International Travel Advice Treatment

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    Seek medical care immediately if you develop symptoms of an infectious disease while overseas or after your return. Getting prompt care can be lifesaving. For example, about 2% of people infected with malaria die, usually because they waited too long for treatment. You should also seek immediate medical attention if you are bitten by an animal while traveling.

    If you become ill or are injured while abroad, contact the nearest U.S. embassy or consulate. They will provide you with a list of recommended doctors, dentists, medical specialists, clinics, and hospitals. If your illness or injury is serious, officials from the embassy or consulate will help you find medical assistance. At your request, they will also notify your family or friends of your condition.

    Standards of medical care in other countries do not always meet those in the United States. Therefore, you should be prepared for different procedures and approaches to care if you seek medical attention in a different country. For example, in many countries, physicians use drugs that have not been approved for use in the United States by the Food and Drug Administration. In addition, many drugs that require a prescription in the United States can be purchased over-the-counter in many areas of the world.

    In developing countries, some medications that are used only in cases of life-threatening infection in the United States are routinely used for minor infections because of cost concerns. Two particular drugs that should be avoided are chloramphenicol (Chloromycetin), an antibiotic that can cause a fatal form of anemia, and clioquinol (Vioform), a drug used to treat diarrhea that can cause severe neurologic damage.

    If you develop traveler's diarrhea, be sure to take in adequate amounts of fluids to prevent dehydration. Many people find that fruit juices and soft drinks (preferably without caffeine) are the easiest fluids to tolerate during an episode of traveler's diarrhea. Be sure to avoid any fluids or foods that may be contaminated. A simple practical rehydration method for adults with traveler's diarrhea includes drinking bottled water and eating saltine crackers.

    If you plan to travel into an area where malaria is a problem, consider carrying an antimalarial drug with you. If you are traveling to a remote area where malaria occurs and medical care is likely to be unavailable, ask your doctor about prescribing a specific antimalarial medication such as sulphadoxine-pyrimethamine for self-treatment. Should you develop symptoms of the disease, you can then promptly self-administer the drug. This is only a temporary measure, however, and you should seek medical care as quickly as possible.

    Your doctor is the best source of information on the drug treatment choices available to you.

    Drink plenty of fluids to prevent dehydration if you have traveler's diarrhea. If you become severely dehydrated, your physician may advise you to use an oral rehydration solution. These are packets of salt and carbohydrates that can be purchased from a pharmacist in the United States before you leave on your trip. They are also widely available abroad. Follow the directions closely as to how much (safe) water should be used for each package.

    In severe cases, travel-related illnesses may require surgery. S. typhi bacteria can linger in the gallbladder; therefore, surgery to remove the gallbladder is sometimes necessary for people who have a relapse of typhoid fever, who need treatment for the illness but cannot tolerate antimicrobial (antibiotic) therapy, or who are persistent carriers of the disease.

    Alternative therapies should be used only to complement conventional medical treatments. Always consult your physician first if you have symptoms of a travel-related illness. The herb goldenseal (Hydrastis canadensis), which has antibacterial properties, is sometimes used to treat traveler's diarrhea. Make a tea by pouring one cup of boiling water onto two teaspoons of the dried and powdered rhizomes and roots of the plant. Steep for 10 to 15 minutes. Drink three times daily.

    Eucalptus (Eucalyptus globulus), which also has antibacterial actions, has a long history for treatment of typhoid fever. To make a tea, steep one to two teaspoons of the dried leaves in a cup of boiling water for 10 to 15 minutes. Drink three times daily.

    To help speed up recovery from malaria, herbalists sometimes recommend boneset (Eupatorium perfoliatum), a herb used historically by Native Americans to treat fevers. Make a tea by steeping one to two teaspoons of the dried herb in a cup of hot water. Drink it several times throughout the day.

    To help relieve some of the symptoms associated with hepatitis A, homeopaths sometimes prescribe Phosphorus. Homeopathic remedies for malaria include Arsenicum album and Sulphur.

