Civil Surgeon International Travel Resources
Traveling overseas, especially to third world countries in Africa, Latin America and Asia, can be fun but you need to follow certain rules to stay healthy and enjoy your trip. The civil surgeon doctors at Crown Medical Center's Yellow Fever Travel Clinic have developed the following health plans, when followed will make you stay healthy and enjoy your oversea trip.
If you are planning to travel to a third world country please see your civil surgeon doctor at least four to six weeks before you leave so that you will have adequate time to receive necessary vaccinations and have time also for the vaccinations to work before you leave. This six-week period also allows for enough time to receive and start taking your prophylactic anti-malarial medication if you are traveling to malaria endemic country.
When you visit your civil surgeon doctor, ask him/her if there are medicines or extra safety precautions that you should take, for example, people who have congestive heart failure may need to take shorter flights with more stops to avoid long periods of sitting. Anyone visiting Africa, Latin America or Asia may need to take extra preventative medicines for parasitic and other insect borne diseases.
Before traveling to the third world nations you may need to get some vaccinations and medications for diseases you might be exposed to in the foreign land.
The civil surgeon doctors at Crown Medical Center, offer pre-travel counseling, preventive medications and vaccinations. When the individual returns from oversea trip, we usually recommend they visit our civil surgeon doctors for routine check-up.
We usually recommend that individuals receive these routine shots: measles | mumps | rubella (MMR) vaccine, diphtheria/pertussis | tetanus (DPT) vaccine, poliovirus vaccine, etc (if they are not up to date). We also provide the H1N1 vaccination through our yellow fever travel clinic.
In addition the civil surgeon doctors at Crown Medical Center offers the following shots and vaccinations listed below. We have developed a short narrative to assist the readers understand the importance of having these vaccinations.
We recommend yellow fever vaccination for travelers to most developing countries: For all travelers >9 months of age. Host countries will require travelers arriving from countries where yellow fever is present to present proof of yellow fever vaccination. Vaccination should be given 10 days before travel and at 10 year intervals if there is on-going risk.
Hepatitis A or immune globulin (IG)
This is recommended for all unvaccinated people traveling to or working in countries with an intermediate or high level of hepatitis A virus infection. Exposure might occur through food or water. Cases of travel-related hepatitis A can also occur in travelers to developing countries with "standard" tourist itineraries, accommodations, and food consumption behaviors.
We recommend this vaccine for all unvaccinated persons traveling to or working in countries with intermediate to high levels of endemic hepatitis B virus transmission, especially those who might be exposed to blood or body fluids, or have sexual contact with the local population, or be exposed through medical treatment (e.g., for an accident).
We recommend this shot for all unvaccinated people traveling to or working in West Africa, especially if visiting smaller cities, villages, or rural areas and staying with friends or relatives where typhoid exposure might occur through food or water.
We recommend getting this shot if you plan to visit countries that experience epidemics of meningococcal disease during December through June.
This is recommended for travelers spending a lot of time outdoors, especially in rural areas, involved in activities such as bicycling, camping, hiking, or plan to be in contact with animals and other wild life. Also, children are considered at higher risk for rabies because they tend to play with animals and may not report bites.
We recommend this shot for adult travelers who have received a primary series with either inactivated poliovirus vaccine (IPV) or oral polio vaccine (OPV). They should receive another dose of IPV before departure. For adults, available data do not indicate the need for more than a single lifetime booster dose with IPV.
International Travel Health Education
In addition to receiving full complement of your vaccination shots, it is important that individuals traveling to malaria endemic regions of the world receive more health education on insect borne diseases such as malaria and dengue fever and learn how to protect themselves. Get free email updates from the Center for Disease Control and Prevention to keep abreast of current international travel health advisories.
This is very endemic in West Africa, and it is characterized by fever and influenza-like symptoms such as chills, headache, body ache and general weakness. These symptoms can occur at intervals. Malaria may be associated with anemia and jaundice and symptoms can develop as early as 7 days after being bitten by carrier mosquitoes and as late as several months after departure from a malarial area or after the individual had stopped taking their medicines.
