INTERNATIONAL TRAVEL HEALTH

1. INTERNATIONALTRAVEL HEALTH Staying Well While Adventuring

2. Catherine Ebelke PA-C Montana State University Bozeman Student Health Service

3. Preparing for Your Travels Travel Health Class  Travel Packet Travel Health Appointment  Destination issues • Personal Health • Receive immunizations and prescriptions  WHO International Certificate of Vaccination (“Yellow Card”)  Handouts  Available any time for questions via phone or e-mail Yellow Fever Vacc appointment @ GCHD if needed

4. OTHER PREPARATIONS  Make copies of important documents and distribute them appropriately  Determine insurance coverage for illnesses and accidents while abroad  Consider evacuation insurance

5. TRAVEL KIT (AKA Stuff Not To Forget…..)  Prescription Meds  OTC preparations  Contacts, more contacts, extra lens solution  EYEGLASSES!!!  Sunglasses  Sunscreen  Lip protectant w/ good SPF • Antiseptic hand wipes / Gel • Rehydration salts / Emergen-C • Ware purification supplies  Thermometer  EpiPen  Feminine Hygiene Products  Condoms  Special lotions, creams, soaps  Insect repellent (DEET) • Permethrin • Duct Tape • SNACKS!

6. SAFETY CONCERNS Accidents are the leading cause of trip interruption, injuries, and death Pedestrian  Vehicular  Bicycle  Motorcycle / Moped  Outdoor activities

7. PERSONAL SAFETY Theft and other personal crimes can occur anywhere (US or abroad) ; do what you can to decrease your chances of it happening to you

8. PERSONAL SAFETY  Travel with at least one other person well known to you  Do not go out with a stranger  Make sure others know of your specific travel plans  Do not travel in places which are known to be dangerous  Do not wear expensive jewelry or expensive clothes; try not to “exhibit” your camera, i-pod, wad o’ cash……  Use a hidden security belt  Travel with at least one other person well known to you  Try to look like you know just what you’re doing and where you are going, even if that may not quite be the case  Keep your wits about you and keep thinking!

9. AWARENESS Local customs / habits / laws Cultural norms  Possible lack of safety oversight Traffic  Individuals  Law enforcement  Infrastructure

10. RABIES • Virus that is almost 100% fatal • There is no treatment for the disease • Widespread distribution around the world but much higher in many developing countries • Vaccination is in short supply internationally at this time

11. RABIES • Try to avoid contact with stray or feral animals (dogs, monkeys, etc) • If there is any saliva contact, it is extremely important to wash immediately with soap and water and then to seek medical care to include rabies vaccination ASAP. • This is usually a trip-interrupting event - but is of utmost importance • Vaccinations are expensive but not painful; series of 5 over a few weeks after initial Ig

12. SUBSTANCE ABUSE • Alcohol, street drugs, unknown substances • Leads to higher rates of crimes including violent crimes such as rape • You are under the jurisdiction of the country you are visiting • VERY RISKY BUSINESS!!!

13. Getting There …..

14. AIR TRAVEL TIPS  Stay well-hydrated  Only small amounts of alcohol and caffeine  “Travelers Thrombosis” • Blood clot that starts in lower leg and can migrate to lungs • Exercises • Walking around cabin very important • Women on estrogen-containing meds at increased risk but everyone can be at risk and needs to consider prevention important

15. STAYING WELL

16. GENERAL TIPS • Stay well-hydrated • Try to maintain a good diet • Get plenty of exercise • Try to get adequate sleep • Get health concerns evaluated

17. IMMUNIZATIONS ARE AN EXCELLENT WAY TO PREVENT MANY DISEASES!

18. IMMUNIZATIONS :YELLOW FEVER The only immunization that can ever be a requirement is Yellow Fever Vaccination Regions with Yellow Fever include Africa and some South American countries Cost is approx $100 Vaccination lasts 10 years Appointment needed for this at GCHD or other facility

19. IMMUNIZATIONS :Hepatitis A  Transmitted via food and water  Very stable virus  Outbreaks common throughout the world  Vaccination is a series of 2 shots  Now a recommended vaccination for all children in the US  Very highly recommended to all !

20. IMMUNIZATIONS :Hepatitis B Transmitted via blood, body fluids  Lifelong very serious disease  Treatment very difficult, expensive, and success rates poor  Vaccination is a series of 3 shots  Now a required childhood immunization in the US  Very highly recommended to everyone!

21. HEPATITIS C • Transmitted via blood • Increased risk with tattoos, piercings, barber shop / street shaves, blood transfusions, IV Drug Abuse • No vaccine available……prevention very important!

