Traveler's Health in Exotic Destinations

Introduction
Traveling to 'exotic' foreign destinations is becoming increasingly common. While abroad, travelers can be exposed to a variety of health problems that they would not encounter at home. Traveling to the less developed countries in the tropics poses particular hazards.

While there is often much attention paid to more unusual diseases such as malaria or encephalitis, it is much more likely that illness from poor sanitary conditions and hygiene (such as Hepatitis A or traveler's diarrhea) will occur.

What Counts as 'Exotic'
Broadly speaking, it is considered to be travel to the following areas: South East Asia, the Far East, India, the Pacific islands, Central and South America, Caribbean Islands and Sub-Saharan Africa.

The risk of health problems is not simply due to the climate in these regions (although this is important) but is also due to the level of local development. Areas in temperate countries can also be affected.

In general, you are less likely to get ill staying in a first class hotel than camping in remote areas, where facilities will be basic. However, it is still very important that all travelers to exotic destinations consider the health risks. Most of these can be minimized by making the necessary preparations before traveling, taking sensible measures whilst away and watching out for any problems which come to light on returning home.

Preparation
It is important to seek up-to-date advice before traveling to the tropics. It is also important to seek this advice at least one month before traveling as it can take as long as one month for some immunization (vaccination) courses to be complete and effective.

Immunizations
The recommendations for immunizations change frequently and vary from country to country and even between regions within large countries. Always seek informed medical advice.

Malaria
Malaria is a serious threat in many tropical climates. It is an infection caused by a parasite that enters the blood stream through mosquitoe bites. By taking anti-malarial drugs - known as malaria prophylaxis - this infection can often be prevented. To be effective, the drugs need to be taken regularly throughout the trip. They may need to be started 1-2 weeks (depending on the drug) before traveling and continued for one month afterwards.

The malaria parasite has developed resistance to some drugs in some areas. Your GP will advise about which are the most effective drugs to take for those particular regions.

All anti-malarial drugs can cause side-effects. These include minor stomach upsets and headaches, but these need to be considered in the context of the real risk to health of catching malaria. Despite media attention on the drug mefloquine (Lariam), the major side effects such as convulsions and psychiatric disturbances are very rare (reported in about 1 in 10,000 people) and it remains an effective and important drug for defending against malaria in areas where there is resistance to other drugs. Doxycycline is another medication often prescribed. It should not be given to children under 8 or pregnant women, and can cause photosensitivity and thrush.

Insurance
Before traveling, it is also essential to obtain comprehensive travel insurance with medical cover, including emergency assistance and evacuation. Medical treatment can be extremely costly and treatment may not be available in some places without proof of your ability to pay. Additionally, if appropriate care isn't available locally, you may need to be evacuated.

If you are planning 'adventure' activities such as scuba diving or mountaineering, ensure that these are also covered by your policy.

Whilst traveling
Various simple precautions can be taken whilst on holiday to help avoid many health problems.

Poor hygiene and sanitation standards can expose the traveler to food or drink contaminated with a range of bacteria, viruses, parasites and other causes of illness. Simple measures can help reduce the risks. Hand washing is vital after going to the toilet and before handling food. If there is doubt about the hygiene of local tap water, it needs to be boiled or sterilized (preferably with an iodine-based preparation). Alternatively, bottled water (from a sealed bottle) can be used. Ice, including ice in alcoholic drinks, and ice cream should be avoided in all remote areas. Care must be taken with uncooked foods, including salads and fruit/vegetables (unless peeled by you). Food should be freshly cooked and served piping hot

Packing an anti-diarrheal medicine such as Immodium is sensible. For persistent vomiting or diarrhea, seek medical advice, as some illnesses may benefit from a course of antibiotics

Insects, especially mosquitoes, can carry a variety of tropical illnesses. Therefore, it is important to avoid being bitten. Mosquitoes transmit malaria bites most commonly before dawn or after dusk, so this is when most care must be taken. Wear long sleeves, trousers and socks if possible, remembering that some insects can bite through very thin garments. Use insect repellent on the skin, reapplying every couple of hours. High concentrations should be avoided in young children. Use mosquito netting over beds - these can also be impregnated with repellent

HIV and other sexually transmitted diseases are extremely common in certain areas. As many as 1 in 4 adults (most of whom are heterosexual) are HIV positive in certain areas of Africa and South East Asia. Using condoms with any new sexual partner is essential

The risks of sunburn and sunstroke are much higher in the tropics. Using sunscreens, clothing and shade to protect the skin is vital. Increasing fluid intake and avoiding strenuous exercise until accustomed to the climate will help

Avoid bathing in fresh water (lakes, rivers and streams) in tropical regions. These can be infected with water-borne parasites such as schistosomiasis, responsible for the disease bilharzia

A significant number of medical problems occurring abroad are as a result of accidents. Take extreme care on the road, whether you are a pedestrian or a motorist, since road and vehicle safety standards can vary greatly. Also beware of the risks involved in unaccustomed activities, such as riding a scooter or water sports. Violent crime towards holidaymakers is not too common. To avoid becoming a target, it is important to seek advice about which areas are unsafe, especially after dark, and to avoid carrying large amounts of money and valuables, or displaying wealth in an obvious manner

On Return from Holiday
Some diseases picked up overseas only become apparent on returning home. If traveler's diarrhea does not clear up quickly, you should consult a doctor.

It is particularly important to seek medical advice promptly for any feverish illness that develops for up to three months after a trip to an area where malaria is prevalent. Remember that the preventative drugs for malaria need to be continued for 1 month after leaving the malarial region.

For Further Information:
International Travel and Health (World Health Organization)
http://www.who.int/ith

International Society of Travel Medicine
http://www.istm.org/

National Centers for Disease Control and Prevention (USA): Travelers Health
http://www.cdc.gov/travel
 
This is for information only. For a detailed opinion or personal advice, please consult with your own doctor

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