April 2008

By Travis Marshall

It's a big, bad world out there. But hey, that's why you travel far and wide for the best diving, right? To get out on the fringe, past the point where beaten-track travelers stop and look longingly over their shoulders before hightailing it back home. Within reason, seasoned dive travelers rarely let the risk of exotic diseases limit their destination possibilities, and honestly, travel health is just as important in developed areas as undeveloped ones. Whether you travel for business, to visit family or to dive those little-known reefs, any time you travel abroad, knowing what's out there, taking the right preventative measures and accurately managing your risk is a prerequisite for getting to the heart of your destination. And make no mistake, travel health isn't important just for your own personal safety. In a world so small that diseases like SARS and avian flu can go continent-hopping, you need to make sure your health is sorted out beforehand to make sure you're not spreading anything yourself. Read the following 10 steps for a no-hassle guide on getting health-conscious for your next trip:

1 Start researching well before your departure

The Centers for Disease Control and Prevention (CDC) suggests sorting out the medical requirements for your trip at least four to six weeks before shipping out because some vaccinations need time to take effect and others require more than one dose. That's not to say that you should skip this step altogether if you arrange your trip on the fly though. If you have a month, a week or even a day before it's time to go, the best place to start is the "Traveler's Health" section of the CDC web site: cdc.gov/travel. Select your destination from the drop-down menu to find up-to-date local and regional information on disease outbreaks, places to avoid and a list of required or suggested vaccinations and medications. The next stop is a doctor to get specific advice about these treatments. You can check with your primary physician, but he or she may not be completely up-to-date on changes in travel medicine. "A good travel health specialist is trained and certified for travel medicine," says Dr. Fernando Alvarado of Infectious Disease Consultants, a travel health clinic near Orlando, Fla. "And travel clinics generally have more travel vaccines available than the average primary care office." The American Society for Tropical Medicine and Hygiene (astmh.org), and the International Society of Travel Medicine (istm.org) both have extensive listings for travel health clinics worldwide.

2 Get the right jabs for the right place

Many of the vaccines you'll get when you visit a travel health specialist are not for tropical diseases. In fact, one of the first orders of business for a travel health doc is to check that you're up-to-date on many standard vaccinations. Alvarado says as much as 80 percent of adults in the U.S. don't get their booster shots for the vaccines they received as children, and they should--especially when traveling abroad. Measles, for example, has been all but eradicated in the States, but in Europe--even in Great Britain--that's not the case. So, if you're not up-to-date with your measles/mumps/rubella (MMR) shot, you could be at risk even in other highly developed countries. Diptheria/tetanus is another one Alvarado checks for, as well as hepatitis A and B. A yellow fever vaccination is required in most parts of sub-Saharan Africa and tropical South America, and a typhoid fever vaccination may be given if you're traveling to certain parts of Latin America or the Indian subcontinent. Again, specific needs apply to different regions of the world, so make sure you talk with a medical professional with knowledge in travel medicine while planning your trip.

3 A little travel insurance can make a big difference

If you have medical insurance at home, double-check before you go to see what coverage you have outside the States. Many providers don't cover medical expenses abroad, but even if yours does, it may not cover a medical evacuation, which can cost tens of thousands of dollars or more depending on your location. A short-term travel insurance policy can fill in those gaps, and the State Department lists some providers here: travel.state.gov/travel/tips/brochures/brochures_1215.html.

Frequent travelers can find providers that offer an annual membership, or you can get individual trip coverage. If you already have diving insurance from Divers Alert Network (DAN), you've got some travel insurance as well. TravelAssist coverage is part of your DAN membership, and it provides evacuation coverage up to $100,000 per person; visit diversalertnetwork.org to see full coverage details. Make sure to carry copies of the documents from all your pertinent medical coverage.

4 Bring what you need

Depending on your destination, medical supplies, even basic ones like pain relievers or clean bandages, may be in short supply. It's best to bring any medications you'll need along with you. If you need to bring prescription medications on your trip, make sure to pack them in your carry-on luggage in their original bottles. Alvarado recommends also bringing antibiotic soap or alcohol-based hand sanitizer; a wide-brim hat and sunscreen with a sun protection factor of eight or higher; long clothes and bug spray with DEET in a concentration of 20 to 30 percent; sturdy shoes (not sandals); and a phrase book for the language of the country you are visiting in case you have to explain your health problems to a foreign doctor.

