Take precautions if you’re planning to go abroad.
EACH YEAR, MORE THAN 30 million Americans travel internationally by air, according to the National Travel and Tourism Office. That’s not counting those who drive or walk across the border.
But while many globetrot for work or pleasure without health incident, public health, travel and tropical medicine experts say that often a lack of preparation or awareness of the potential health risks associated with international travel may pose a danger to the individual as well as to others in the communities where that person resides.
Malaria, which killed an estimated 429,000 people worldwide in 2015, according to the World Health Organization, was eliminated in the U.S. in the 1950s. Yet the number of imported cases has crept up here in recent decades. According to research in April in the American Journal of Tropical Medicine and Hygiene, there were an estimated 22,029 malaria-related hospitalizations – averaging 1,469 each year – in the U.S. from 2000 to 2014.
Travelers in places where malaria is present, like West Africa, are urged to talk with their doctors about taking antimalarial medications to prevent contracting the life-threatening blood disease that’s caused by parasites and transmitted by mosquito bites.
But the threat to health needn’t be exotic. In fact, in addition to not getting vaccines to protect against diseases like yellow fever, many travelers face added health risks when abroad because they’re not caught up on routine vaccines.
In some cases, people who aren’t up to date on getting two doses of the measles, mumps, rubella, or MMR, vaccine contract measles – a highly contagious, dangerous viral infection – while traveling internationally and spread it to others who aren’t immune when they return home. Endemic measles was eliminated in the U.S. in 2000. But imported cases of the viral infection have sparked a number of measles outbreaks here in the past few years, says Kelly Holton, spokeswoman for the Travelers’ Health Branch of the Centers for Disease Control and Prevention.
Measles can be spread days before the appearance of the characteristic rash, which typically starts with flat red spots, and it can lead to complications ranging from diarrhea to hearing loss, pneumonia and brain swelling. Children are particularly vulnerable; about 1 or 2 of every 1,000 who contract measles will die from it, according to the CDC.
Fortunately, clinicians note that the MMR vaccine is highly effective in protecting kids and adults from getting the disease. But not everyone has received the vaccine, or is immune to the measles. Adults born in the U.S. before 1957 are presumed to have immunity because of the widespread nature of measles before that time, and don’t need the vaccine. Others, including pregnant women, should not get the vaccine. But it’s safe for most, though experts say with all vaccines – as with treatments or medications – it’s important to talk with a doctor first about the risks and benefit.
However, research published in the Annals of Internal Medicine in May finds that more than half of travelers who were eligible for the MMR vaccine didn’t get it. Clinicians at 24 pre-travel clinics studied determined that 16 percent of international travelers who went to one of the clinics between 2009 and 2014 were eligible for an MMR vaccine. However, of 6,612 adult travelers providers considered eligible for the vaccine, “only 47 percent were actually vaccinated at the pre-travel encounter,” says Dr. Emily Hyle, an infectious disease specialist at Massachusetts General Hospital and an instructor of medicine at Harvard Medical School. That was of particular significance, because the CDC and the Advisory Committee on Immunization Practices recommend that all international travelers be up to date on MMR vaccination prior to travel; that means having received two documented doses of the vaccine.
Of those patients eligible for the vaccine, nearly half – or 48 percent – refused it. “We found that 74 percent of the travelers who had refused [did so] because they said they weren’t worried about measles as an illness,” Hyle notes. The study also found that in 28 percent of cases where the adult traveler was eligible for an MMR vaccine the provider didn’t offer it. Experts say travelers and health providers could benefit from further education about the importance of travelers being up to date on vaccines as well as discussing other vaccines that may be recommended prior to travel. Many international travelers don’t think or know to check on what sort of health precautions they should take before or while traveling, says Dr. Abinash Virk, a travel and tropical medicine specialist at Mayo Clinic in Rochester, Minnesota. She adds, though, that recent outbreaks like that involving the Zika virus have raised awareness of the risks of international travel somewhat.
To assess that risk before departing, on cdc.gov/travel would-be travelers can look up their destinations to find out what vaccines or other health precautions are recommended. “We have destination pages for every country in the world, along with some places that aren’t countries,” Holton notes – 242 destination pages in all.
“The first recommendation is to think in advance,” says Dr. Mirella Salvatore, an assistant professor of medicine at Weill Cornell Medicine in New York City and a travel medicine specialist who sees patients at the affiliated Weill Cornell Travel Medicine practice. She recommends seeing a health care provider for a travel-related health consult at least one to two months prior to travel. That’s because it typically takes vaccines a couple weeks before they become fully effective; and in some cases, an additional dose or doses of the vaccine, or booster shots, are needed.
Of course, travelers can’t rely on vaccines alone to protect against health risks. Experts emphasize understanding all recommended precautionary measures when traveling internationally for that locale, which could range from taking prophylactic drugs – like antimalarial medications – to wearing bug repellent.
Along with information on its website, the CDC offers two free apps for travelers. One, called “TravWell,” is a planning tool. You can plug in the dates of your trip and where you’re traveling and it will list recommended vaccines; and you can put in your vaccine history and set reminders, say, if you need another dose of a vaccine. Taking malaria drugs? “If you put in which malaria medicine you’re prescribed, it knows what interval you’re supposed to take that on, and you can set a reminder, so you don’t forget to take your malaria meds,” Holton says. There’s a customizable health packing list, and you can also store pictures of any of your important health documents, like your vaccine card listing vaccines you’ve received or copies of your prescriptions. “So that if you lose the paper copies you have a back-up,” she says.
In addition, the CDC’s app “Can I Eat This?” allows travelers to plug in the country they’re traveling in and answer a few questions about what they’re about to eat or drink. “It will tell you if that fits within our recommendations or not,” Holton says. “We can’t promise you [that] you won’t get traveler’s diarrhea, but this is to help people make safe food and water choices without having to remember a long list of rules.”
Besides the place where you’re planning to travel, consider also your own health before departing – or even setting your destination. Chronic conditions and other health issues should be discussed with your primary care doctor and any travel medicine specialist you see before setting out. For some – including those who may be immunocompromised, or who may otherwise not be able to get vaccinated against diseases in an area where they plan to travel – experts say, it might be best to choose to travel somewhere else.
Don’t assume, either, that because you’re traveling to a developed country in the Western world you won’t face any health risks. “Right now there’s several countries in Europe that are experiencing large measles outbreaks,” Holton says. The CDC has issued travel advisories for Belgium, Germany, Italy and Romania because of outbreaks of measles in those countries, and the agency emphasizes its recommendation that all internationals travelers be up to date on their measles vaccinations; the World Health Organization said in March that the largest measles outbreaks in Europe are taking place in Romania and Italy. “So even if it is a developed country, there’s still some things to pay attention to, and often it falls into that routine vaccine category,” Holton says.
Virk adds that the flu vaccine should also be considered before traveling, since there are so many cases of the virus globally and it’s a year-round problem in the tropics. That’s particularly true for vulnerable populations – such as older travelers – who are more susceptible to the flu. The same goes for discussing with a doctor whether a pneumonia vaccine may be appropriate. “It’s a total health issue,” she says. In other words, consider your complete health picture, along with the risks specific to where you’re going. And before you depart, talk with your health provider to make sure you’re taking all necessary precautions – whether the threats are exotic or not – for the sake of your health and others in the community to which you return.
This article originally appeared in US News & World Report.
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