Health

These sites provide information about immunizations and precautions for world wide destinations.

In North America, Europe, Australia, New Zealand, South Korea, Japan, and a few other places your most likely health problems are foot blisters, colds, and constipation. In the rest of the world most travelers are likely to encounter nothing more than mild diarrhea from unfamiliar microbes introduced into the intestines.

Don't allow fear of health problems forestall developing world travel. With sensible precaution of seeking and following advice from a travel clinic your health risks are greatly reduced, as most risks are directly related to awareness.

I also visit my doctor and dentist for regular checkups. If there are any preexisting health conditions I get a letter from my doctor outlining the situations and any special treatment. I also take a copy of any relevant presecriptions. In addition I take a copy of my eye glass prescription. Eye glasses and prescriptionsfor single vision lenses are very inexpensive in developing countries.

The following section is to aquaint you with all the areas you can take precautions regarding your health. The cites above and your travel medicine clinic are the best sources for current information from professionals in the field.

Immunizations

Travel clinics in most countries will advise you on immunizations and the health risks in the areas you are traveling to.  This link is one of the best I have seen for immunizations for independent travelers
http://travelindependent.info/b4yougo.htm

The costs can vary for each immunization and some can be very expensive. Preventive vaccinations are usually not or only partly covered by your health insurance.

Here is a list of the common immunizations:

• Cholera
• Diphtheria
• Hepatitis A and B
• Meningitis (Meningococcal Meningitis)
• Polio
• Tetanus
• Tuberculosis
• Typhoid
• Yellow Fever
• Rabies
• Japanese Encephalitis

Depending on which regions and countries you'll be visiting, you might need vaccinations before you leave to prevent catching local diseases against which you have no natural immunity. Most really dangerous diseases have been all but eliminated in developed countries. But when you travel in some third world countries, exposure to these diseases is a real threat.

Checking for any preventive immunizations is therefore another essential step to take before leaving your country. Consult a travel clinic at least one to two months before your planned leaving date. They will help you determine the preventive shots you might need.

The principle behind a vaccine or immunization is to expose your body's system to the disease after it has been rendered harmless. By doing so, the body can build up its own natural protection so that if it encounters the virus, the body will be "immune" to its effects.

International Health Certificate (Yellow Booklet)

This card documents your immunization history. Required for entry to some countries for proof of yellow fever inoculation, it is available from travel clinics.

Make sure to bring your vaccination booklet with you on your journey, because in some countries (Some Africa and South America) you need to prove that you've had a particular preventive shot before you're even allowed to pass the border. I have been asked on numerous occassions for my vaccination booklet in both Africa and South America.

As noted above here are some of the immunizations you may need:

Cholera - is spread through water. The vibrio cholera bacterium invades the intestine and releases a toxin that causes massive fluid loss through diarrhea. Patients die from dehydration. A vaccination is available but is relatively ineffective against modern strains of cholera. The disease can be treated with antibiotics and requires hospitalization.

Diphtheria - caused by a bacillus bacteria that invades tissues in the upper respiratory tract and releases toxins that are potentially fatal. Diphtheria may be treated or vaccinated against. After an initial course of three injections, boosters are necessary every 10 years.

Encephalitis - an infection of the brain, often caused by viruses transmitted by ticks or mosquitoes. Vaccines are available for Japanese encephalitis and the tick-born encephalitis found in Asia. Encephalitis is not of great risk to travelers. Consider the vaccination if spending a month or longer in a high risk area, making repeated trips to a risk area or visiting during an epidemic. It involves three injections over 30 days. The vaccine is expensive and has been associated with serious allergic reactions so the decision to have it should be balanced against the risk of contracting the illness.

Hepatitis A - the most common travel-acquired illness after diarrhea which can put you out of action for weeks. Hepatitis A is not life threatening, but unpleasant, and is transmissible by food and water. Havrix is a vaccination which provides long term immunity (possibly more than 10 years) after an initial injection and a booster at six to 12 months. Gamma globulin is not a vaccination but is ready-made antibody collected from blood donations. It should be given close to departure because, depending on the dose, it only protects for two to six months.

Hepatitis B - transmissible by contact with body fluids (such as blood and through sexual contact). Hepatitis B is said to be 100 times more transmissible than HIV/AIDS. Hepatitis B and C will eventually kill you. Travelers who should consider a hepatitis B vaccination include those visiting countries where there are known to be many carriers, where blood transfusions may not be adequately screened or where sexual contact is a possibility. It involves three injections, the quickest course being over three weeks with a booster at 12 months.

