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Travel Health Risks Information CDC Diseases International Travelers

Health risks and precautions: general considerations

People in their home environment live in a state of equilibrium with the locally occurring strains of microorganisms and with the altitude and climatic conditions of the region. However, this is an unstable equilibrium that can be upset even in the home environment by factors such as the arrival of an unfamiliar microorganism, seasonal changes in climate and unusually stressful situations.
The many physical and environmental changes encountered during international travel may upset this equilibrium to an even greater extent: sudden exposure to significant changes in altitude, humidity, microbial flora, sunlight and temperature, exacerbated by stress and fatigue, may result in ill-health and an inability to achieve the purpose of the journey. The health risks associated with international travel are influenced by characteristics of the traveler (including age, sex and health status) and by characteristics of the travel (including destination, purpose and duration).
Forward planning, appropriate preventive measures and careful precautions can substantially reduce the risks of adverse health consequences. Although the medical profession and the travel industry can provide a great deal of help and advice, it is the traveler's responsibility to ask for information, to understand the risks involved, and to take the necessary precautions for the journey.

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Disease and Travel Health Risks for International Travelers

Outbreaks - Health Notices
Information on outbreaks of concern to international travelers.

Diseases of the week - News
Information about specific diseases that can affect travelers.

Diseases Directory and Prevention A - Z
Information about specific diseases that can affect travelers.

Destinations and Diseases
Destination Specific Disease Types

Travel Health Notices
Recent Notices for Travelers

Travel and Vaccination Recommendations
CDC’s vaccination recommendations for travelers of all ages.

All Vaccinations and Vaccines List
List of Vaccines Used in United States

International Travel Health with Your Pet

Safe Food and Water Safety for Travelers
How to avoid illness from food or water.

Traveling with Children
What to do before taking children to other countries.

Disabilities and Special Needs Travelers
Health Information for travelers with special needs such as disabilities

Cruise Ships and Air Travel Health Risks.

Find a Clinic before or after Health Problems

Reporting Death or Illness while traveling

Adventure Travel Health and Survival

Laws and Regulations for traveler's health

Global Health Security Agenda Programs Protect Americans from Infectious Disease Threats


There are 3 types of insurance you should consider for your trip:

Trip cancellation insurance, travel health insurance, and medical evacuation insurance. These will cover different situations and may give you financial peace of mind, as well as allowing for safe and healthy travel.

Trip Cancellation Insurance

Trip cancellation insurance covers your financial investment in your trip, such as flights, cruises, or train tickets. Carefully examine the policy to make sure that it covers what you need it to cover, including cancellation if you or a close family member gets sick. Depending on the policy, trip cancellation insurance might not cover any medical care you need overseas, so you may need a separate travel health insurance policy.

Travel Health Insurance

If you need to go to a hospital or clinic overseas, you will probably be asked to pay out-of-pocket for any services, which could be very expensive. Even if a country has nationalized health care, it may not cover people who are not citizens. Before you go, you should consider your insurance options in case you need care while you are abroad, especially if you have existing health conditions, will be away from home for a long time, or will be engaging in adventure activities such as scuba diving or hang gliding.
If you have health insurance in the United States, find out if it will cover emergencies that happen abroad. Ask if your policy has any exclusions, such as for preexisting conditions or adventure activities. If your health insurance coverage is not adequate, consider buying a short-term supplemental policy. Look for a policy that will make payments to hospitals directly.

Medical Evacuation Insurance patient being loaded onto helicopter

If you are traveling to a remote destination or to a place where care is not likely to be up to US standards, consider buying medical evacuation insurance. This can be purchased separately or as part of your travel health insurance policy. This insurance will pay for emergency transportation from a remote or poor area to a high-quality hospital. Make sure that the policy provides a 24-hour physician support center.

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Travel Risks, Health Related Warnings and Information

Key factors in determining the health risks to which travelers may be exposed are:

Destinations
-duration of visit
-purpose of visit
-standards of accommodation and food hygiene
-behavior of the traveler

Destinations where accommodation, hygiene and sanitation, medical care and water quality are of a high standard pose relatively few serious risks for the health of travelers, unless there is pre-existing illness. This applies to business travelers and tourists visiting most major cities and tourist centers and staying in good-quality accommodation. In contrast, destinations where accommodation is of poor quality, hygiene and sanitation are inadequate, medical services do not exist, and clean water is unavailable may pose serious risks for the health of travelers. This applies, for example, to personnel from emergency relief and development agencies or tourists who venture into remote areas. In these settings, stringent precautions must be taken to avoid illness.
The duration of the visit and the behavior and lifestyle of the traveler are important in determining the likelihood of exposure to many infectious agents and will influence decisions on the need for certain vaccinations or ant medication. The duration of the visit may also determine whether the traveler may be subjected to marked changes in temperature and humidity during the visit, or to prolonged exposure to atmospheric pollution.
The purpose of the visit is critical in relation to the associated health risks. A business trip to a city, where the visit is spent in a hotel and/or conference center of high standard, or a tourist trip to a well-organized resort, involves fewer risks than a visit to remote rural areas, whether for work or pleasure.
However, behavior also plays an important role; for example, going outdoors in the evenings in a malaria-endemic area without taking precautions may result in the traveler becoming infected with malaria. Exposure to insects, rodents or other animals, infectious agents and contaminated food and water, combined with the absence of appropriate medical facilities, makes travel in many remote regions particularly hazardous.