    Pregnant women should take special precautions while traveling. Many infectious illnesses such as the flu, pneumonia, malaria, and meningitis can be more severe during pregnancy. Contracting such an illness during pregnancy may increase your risk of premature delivery or other medical problems for the mother and/or baby.

    The option of taking preventive medications is more limited for pregnant women because of the potentially harmful effects the drugs may have on the baby. Live vaccines are generally not recommended for pregnant women except in high-risk situations. Some antibiotics should also be avoided, including tetracyclines, quinolones, and probably sulfonamides. Immune globulin may, however, be administered safely for preventing hepatitis A. Antimalarial drugs that may be used safely by pregnant women include chloroquine and proguanil.

    People with heart disease or other chronic illnesses should take special precautions during travel.

    • Heart disease: More people die of heart attacks and other cardiovascular problems while traveling than of any other illness.

      Be sure to have your physician examine you for potential cardiovascular problems before embarking on a trip; particularly if you are going to be traveling to a remote area or a physically demanding environment. If you have a diagnosed cardiovascular problem, be sure to take extra supplies of all medications with you. Keep the medications in your carry-on luggage along with a recent copy of an electrocardiogram and the name and telephone number of your physician. If traveling by air, sit in an aisle seat and walk and stretch often. Be sure to drink plenty of fluids during the flight and avoid alcohol. Such precautions can help prevent a heart attack or stroke.

    • Lung disease: If you have a chronic lung disease such as emphysema or chronic bronchitis (together known as chronic obstructive pulmonary disease, or COPD), you should check with your physician before traveling by air, as you may need supplementary oxygen during the flight. Airlines do not permit passengers to bring their own oxygen tanks onto flights. Your physician will need to call the airline at least two to three days before your flight to order the oxygen for you. If you have asthma, make sure you take all your medications for both prevention and treatment with you. Also, make sure that you have specific instructions from your physician about how to manage an attack of asthma, especially if sophisticated medical help may not be readily available.
    • Diabetes: While traveling, people with diabetes must be particularly careful about how much and when they eat and exercise. In addition, changing time zones may temporarily alter insulin dosages. Be sure to discuss your travel itinerary and its possible effects on your diabetes medication with your physician before leaving for your trip. Keep all medications, insulin syringes and needles, glucose-monitoring equipment and supplies, and snacks in your carry-on luggage. Wear a medical ID tag at all times, and carry the name and telephone number of your physician with you. To avoid developing serious foot problems while traveling, wear comfortable shoes and be sure to check your feet daily for signs of injury or infection.
    • HIV: Live vaccines are generally not recommended for the HIV-infected traveler. Inactivated vaccines may be given, although they tend to be less effective in people with HIV infection.

    People with HIV are at a greater risk of contracting illnesses that are spread through contaminated food and water.You should take extra precautions to protect yourself against such contamination. Also, ask your physician if you should take prophylactic antibiotics for traveler's diarrhea. To protect yourself from malaria, use insect repellant and be vigilant about wearing long clothing. Also, to prevent hookworm and other infections, avoid having any direct skin contact with soil or sand that may be contaminated with fecal matter.

    If caught and treated early, most travel-related infectious illnesses can be treated effectively. In recent years, however, many illnesses once considered to be under control, such as cholera and dengue fever, have been reemerging as global health problems. In addition, antibiotic-resistant strains of many diseases are spreading at an alarming rate. New and deadly infectious diseases, such as that caused by the Ebola virus, are also emerging as a growing health threat. Travelers, particularly those visiting developing countries, should be extremely cautious, and take all necessary preventive actions to protect themselves while abroad.

    Because some travel-related infectious pathogens are difficult to eradicate from the body, it is very important that you follow your physician's recommendations for follow-up care. You should take all medications for the prescribed length of time designated by your physician, even if you no longer have symptoms. Keep all appointments, and be sure to call your doctor if you are experiencing any difficulties with your medication (such as trouble taking medication as prescribed, or unpleasant side effects), or if your symptoms worsen. You should also be sure to have all follow-up tests. Until your physician has declared you free of all pathogens, take all recommended precautions to avoid spreading the illness to others.

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