Travel Health

Topic Overview

How can you stay healthy on your trip?

The best way to stay healthy on your trip is to plan before you go. If you are planning to travel to another country, see a doctor several months before you leave so you will have time for vaccines (immunizations) that you may need to get ahead of time.

Also ask your doctor if there are medicines or extra safety steps that you should take. For example, if you have asthma, you may have to avoid stays in polluted cities. Or someone visiting the tropics may need to take medicine to prevent malaria.

Where can you get the best information?

You can use the Internet to find general travel health information. Just make sure that the information is up-to-date and from a reliable source. See the following websites before you travel:

• Centers for Disease Control and Prevention (www.cdc.gov/travel): This site has information on travel health and safety, required immunizations, and disease outbreaks.
• World Health Organization (www.who.int/ith/en): You'll find information on travel, recommended immunizations, and disease outbreaks throughout the world.
• U.S. State Department (www.usembassy.gov): This site has information on where to get the best medical care in the region you are visiting. It lists every U.S. embassy worldwide and lists some doctors and medical facilities in those countries. Take along the phone numbers and addresses of embassies in the areas you will visit.

Which immunizations and medicines will you need?

Vaccines that may be recommended include those for:

• Hepatitis A and hepatitis B.
• Yellow fever.
• Influenza or complications of pneumonia (pneumococcal vaccine).
• Typhoid fever.
• Polio, if you are traveling to areas where polio is common.
• Childhood infections, if they are not up-to-date for you and your children. These include shots for polio, diphtheria, measles, mumps, whooping cough, and rubella.
• Rabies, if you may be handling or near animals in parts of the world where rabies is common.

If you plan to visit an area where malaria is common, start taking medicine ahead of time to prevent malaria infection.

What precautions should you take while you travel?

Before you go, learn about the places you plan to visit. For example, find out if the water is safe to drink or if you need to worry about malaria.

Basic safety can prevent some problems:

• Developing countries may not have safe tap water. When visiting these places, drink only beverages made with boiled water, such as tea and coffee. Canned or bottled carbonated drinks are usually a safe choice. Don't use ice if you don't know what kind of water was used to make it.
• Do not eat raw vegetables, raw fruits, or raw or undercooked meat and seafood.
• In areas where mosquito-borne illnesses are found, use DEET insect repellent. Wear long pants and long-sleeved shirts, especially from dusk to dawn. Use mosquito netting to protect yourself from bites while you sleep.
• Motor vehicle accidents are a leading cause of injury among travelers. If you drive, be sure to learn the custom and rules. If you use hired drivers (such as in a taxi), don't be afraid to ask your driver to slow down or to drive more carefully. Use seat belts if possible.

What if you get sick while you are traveling?

If you become seriously ill while traveling, your country's embassy or consulate can help you find medical care. If you become ill with a fever or flu-like illness while traveling in malaria-risk areas, get medical help right away.

Diarrhea is the most common illness to strike travelers. Most cases of traveler's diarrhea get better in 1 to 3 days without treatment. But see a doctor if diarrhea lasts longer than 7 days, or if you have a high fever, blood or mucus in your diarrhea, or signs of dehydration.

Should you see a doctor when you return?

If you were healthy during your trip and you feel well when you return home, you probably don't need to see a doctor.

See your doctor when you get home if either of the following occurs:

• You were sick with a fever or severe flu-like illness while traveling.
• You develop these symptoms within 6 months of coming home.

Tell your doctor the places you visited and whether you think you may have gotten a disease. Many diseases don't show up right away. And some can take weeks or months to develop.

Frequently Asked Questions

Before You Go

Proper planning is the best way to stay healthy during your trip. This takes time. You'll want to gather both travel and health information, and think about your special needs.

See a doctor several months before you go so you'll have time to get vaccines or make other health preparations.

