Travel Clinic Travel Clinics For Safe International Travel: Prevention Pays
Airlines have made the world smaller, countries closer, and tropical diseases easier to contract. The
last decade of international business opportunities have led to a dramatic increase in more foreign
travel by Americans. There is also a new trend to travel to out of the way places to "get back to
nature" as seen in the influx of tourists to the Amazon. With the emphasis on exotic travel comes the
danger of exotic diseases such as malaria, typhoid fever, hepatitis, Schistosomiasis (parasite),
amoebic dysentery (parasite), yellow fever (viral), and Dengue fever (viral).
As infectious disease physicians who specialize in preventing illness in the international traveler we
have seen the unprepared traveler return with malaria, dysentery, severe skin rashes, parasitic
diseases, hepatitis, and tropical fevers. Fortunately 90% of theses diseases are preventable and the
prepared traveler is a healthy traveler. Prevention should begin well before the trip starts.
Traveler's diarrhea is the most common illness that can ruin a trip for the foreign visitor. Southeast
Asia, South and Central America, Mexico and Africa are the most common areas of concern for
traveler's diarrhea, but almost any country can be implicated for the unwary. Prevention is to avoid
local water, salads, unpeeled fruits, food from street vendors, and cold toppings such as whipped
Traveler's diarrhea is caused by bacteria most commonly, but can be from a virus or parasite as well.
Physicians will often prescribe medicines that will prevent or treat this illness. These medicines are
very effective and are a must as 50% of tourists to tropical countries come down with this malady.
Persons who develop high fever, prolonged nausea with vomiting, or blood in the stool despite
antibiotics should seek immediate physician attention as it may be typhoid fever.
Malaria has become a serious problem for the tourist to tropical climates. In the past chloroquine was
an acceptable preventative medicine for almost anywhere in the world, but not anymore. It has
become a drug of limited usefulness to most malaria regions because of resistance. Now drugs like
mefloquine, malarone, or tetracycline are necessary for many continents. Mosquitoes have also
developed resistance to DDT so malaria is on the upswing in many tropical areas. It is important for
the tourist or travel agent to seek the advice of an experienced travel physician for antimalarial
prevention for South America, Southeast Asia, and Africa. The number of cases of malaria in tourists
returning to the United States has been increasing - probably due to increased travel and the failure
of prophylaxis from chloroquine, and failure to use insect repellants.
Immunization is of primary importance to prevent many diseases, which the traveler may encounter.
Basic immunizations such as tetanus, rubella (German measles), rubeola (measles), mumps,
influenza, and pneumonia vaccine (Pneumovax) (for those over 50 years of age) should be brought
up-to-date, as all of these diseases are more common in third world countries. Polio vaccine by
injection should be given for certain areas as well if not received in the last ten years. Special
immunizations are necessary for high risk countries such as yellow fever for certain parts of Africa
and South America, and the typhoid vaccine for tropical climates, and Japanese B vaccination for
Smallpox vaccine is no longer needed as this disease has been eliminated worldwide. Cholera
vaccine is ineffective, and is rarely given. Prevention of meningitis with a vaccine is important for
sub-Saharan Africa and occasionally Saudi Arabia, as well as during specific outbreaks.
Hepatitis A (infectious hepatitis) is prevented by giving vaccine and is important for travelers to most
third world countries. Hepatitis B vaccine is needed for persons living in foreign countries for
prolonged periods of time or to health care personnel who will be working directly with patients in a
foreign country. There is now a combination vaccine if both are needed.
Because tourists today are interested in traveling to more out of the way places and in many cases
more dangerous disease areas, it is important for travel agencies who specialize in international
travel to utilize medical travel advice, which is up-to-date. Epidemics in certain foreign countries may
drastically change medical advice from week to week. For example, Hong Kong, which usually is a
very safe place to travel without risk of disease, had a major outbreak of Hepatitis A, which suggests
that Hepatitis A vaccine should have been given to persons traveling there. The ongoing cholera
epidemic in South America suggests that food selection for visitors there is critical to avoid dysentery.
Travel clinics specialize in both preventing illness in travelers and treating unusual diseases that may
be acquired in a foreign country. Travel information is made timely to the travel physician through
computer link-ups which are updated bi-weekly. This allows the physician to be aware of epidemics
as mentioned above and change medical advice to those countries in an efficient manner. An
example of this is an outbreak of resistant malaria (vivax) in New Guinea, which had never been
reported anywhere in the world, making chloroquine a useless preventative there. In its place can be
substituted tetracycline or mefloquine or malarone through a travel physician.
In summary, travel advice for prevention of travel disease is best done by those who are interested in
travel medicine. For the travel advisory clinic at NorthEast Medical Center, call 704-783-1766. It is
located at 200 Medical Park Drive, Suite 280, Concord, North Carolina 28025.
Allen Krusell, MD Sue Garwood, MD W. Lee Fanning, MD Infectious Disease and Travel Medicine Specialists
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