeping elevation more rapidly, spend a second night in the same elevation.
Avoid alcohol, sleeping pills, and narcotic pain medications

Taking the medication acetazolaminde does not prevent altitude illness, but can help you acclimatize faster and with fewer symptoms. It is recommended for persons who have repeatedly had altitude illness in the past or who cannot stop to acclimatize.

Beating Jet Lag

Jet lag is usually more obvious when flying east and less so when flying west. Tips for reducing jet lag:

If possible, choose daytime flights
Prior to travel, shift your sleep schedule 1-2 hours toward matching the destination time zone. After arrival, adjust your mean and sleeping times to those of your destination as soon as you arrive. Taking short naps (eg. 20 mins) may help promote daytime alertness without interfering with nighttime sleep.
Exposure to daylight at the right times can help reset the sleep cycle more quickly. After flying east, expose yourself to bright daylight in the morning, and avoid bright light in the evening. When traveling west, do the reverse: seek out bright light in the evening and avoid it in the morning.
Upon arrival, drinking a caffeinated beverage during the local morning can promote alertness. Avoid caffeine later in the local day as it may interfere with sleep.

Consuming the natural human hormone melatonin, 3 mg once daily before sleep, may help reduce jet lag, Avoid tablets that may contain additives and/or impurities.

Preventing or Otherwise Treating Rabies

Rabies is a viral infection of the nervous system that causes aggressive behavior, excess salivation, muscle spasms, convulsions, coma, and death. The virus is found in the saliva and nerve tissue of rabid mammals.

Rabies is most commonly transmitted by a bite from a rabid animal. It can also occur from a scratch by an animal with contaminated claws, a lick on an area of broken skin or mucous membrane, or by getting saliva from an infected animal on your hands, then touching your eyes or mouth. Bat bites an be so tiny as to not be noticed — people have gotten rabies while sleeping in a room with a rabid bat.

In developing countries, especially Africa and South/Southeast Asia, unvaccinated domestic dogs are everywhere and cause 99% of human rabies cases. Remember, though, that virtually any mammal can become infected and transmit rabies.

Avoid Animal Saliva

Reduce your risk of contact with animal saliva:

Avoid touching animals, especially stray dogs and any animals that are acting aggressively
Do not feed wild or stray animals.
Do not touch or pose for photographs close to monkeys. They look cute but frequently bite.
Children are at higher risk of animal bites and should be encouraged to report all direct contact with animals.

If You Are Bitten, Scratched or Licked on Open Skin

Wash the wound or area immediately with plenty of soap and clean water and apply iodine.
If a dog can be caught, quarantined, and reliably observed for days to see if rabies symptoms develop, then you may not need rabies prevention shots.
Most often, however, the animal cannot be caught & observed, and so you can’t determine whether it had rabies or not. Get to a major medical center ASAP, preferably within 2 days, to start your rabies prevention shots. If there’s a significant bite wound you may need even more immediate medical attention.

Rabies is Deadly, But Preventable

So few humans are known to have survived rabies that the disease is considered to be fatal once symptoms start.

Because rabies is so deadly, rabies prevention shots are recommended even when chances are low that the animal was infected.

After a bite, scratch, or lick on open skin, human rabies symptoms appear an average of 4 – 6 weeks later (but can appear as early as I week later and as late as several years later). Rabies prevention shots, though inconvenient, are virtually 100% effective in preventing rabies when started soon after exposure and given exactly according to the schedule below.

Rabies Prevention Shots – After Saliva Contact

If you never had rabies vaccine (or if you only had 1 or 2 doses) then the prevention regimen recommended in the USA is:

One dose of Human Rabies Immune Globulin (HRIG) injected in and around the wound area. HyperRAB and Imogam are the better brands but FaviRab is also acceptable;

plus:

4 doses rabies vaccine, injected in the deltoid (shoulder) muscle (not the buttocks or stomach!) The 1st dose is given immediately along with HRIG, and the other doses on days 3, 7, and 14. Keep to this schedule (unless otherwise told by your physician). Obtain one of the “cell-culture” vaccine brands: VeroRab, RabiPur, RabAvert, Rabivac, or Imovax Avoid “nerve-tissue” vaccines (Semple or Fuenzalida) which are less effective neurological side effects.