To get started

• Think about the type of shape you're in. Most travel, even if you are going on a guided tour, typically demands more physical effort than is required at home. Boost your fitness by starting an exercise program, such as fitness walking, in advance.
• Make a first aid kit with items such as pain relievers, sunscreen, insect repellent, moleskin, antifungal and antibacterial ointments, medicine for motion sickness, and antidiarrheal medicines.
• If you have health insurance, find out how your insurance works outside of the United States. If your insurance company doesn't cover you in other countries, you may want to think about buying travel health insurance. Use the Internet to search for "travel insurance compare" to get websites that help you compare types of travel insurance.

Get the information you need

You can use the Internet to find general travel health information. Just make sure the information is up-to-date and from a reliable source. See the following websites before you travel:

• Centers for Disease Control and Prevention (www.cdc.gov/travel): This site has information on travel health and safety, required immunizations, and disease outbreaks.
• World Health Organization (www.who.int/ith/en): You'll find information on travel, recommended immunizations, and disease outbreaks throughout the world.
• Centers for Disease Control and Prevention (CDC) Vessel Sanitation Program (www.cdc.gov/nceh/vsp): This site contains information from the CDC about cruise ship sanitation inspection scores.
• U.S. State Department (www.usembassy.gov): Information on where to get the best medical care in the region you are visiting. It lists every U.S. embassy worldwide and lists some doctors and medical facilities in those countries. Take along the phone numbers and addresses of embassies in the areas you will visit.

Get needed vaccines and medicines

Check with the nearest travel health clinic, your regional health department, your doctor, or one of the websites listed above to see what kind of vaccines you should get. In the United States, most state health clinics can give you travel vaccines, some medicines, and healthy travel tips.

See your doctor or go to a clinic several months before your trip, or as soon as you can. Some vaccines need to be given in more than one dose. For example, if you need protection from hepatitis A, you'll need two doses of hepatitis A vaccine spaced at least 6 months apart.

You may need vaccines to protect against:

• Childhood infections, if they aren't up-to-date for you and your children. This includes shots for polio, diphtheria, measles, whooping cough (pertussis), mumps, and rubella.
• Tetanus, if you haven't received one in the last 10 years.
• Hepatitis A, if you are going to developing countries where the disease is common. The vaccine is given as two shots. The first hepatitis A shot usually works in about 4 weeks. It protects most people from getting hepatitis A. The second shot is given at least 6 months after the first shot and provides lasting protection.
• Hepatitis B.
• Yellow fever. This vaccine is now required for travelers who plan to visit countries in South America and Africa where the disease is active.
• The flu or complications of pneumonia (PPSV vaccine or PCV vaccine).
• Typhoid fever, especially if you are traveling to an area where the risk of typhoid fever is high. These areas include Central and South America, Africa, and Asia. Your doctor, health clinic, or health department will have the most recent recommendations.
• Rabies, if you may be handling or near animals in parts of the world where rabies is common.

More immunizations may be needed depending on the area you are visiting, how long you will be there, and the purpose of your journey. For example, if you will be trekking in rural Asia for a month or longer, you may need a vaccine for Japanese encephalitis.^{footnote 1}

A vaccine for traveler's diarrhea and cholera, called Dukoral, has been approved in Canada and Europe. But it is not available in the United States.

To learn more, see the topic Immunizations.

Malaria

Ask about a prescription for antimalarial drugs if you will be visiting an area that has malaria. This includes large areas of Central and South America, Haiti and the Dominican Republic, Africa, the Indian subcontinent, East Asia, Southeast Asia, the Middle East, and many South Pacific islands.

You may need to take one of several different preventive medicines, depending on the type of malaria parasite in that part of the world. These medicines need to be taken daily during your travels and for a specified time after you return. It is important to take all the tablets you were given. This may mean taking antimalarial tablets for several weeks after you get home.

Personal health needs

If you have any chronic diseases or other health concerns, such as birth control or allergies, see your doctor. You may need to take other steps or make adjustments in your travel plans.

