World's Worst Travel Diseases (And How To Avoid Them)
Alvaro Rodriguez, flckr
Each year, Americans take more than 300 million trips abroad, and travel to developing countries is on the rise. According to the CDC, an estimated 30-60 percent of travelers visiting developing nations -- over 10 million people every year -- become ill as a result of their trips.
Here, we've outlined seven of the world's worst travel diseases. And while our list is by no means inclusive, it highlights some of the deadliest diseases alongside those that are less dangerous but far more common -- each with an emphasis on what you can do to stay healthy while traveling.
Who's at risk: Transmitted by the bite of the female mosquito, malaria is widespread in many countries of the world, especially in rural or jungle areas: Africa, Asia, (including South Asia, Southeast Asia, and the Middle East), large areas of central and South Americas, parts of the Caribbean, Eastern Europe, and the South Pacific.
What it is: Malaria may conjure up images of mosquito netting and 1940s safari movies, but this deadly disease is certainly not a thing of the past; every year there are 350-500 million cases of malaria worldwide, with around 1 million fatalities. Warning signs include fever and flu-like symptoms, including fatigue, muscle pain, headache, chills. Severe cases can result in seizures, mental confusion, kidney failure, acute respiratory disease syndrome, coma, and death.
Preventive Measures: "Mosquito avoidance" in medical parlance is all-important: wearing long pants, using insect repellent containing 30-50 percent DEET, using bed-netting or better yet, choosing an air-conditioned hotel room, and avoiding exposure at night when mosquitoes are most active.
There are also several preventive drug treatments (chemoprophylaxis) that are available. Your doctor will decide which might be appropriate according to your destination, as some strains of malaria are resistant to certain drug therapies -- the CDC's malaria map details areas of drug-resistance.
Dr. Salvatore stresses the importance of taking malaria prophylaxis. "Some people have the misconception that all 'malaria pills' make you crazy because they have heard of the side effects of larium (mefloquine). However, malarone is well-tolerated and does not have any psychiatric side effects."
Who's at risk: After an epidemic strain of cholera was confirmed in Haiti, the CDC and the United States State Department issued travel warnings for this country, advising U.S. citizens to avoid all non-essential travel to Haiti. A large number of the reported cases of cholera are in a rural area about 50 miles north of Port-au-Prince. While most travelers are not, strictly speaking, at high risk for getting cholera, the size of this outbreak makes all sorts of ordinary activities risky: eating undercooked food (especially seafood), or dining in a restaurant, brushing teeth or drinking beverages (including ice) that may be contaminated.
What it is: Cholera is a potentially fatal bacterial infection that causes severe diarrhea and dehydration that is usually spread by eating or drinking contaminated food or water.
Preventive Measures: When traveling in an area with dubious sanitary conditions, drink only unopened bottled water or canned beverages. Tap water must be boiled or treated with household bleach or chlorine tablets to be considered safe enough to wash food, kitchenware, and food prep areas. Avoid raw foods in general, and eat only fruit and vegetables that you peel yourself. Essential for anyone going to Haiti: water purification tablets, oral rehydration salts and a prescription antibiotic to take for travelers' diarrhea.
Who's at risk: Anyone and everyone, but especially those traveling with others in closed quarters, like on a bus or airplane. Who hasn't been trapped on an airplane with someone hacking away in the next row, or worse, in the next seat?
What it is: Cough, sore throat, fatigue, fever, chills, headache and muscle ache are all symptoms of the flu. It can be difficult to distinguish influenza from other respiratory ailments, and most people recover within a week or two regardless. But the flu can be very serious for young children, with very high fever, pneumonia, diarrhea, and seizures. Older people or those with other serious health problems are also at greater risk.
Preventive Measures: You can take all the vitamin C, zinc, elderberry, and other herbal remedies recommended by your acupuncturist, but the best defense against influenza is getting the flu shot, either from your doctor, a clinic, or from one of the thousands of drugstores across the country that are offering it. Other tips for keeping the flu at arm's length include frequent hand-washing, and always carrying hand-sanitizing wipes or gel. And stay away from shared items like airplane blankets, even if they're available -- it may or may not have been washed.
Who's at risk: While you can develop pneumococcal pneumonia at home, rates are higher in developing countries, and travel may increase your chances of exposure to infected people, (long flights, boat trips, crowded waiting areas, handrails, etc.). In addition to being tiring and stressful, long airplane flights can dry out nasal passages, leaving you more open to infection.
What it is: The most common cause of pneumonia is a respiratory infection caused by Streptococcus pneumoniae bacteria, which can also cause meningitis and bacteremia (an infection of the blood stream) as well as sinus and ear infections. While sinus and ear infections are hardly life-threatening, they can become extremely painful with the pressure changes of airplane travel.
Preventive Measures: The good news is that there is a safe and effective vaccine for pneumonia. "It's really a good idea," advises Dr. Angelo Scotti, an infectious disease specialist formerly with the CDC and now in private practice, "because it protects you against the drug-resistant strains of pneumonia that are out there." For extra protection, avoid alcohol, drink water and try coating the inside of your nose with a nasal moistening gel like Simply Saline or Nose Better to help prevent infection.
Who's at risk: Dengue is widespread in most tropical countries of Asia, the South Pacific, Africa, Central and South America, and the Caribbean. Unlike malaria, though, dengue infections are common in urban areas, as the Aëdes mosquito that carries dengue lives indoors in bathrooms and in cool, dark places behind curtains, under beds or in closets.