If you’ve already had 3 doses of rabies vaccine in the past then you need just 2 boost doses of rabies cell-culture vaccine, on day 0 and day 3.

Note: Persons with immune system suppression should always get 5 doses of rabies vaccine, not 4.

Motion Sickness

Motion sickness may be controlled by eating lightly, avoiding alcohol, sitting in the most stable portion of the craft (over the wings on a plane, near the front of a train, or amidships on deck), and keeping the eyes closed or wearing dark glasses to reduce eye stimulation. Motion sickness is easier to prevent than to treat once it occurs.

Natural Cures for Motion Sickness

Breathing should be your first and easiest defense against motion sickness. Slow inhales and exhales give your brain more oxygen to fight the sickness and will instantly start to reduce dizziness.
Focusing your eyes on stationary objects will keep from exacerbating the mental fatigue. Keep your body still with your head forward and eyes looking strait.
Peppermint essential oil under the nose and on your temples has worked like a charm for myself.
Ginger has been a common remedy for motion sickness and nausea. Brew some in your tea, munch on a ginger drop or bring some ginger tablets along while traveling.

The 101 On Malaria

Malaria is a common and often deadly disease. Worldwide, there are an estimated 500 million severe cases and one million deaths from malaria each year. At least 10,000 travelers fall ill annually, about 800 of whom are from the USA.

Most of the world’s malaria occurs in sub-Saharan Africa, but malaria occurs almost everywhere in the tropics and sub-tropics. It is caused by a microscopic parasite called Plasmodium that infects human red blood cells.

How Malaria is Transmitted

The parasite is transmitted from one human to another by the bite of an Anopheles mosquito. An infected mosquito literally throws up into your body when biting you and the parasite instantly enters your blood stream. Anopheles mosquitoes are night feeding, and so malaria transmission usually occurs from dusk (nightfall) until dawn.

Fun fact (for males at least): only female mosquitos ever bite humans. Males are happy with fruits and other bloodless feasts while the females need the blood for reproduction.

Malaria Risk for International Travelers

Your personal malaria risk depends on the countries you plan to visit, your specific destinations within those countries, your length of stay, the season of travel, and how much mosquito exposure you will have during the evening and nighttime hours.

The geographical distribution of malaria is always changing. Global warming is expected to result in expansion of malaria to higher elevations and to more temperate climates. Visit your AITC clinician to review up-to-date resources and to know whether you have malaria risk at the specific destinations on your trip.

The CDC (Centers for Disease Control) created this handy interactive map which “provides information on the malaria endemicity throughout the world”: CDC Malaria Map Application

Travelers from the USA going to malaria areas are highly vulnerable — they have little or no immunity and can suffer from delayed or wrong malaria diagnosis when returning home.

Preventing Malaria

There is no approved vaccine to prevent malaria (though several are in development). However, there are several effective malaria prevention medications. Malaria prevention medications do not prevent mosquito bites and do not prevent infection. Instead, after a bite from an infected mosquito, they prevent the parasites from reproducing inside the human body.

Chloroquine Mefloquine, and Doxycycline (recommended) destroy parasites that have entered the bloodstream after maturing in the liver. They must be continued for 28 days after leaving the malaria area, to destroy parasites that may still be released into the bloodstream.

Atovaquone-Proguanil (Malaronel destroys parasites released from the liver into the bloodstream but also prevents parasites from maturing in the liver. It must be taken for 7 days after leaving the malaria risk area.

No prevention medication is 100% effective. Always use insect precautions even while taking your medicine.

How to Disappoint a Mosquito

Your international trip will most likely expose you to bites from insects like mosquitoes, flies, fleas, tics, spiders and other “bugs” that transmits serious infections. For some diseases like malaria, yellow fever, Japanese Encephalitis and tick-borne Encephalitis, insect protection is essential because the available drugs or vaccines are not 100% effective at preventing infections. For others, no preventative drugs or vaccines are available.