• Carry a letter from your doctor describing your conditions, a list of your routine medicines including their generic names, and written prescriptions for refills if you will be gone long.
• Leave your prescription medicines in the original containers-your name must match the name on the bottle-and pack them in a waterproof container in your carry-on luggage. Take extra amounts of your routine medicines packed in checked luggage in case of theft or loss.
• If you have a heart condition, travel with a copy of your most recent electrocardiogram (EKG, ECG) for comparison in case you have chest pain or other symptoms.
• If you have diabetes, you can take precautions to prevent problems while traveling. For example, wear a medical identification tag and take extra medicine with you.
• If you have asthma, chronic obstructive pulmonary disease (COPD), or other lung diseases, you may need to avoid stays in polluted cities or at high altitudes.
• If you are pregnant, talk to your doctor before making any travel decisions. If you decide to travel, take some general precautions while traveling, such as notifying the airline of your condition before you fly and taking a few walks while on a long flight to increase the blood circulation in your legs. (This is good advice for all travelers.)

Precautions Along the Way

Traveling comes with a whole new set of things to think about. The following can help you stay healthy and enjoy your trip as much as possible.

Tips for flying

Flying isn't always fun. But you can take steps to make it easier and to feel better during and after your flight.

• Pack anything that may cause problems at security-such as gels, liquids, sharp scissors, or pocket knives-in the luggage you plan to check. For an updated list of what isn't allowed in carry-on luggage, see the Transportation Security Administration website at www.tsa.gov/travelers/airtravel/prohibited/permitted-prohibited-items.shtm.
• Wear roomy, comfortable shoes that slip on and off. These are easy to remove when you go through security at the airport. They will also be more comfortable if your feet swell on the plane.
• Walk around the plane during flights to prevent dangerous blood clots during long periods of travel. Sitting still for 4 hours or more slows down the blood flow in your legs and raises your blood clot risk.
• Take steps to prevent jet lag, such as drinking plenty of liquids and changing your sleep schedule to the new time zone.

  Sleep Problems: Dealing With Jet Lag

If you have a fear of flying, talk to your doctor. He or she may recommend medicines, hypnosis, or breathing, visualization, and relaxation exercises to help you feel less afraid.

Water and food safety

Contaminated water and food are the most common cause of illness in travelers.

Drinking water

• Don't drink tap water if it may not have been properly treated.
• Don't brush your teeth with tap water.
• Drink beverages made with boiled water, such as tea and coffee. Canned or bottled carbonated beverages (including bottled water and soft drinks), beer, and wine are also usually safe.
• Don't accept ice in drinks. It may be contaminated.
• Dry the opening of wet cans or bottles before taking a drink.

Travelers to backcountry areas of North America should also take precautions with water. Even though the water in high mountain lakes looks sparkling clear, it may be contaminated with Giardia intestinalis, the parasite that causes giardiasis. Take simple precautions to avoid this illness, such as boiling the water.

Food

• Avoid raw fruits (unless you wash and peel them yourself), raw vegetables, and raw or undercooked meat and seafood.
• Try to eat steaming hot, well-cooked food.
• Don't get foods or drinks from street vendors.
• Make sure dairy products have been pasteurized.

Taking these precautions with food can help prevent infections, like tapeworm.

To learn more, see the topic Food Poisoning and Safe Food Handling.

Swimming and water sports

Swimming in contaminated fresh water, such as ponds or rivers, can expose you to diseases. Even swimming pools with inadequate chlorination pose a risk. Talk to your doctor if you plan on doing recreational water sports-such as white-water rafting, adventure racing, or kayaking-in tropical and backcountry regions.

To prevent fungal or parasitic infections and injuries, do not go barefoot. Try to keep your feet as clean and dry as possible.

Although sea water is usually safe from disease, swimming or diving in sea water can still be dangerous. Avoid swimming or wading in sea water near a river, estuary, or other outlet from inland. Swimming when you have an open cut or sore can also increase your risk of getting an infection. In developing countries, sea water around big cities and other populated areas may not be safe. For more information, see the topic Marine Stings and Scrapes.

