International travel: Staying healthy far from home

Getting vaccinated and packing an extra supply of medications are among the many things you can do to ensure a healthy and comfortable trip abroad.

International travel can be the adventure of a lifetime. Whether you visit the great cities of the world or explore the most remote locales on the planet, the rewards can be unforgettable. But though the rewards of travel abroad can be significant, you may also encounter risks to your health. Getting the right vaccines before you travel, packing the proper medications and planning ahead are all things you can do to ensure a safe and healthy trip.

How risky is it?

Most people who travel to major cities and stay in clean, well-maintained hotels don't get sick. Those who do often come down with common complaints — colds, bronchitis, diarrhea. The risk of more serious illnesses such as malaria and yellow fever depends on when and where you travel, how long you stay, and what kinds of precautions you take. Here are some practical steps that can help you stay healthy.

Plan ahead

You may not need much more than carry-on luggage for a weekend in London, but longer stays in remote places require some advance planning.

Learn about vaccinations. Start by visiting the Web sites of the Centers for Disease Control and Prevention (CDC), the World Health Organization (WHO) or the U.S. State Department's Overseas Citizens Services. These sites can tell you which vaccines are recommended or mandatory for the countries you plan to visit. It's best to find out about vaccines at least six weeks in advance. That's because it may take several weeks for immunity to develop, and you may need more than one dose of the vaccine for full protection. Certain malaria drugs also need to be started two weeks before you travel.

Keep in mind that no vaccines exist for some of the world's most life-threatening infections, including HIV/AIDS and malaria. And the vaccines you do receive aren't 100 percent effective at preventing illness. You still must take common-sense precautions to avoid getting sick.

A word of caution: Some vaccines and antimalarials aren't appropriate for infants and children, pregnant women, or people with chronic medical conditions. Others can cause severe side effects even in otherwise healthy people. Discuss the risks and benefits of any vaccine with your doctor before being immunized.
Have vaccinations verified. If you receive any vaccines, ask your doctor, travel medicine clinic or health department for an immunization certificate standardized by the WHO. And if you're allergic to any mandatory vaccines, get a medical waiver on your doctor's letterhead stationery.
Malaria protection. Take extra precautions if you'll be traveling for more than six months to countries where malaria is common. Studies show that travelers who spend extended periods of time in countries where malaria is prevalent have a higher risk of getting the disease than do those who stay for shorter periods. During a long stay, travelers are more likely to stop taking malaria medication and to ignore or minimize the importance of seasonal treatment. Be sure to take an adequate supply of malaria medication with you. Counterfeit drugs are common in the developing world.
Take a summary of your medical history. Make several copies of an abbreviated version of your medical records. In case of an emergency, you may need copies for the medical professionals caring for you.
Update the usual suspects. Talk to your doctor about updating routine immunizations such as tetanus, pneumonia, polio, influenza and measles-mumps-rubella — diseases that are still a threat in some parts of the world.

Be prepared

"Expect the best, but prepare for the worst" should be the official travelers' motto. Planning what to do if you have an accident or become ill could save your life.

Check your health insurance policy. Find out ahead of time how your health insurance handles medical care when you travel abroad. Although some insurance companies will pay for "reasonable" hospital costs abroad, very few will cover medical evacuation, which can cost as much as $100,000. In most cases, Medicare won't cover you outside the United States. For these reasons, consider purchasing a supplemental policy that guarantees medical payments and transport. You may also want to inquire about insurance that covers the cost of returning the remains of a loved one who passes away overseas. Without insurance, this can be very difficult. If you have an underlying medical condition, research travel insurance companies carefully. Policies may vary considerably in their coverage of pre-existing illnesses. A complete list of these companies is available at the U.S. Department of State Web site.
Know where to go. Bring a list of recommended hospitals along your route. This is more important if you will be traveling for an extended period of time. You can often get this information from your doctor, local or state medical society, the International Association for Medical Assistance to Travellers, or the U.S. State Department's Overseas Citizens Services. A definitive medical reference, the Official ABMS Directory of Board Certified Medical Specialists, may be available in your local library. Several private organizations such as International SOS and MEDEX will provide medical information and insurance for a fee. If you forget to do your homework, most major credit card companies and U.S. embassies and consulates can steer you in the right direction. When in doubt or the timing is critical, consider going to a university hospital for help.
Bring a copy of your prescription. If you use prescription drugs, it's a good idea to bring along an extra prescription in case your medication is lost or stolen. But be sure your doctor indicates both the brand name and the generic name of the drug. Depending on where you are, medications with the same brand name may have very different active ingredients. In addition, when purchasing medication abroad it may help to tell the pharmacist the disease or condition the drug is designed to treat. This may help ensure that you'll get the correct medication.
Take special precautions for a chronic illness. If you have a chronic illness, such as cardiovascular disease, hepatitis, diabetes or HIV/AIDS, you may be at increased risk when you travel. Be sure to carry the name of your doctor and contact details, information about your condition and any medications you take, and a letter from your doctor certifying that you need certain drugs or medical items such as syringes — anything that might raise a red flag going through customs and security checkpoints.

Pack carefully

Here are some things to consider:

Pack extra supplies of prescription medicines. Bring your medication with you — it can be challenging to get prescriptions filled abroad. Divide medications between your carry-on bag and checked luggage in case of loss or theft. Keep prescription drugs in their original bottles with typed labels. The name on the labels must match the name on your identification, or you won't be allowed to bring the bottles onboard.
Take a basic first-aid kit. Include pain relievers, antibiotic ointment, anti-diarrheal medication and bandages. Also pack sunscreen, extra prescription eyewear and motion sickness medication if you use it. These items may be expensive or in short supply in foreign countries.
Bring hand wipes and hand sanitizers. Pack disposable hand wipes or an alcohol-based hand gel containing at least 60 percent alcohol for times when soap and water aren't available. They kill most germs and are safe for children.
Check security precautions. Security precautions can change often and may vary with your destination. Check with your airline to determine what items you can safely take on the plane with you.

Use common sense

To be safe, avoid the following:

Food from street vendors
Raw or undercooked meat
Dairy products and any foods likely to contain raw or undercooked eggs, such as ice cream, hollandaise sauce and Caesar salad dressing
Raw fruits and vegetables that you can't peel yourself, such as grapes, berries and lettuce
Tap water, water from unsealed bottles and drinks with ice cubes

Post-trip illness

Travelers who pick up infections overseas usually become ill in the first 12 weeks after they return home. Some diseases, such as malaria, may not cause problems until six months to a year later, however, and may occur even if you took antimalarial medication.

If you get sick, be sure to tell your doctor when and where you traveled. If you don't get better or can't get a clear diagnosis, consider consulting a doctor who specializes in international or travel medicine.