• Use a proper insect repellent on exposed skin and frequently reapply.
• When using sunscreen, apply screen first, then repellent.
• Wear long sleeves and pants and tuck in everything.
• Invest in a bed net for the night, and tuck it in.
• Treat all garments and bed net with insect repellent.

Modify Your Behavior to Avoid Bites

Mosquitos enjoy the “smelly-good” perfumes, colognes, hair products and soaps as much as you. Be aware the peak biting times for mosquitoes carrying serious diseases tend to be the twilight periods. Think of them as mini nocturnal bloodthirsty vampires that have the potential to turn you into a braindead zombie in a swift single bite. Inspect you body and clothing for ticks during outdoor activity and at the end of the day. Darker clothes attract mosquitos and make it harder to see tics and other insects that are commonly darker in color.

How to Be a Human Insect Repeller

“DEET is the shit!“ , said the soft-spoken knowledgeable nurse at the SF Department of Public Health. “DEET” is an abbreviation of diethyl toluamide – a colorless oily liquid with a mild odor that repels insects better than any other solvent out there. It’s recommended to use products containing 25-50% DEET. The higher the DEET concentration, the longer the protection. Of course, after I learned this, my search for pure 100% DEET began; ya know the good stuff. Soon I found there is no additional benefit above 50%.

Regardless, if DEET is proven to be the most effective chemical, I don’t care for a product diluted with unnecessary ingredients. Enter, Repel 100 Insect Repellent—a 98.11% DEET product.

Notice I mentioned DEET is a chemical? One that “is caustic to plastics and other synthetic materials.” The same chemical has been linked to everything from skin rash to cancer. So I won’t be putting DEET on my skin, but it will still service its purpose as surrounds the perimeter of my bed and insect net.

Fear not, catnip to the rescue! Yep. In this lab study every cat’s favorite drug worked ten times better than DEET! Though it does not last quite as long, catnip is an excellent plant-based insect repelling alternative. It’s the plant’s oils that provide the repellant. Meaning it must be crushed to release the oils to become the effective repellant it is.

Second runner up: Lemon Eucalyptus essential oil. Why? A plant’s trichomes are what release scents interfere with insect’s chemical and nostril cues. The larger and more densely packed the trichomes on a plant’s foliage, the stronger the scent. Lemon Eucalyptus has large trichomes that release some of the strongest (and quite pleasing in my option) scents that mosquitos aren’t the fondest of. As a bonus, the lemon’s acidity will kill unwanted toxins hiding in your skin and leave you smelling, looking and feeling fresh and mosquito free!

Mosquitoes use chemical, visual, and thermal cues to locate us.

With this information, I concocted an insect repeller and will be paying very close attention on how well disappoints mosquitos. Here’s the recipe for what I like to call the Insect Disappointment Ointment:

Fill spray bottle (I used 4 ounce) 1/2 full with distilled or boiled water
Add 30-50 drops of 100% Pure Catnip Essential Oil
Add 30-50 drops of Lemon Eucalyptus Essential Oil
Add 30-50 drops of essential oils to desired scent. The more oils you use, the stronger the spray will be.
- Other oils I recommend trying to scent it up: Rosemary, Clove, Cajeput, Lavender and Cinnamon.

Caution: be easy on the catnip if you will be in mountainous areas where wild cats might be present. Unless you want to be raped by a mountain lion.

I plan on somehow capturing and testing the plant power of Catnip, Lemon and Eucalyptus against the synthetic power of DEET. Keep you posted on the experiment.

Travelers’ Diarrhea

Travelers’ diarrhea (TD) is extremely common. If you’re going to Latin America, Asia, or Africa, you have a 50% chance of getting it during your trip. It is also known as Turista, Montezuma’s Revenge, Delhi Belly, and other such colorful names. TD is often a very unpleasant experience.

TD usually starts several days, and almost always within the first 2 weeks, after arrival.
Diarrhea is usually watery and averages 3-5 stools per day but can be much more frequent. In up to 15% of cases, stool contains blood and/or mucus.
Fever, abdominal pain, cramping, nausea, vomiting, and an urgent need to pass stool are common.
Illness usually lasts I -5 days and improves without specific treatment, but it can go on longer and be severe enough to require medical attention

What Causes Travelers’ Diarrhea?