Meningococcal Meningitis - an infection of the lining of the brain and may be fatal (you can die from it within a few hours). It is spread by inhaling droplets of sputum that some one may cough or sneeze up. Even healthy people carry this disease. Vaccinations are available for some forms of meningitis. There are many carriers and vaccination is recommended for travelers to certain parts of Asia, India, Africa and South America. A single injection will give good protection for three years. The vaccine is not recommended for children under two years because they do not develop satisfactory immunity from it.

Polio - an infection of the central nervous system that results in paralysis. It is untreatable but a vaccine is available Polio is a serious, easily transmitted disease, still prevalent in many developing countries. A booster every 10 years maintains immunity.

Rabies - Vaccination should be considered by those who will spend a month or longer in a country where rabies is common, especially if they are cycling, handling animals, caving, traveling to remote areas. The rabies vaccination involves three injections over 21 to 28 days. If someone who has been vaccinated is bitten or scratched by an animal they will require two booster injections of vaccine (those not vaccinated require more).

Tetanus - a potentially fatal disease caused by a clostridium bacteria that enters the body through a wound, causing muscle spasms, etc. Tetanus is difficult to treat and can be fatal but a vaccine is available. Everyone should have this vaccination. After an initial course of three injections, boosters are necessary every 10 years.

Tuberculosis - a bacillus bacteria that is on the rise across the world although the risk to travelers is usually very low. It is difficult to treat, and may require patient isolation, and can be particularly dangerous when it infects the respiratory system. For those who will be living with or closely associated with local people in high risk areas such as Asia, Africa and some parts of the Americas and Pacific, there may be some risk. As most healthy adults do not develop symptoms, a skin test before and after travel to determine whether exposure has occurred may be considered.

Typhoid - an infection caused by a Salmonella bacterium that may spread through food or water (this is an important vaccination to have where hygiene is a problem). Typhoid causes severe fevers, etc. but infections may be treated and vaccines are available (either as an injection or oral capsules).

Yellow Fever - now the only vaccine which is a legal requirement for entry into many countries, usually only enforced when coming from an infected area. Protection is recommended where the disease is endemic (ie. Africa and South America). You usually have to go to a special yellow fever vaccination center. This vaccine lasts 10 years.

Given the rise and nastiness of Japanese Encephalitis I have opted for this shot, but have not had the rabies shot.

Malaria Prophylaxis and Dengue Fever

Malaria protection options are well worth discussing with your medical travel advisor and also doing research on your own.  I always use the recommended ones in malaria prone areas.  The debate on the topic is endless.  A great first resource is http://travelindependent.info/b4yougo.htm

Dengue fever is also transmitted through mosquitoes and the only protection is a good mosquito repellent and to cover up.

Malaria poses the greatest health risk to travelers in warm climates, and is in fact the greatest health threat to humanity. Mosquitoes are becoming insecticide-resistant and forms of malaria become drug-resistant.

Malaria is spread by the bite of the Anopheles mosquito, which generally feeds dusk through dawn. Symptoms for the first three types may include the classic malarial fever, which is called an ague (pron. ae gyoo). This occurs in three stages which rhythmically coincide with millions of parasites being released into the bloodstream after bursting out of red blood cells. First is a cold stage characterized by severe shivering, followed by a high fever stage of up to 105º F (40º C). Finally there is intense sweating which brings the fever down. The victim may also vomit and have a bad headache. The patient is left weak and tired, and sleeps.

These stages may occur cyclically, either every other day or every third day, but only after the disease is well-established. Malaria can be diagnosed by a blood test. In even the most primitive clinics results of malaria tests are available in less than an hour.

Malaria prevention is complicated, so only trust a high quality travel clinic to prescribe the proper medications for your specific destinations.

Chloroquine (brand names Aralen, Avloclor, and Resochin) should be taken weekly beginning at least one week before entering a malarial area, and continuing four weeks after leaving. Beginning the regimen two weeks before departure is often recommended so there will be time to change medication in case of reaction. It's traditional to take chloroquine--and to remind other travelers to do so--on Sunday.

In falciparum malarial areas, such as Africa, a weekly dose of mefloquine (brand name Lariam) may be prescribed. Three tablets of sulfadoxine/pyrimethamine (brand name Fansidar) may be prescribed to be taken immediately if flue-like symptoms suddenly develop. Some people have severe skin reactions to Fansidar, and various neurological, psychiatric, and flue-mimicking symptoms have been ascribed to Lariam.

Chloroquine and the other anti-malarial drugs are not vaccines, and they do not guarantee immunity from infection. They are prophylactic medications--taken properly, they usually suppress and prevent malaria. Thus most travelers who take the proper medications, use DEET insect repellent, wear long sleeves and pants, and drape mosquito netting around their beds don't get malaria.