What it is: Mosquito avoidance is crucial even if you take anti-malaria drugs, as there are many other mosquito-borne diseases travelers should be aware of, including dengue fever. Though people may be infected with dengue and not become ill, symptoms including fever, headache, back pain, and severe muscle ache may develop in four to seven days.
Preventive Measures: There are no specific drug treatments for dengue, but travelers should avoid mosquito bites by wearing long pants and long sleeves. The afflicted should get bed rest, plenty of fluids, and acetaminophen to control the fever. Aspirin, ibuprofen, and other NSAIDs should be avoided because of their anti-coagulant properties, as about one percent of patients with dengue fever develop dengue hemorrhagic fever (DHF) three to seven days after the fever subsides.
Who's at risk: Every year, the CDC reports that between 30 percent and 70 percent of international travelers develop diarrhea, depending on the destination. Young adults, people taking antacids or acid blockers, and patients with diabetes or inflammatory bowel disease may be at higher risk.
What it is: Diarrhea is just a symptom -- the cause may be any of several fairly common bacteria: E. coli, Campylobacter, Shigella, or Salmonella. TD can also be caused by a virus, such as a norovirus or rotavirus; it can also be caused by a protozoan such as Giardia or Cryptospoidium.
Preventive Measures: If you want to see something of your destination (other than the bathroom at the Sheraton), "Don't drink the water -- anywhere," advises Dr. Scotti. Since contaminated food or water is usually the culprit in "Montezuma's Revenge," drink only sealed, bottled water, and use it to brush your teeth. Avoid raw and undercooked foods. Eat only fruit and vegetables that you can peel yourself. Avoid salads and buffets where food sits out. Opt for meals that are freshly cooked and served piping hot -- even if means skipping that quaint-but-questionable little joint. "Let your guard down once and you have a chance of being infected," says Dr. Scotti.
Even if you take precautions, there are many things beyond your control, such as sanitary conditions in a restaurant kitchen. Some travelers rely on Immodium (Loperamide) but do not take it if you also have a fever and bloody stool. Dr. Scotti prefers Pepto-Bismol (bismuth subsalicylate), "The liquid works better, but the tablets are easier to carry. Don't take Paregoric or anything with codeine in it. Anything that slows down the motility of the gut, may allow the organism to penetrate into the bloodstream."
Your doctor may give you an antibiotic for self-treatment in case of diarrhea. Be sure to avoid dehydration by drinking plenty of liquids -- bouillon and water. After a litany of warnings, Dr. Scotti has one piece of advice most travelers can embrace: "Drink wine. It actually decreases your risk of getting infected."
Who's at risk: Anywhere where there are lots of people in closed quarters, like on a cruise ship.
What it is: While the overall incidence of norovirus infection is relatively small, this gastrointestinal virus spreads easily and causes vomiting and diarrhea which can last two to three very unpleasant days.
Preventive Measures: There is no vaccine to prevent norovirus infection and there is no drug to treat affected people, so travelers must rely on preventive measures -- hand-washing and avoiding contact with infected people or contaminated surfaces.
Norovirus, however is not easily killed by routine cleaning, and requires a thorough sanitizing with a bleach-based cleaner. After several frightening outbreaks on cruise ships, the cruise industry on the whole has responded with improved cleaning procedures and quarantine of infected patients. Check on your cruise ships sanitation inspection record.
Before you go
Get vaccinated four to eight weeks before you leave.
Plan the trip of a lifetime -- China, India, a cruise down the Amazon or an African safari -- now how many people are prepared? Not many, according to Dr. Mirella Salvatore, Interim Medical Director of the Infectious Disease Associates of NewYork-Presbyterian Hospital/Weill Cornell Medical Center in New York City. "The biggest mistake people make is not planning ahead. People come into the clinic and say, 'I'm leaving tomorrow. What should I do?' Many travelers that could have benefited from vaccinations have to go unprotected, because there is not enough time. Some antibodies take weeks to develop."
Choose your destinations wisely.
For older people or anyone with other health issues, check with a physician before you even book a trip to a high-risk destination. "A patient may decide to go to a place where yellow fever is endemic," reports Dr. Salvatore, "But yellow fever is a live vaccine, with a higher risk of side effects for older people with health problems. People who are immuno-compromised could have chosen a less challenging destination."
It's all in the details.
When you see your doctor, bring a record of previous vaccinations and a detailed itinerary. As an example, for one traveler to Brazil, headed for Carnaval in Rio de Janeiro, the biggest health risk may be STDs; for a backpacker intent on visiting Iguaçu Falls, yellow fever, hepatitis, malaria, typhoid, and even rabies may be dangers. Depending on your destination, some other vaccines to discuss with your doctor include: typhoid, meningitis, Japanese encephalitis. Keep a record of all vaccines and keep it with your passport.
Don't be stingy.
Dr. Ronald Primas, the Medical Director of NY Hotel Urgent Medical Services, has seen travelers before they leave on a trip -- and after things go wrong. "The people that I treat who get into the most trouble are the most frugal" -- in other words, those who may not want to spend money on the recommended drugs or vaccinations. Dr. Primas also cautions, "The #1 reason people cancel a trip or return home early is a dental emergency. See the dentist before you leave, and pack a dental emergency kit."
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