5 Avoid the most common ailment among travelers

So-called Montezuma's Revenge, or traveler's diarrhea (TD), is by far the most common travel-associated affliction. The CDC says as much as 50 percent of travelers on a one- to two-week trip will get TD, and ingested bacteria cause 80 to 85 percent of these cases. Using the aforementioned hand sanitizer neurotically and watching what you eat are good ideas anywhere you go. The CDC reports that regular doses of Pepto-Bismol--two ounces of liquid or two chewable tablets, four times a day starting the day you arrive--can significantly reduce your chances of getting TD, even in high-risk areas. Alvarado says he'll often prescribe the antibiotic Cipro for travelers to carry with them--just in case--and taking it for a day or two will often clear up any TD problems. You can also treat TD with loperamide (Imodium). But this physically blocks up your bowels, which can be helpful in rough situations--like a 12-hour bus ride without a toilet--but your body is trying to get rid of nasty invaders, so don't use it for long periods of time.

6 Be picky about your food

Contaminated food and water can carry E. coli, the most common cause of TD, but also giardia and hepatitis A. Only eat well-cooked foods that are still hot and no salads or raw vegetables. Fruits that you've peeled yourself should be fine. "We have a saying: Peel it, cook it or don't eat it," Alvarado says. Also avoid unpasteurized dairy products. Liquids in sealed containers--bottled water, soda, beer--are your best drink choices, but open them yourself and drink from the bottle or can, or from a clean, dry glass. Coffee, tea and anything made with boiling water is good as well. Go without ice if you don't know for certain that it was made with treated water--ditto for local fruit juice. And if the local tap water isn't clean enough to drink, definitely don't use it to brush your teeth.

7 Beat the bugs

There are three major illnesses carried by biting insects in the tropics: yellow fever, dengue fever and malaria. The first line of defense against all three is careful prevention. Use liberal amounts of bug spray--DEET is the most widely used and researched active ingredient, use it in concentrations of at least 20 percent every six hours and every time you get out of the water--wear long clothes during peak bug times, and if you're in a high-risk area and your room doesn't have good screens or AC, sleep under a treated mosquito net. There is a vaccine for yellow fever, and it's required for travel in places where yellow fever is a problem.

Malaria prevention comes in pill form. You should start taking the pills before your trip to make sure there are no serious side effects; then continue taking them for up to four weeks after you return as malaria has a two-week incubation period. "Malaria prophylaxis is necessary when traveling to an endemic area." Alvarado says. "Malaria is real, it can be fatal and there is no vaccine." Malarone is the most common for trips of two weeks or less; for longer trips, Methloquine is the preferred choice. Chloroquine still works in many parts of the Caribbean--much of the malarial world has chloroquine-resistant strains--and it's cheaper than the other options.

Dengue fever is deadly, and it's the biggest bug-borne concern for U.S. based divers because the Caribbean and Central America are common places for this disease to crop up. There are no medical preventatives for dengue fever, just common sense, long clothes and a lot of bug spray.

8 Watch where you swim

When you're out on the dive boat, chances are the water is pretty clean. But in some areas, the water near land or in inland lakes and rivers can be tainted by human or animal waste--especially in developing countries, or in seaside areas where boats may discharge waste in busy harbors. Bacteria and parasites can get into your body through your ears, eyes, nose and mouth or through fresh cuts or scrapes on your body. Don't swim in questionable water with open cuts or scrapes, and avoid swallowing the water or submerging your head.

9 Seeing a doctor abroad? Know how to find a good one

If you're having medical problems on your trip, need immediate care and don't know where to go, you can usually contact the travel health clinic where you did your pre-travel evaluation, or else contact the nearest U.S. embassy or consulate, hotel doctors or even credit-card companies. Again, with DAN's dive insurance, you'll also have access to 24-hour, multilingual, nondiving medical information and assistance, including physician referrals. Health care providers in foreign countries will sometimes require payment in cash or credit card when they provide treatment. If you have applicable insurance coverage, make sure to keep copies of all receipts and documents regarding your treatment abroad.

10 Get checked out when you return to keep small problems from growing large

Sometimes health problems picked up abroad don't show symptoms until after you get back home. "Treatment is necessary after you return if you have a fever, diarrhea, jaundice, muscle or bone aches or any other symptoms that might indicate a tropical disease," Alvarado says. "And if you're going to an emergency room, a phone call to the travel clinic doctor or nurse could provide important information."