22. IMMUNIZATIONS Tetanus / Diphtheria / Pertussis Within the last 5 – 10 years Typhoid Vaccination : Oral or Injectable For developing countries Meningitis : for certain destinations and situations Polio : for certain destinations only; one adult booster lasts a lifetime

23. IMMUNIZATIONS Occasionally we may recommend:  Influenza Vaccination  Japanese Encephalitis Vaccination (3)  Pre-exposure Rabies Vaccination (3)  Varicella (chickenpox) (2)  Pneumococcal Vaccination  PPD (TB skin test) upon return

24. SEXUALLY TRANSMITTED DISEASES • Hepatitis B • HIV / AIDS • Herpes • Chlamydia • Gonorrhea • Syphilis • Genital Warts • Others

25. SEXUALLY TRANSMITTED DISEASES Studies have shown that there is greater sexual promiscuity and often a “disconnect” between reality at home and reality abroad when traveling internationally

26. PSYCHOLOGICAL ASPECTS OF INTERNATIONAL TRAVEL International Travel may uncover or intensify underlying psychological or psychiatric conditions

27. PSYCHOLOGICAL ASPECTS OF INTERNATIONAL TRAVEL • Completely new experience on many levels for most people • Homesickness common; loneliness is not unusual • Very important to stay in good touch with folks back home as well as being open to new friends; a diverse community of support is vital • Reach out to others if you feel they are struggling, or if you are having troubles yourself

28. For Travel to Developed Countries........ You’re All Set !!! HAPPY TRAILS!!!!!

29. FORTRAVEL TODEVELOPING COUNTRIES

30. SPECIALCONSIDERATIONS Food and Water Borne Illnesses & Insect Borne Illnesses

31. FOOD AND WATER BORNEILLNESSES • Infectious diarrhea • Food poisoning • Hepatitis A • Typhoid • Polio • Cholera • Others

32. FOOD AND WATER BORNE ILLNESS PREVENTION • Wash hands with clean water or use antimicrobial handwipes or hand sanitizer • Brush teeth with bottled / clean water • Try to use clean, dry utensils and dishes

33. FOOD AND BEVERAGEPRECAUTIONS  Cook It  Boil It  Peel It…..  Or Forget It !!!

34. COOK IT !  Eat hot foods piping hot  Do not eat raw or undercooked foods  Street vendor food may be risky

35. BOIL IT !!! • Drink bottled water from sealed bottles • Arrange an effective water treatment plan • Iodine / chlorine tx + Vit C • Drink canned or bottled beverages (juice, soda, beer, wine) • Hot drinks are usually OK • Avoid ice cubes!

36. PEEL IT !!! • Buy cleanable fruits at markets, shops, stalls, bicycle vendors • Clean thoroughly, dry and then peel, using clean hands and utensils • If it can’t be peeled, consider not eating it

37. Still, despite all your best efforts, you may develop… Traveler’s  diarrhea

38. ….and you would not be alone.

39. TRAVELERS DIARRHEA • Experienced by >60 % of travelers during visits to developing countries • Causes : primarily bacteria; may also involve viruses, parasites, toxins • Sources: fecal contaminated food and water, dirty hands

40. TRAVELERS DIARRHEA… not! Mild Symptoms • Increased number of loose stools • Feeling fine • No treatment necessary • Make sure to stay well-hydrated

41. TRAVELERS DIARRHEA Moderate to Severe Symptoms :  Abrupt Onset  Many loose to explosive stools  Occasionally bloody stools  Body aches, fever, abdominal cramping  Usually no vomiting

42. TRAVELERS DIARRHEA For Moderate to Severe Symptoms :  Take antibiotic (Cipro or Azithro) as prescribed  Rest  Eliminate caffeine, greasy, spicy foods, and alcohol  Stay well-hydrated!!!

43. TRAVELERS DIARRHEA The use of bowel paralytics (Imodium, Lomotil) is NOT recommended unless travel without facilities is essential

44. TRAVELERS DIARRHEA Make sure to get checked out :  If symptoms do not resolve in a relatively short amount of time  Significant belly pain  Vomiting  Dehydration

45. FOOD POISONING Caused by ingested toxins  Abrupt onset of violent, severe vomiting and diarrhea  Usually occurs 4 – 12 hours after eating “suspicious” food  Self-limited; resolves on its own within 6 – 12 hours !!! Hydrationvery important !!!

46. HEPATITIS AVaccination : JUST DO IT !!!!

47. TYPHOID FEVER • Food and water borne bacterial illness (Salmonella) • Increased risk in developing countries • Vaccination (oral or injectable) recommended for extended stays, adventurous eating, rural travel

48. POLIO ‡ Food and water borne virus ‡ Devastating lifelong illness ‡ Outbreaks exist in many parts of the world ‡ One-time adult booster recommended if traveling to those parts of the world with Polio

49. INSECT BORNE DISEASES  Malaria  Dengue Fever  Yellow Fever  Sleeping Sickness  Leishmaniasis  Many others…

50. INSECT PROTECTION This is the single most important thing to do in areas with insect borne disease !!!