Insect-borne disease

Mosquitoes, flies, fleas, and ticks all spread disease. These diseases include:

• Malaria.
• Lyme disease.
• West Nile fever.
• Yellow fever.
• Dengue fever.
• Chikungunya fever.
• Zika virus.

Malaria is the insect-borne disease of most concern to travelers in tropical and subtropical regions. Although antimalarial medicines kill the malaria parasite in the bloodstream, this protection isn't complete. Take protective measures along with taking antimalarial medicine.

Ticks inhabit many regions, including Europe, Canada, and the United States. Although it is rare for travelers to contract diseases from ticks, some of the diseases are serious. For information on how to prevent tick bites, see the topic Tick Bites.

Here are some tips that can help you avoid mosquitoes and other insects:

• Use DEET or other insect repellents on your skin.
• Sleep under a bed net to prevent insects from biting you while you sleep. Permethrin or deltamethrin insecticide sprayed on bed nets will protect against mosquitoes for weeks to months.
• Use mosquito coils. The smoke from these slow-burning coils repels mosquitoes.
• Wear light-colored and loose-fitting long pants and long-sleeved shirts. This is especially important from dusk to dawn, when mosquitoes that spread malaria and other diseases bite. Insect repellent applied to clothing is effective for longer than it may be on the skin.

Do not use home remedies like eating garlic, rubbing garlic on your skin, or taking vitamin B. They do not prevent bites.

Sun and heat exposure

Many travelers underestimate the sun's strength and overestimate the amount of protection their sunscreen offers. This can add up to at least an uncomfortable sunburn and other skin damage.

Steps you can take to protect yourself from the sun include using sunscreen and wearing a hat and sunglasses.

Heat can also cause problems such as heat exhaustion or heatstroke. Sometimes it's hard to keep cool while you are active in a hot environment. But you can take steps to prevent heat-related illness.

• Before you travel to a hot environment, you can improve your ability to handle heat. Start by exercising for a short time in the heat. Then for the next 2 to 3 weeks, slowly increase the time you exercise in the heat.
• If you are not used to the heat, limit the amount of time you are out in the hottest part of the day.
• Drink plenty of water. Losing 2% to 3% of your weight through sweat increases your risk of a heat-related illness.
• Do not drink alcohol. It increases your risk for dehydration.
• Some medicines can make a heat-related illness more likely. If you take medicines regularly, ask your doctor for advice about hot-weather activity and your risk for heat-related illness.

Injuries

Although disease is a big risk while you are traveling, you should also be aware of the risk of injury.

• Motor vehicle accidents. They are a leading cause of injury among travelers. Bad roads, poor driver training, and crowded roadways can make driving dangerous in other countries.
  • Learn local driving customs and road signs.
  • Try to travel during daylight.
  • Always use seat belts.
  • Ask taxi drivers or other hired drivers to slow down or drive more carefully if you feel unsafe.
  • Wear helmets and protective clothing when riding motorcycles or bicycles.
• Animal bites. Take care around dogs and other animals. Dogs in developing countries may bite, and rabies is a concern. If you are bitten by an animal, wash the bite with clean water and seek medical attention immediately.
• Wounds. Most wounds sustained in developing countries carry a higher risk of becoming infected. If you get even a minor wound, clean it as soon as possible with large amounts of warm, clean water. Apply a thin layer of petroleum jelly, such as Vaseline, and a bandage.

If you haven't had a tetanus shot in 10 years, you should get a booster dose before you leave on your trip. But if you don't get a tetanus shot before you leave, you should get one after an animal bite or an injury that results in a break in the skin.

Altitude

Altitude sickness happens when you can't get enough oxygen from the air at high altitudes. This causes symptoms such as a headache and loss of appetite. The best treatment for altitude sickness is to go to a lower altitude. But if you have mild symptoms, you may be able to stay at the higher altitude and let your body get used to it.

