• Resources
• Pre-Travel Advice
• Diseases and Prevention

Resources

International Association for Medical Assistance to Travelers (IAMAX)
1623 Military Rd. #279
Niagara Falls, NY 14304-1745
716-754-4883
www.iamat.org/

CDC - Travelers' Health
877-FYI-TRIP (toll free)
Malaria Hotline:
770-488-7788 (M-F, 8am-4:30pm, eastern time)
770-488-7100 (after hours emergencides)
wwwn.cdc.gov/travel/default.aspx

State Department Travel Center
888-407-4747
202-501-4444 (from overseas)
www.travel.state.gov/

Fujmoto, Robin and Dessery. (2003). The Medical Guide for Third World Travelers, 3rd ed. Prairie Smoke Press: Brooklyn Center, MN
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Pre-Travel Advice

• 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.
  
• Travel with a brief medical summary and a copy of EKG/chest X-ray.
  
• Check on health insurance/evacuation insurance.

Pre-Travel Advice for Prolonged Travel

• 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!

Routine Immunizations

• 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

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Diseases and Prevention

Cholera

• The World Health Organization and the CDC do not recommend cholera vaccinations for travelers.
  
• Some countries require proof of vaccination for entry
  
• Vaccination clinically needed only for those individuals lacking gastric acid
  
• Vaccination is only 50 percent effective
  
• Vaccination requires booster doses every 6 months
  
• Generally not recommended

Hepatitis A

• "Infectious" hepatitis - oral or fecal transmission extremely common in developing countries
  
• Children less than 2 years old generally without symptoms
  
• Adults can have symptoms of fever, nausea, vomiting, jaundice, lasting weeks or months
  
• Less than 20 percent of adults in U.S. under 50 have antibodies
  
• Vaccines:
  • 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
    
  • 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 vaccines:
  • Adults should receive two doses and 6 to 12 months apart
    
  • Pediatric (2-18 years old) should receive two doses 6 months apart

Hepatitis B

• "Serum" hepatitis
  
• Transmitted through blood (blood products, sexual routes)
  
• 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
  
• Usually need 2 months for initial immunization (0, 1, 6 months or 0, 1, 2, 12 months)
  
• Can use accelerated series - three doses in three weeks, plus one dose in 12 months

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
    
  • MUST have immediate access to medical care for 10 days after each dose

Malaria

• Disease acquired through the bites of infected anopheles mosquitoes
  
• Exists in tropical or developing countries
  
• Many areas have chloroquine-resistant malaria
  • Mefloquine (Larium) is used for travel in these areas
    
  • Taken 1 week prior to departure with weekly doses throughout trip continuing for four weeks after leaving malarious area
• Reduce your risk of malaria infection by:
  • Avoid outdoor activity between dusk and dawn
    
  • Wear protective clothing - treat clothing with permethrin
    
  • Use mosquito netting
    
  • Use insect repellents that contain DEET

Measles, Mumps, and Rubella (MMR)

• Booster is recommended for travelers who:
  • Were born after 1956 and did not get booster dose after age four
    
  • Received MMR between 1963-67 but do not know which vaccine
• Booster is not recommended for:
  • Women who are pregnant or suspect they may be pregnant
  • Pregnancy should be avoided for at least three months after vaccination

Meningococcal Vaccine

• Risk to travelers of this disease is low
  
• Vaccine is available
  
• Booster doses given every three years to those at risk

Polio

• Is a hazard in third-world countries.
• Vaccine recommendations for high risk areas
  • Three doses of oral vaccine or injected vaccine for primary immunization
    
  • 1 booster prior to travel for adults who have received primary immunization series

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
  
• Rabies vaccine:
  • Requires a dose series for prevention
    
  • 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

Tetanus-Diphtheria

• Occurs in the United States and abroad
  • Vaccine recommendations:
    • Primary immunization during childhood for most adults
      
    • Booster doses 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

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
  
• Prevention of 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

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
  
• Typhoid vaccine (injectable version):
  • Requires two injectable doses four weeks apart or three doses at weekly intervals
    
  • Provides approximately 70 percent protection
    
  • Booster dose required every three years
  
  
• New typhoid vaccine
  • Highly purified vaccine - not killed bacteria
    
  • Takes two to four weeks to develop immunity
    
  • Highly effective single dose provides protection for two years
    
  • Can be used in children as young as age two
  
  
• Oral typhoid vaccine
  • Four oral doses every other day
    
  • Highly effective
    
  • Booster dose needed every five years

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 needed every 10 years

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