Dengue fever (den gay) is also called breakbone fever after the debilitating pain it causes. It is another viral, hemorrhagic disease transmitted by day-feeding Aëdes aegypti mosquitoes, and thus found in tropical and subtropical regions worldwide. While I was in the Petén region of Guatemala an epidemic of dengue was ravaging the local population.

Symptoms appear five to eight days after a bite from an infected mosquito, and include high fever, severe muscle and joint pain, and rash. They subside and recur about every three days. Recovery takes several weeks, with victims rarely dying.

.Prevention is, as always, by avoiding mosquito bites. There is no vaccine.

Prescriptions and Pharmacies

I always take a prescription for antibiotics for intestinal ailments and also for respiratory infection (sinus) since I am susceptible to sinus infection.  I have used all of these often. If you are prone to urinary tract and yeast infections you may want to bring the medication with you if you are traveling outside developed countries.

Most countries have a wide range of pharmaceuticals available and I have found that in most countries the pharmacists generally speak some english. In fact, in many developing countries the pharmacists will often diagnose simple maladies and provide the appropriate medication. The clinics or hosptials also have doctors who will quickly diagnose and provide the appropriate medication and generally for a very small fee.

Many  of these drugs can be purchased in developing countries for less then the cost at home.  The authenticity of the drugs may be suspect in some continents, especially Africa.  In the country of my travels, I have purchased altitude sickness drugs, malaria prophylaxis as well as drugs for giardia and bilharzias to name a few.

I have been sick when I have been in my hotel and the owner or staff will recommend a doctor or have gone with me to the clinic or pharmacy.

Travel Health Insurance

Many companies sell travelers' health insurance for up to several dollars per day. Usually you pay the medical costs while abroad, but are reimbursed upon return. More expensive plans pay for emergency air transport home.

If you already have health insurance check if your current plan provides coverage in other countries. Many people opt for the additional medical coverage especially one that covers emergency air transport.

Age and pre existing health conditions are the biggest factor in the costs of travel health insurance. This is a good area for debate as this site is geared to older adventure travelers. I am covered through my work and need to explore more options about additonal health insurance.

Women Health and Related Issues

Since this is site is targeted to women. There are some health issues that need to be included here.

Cystitis is a common infection of the urinary tract and bladder among travelers. The main symptom is a frequent urge to urinate, accompanied by burning or stinging. The amount of urine passed is usually small, and the pain can be great. Cystitis is sometimes associated with sex, and symptoms are similar to several sexually transmitted diseases which can lead to infertility and cancer if not properly treated. Therefore a doctor must always be consulted.

Treatment is with an antibiotic to eliminate the infection and prevent it from spreading.

Initial pain can be relieved with the urinary tract analgesic phenazopyridine hydrochloride, available through prescription (Pyridium) or over the counter (ask a pharmacist). This is a pain reliever, not an infection fighter, a doctor must always be consulted, perhaps especially if symptoms seem to go away on their own.

I always wear panti liners when I am on long transport trips and especially in hot and sweaty countries in order to keep fresh.

Vaginal infections often occur in tropical climates and from taking antibiotic for ailments may increase incidence, which may  be reduced by wearing light, loose clothing, and cotton underwear instead of nylon.

Condoms help to prevent sexually transmitted diseases and are readily available all over the world.

Tampons and Pads are available in Europe, Australia and New Zealand. Tampons are harder to come by in many developing countries. I alway bring tampons when I am traveling in developing countries. The rest I buy on the way.

Typical Health Issues of Interest to Travelers

The following is a concise overview of major threats facing travelers. Please seek professional medical advice from a travel clinic before visiting the developing world.

Colds are common among travelers. Because there are over two hundred viruses associated with colds, those prevalent in Europe or China may quickly overwhelm your immune system. Since colds are transmitted primarily by direct contact, incidence is reduced by washing hands, especially before eating, and by keeping fingers away from the face and nasal passages.

Diarrhea is often contracted by visitors to the developing world for a few days. It is generally no great problem, and the discomfort usually lessens after a day or two. Diarrhea is most often caused by unfamiliar bacteria. It's best to let normal diarrhea run its course, which takes two to five days. Drink plenty of liquids to flush-out your system, and to avoid dehydration. Eat no solid foods on the first day. On the second day begin eating bland foods such as toast, soup, rice, and bananas.

If you need to plug your system for a day so you can travel, the over-the-counter drug Immodium works safely and well. The active ingredient in Immodium is loperamide, which is also used in several other medications. Do not use loperamide for extended periods as the intestines must be cleansed naturally. Loperamide doesn't cure anything.

Many travelers swear by Pepto Bismol tablets for soothing the stomach and easing diarrhea. I usually have these tablets in my pack, and when traveling developing countries, several in my wallet.

