Overview of Travel Health and Safety

Problems from Physical Contact

Some diseases are transmitted through physical contact, sexual activity, or contact with blood. Many of these diseases are more prevalent in developing countries than elsewhere. However, the following guidelines can help prevent these health problems no matter the destination.

Hepatitis B

Hepatitis B is a serious infection of the liver caused by the hepatitis B virus. Transmission is through needlesticks, sexual contact, tattooing, blood transfusion, nicks during haircuts or manicures, injection-drug use, or from an infected mother to her infant at birth. Symptoms, which typically begin 6 weeks to 6 months after infection, include loss of appetite, fever, nausea, vomiting, fatigue, and stomach pain; dark urine and jaundice (yellow skin and eyes) are also common. People who develop chronic hepatitis can spread the disease to others for the rest of their lives and can develop long-term liver disease, such as cirrhosis (which destroys the liver) or liver cancer.

Prevention: Hepatitis B vaccination consists of a series of 3 injections over a 6-month period. An accelerated schedule of 3 doses over 3 weeks or a 2-dose adult vaccine are available. A combined hepatitis A-hepatitis B vaccine is also available. Vaccination is now routine in children in most countries and should be considered for all travelers because predicting exposure to blood or bodily fluids during travel is difficult. The relative likelihood of future international travel warrants consideration of a vaccine that confers lifelong protection. Very short-stay travelers without risk behaviors are the lowest priority, but vaccination should be recommended, especially for frequent or long-term travelers or to those anticipating medical care while abroad.

Rabies

Rabies is a uniformly fatal viral infection of the central nervous system that is transmitted through contact (bites, scratches, licks) with the saliva from infected animals. Many animals can transmit rabies (e.g., bats, cats, coyotes, dogs, foxes, ferrets, jackals, raccoons, skunks, and wolves). Risk of rabies varies widely between countries. Symptoms are not usually present during the incubation period, which can last from 4 days to 4 years or more. The onset of disease is still preventable during the incubation period, so prompt treatment is vital. Once symptoms appear, the disease is almost always fatal. Early symptoms include tingling at the site of the bite, followed by fever, muscle aches, anxiety, depression, irritability, and sometimes respiratory or GI symptoms. The victim eventually experiences sensitivity to light, sound, and touch, and will have severe throat spasms when trying to drink water. Dementia, convulsions, and paralysis precede death.

Prevention: Avoid direct contact with all dogs (including puppies) and other biting mammals, including bats. A health care provider can determine whether vaccination is necessary, based on factors such as whether rabies is present at the destination, the duration of stay, planned activities, and age (for children); children who play outdoors in developing countries are at increased risk for rabies. Another factor is the availability within 24 hours of modern rabies vaccine and immune globulin for postexposure use. Preexposure vaccination consists of 2 doses 7 days apart followed by either a titer check (vaccine response laboratory test) 1 to 3 years after series completion with a booster (third dose; given only if necessary) or alternatively, an empiric booster (third dose; no laboratory testing) given 21 days to 3 years after series completion.

Preexposure prevention consists of 2 injections given over a 3- to 4-week period. If time is limited, at least 2 doses spaced by 1 week will give some benefit.

If an exposure does occur, the most reliable methods of preventing rabies are vaccination and thorough wound cleaning. Anyone who receives a bite, scratch, or lick on broken skin should immediately cleanse all wounds thoroughly with soap or povidone iodine under running water (if possible) for a minimum of 15 minutes and urgently seek medical help. Never presume an animal is free of rabies. Any contact with animal saliva in a rabies-endemic region should be evaluated by a medical professional. If exposure is suspected, even for those who have received the preexposure vaccine, a limited series of postexposure injections must be given. Those who have not received the preexposure vaccine series must receive longer treatment, including both vaccine and rabies immune globulin injections.

Sexual Contact

Sexual contact with new or casual partners can lead to sexually transmitted diseases and should be avoided. Unprotected casual sex is always high-risk behavior.

