International Travel Tips
International Association for Medical Assistance to Travelers (IAMAT)
417 Center Street
Lewiston, NY 14092
Centers for Disease Control (CDC)
U.S. Department of State
8 to 10 p.m. Mon.-Fri.,
9 a.m. to 3 p.m. Sat.)
(202) 634-3600 (after hour emergencies)
Dessery and Robin, The Medical Guide for Third World Travelers, 2nd ed. San Diego. KWP Publications, 1992
- Discuss pre-existing medical conditions with physician.
- Plan for travel immunization at least one month prior to travel.
- Plan two to three months in advance for extended travel.
- Brief medical summary with copy of EKG/chest x-ray
- Check on health insurance/evacuation insurance.
- Visit dentist.
- Carry extra pair of glasses/contact lenses.
- Bring copy of optical prescription.
- Bring ample supply of all medications.
- Assemble a medical kit.
- Use caution with foreign medications
- Measles, Mumps, Rubella (MMR) -- One booster dose after age five if born after 1956. Avoid with pregnancy
- Polio -- One booster dose after age 18 for travel to high risk areas (must complete primary series)
- Diphtheria - Tetanus -- Normal booster doses every 10 years for all. Consider booster within five years for certain types of travel
Polio -- Is a hazard in underdeveloped countries. Vaccine recommendations for high risk areas include three doses of oral vaccine or injected vaccine for primary immunization. One booster prior to travel for adults who have received primary immunization series.
Tetanus-Diphtheria -- Occurs in the United States and abroad. Vaccine recommendations include primary immunization during childhood for most adults. Booster doses are needed every 10 years. Booster doses should be up-to-date prior to travel. Consider a dose within past 5 years if prolonged or remote travel is anticipated.
Yellow Fever -- Occurs in tropical Africa, South America and Panama. Immunization is required for entry into some countries in areas listed above. Required for entry into countries if coming from a yellow fever endemic area. Avoid vaccine if pregnant. Booster is needed every 10 years.
Cholera -- The World Health Organization and the CDC do not recommend cholera vaccinations for travelers. Some countries require proof of vaccination for entry. Vaccination needed only for those individuals lacking gastric acid. Vaccination is only 50 percent effective and requires booster doses every 6 months.
Hepatitis A -- oral or fecal transmission extremely common in developing countries. Children less than 2 years old generally without symptoms. Adults - fever, nausea, vomiting, jaundice - lasting weeks-months. Less than 20 percent of adults in U.S. under 50 with antibodies. Immune globulin (gamma globulin) used to prevent infection. IG from human serum rendered safe by special processing. Can last up to 5 months. Smaller doses for shorter trips. You need to wait 4 weeks after a live virus vaccine (MMR). New inactivated vaccine now available. Confers 80-98 percent protection in 15 days. Adult and pediatric vaccine.
Typhoid -- Found in many developing countries. Acquired through contaminated food or water. High fever, muscle aches, abdominal pain, headaches. Most cases occur in adults. Can be life-threatening if untreated. Highly purified vaccine - not killed bacteria. Takes two to four weeks to develop immunity. Highly effective single dose provides protection for two years. It can be used in children down to age two. Oral vaccine consists of four oral doses every other day. It is highly effective and a booster dose is needed every five years.
Hepatitis B -- Transmitted through blood (blood products, sexual routes). It is similar to hepatitis A but usually less abrupt onset. Ten percent chronic carrier states. Now used for children. Indicated for long-term travelers (especially children), those living or receiving medical care abroad and those anticipating sexual contacts with local residents You usually need 2 months for initial immunization (0, 1, 6 or 0, 1, 2, 12 months). Can use accelerated series - three doses in three weeks, plus one dose in 12 months.
Risk to travelers of this disease is low. Vaccine is available in booster doses every three years to those at risk.
Japanese Encephalitis -- Occurs in the Far East and Southeast Asia. Rare disease in travelers. Mosquito-born infection. Highest occurrence in rural farming areas during summer and autumn. Vaccination should be considered if spending more than 30 days in rural areas. Vaccination requirements: Three doses given on days 0, 7, 30 or 0, 7, 14. You must have immediate access to medical care for 10 days after each dose.
Rabies -- Low risk for short-term travelers. Young children, field workers, animal handlers, long-term visitors or hikers traveling in remote areas may consider vaccine. The vaccine requires a dose series for prevention. This eliminates the need for the rabies immune globulin, which is difficult to obtain in third-world countries. If three dose immunization series is given, then only two additional doses are needed following a bite, versus the five-dose series.
Malaria -- Disease acquired through the bites of infected anopheles mosquitoes. It exists in tropical or developing countries. Many areas have chloroquine-resistant malaria. Mefloquine (Larium) is used for travel in these areas. It is taken a week prior to departure with weekly doses throughout trip continuing for four weeks after leaving malarious area. You can reduce your risk of infection by avoiding outdoor activity between dusk and dawn, wearing protective clothing (treat clothing with permethrin), using mosquito netting and using insect repellents which contain DEET.
Travelers' Diarrhea -- Caused by a variety of viral, bacterial and parasitic diseases. Most cases are mild and self-limited (three to six days). Incubation period averages three days. To help prevent travelers' diarrhea, avoid contaminated food and water. Medications are available and can be prescribed to take if symptoms develop. Use of prophylactic antibiotics is not recommended.