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Travel health is more than vaccines
Last year I visited Tanzania, an African country where malaria is rampant. In parts of the country, villagers receive 300 infective mosquito bites per year -- meaning, on average, they're exposed to malaria almost nightly. Did I smear insect repellent all over my body and down malaria pills during my stay? You bet. Without these measures, the malaria stakes in Africa are high. Even with them, there are no guarantees. And there is no vaccine.
A mosquito-borne scourge rarer than malaria is yellow fever. Although taking malaria precautions is a good idea, it's voluntary; getting a yellow fever shot isn't. Many African countries -- mostly in the continent's sub-Saharan midsection -- require proof of vaccination before you can apply for a visa.
FOR THE RECORD:
Vaccination sites -- In "Travel Health Is More Than Vaccines" (Feb. 2), a list of resources for travelers seeking information on vaccinations showed the Long Beach Department of Health and Human Services as being a part of the Los Angeles County Department of Health and Human Services. The Long Beach department is independent of the L.A. County department.
Years ago in my travel medicine practice, I saw safari-goers who wanted yellow fever shots and nothing else because a consular official or travel agent had told them that was the only official requirement. When I offered them malaria pills and optional vaccines (hepatitis A or typhoid, for example), they declined. I held my breath and prayed.
Today's more sophisticated travelers, armed with better information -- much of it on the Internet -- welcome a full package of prevention. But online intelligence has its downside. Scare stories about side effects inhibit some patients from taking recommended drugs and vaccines. With the glut of information on the Web, others fixate on exotic outbreaks like, say, plague or leptospirosis (a waterborne infectious disease) in less developed nations while ignoring more immediate, if mundane, threats.
Let's say you're asthmatic or you're a past or present smoker. Both conditions predispose you to lung infections. Now picture yourself on a long overseas flight. Especially during fall and winter, you can expect to share your airspace with respiratory viruses from fellow passengers. What's your best defense? No. 1: a garden-variety flu shot plus one-time pneumonia vaccine. No. 2: washing hands frequently to lose bugs acquired by touching surfaces or other people.
Covering your mouth and nose with a handkerchief or paper surgical mask (purchased at a drugstore) is another good idea when you're seated near a cough or cold sufferer. And the mask will come in handy in foreign cities with sky-high air pollution, such as Bangkok, Thailand and Beijing.
Travelers with chronic heartburn, or GERD (gastroesophageal reflux disease), should be extra careful to avoid food- and waterborne illness. Chances are they're on drugs that neutralize stomach acid and, as a result, lower defenses against traveler's diarrhea. For these folks, dietary do's and don'ts are especially apt: Beware of salad bars, buffets and unpeeled produce, and stick to hot, freshly cooked foods and boiled or bottled beverages minus the ice.
Before an exotic trip, patients with preexisting stomach, bowel or liver disorders should definitely get vaccines for hepatitis A and typhoid, both "filth-to-mouth" infections. While abroad they should treat turista symptoms with an antibiotic at the first sign of distress.
Hepatitis A vaccine is also recommended for healthy travelers to countries where hygiene is less than optimal. Although a complete series consists of two shots six to 12 months apart, the first injection, given at least two weeks before travel, provides adequate protection for most trips.
The biggest overseas health threats, however, aren't infections. They're preexisting diseases and accidents. Half of all travel-associated deaths are due to heart attacks and related problems; about one-quarter are from trauma (this rate is several times higher than for nontravelers), especially those linked to traffic accidents.
When disaster strikes, you'll find the most modern health care in the capital city of a developing country. Ask embassies, expatriates, an international clinic or hotel staff for referrals. Evacuation is another option, as long as the subject is reasonably stable; the last thing a seriously ill or injured person needs is hours on a small aircraft with rudimentary medical services.
Today most travelers know that unscreened blood products can transmit HIV, hepatitis B and hepatitis C. Unlike hepatitis A (a serious but temporary illness), this deadly trio of viruses can all remain blood-borne for years, causing dangerous long-term consequences such as immune suppression or liver failure.
When counseling younger patients, I often cite transfusion risks to discourage trauma-prone sports and other indiscretions. Even prudent people can become reckless on vacation -- forgetting motorcycle helmets and seat belts, driving drunk. Avoiding unprotected sex is another mantra for people of all ages.
On a long trip to a developing country or a remote location, it's smart to carry a few of your own sterile needles and sutures. And throughout the tropics, if you must seek health care, beware of unnecessary injections, which are still popular in many places.
The specter of blood-bearing needles underscores one more reason for routine medical housekeeping before an international trip. Several years ago, a survey of Americans middle-age and older revealed that only half had protective antibody levels against tetanus. If you're in the vulnerable group and you scrape your elbow or shin overseas, you do not want a tetanus booster of unknown manufacture via a needle of dubious history.
Save yourself some grief and get up to date before you go.
Here are some useful resources:
The Centers for Disease Control and Prevention: Immunization hotline, (800) 232-2522; travelers' health hotline, (877) 394-8747; http://www.cdc.gov. This is the central source for travel health information in the U.S.
International Society of Travel Medicine: (770) 736-7060, http://www.istm.org. An association of travel health professionals; Web site provides lists of travel clinics by area.
American Society of Tropical Medicine and Hygiene: (847) 480-9592, http://www.astmh.org. An association of tropical disease and travel health specialists; Web site provides directory of doctors by area (an asterisk preceding a physician's name denotes board certification).
Los Angeles County Department of Health and Human Services, Long Beach: 2525 Grand Ave., (562) 570-4222. Offers low-cost travel immunizations, including yellow fever, without a doctor's consultation (by appointment only). Can also write prescriptions for malaria and traveler's diarrhea.
Pasadena Public Health Department: 1845 Fair Oaks Ave., (626) 744-6128. Offers low-cost travel immunizations without a doctor's consultation (walk-ins and by appointment).
Claire Panosian Dunavan is an infectious disease specialist at UCLA Medical Center and director of UCLA's Travel and Tropical Medicine Clinic.