Eating foods that are contaminated by unclean hands or by flies that land on your food
Poor hand washing by food handlers or by you after using the restroom
Inadequately treated drinking water
Poorly cleaned fruits and vegetables, served raw, that have been in contact with fecal matter

TD is not caused by “different water than what you’re used to.” It is an infection caused by microorganisms that get into your mouth. TD is caused by bacteria (most frequently), viruses and parasites.

The typical watery diarrhea is due most commonly to E. con bacteria. Other causes include Norovirus and Rotavirus. Profuse watery diarrhea can be due to Cholera.
Dysentery (diarrhea with blood and/or mucus) may result from the bacteria Shigella, Campylobacter, Salmonella, or Yersinia, or from the parasite Entamoeba.
Slow-onset diarrhea with prominent gas and bloating is typi-cal for the parasite Giardia

How To Avoid Travelers’ Diarrhea

See Food & Water Safety, Section Above

Travelers cannot completely control their microbial environment. One ill person preparing your food in a restaurant is all it takes to get sick.

Taking Pepto-Bismol daily while traveling is reported to prevent about 50% of travelers’ diarrhea.

Probiotics are dietary supplements containing live bacteria or yeast. Results of scientific studies suggest that in healthy individuals, using the yeast Saccharomyces boulardii or a mixture of the bacteria Lactobacillus and Bifidobacterium starting several days before travel may prevent 10-15% of cases of travelers’ diarrhea. Typically available through specialty natural foods and nutrition stores.

You’ve Got the Shits, Now What?

Managing Mild Travelers’ Diarrhea:

Mild travelers’ diarrhea usually resolves in – 2 days without antibiotic treatment
Drink plenty of water to stay well-hydrated
Eat foods easy to digest: rice, bread, saltine crackers. Avoid fatty or spicy food, dairy, coffee, caffeine, and alcohol

Managing Moderate-to-Severe Travelers’ Diarrhea:

Your illness is moderate-to-severe if you have one or more of the following:

Watery stools 3 or more times daily
Urgent need to pass stool, requiring constant access to a restroom
Vomiting
Significant cramping or painful spasms
Losing a high volume of water in stools
Fever and/or mucus and/or blood in stool
Weakness, fatigue, inability to carry out daily activities

Even in moderate-to severe travelers’ diarrhea, most cases of illness will resolve in 3-5 days without antibiotic treatment. The most important factor in self-care of moderate-to-severe travelers’ diarrhea is to maintain hydration.

Oral Rehydration

Signs of dehydration: confusion, lethargy, decreased urination, concentrated dark urine, sunken eyes, skin tenting.

Here are recommended methods for proper diarrhea rehydration:

Do not use plain water for rehydration in moderate-to-severe travelers’ diarrhea. To keep body salts in balance while rehydrating, you must replace not only the water lost from vomiting and diarrhea, but also the essential body salts.
Oral rehydration solution (ORS) packets can be purchased at many pharmacies overseas. The powdered salts should be mixed with bottled or disinfected water.
Travelers can make their own ORS by adding 1/2 teaspoon table salt, 1/2 teaspoon baking soda, and 8 teaspoons sugar to I liter of bottled or disinfected water.
If gulping down ORS results in more vomiting, take smaller amounts at a time. Sometimes, the stomach is so sensitive that it can only handle I teaspoon per 5 minutes. Imodium may help limit the number of stools and reduce water loss. It can be helpful in situations requiring bowel control when you are not near a restroom

When to Seek Dehydration Medical Care

Immediately, if you have moderate-to-severe diarrhea and you are pregnant, have immune system suppression or have diabetes, heart or kidney disease
After 3 days of antibiotic if you are no better or are worse. You may need stool testing and/or different antimicrobial.
Right away, in a small child with diarrhea and vomiting > 4 hours or who can’t hold down oral rehydration fluid. Small children become dehydrated much more quickly than adults.
Signs of dehydration: confusion, lethargy, decreased urination, concentrated dark urine, sunken eyes, skin tenting.
If your diarrhea last more than a week

