How to arm myself for safe travel?

According to the World Health Organization (WHO), more than 900 million international journeys are undertaken every year that consequently expose many people to a wide range of health risks. Thankfully many of these risks can be minimized through simple precautions taken before, during and after travel. Immunization is one such precaution and is a proven tool for controlling and, in some cases, eliminating life-threatening infectious diseases. Globally, vaccines are estimated to prevent 2-3 million deaths each year.

There are 2 groups of vaccines: routine vaccines that everybody should have whether they travel or not and those only needed when travelling. The WHO recommends that all travelers—both domestic and international—should be up-to-date with routine vaccinations. These may include measles, rubella, mumps, diphtheria, tetanus, pertussis (whooping cough), hepatitis B, Haemophilus influenzae type B, human papillomavirus (HPV), seasonal influenza, influenza A (H1N1), pneumococcal disease, rotavirus, tuberculosis (TB), varicella (chickenpox) and poliomyelitis.

Travel is a good opportunity to review the immunization status of infants, children, adolescents and adults. Non-immunized or incompletely immunized travelers should have their routine vaccinations as recommended by a physician, in addition to those needed for international travel.

Travel vaccines

Hepatitis A is a common viral infection that is transmissible through food and water, or by direct contact with an infectious person. Usually associated with poor sanitation and lack of potable water, hepatitis A attacks the liver causing debilitating symptoms. A two dose vaccine (more than 6 months between each dose) provides lifetime protection. However, one dose, preferably 4-6 weeks but even up to the week before travel, will protect most travelers; the second dose gives long term protection. It is a common disease in many developing countries.

Influenza causes fevers, cough, headaches, muscle aches and can cause serious illness or even death. It is very common in travelers and found worldwide. The flu strain causing the illness changes often, so to be protected you need an annual vaccine when they are released, typically in autumn before the winter flu season.

Japanese encephalitis is a viral disease that causes inflammation of the brain. Transmitted through mosquitoes, it can rapidly cause high fever, headache, stiff neck, disorientation, seizures and death. If you are visiting areas outside major cities in Southeast Asia and South Asia for an extended period of time, particularly in rural areas where there are rice paddies and or pigs, this vaccine is recommended.

Meningitis is a very serious infection that affects the membrane around the brain; it can be fatal in 50% of cases if left untreated. There is a vaccine for the bacterial form of meningitis that is especially common in the sub-Saharan “meningitis belt” of Africa. If you plan to attend the Hajj in Saudi Arabia, it is required for entry as this disease is very common in these settings.

Rabies is a fatal disease if left untreated that is transmitted through the bodily fluids (usually via a bite) of an infected animal such as a dog, bat, or other animal. Getting the vaccine is very important, as there is no cure; once it develops in an infected person, the disease is fatal. The preventative vaccine for rabies is three separate shots taken over at least 3 weeks. However immunization does not eliminate the need for treatment should you be bitten; in the event of an attack you will need two booster shots spaced 3 days apart. A non-immunized person who is bitten by a rabid animal will require immediate medical attention and four doses over 2 weeks; in many areas of the developing world, where rabies is most prevalent, these may not be readily available.

Typhoid is another disease usually contracted from contaminated food or water. Typically it results in very high fevers and pain in the abdomen; it can become very serious and lead to death. There are several vaccines available, but all should be completed at least 2 weeks before traveling. Typhoid is commonly found in much of the developing world.

Yellow fever is a viral hemorrhagic disease that causes serious illness and often death and is commonly found in the tropical areas of Africa and South America. It is transmitted through infected mosquitoes. The WHO’s International Health Regulations state that many countries require proof of yellow fever vaccination from travelers arriving from certain countries before allowing entry.

Malaria is another common disease transmitted by mosquitoes to humans that is estimated to have killed 655,000 people globally in 2010. It is found in Africa, Asia, Latin America and, to a lesser extent, Europe and the Middle East. Although it is the current focus of intense medical research, there is presently no vaccination for malaria. There are, however, several medications available to reduce the likelihood of malaria infection. If you plan on traveling to a high risk area, please first consult with a physician.

Because no vaccine is completely effective, travelers must use common sense in conjunction with immunizations to protect against infection. For example, there are many things you can do to minimize mosquito and other insect bites, which may prevent yellow fever, Japanese encephalitis, as well as diseases with no current vaccines like malaria and dengue fever.

Wearing protective clothing such as long sleeve shirts and pants, closing windows and using air conditioning in hot environments and using a permethrin-treated mosquito net over a bed at night will greatly reduce mosquito bites. Furthermore, repellants that utilize 25-35% DEET as their active ingredient will also help. They should be applied every 4-6 hours, especially before going to sleep. DEET is safe for kids and pregnant women, but care should be taken not to get it into the eyes or mouth.

Because vaccines each have unique side effects and varying dosage schedules, it is extremely important to arrange a pre-travel consultation with your physician at least 1 month before your trip. They will require a copy of your immunization record and your itinerary.

References:

http://www.cdc.gov/travel/

http://www.who.int/topics/immunization/en/

http://www.uptodate.com/contents/immunizations-for-travel