Steps to prevent altitude sickness include eating breads, grains, and pasta and not flying directly from low altitudes to high altitudes. You may also be able to take medicine to prevent altitude sickness.

Scuba diving safety

You will learn about safety in your scuba diving certification class. If you plan to get certified while traveling, find an experienced, certified teacher that you feel comfortable with. Several groups, including the Professional Association of Diving Instructors (PADI) and the National Association of Underwater Instructors (NAUI), certify instructors and dive shops all over the world.

If you are a new diver, it is best to go with an experienced guide, also called a dive master. Most accidents and problems occur when divers ignore the rules and push their limits. Here are some general diving rules:

• Only dive if you feel comfortable.
• Use equipment that you are familiar with and that is in good repair.
• Know what to do if something goes wrong.
• Always dive with a buddy.
• Go down and come up slowly. Don't hold your breath.
• Know and follow recommended depths and time limits.
• Allow enough time between your last dive and your flight home.

Other concerns

• The motion of cars, planes, trains, boats, or ships can make some people sick. If you know that you get motion sickness, pack medicines to prevent it. To learn more, see the topic Motion Sickness.
• Air pollution can pose a serious threat to those with asthma or other respiratory conditions. When air quality is poor, avoid the area or stay indoors as much as possible.
• Sexual activity can lead to sexually transmitted infections. Practice safer sex and use condoms to prevent infections.

What to Do if You Get Ill

Serious illness

If you become seriously ill while traveling, your country's embassy or consulate can help you find medical care. For a complete list of embassies and consulates, see the U.S. Department of State website at www.usembassy.gov. You can also get the contacts for local doctors and medical clinics. If you become ill with a fever or flu-like illness while traveling, seek medical attention immediately.

Diarrhea

Traveler's diarrhea is the most common illness when traveling. Most cases get better within 1 to 3 days without medical treatment.

Most doctors recommend trying to keep to your normal diet as much as possible. If you are vomiting, this may be hard. Try drinking clear liquids. Watch for signs of dehydration, such as a dry mouth and less urine. If possible, drink rehydration drinks to replace lost fluids and electrolytes. Before you go, buy dry packets of oral rehydration mix at a drugstore.

See a doctor if diarrhea doesn't subside or if you have a high fever, blood or mucus in your stools, or signs of dehydration. Watch closely for signs of dehydration in children, because children with diarrhea can quickly become seriously dehydrated.

Your doctor may be able to give you antibiotics to take if you get diarrhea. But some antibiotics can be dangerous if you have bloody diarrhea. Make sure you talk to a doctor before you take antibiotics for bloody diarrhea. And don't take antibiotics to prevent diarrhea.

Antidiarrheal medicines, such as those containing bismuth (examples include Bismatrol and Pepto-Bismol) or Imodium A-D (nonprescription) and Lomotil (prescription), give relief from cramping and frequent stools. But you shouldn't take them if you have a fever or blood or mucus in your stools.

See a doctor right away if you have bloody diarrhea.

To learn more, see the topic Traveler's Diarrhea.

Post-Travel Care

If you have been healthy during your trip and feel well when you return home, you don't need to see a doctor. But if you've been ill, especially while traveling to regions where disease is prevalent, you need to see a doctor.

Many diseases don't show up right away. Some take weeks to months to develop. For example, 90% of travelers who get malaria don't become ill until after they return home.^{footnote 2}

See your doctor when you get home if either of the following occurs:

• You were sick with a fever or severe flu-like illness while traveling.
• You develop these symptoms within 6 months of coming home.

Tell your doctor the regions you visited and about any exposure to disease.

It's important to be aware of other symptoms besides a fever. See your doctor if you have:

• Diarrhea that won't go away or that keeps coming back.
• A skin rash or sores.
• Jaundice (typically most noticeable when the whites of the eyes appear yellow).
• Unexplained weight loss.
• Shortness of breath.
• Fatigue.