Disease Destinations
Before venturing overseas, visit a travel clinic
By Erin Bell

Thirteen-year-old Mbolle Akume was feeling dizzy and weak, and she wasn’t sure why.

Akume, now 15, had just returned to the United States from a stay with extended family in West Africa when she began sweating excessively and experiencing powerful headaches. Her parents, startled at her symptoms, took her to the emergency room, where she was diagnosed with malaria, a potentially deadly disease carried by mosquitoes in tropical regions.

“I was bitten by those pesky insects on a daily basis, but wasn’t concerned,” Akume says. “I never really used repellent because I didn’t like it. My aunts and uncles [in Africa] used to tell me that the mosquitoes enjoyed sucking foreign blood, and that was why they attacked me.”

Akume never dreamed a visit to a place that members of her family called home could bring on such an illness. But as vacationers now venture off to far-away places, their risk of disease is greater – and often they have no idea of the danger.

“When you’re booking your vacation, there’s nothing that says, ‘Wait – worry about this!’” says Debrah Meislich, MD, a pediatric travel specialist at Cooper University Hospital. “When travel doctors advise, we live in the real world. We consider everything.”

Meislich says a travel doctor’s job is to gather information about your trip, then find the best ways to keep you healthy while you’re traveling. If you have an international trip scheduled, she advises calling a travel clinic and telling the staff about your plans. They will tell you if you need to see a travel physician. If you do, you’ll be asked at the visit to tell the doctor details about your trip – where you’re going, for how long, who is going with you and what excursions you have planned.

Generally, a visit to a travel clinic is not covered by insurance, and the typical cost is between $100 and $150.

At an appointment, Meislich also reviews what prescriptions are needed for travel. For some diseases, like malaria or yellow fever, the best protection is to make sure you’re vaccinated beforehand.

“Vaccines do not give you immediate immunity, which is why you have to see a travel doctor at least two weeks before you leave,” Meislich says. Often, the immunity from a vaccination takes 10 days to two weeks to strengthen. If you are traveling to India, for instance, you would take a pill every other day for eight days to protect yourself from typhoid fever. The eight-day series must be completed before leaving. If you’ll be backpacking through the jungle, Meislich advises pre-exposure rabies shots done in a series of injections, meaning you’ll need several appointments.

“We always strongly suggest vaccines, but there are some places where you can’t actually get in the country without a yellow fever vaccine,” Meislich says. Many countries, including Ghana, India and Mali, require the vaccination – and Meislich warns that if you do not have proof of vaccination when going through customs in those countries, you may not be granted entry. You could opt to receive the vaccination right there in the airport, but that can be costly and unsafe.

“You could be pulled out of line at the airport and have to pay for it, because otherwise you’re stuck,” she says.

Travel doctors can also provide health advice specific to your destination. “We get minute-to-minute updates and travel advisories,” Meislich says. Travel clinics are the first to know when there is an outbreak of polio in Kenya, chikungunya in Saint Maarten or even violent protests in Nigeria.

Meislich also urges travelers to check the websites of the World Health Organization and the Centers for Disease Control and Prevention (CDC) for up-to-date information on their destination. The CDC offers travel advisories, assigning a warning level to various countries, the most extreme being “Warning Level 3, Avoid Nonessential Travel.”

No matter the country, Meislich says she always offers the same simple advice, because it’s worth repeating: wash and sanitize your hands regularly with water you know has been treated. This can help prevent traveler’s diarrhea or parasitic infections. Water safety is a problem in many developing countries, she adds, so drink only water from a bottle, and make sure that bottle is sealed.

“It’s becoming a huge problem in places like India, where people are reusing the bottles, filling them with local water and selling them for profit,” Meislich says. “With the recapping going on, I recommend you spend a little extra to buy a brand that is recognized on a national level.”

In less-developed countries, Meislich recommends taking extra care to watch what you eat as well. If you can’t prepare meals yourself, make sure they are cooked. Stay away from what the CDC calls “bushmeat” – monkey, bat or other wild game.

In tropical areas, the biggest concerns come from the smallest of things – mosquitoes that carry diseases. Even in popular vacation destinations like Punta Cana and Costa Rica, visitors are at risk for malaria.

“The best protection is a great bug spray,” says Lorri Connelly, RN, who works with Meislich at Cooper. Many diseases, such as dengue fever, are carried by mosquitoes and spread to new people with a single bite. Use insect repellant with at least 25 percent DEET for the strongest effect, Connelly says.

When visiting a country that has a risk for malaria, such as the Dominican Republic, first apply sunscreen to your skin and allow it to dry before spraying yourself and your clothes with the bug spray. If you’re sleeping in a room that is not sealed or does not have air conditioning, the mosquitoes can attack at night, so make sure your bed has netting surrounding it.

“With malaria, those mosquitoes like to bite feet at night,” Meislich says. “With dengue fever, those mosquitoes will bite all day long, so you have to be careful.” Stay away from lakes in tropical areas, as mosquitoes are drawn to the humid climate.

It’s worthwhile to pack yourself and your family a health kit before you leave, Meislich says. A basic health kit should include bug spray, sunblock, ibuprofen,  antihistamines, and anti-itch and antibiotic ointments.

Before you leave, Meislich says to write down contact information for the U.S. Consulate in the country you are visiting, and keep that information with you. Make sure you have copies of all your necessary travel documents to bring with you, as well as copies to leave with family members or trusted friends back home. “Kids’ passports are a hot commodity in some countries,” Meislich warns. “That’s why I always say make copies, and keep them with someone at home. That way, if something happens or you’ve lost a passport, you can get the information you need.”

Meislich urges travelers to also do their own research before they go. “Knowledge is power in these cases,” Meislich says. “You can be as informed as you want to be. You’ve just got to do the leg work and find it out.”

“This is not the United States of America you’re going to,” Connelly adds. “It’s a different world.”

July 2014
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