Dysentery is a severe infection of the intestines, characterized by passage of mucus and blood. It has two forms: bacillary and amebic. While both are prevalent in many developing countries, they are rare in travelers compared to simple diarrhea.

Bacillary dysentery is also called shigellosis, after the shigella bacteria which cause it. Bacillary means "rod shaped," which describes the bacterium. The usual source is from infected food handlers failing to wash hands properly, and from flies landing on food after having been somewhere nasty.

Symptoms begin one to four days after infection, and are characterized by a sudden onslaught of watery diarrhea, abdominal pain, vomiting, nausea, and fever. After several days blood and mucus begin passing. It is highly contagious.

Treatment consists of rehydration therapy. Solid food should not be eaten for the first day or two. Antibiotics may be useful. Most victims begin recovering after about a week. Babies, children, and old people risk death due to dehydration.

Amebic dysentery is also called amebiasis, from the single-celled ameba (smallest animal) parasite entameba histolytica. Amebic dysentery results from swallowing the histolytica cysts via infected water or food (especially beware lettuce, uncooked vegetables, and unpeeled fruit). It is found in the same areas as bacillary dysentery.

Symptoms range from a few loose stools with rumbling pains in the stomach, to a severe case with high fever and bloody, watery diarrhea. It comes-on slower than bacillary dysentery. It can cause shaking chills, fever and weight loss.

Treatment is with rehydration therapy and amebicide drugs such as metronidazole, which effect full recovery within a few weeks. It won't go away on its own like bacillary dysentery.

Prevention for dysentery is by eating only cooked vegetables and peeled fruits, and by only drinking boiled or purified water.

Food Poisoning

I use the term food poisoning for three intestinal wars that for some reason went far beyond the mild discomforts of travelers' diarrhea.

1)  Seek medical help if at all possible. Serious food poisoning often kills, especially the young, the old, the weak, and those with pre-existing conditions.

2) There may be a warning or premonition of your impending fate, so take action while you can, such as get to a doctor or clini and drink lots of clean water.

3)  After the initial wave of expurgations and you're well into the dry heaves, drink clean fluids even when they soon come back up. This cleanses the system faster, and the ten percent that is absorbed staves off dehydration. While clear liquids are often recommended, I prefer any soft drink for extra energy. This is the only time I drink soft drinks.

4)  Don't plug up your back end with drugs. The toxins must get out.

Constipation is common due to the change in routine and diet. Make a point to drink plenty of fluids, and eat roughage.

Other

Schistosomiasis (bilharzias) is common in tropical regions worldwide, affecting about 200 million people. It is caused by several species of flukes (flattened worms) called shistosomes. They live in fresh water lakes and rivers, where they live part of their life cycle in snails.

Symptoms vary from none to serious. The first is usually an itchy rash where the parasite has burrowed through the skin. Weeks later flu-like symptoms may begin, including high fever, chills, muscle aches, and diarrhea. The symptoms may go away and recur a month or two later.

Treatment is with a single dose of an anthelminthic (antiparasitic) drug, which kills the flukes. Prevention is by avoiding freshwater rivers and lakes in the tropics, but especially the Nile Valley, where schistosomiasis is rife.

Giardiasis (beaver fever) is the bane of wilderness backpackers in the United States. It is also found worldwide, especially in the tropics and the public water systems of the former Soviet Union. It is an intestinal infection caused by a single-celled parasite. Wilderness backpackers in the U.S. must treat all water, even from crystal clear brooks in Yosemite, due to the prevalence of this organism.

Giardia cysts (eggs) are spread from the feces of infected animals. The cysts hatch two or three weeks after ingestion, causing abdominal symptoms such as violent diarrhea, foul-smelling gas, and cramps. Sixty percent of those infected, however, show no symptoms. Giardiasis clears up on its own after two or three weeks, although metronidazole speeds recovery. Prevention is by drinking only pure or treated water.

Breaks and Slow Travel

I like to travel at a leisurely pace. If the costs are low and you find a hostel or a place you like take an extra day to "hang out". Wander into the local square, write in your journal in a local cafe, have a massage or sauna at the local hamman or go to a local movie. Go to an air conditioned mall, go to the British Council Library and catch up on reading. Sit in the lobby of a first class hotel and read the paper and use the wash room. I love doing local activities. Even if I do not understand the language, movies in other countries are another entire experience.

Aids

The hardest hit area is sub-Saharan Africa. In some areas up to fourty percent of the population are carriers, as well as nearly all prostitutes. In Africa AIDS is spread primarily through heterosexual sex. The blood supply in Africa is likely to be poorly screened, if at all, so you must avoid transfusions. Travelers in Africa should bring their own hypodermic needles for emergencies.

AIDS is also spreading rapidly in Asia, again primarily through heterosexual contact. Since the epidemic became widespread there only a few years ago.