Medically Speaking: Article 5

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Articles and Publications: Medically Speaking

Medically Speaking: Archives

The Vaccinated Traveler
by Margaret Trexler Hessen, M.D.
specialist in infectious diseases & member of the Delaware County Medical Society

Spring is on the way, and many people are making summer vacation plans. Those lucky vacationers whose plans include travel abroad (particularly in areas other than Canada, western Europe, Australia, or New Zealand) should consider the need for vaccination or other preventive measures against “exotic” diseases.

Everyone should be “up to date” on the usual childhood vaccines, but this is particularly important for those undertaking travel abroad, where exposure to such diseases may occur more commonly and where good medical care for such conditions may not be readily available. For those who haven’t had a tetanus shot in the last ten years, a dT booster is in order (dT is diphtheria/tetanus, and diphtheria has been reported in eastern Europe as well as other areas of the under-developed world). Travelers born after 1957 should check to see if they’ve had the currently recommended series of two MMR (measles/mumps/rubella) vaccines. Likewise, people traveling to some areas of Africa and India may need to consider a polio booster, depending on the details of their itinerary, their age, health status, and the date of their initial polio series.

Some countries require proof of vaccination against certain diseases either for visa application or for presentation at the border. Additionally, although many countries have no requirements, the climate and conditions favor the spread of diseases that do not generally occur in the United States, such as malaria and yellow fever. Vaccines and other precautions are prudent, even if not required. For example, travelers to certain areas in Africa and South America may be required to show proof of yellow fever vaccine. Even if not required, vaccination may be an appropriate precaution depending on the particular area of travel, the likelihood of exposure to mosquitoes (who transmit the disease), and the overall health of the traveler. Likewise, travelers to some areas of Africa, South America and Asia might benefit from preventive medicine and other protective measures (mosquito repellant, mosquito nets, etc) against malaria, another mosquito-borne disease.

Inadequately treated water or food prepared in unsanitary conditions can also cause disease. Some of these diseases can be prevented by avoiding high risk foods (uncooked fresh fruits and vegetables, for example) and by drinking only boiled water or beverages that have been bottled or canned (no ice cubes unless made from boiled or bottled water). Added protection can be gained against some food-and-water-borne diseases by vaccination. For example, vaccines against typhoid fever and hepatitis A are available, effective and safe for most travelers. Travelers to Africa, Asia and South America should consider these vaccines.

Other vaccines may occasionally be recommended, depending on the area of travel, the duration of travel, and the likelihood of unusual exposures. Some of these less frequently recommended vaccines include rabies, hepatitis B, and Japanese B encephalitis. Likewise, preventive medicines for altitude sickness and other non-infectious conditions of travel may be appropriate under some circumstances.

Governmental requirements for vaccines can usually be provided by a travel agent or the embassy of the country where travel is planned. Even if there are no governmental requirements, those contemplating travel should seek a physician’s assessment of the medical advisability of various vaccines based on the details of the itinerary and their personal health status. Because some vaccines are given as a series, and because of the time required after the vaccine for the body to develop immunity, travelers should allow at least 6 weeks for this process. Additionally, one should plan to have a supply of any regularly prescribed medicines adequate for the entire trip, first aid supplies, extra glasses or contact lenses, sunscreen, and insect repellant. It’s a good idea to have a supply of over-the-counter anti-diarrhea medicines to treat mild cases of traveler’s diarrhea. A doctor may also provide a prescription antibiotic to be taken along for self-treatment of traveler’s diarrhea, respiratory ailments encountered after long flights or in highly polluted cities, etc. Lastly, many health insurance companies provide no coverage for illness outside the U.S., so travelers should check their policies and consider buying supplemental coverage.

Exotic travel is a growing pastime for U.S. citizens, and should be a thoroughly enjoyable and educational experience. Armed with good medical advice and appropriate health protection, the intrepid traveler can reduce the risks that can be associated with such ventures, and can truly have a “bon voyage.”

Note: this article is presented through the efforts of the Delaware County Medical Society and is intended for informational purposes only, the contents should not be intended as medical advice. “You and Your Doctor – Preserve the Relationship”.

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