Vaccines and Vaccine Preventable Diseases

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VACCINE	RISK LOCATION	HOW	RECOMMENDED FOR	TIMING
Hepatitis A	Everywhere, but especially Africa, Asia, Latin America	Food & water	• All travelers • All children age >12 months • Persons with chronic liver disease • Health care workers • Anyone else who seeks to prevent hepatitis A	• 2 does • 0, 6-12 months • Lasts > 20 years
Hepatitis B	Everywhere, but especially Africa, Asia, Latin America	• Blood • Body fluids • Sexual contact	• All travelers (but especially those with possibility of a new sexual partner, tattoo, piercing, acupuncture, medical procedures, or blood exposures) • All children • Men who have sex with men • Injection drug users • Health care workers • Partners/household members of those with hep. B • Anyone else who seeks to prevent hepatitis B	• 3 doses • 0, 1, 6 months • Lasts >20 yrs
Human Papillomavirus (HPV)	Everywhere	Sexual contact	• Males and females age 9-26 years • Other adults who wish to be protected	• 3 doses • 0, 2, 6 months
Influenza	Everywhere	Respiratory secretions	• All persons age > 6 months • Travelers to southern hemisphere July-October, and travelers to tropical areas year-round • Those age > 65 years - Pregnant women • Those with chronic metabolic, lung, or heart disease • Health care workers	• 1 dose • Annually
Japanese Encephalitis (Ixiaro®)	Much of South Asia, East Asia, and Western Pacific Islands	Mosquito bite	• Travelers to risk areas who plan to stay > I month, or who will stay <1 month but visit rural areas, have significant outdoor activity, or are unsure of itinerary • FDA-approved for age > I 7 years g	• 2 doses • 0, 28 days • Lasts > 2 yrs
MMR (Measles, Mumps, Rubella)	Everywhere	Respriatory secretions	• Adults born after 1957 who were not fully immunized and never had measles, mumps, and rubella disease • All children age >12 months • Health care workers	• 2 doses • > 1 month apart
Meningococcal Meningitis	Northern sub-Saharan Africa during dry season	Body fluids (especially saliva)	• Travelers to high risk areas • Required by Saudi Arabia for travelers to Hajj • Age 2-55 years	• I dose • Lasts > 5 yrs
Pneumococcal Disease (Pneumovax®)	Everywhere	Respiratory secretions	• Adults age > 65 • Persons age > 2 years with asthma, chronic metabolic, lung, or heart disease or immune system suppression due to disease or medications • Cigarette smokers	• 1 or 2 doses, depending on your age
Pertussis (Tdap)	Respiratory secretions	Respritaory secretions	Persons age > 10 years due for tetanus booster, or who are pregnant or may have contact with an infant	• 1 booster dose
Polio Booster	Africa, India, South Asia, SE Asia, Middle East	Food & water	• Adult travelers to high risk areas	• 1 booster dose • Lasts lifetime
Rabies	Latin Amercia, Aftrica, Asia	Mammal bite	Travelers planning long stays in risk areas far from major medical centers, or activities with exposure to potentially rabid animals such as rural bike trips	• 3 doses • 0, 7, 21-28 days • Lasts > 2 yrs
Tetanus (Td or Tdap)	Everywhere	Cuts, scratches, wounds	Adolescents and adults due for tetanus booster	• 1 dose • Lasts 10 yrs
Typhoid	Latin America, Africa, Asia	Food & water	• Travelers to risk areas • Age > 2 years (Injection) or > 6 years (capsules)	• 1 dose • Lasts 2-5 yrs
Varicella (chickenpox)	Everywhere	Respiratory secretions	• Adults born after 1980 who do not have natural immunity or documentation of immunization • All children age > 12 months • Health care workers	• 2 doses • > 1 month apart
Yellow Fever	Tropical areas of South America, Africa	Mosquito bite	• Travelers to risk areas where disease is present • Required by many countries to gain entrance • Age > 9 months; caution in those age > 60 years	• 1 does • Lasts 10 yrs
Zoster (Shingles)	N/A	N/A	Age > 60 years who wish to prevent shingles	• 1 does

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Safe Travels!

Do you have any other information you’ve found useful before venture into a foreign land? Comment below and let me know, thanks!