Prevention: Individuals who engage in sexual activity with new partners during travel should use condoms every time to reduce their risk of acquiring sexually transmitted diseases. Because safety standards differ worldwide, bring a supply of high-quality latex condoms, which should be protected from sun and extreme temperatures. Condoms do not eliminate the risk of HIV transmission; a medication is available, along with safer-sex practices, that can prevent transmission to persons who do not have HIV but who are at increased risk of infection. Avoid sexual activity with commercial sex workers. Inhibitions are diminished when traveling away from home and are further diminished by alcohol and recreational drugs; unintentional risk exposure may occur. Human papillomavirus (HPV) is also sexually transmitted and can cause cervical cancer and genital warts; an HPV vaccine is available for persons aged 9-45 years.

Skin Problems

Skin problems can result from contact with people, plants, insects, or animals. Even minor problems should be taken care of immediately to guard against secondary infection.

Prevention: Individuals participating in adventure travel or spending extensive time in rural areas should ask local people, guides, or other contacts about precautions needed to avoid any poisonous plants or animals.

Rashes and other skin conditions (contact dermatitis) can be caused by a variety of products used for cleaning or personal hygiene. If a product being used is suspected to be causing the problem, stop using it and try one with milder or fewer ingredients.

Prevent blisters by wearing soft cotton socks and sturdy, comfortable shoes. Do not break in new shoes during the trip; make sure shoes fit well before departure. Do not pop any blisters that may develop. This leaves damaged skin exposed to bacterial infection. Pad the area with soft, dry gauze and keep it clean. If the blister opens on its own, treat it as any other minor abrasion.

Clean minor cuts or abrasions thoroughly by scrubbing gently with soap and boiled, bottled, or purified water or povidone iodine solution to remove bacteria and debris, then rinse. Coat the area with antibiotic ointment and keep it covered with a clean, dry bandage until it begins to heal.

To relieve the pain of minor burns, apply cool, wet compresses to the area and take oral anti-inflammatory drugs such as aspirin or ibuprofen. Do not apply ice, which can damage already traumatized skin tissue.

Fungal infections (such as "athlete's foot" and "jock itch") are more likely to occur in warm, moist climates. Bring an antifungal skin cream, ointment, or powder for these problems and apply according to package instructions; keep the affected area clean and dry.

Individuals who have a history of allergic reactions should take precautions to avoid allergens and bring a medication that works for their symptoms. Those with severe allergies should wear a medical alert tag and carry a "sting kit" (epinephrine auto-injector and an oral antihistamine) in case of an anaphylactic reaction. (See Pests.)

Consider bringing antihistamines (such as Benadryl), which decrease the allergic response in most people. A topical ointment with hydrocortisone to relieve itching is also helpful.

In Africa, iron all clothing and bedding that were dried outdoors to prevent skin infestation by the larvae of the tumbu fly.

Tetanus

Tetanus is an acute, often fatal, neuromuscular disease caused by organisms found worldwide in dust and soil, especially where animal waste is present. These organisms can infect a wound or other damaged tissue and create toxins that affect the nervous system. Symptoms include muscle rigidity and spasms, usually starting with lockjaw. Severe cases can be fatal. Although highly preventable with vaccination, tetanus is a common disease in developing countries where the vaccine is not widely used.

Prevention: The best prevention is childhood vaccination, which is usually given in combination with diphtheria and pertussis vaccines to children younger than 7 years. A Tdap booster is recommended for all travelers every 10 years (assuming receipt of an adequate primary series) because of increasingly frequent pertussis outbreaks worldwide. Those who received a tetanus booster that did not contain a pertussis component for their most recent booster should receive a dose of Tdap immediately, regardless of the interval since the last tetanus dose. Individuals who are wounded may need a dose of tetanus-containing vaccine depending on how many doses they previously received and when their last booster dose was given.

See Additional Illnesses for less common illnesses that may be contracted from physical contact.