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Written by Dr.Swati Rajagopal

More people are traveling internationally than ever before. This is acting as a double aged sword. On one hand, it enhances global economy and leaves an individual with pleasant experiences. On the other hand, it could expose an individual to infectious agents, injuries related to transportation and certain activities like diving or high altitude hiking.

Fortunately, most travel-related health problems can be prevented with a combination of pre-travel planning, immunizations, and safety precautions during travel. For people who are planning travel outside of their home country, an infectious disease expert should be consulted at least one month prior to traveling. The provider can give immunizations, travel medications, and tips for staying healthy during the trip.

Pre travel information: The first step prior to travel planning is to consult the infectious disease specialist. Detailed history regarding the general health condition of individual is obtained. This is particularly important while planning a trip for individuals who have weakened immune systems as in post transplant individuals.

Certain important points are recorded on this initial visit:

Duration of travel

Season of travel

Countries and regions that will be visited

Planned activities during travel

Place of residence during travel (for example, rural/camp)

Travel medicine-Tips

Part A: Infections

1] Food/Water borne infections: Diarrheal disease in travelers may be caused by a variety of bacterial, viral, and parasitic organisms, which are most often transmitted by food and water. More than 90 percent of illnesses in most geographic areas are caused by bacteria; the most common organism is enterotoxigenic Escherichia coli (ETEC).

Risk factors:

Weak immune systems

Improper storage and handling of food

Cross contamination of food

Transmission of pathogens through food handlers.

Etiology: Bacteria, viruses and parasites act as pathogens.

Pathogens causing travelers’ diarrhea

Bacteria

Enterotoxigenic Escherichia coli

Enteroaggregative E. coli

Campylobacter jejuni

Salmonella species

Shigella species

Clostridium difficile

Vibrio parahaemolyticus (V. cholerae less common)

Viruses

Rotavirus

Enteric adenovirus

Parasites

Giardia lamblia

Cryptosporidium parvum

Entamoeba histolytica (not common)

Symptoms:

Common symptoms include nausea, vomiting, abdominal pain, diarrhea, and fever

Treatment:

Maintenance of hydration

Antibiotics

Antimotility agents – Their use should be discouraged as they only control symptoms, but do not destroy the pathogens.

Doctors tips: Prevention:

Educated choices in selecting food and drinks is prudent

1. Freezing does not kill the organisms that cause diarrheal disease. Thus, ice in drinks is not safe unless made from adequately boiled or filtered water.

2. Outbreaks of diarrheal disease have been associated with bottled water. In most situations, boiling water is the simplest solution in places with poor sanitation and hygiene.

3. Fruit salads, lettuce, or chicken salads are examples of unwise food choices; the ingredients may have been improperly washed and/or may have been sitting for some time without proper refrigeration.

Do’s and Don’ts of water borne infections:

Do not drink or brush the teeth with unboiled tap water.

Do not drink beverages that contain ice made from unboiled tap water.

Drink only boiled tap water, drinks made from boiled tap water

While bottled water is safer than unboiled tap water, the source of the water and bottling conditions are not standardized; thus, other drinks are probably safer than locally bottled water

Tips to reduce risk of food borne infections:

Do not eat unpeeled fruit. Peel any fruit yourself before eating it.

Do not eat raw vegetables

Do not eat or drink unpasteurized (“raw”) dairy products

Do not eat raw or rare meat, fish, or shellfish (including ceviché)

2] Insect and arthropod bites: In certain parts of world, insects like mosquitoes, fleas, bugs and lice, arthopods like ticks and mites can transmit infections like malaria.

Malaria is caused by mosquito- Female anopheles mosquito. The life cycle is complex and is transmitted to man by the bite of the mosquito.

The epidemiology is varied and guidance of an infectious disease specialist is important on deciding about malaria prophylaxis.

Symptoms: Include fever, chills, sweats, headache, myalgias, fatigue, nausea, abdominal pain, vomiting, diarrhea and cough.

Travel advice: A visit to travel medicine clinic would provide an individual with information regarding:

Advice about malaria- Symptoms and signs of the infection.

Guidance on mosquito avoidance- By insect repellants and personal protection

Chemoprophylactic medications like chloroquin, mefloquin, doxycyline etc.

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