No vaccine is currently available for malaria. All travelers to malaria-endemic areas should be advised that taking an appropriate drug regimen and using anti mosquito measures will help them prevent malaria. Because of the evening/ late night feeding habits of mosquitoes, malaria transmission occurs primarily between dusk and dawn. The traveler can reduce their exposure to mosquito bites as follows.
- Using insect repellent. Wearing protective long-sleeved shirts, long pants, and a hat when they are outdoors.
- Remaining indoors in a screened or air-conditioned room during the peak biting/feeding periods of malaria causing mosquitoes.
- Sleeping in an air-conditioned or well-screened room or on a bed covered by nets.
- Spraying the rooms with effective insecticides.
In order for your doctor to assist you prescribe the most effective preventive medicine for malaria, the traveler should let their doctor know which part of the world they intend to visit. This is because anti –malarial drug resistance have been reported in several parts of the world. For example in parts of Africa such as Nigeria, resistance of malaria causing parasite/ bug, Plasmodium falciparum to commonly used anti malaria drug, chloroquine® has been reported. Furthermore malaria parasite resistance to Fansidar ® is common in parts of South America, Southeast Asia and Africa. Resistance to commonly used prophylactic drug, mefloquine® has also been reported in parts of Thailand, Burma (Myanmar) and Cambodia, Laos and in southern Vietnam. The traveler should purchase their anti-malarial medication before traveling out of the USA because drugs purchased overseas in most instances may not be as effective.
Another insect borne disease that is of interest to travelers is dengue fever. Dengue fever and Dengue hemorrhagic fever (DHF) are viral diseases transmitted by Aedes mosquitoes, the species called Aedes aegypti. Dengue, a disease found in most tropical and subtropical regions of the world, has become the most common form of viral disease transmitted by insects to humans. More than 2.5 billion persons now live in areas where dengue is endemic, especially in the tropical countries of the South Pacific, Asia, the Caribbean, the Americas, and Africa. Because persons with milder form of illness, preoccupied with other life struggles may not seek medical help, the incidence of Dengue may be far greater than we know. Few cases of Dengue fever are reported every year in travelers returning to the United States after visits to tropical and subtropical countries.
Dengue fever is characterized by quick onset after an incubation period of 4-7 days on the low end or 3-14 days in most instances. Illness is characterized by high fevers, severe headache, joint and muscle pain. In some patients, nausea, vomiting and rash may be observed. Since the disease is a viral infection it is in itself self-limiting although protracted convalescence period may be experienced in some individual. Most patients with Dengue usually report flu-like symptom, but only your doctor can assist you make a correct diagnosis and prescribe appropriate treatment.
Currently we do not have any vaccines against Dengue. Visitors to dengue endemic areas should practice safety measures already outlined for reducing their risks of being bitten by mosquitoes.
Common sense measures calls for the traveler to be careful about the food they eat and the water they drink in the foreign land.
Illness caused by contaminated food and water are very common in travelers. The simple safety tips narrated below if followed will assist the traveler reduce the incidence of gastrointestinal illness (travelers diarrhea).
Wash your hands very often with soap and water before eating. In the absence of soap and water use an alcohol-based hand gel which can be purchased over the counter from any store in the United States, before your oversea trip. For your safety, drink only bottled or boiled water, or carbonated drinks in cans or bottles. Avoid drinking tap water, fountain drinks, and use of ice cubes because water safety standards are lower in most third world nations. Do not eat food purchased from street vendors no matter how hungry you maybe or how enticing it may look. Eat only well cooked meals and as much as possible avoid eating dairy product unless they have been pasteurized.
Vomiting and diarrhea are usually the most common symptoms of water and food related illness, so make sure you travel with some over the counter diarrhea medicine so that you can treat mild cases of illness before returning to the United State. When you return home and if you are not feeling well, see your doctor immediately and mention that you have recently traveled.
This information is not exhaustive but only a small piece of medical advice developed for people planning overseas travel. If you need more information including needed vaccinations/ shots, please contact The Travel Clinic, Crown Medical Center, Phone numbers 612 871-4354, 612-978-3783, or 763 566-4535. Immigration and Naturalization Terminology can be found outside our website at this link.
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