Medical consultation before travel

Travelers intending to visit a destination in a developing country should consult a travel medicine clinic or medical practitioner before the journey. This consultation should preferably take place 4–6 weeks before the journey, particularly if vaccination(s) may be required. However, last-minute travelers can also benefit from a medical consultation, even as late as the day before travel. This consultation will determine the need for any vaccinations and/or antimalarial medication, as well as any other medical items that the traveler may require. A basic medical kit will be prescribed or provided, supplemented as appropriate to meet individual needs.

A dental check-up is advisable before travel to developing countries or prolonged travel to remote areas. This is particularly important for people with chronic or recurrent dental problems.

Assessment of health risks associated with International Travel

Medical advisers base their recommendations, including those for vaccinations and other medication, on an assessment of risk for the individual traveler, which takes into account the likelihood of catching a disease and how serious this might be for the traveler concerned. Key elements of this risk assessment are the destination, duration and purpose of the visit, as well as the conditions of accommodation and the health status of the traveler.

For each disease being considered, an assessment is also made of:
— availability of prophylaxis, possible side-effects and suitability for the traveler concerned;
— any associated public health risks (e.g. the risk of infecting others).

Collecting the information required to make a risk assessment involves detailed questioning of the traveler. A checklist or protocol is useful to ensure that all relevant information is obtained and recorded. The traveler should be provided with a personal record of the vaccinations given (patient-retained record) as vaccinations are often administered at different centers.

Medical Kit and Toiletry Items

Sufficient medical supplies should be carried to meet all foreseeable needs for the duration of the trip.
A medical kit should be carried for all destinations where there may be significant health risks, particularly those in developing countries, and/or where the local availability of specific medications is not certain. This kit will include basic medicines to treat common ailments, first-aid articles, and any special medical items that may be needed by the individual traveler.
Certain categories of prescription medicine should be carried together with a medical attestation, signed by a physician, certifying that the traveler requires the medication for personal use. Some countries require not only a physician but also the national health administration to sign this certificate.
All medicines should be carried in the hand luggage to minimize any risk of loss during the journey. A duplicate supply carried in the checked luggage is a safety precaution in case of loss or theft.
Toilet items should also be carried in sufficient quantity for the entire visit unless their availability at the travel destination is assured. These will include items for dental care, eye care including contact lenses, skin care and personal hygiene.

Additional health items according to destination and individual needs:

Antidiarrhoeal Medication
-antifungal powder
-anti-malarial medication
-condoms
-medication for any pre-existing medical condition
-sedatives
-sterile syringes and needles
-water disinfectant

Other items to meet foreseeable needs, according to the destination and duration of the visit

Health and Age

Infants and young children have special needs with regard to vaccinations and antimalarial precautions. They are particularly sensitive to ultraviolet radiation and become dehydrated more easily than adults in the event of inadequate fluid intake or loss of fluid due to diarrhea. A child can be overcome by dehydration within a few hours. Air travel may cause discomfort to infants ears due to changes in cabin air pressure and is contraindicated for infants less than 7 days old. Infants and young children are more sensitive to sudden changes in altitude. They are also more susceptible to many infectious diseases.
Advanced age is not necessarily a contraindication for travel if the general health status is good. Elderly people should seek medical advice before planning long-distance travel.

Pregnancy

Travel is not generally contraindicated during pregnancy until close to the expected date of delivery, provided that the pregnancy is uncomplicated and the woman's health is good. Airlines impose some travel restrictions in late pregnancy and the neonatal period.
There are some restrictions on vaccination during pregnancy:
Pregnant women risk serious complications if they contract malaria. Travel to malaria-endemic areas should be avoided during pregnancy if at all possible. Specific recommendations for the use of antimalarial drugs during pregnancy are given in.
Medication of any type should be taken during pregnancy only in accordance with medical advice.
Travel to high altitudes or to remote areas is not advisable during pregnancy.

Disability

Physical disability is not usually a contraindication for travel if the general health status is good. Airlines have regulations on the conditions for travel for disabled passengers who need to be accompanied. Information should be obtained from the airline in advance.

Pre-existing illness

People suffering from chronic illnesses should seek medical advice before planning a journey. Conditions that increase health risks during travel include:

Cardiovascular Disorders
-chronic hepatitis
-chronic inflammatory bowel diseases
-chronic renal disease requiring dialysis
-chronic respiratory diseases
-diabetes mellitus
-epilepsy
-immunosuppression due to medication or to HIV infection
-previous thromboembolic disease
-severe anaemia
-severe mental disorders
-any chronic condition requiring frequent medical intervention.

Any traveler with a chronic illness should carry all necessary medication for the journey and for the entire duration of the trip in their hand luggage. The name and contact details of their physician should be carried on their person with other travel documents, together with information about the medical condition and treatment, and details of medication (generic drug names included) and prescribed doses. A physician's letter certifying the necessity for any drugs or other medical items (e.g. syringes) carried by the traveler that may be questioned by customs officials should also be carried.


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