Mary D. Nettleman, MD, MS, MACP is the Chair of the Department of Medicine at Michigan State University. She is a graduate of Vanderbilt Medical School, and completed her residency in Internal Medicine and a fellowship in Infectious Diseases at Indiana University.
Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
The imposition of stricter security measures for commercial airline passengers following the Aug. 10, 2006, arrests of individuals engaged in a terrorist plot to bomb U.S.-bound planes from Britain has left many travelers wondering how to manage their health conditions while traveling. The following tips may help those who are concerned about health issues when traveling by air:
Remember that prescription medications are allowed in carry-on bags,
with some restrictions. Prescriptions must be in their original pharmacy
container labeled with the name of the passenger. Be sure that the name is
the same as on your ticket. Don't combine your medications into one bottle;
take each type of medication in its own labeled bottle. Place all
medications in a plastic bag for ease during security screening.
Nonprescription medications are also allowed, but remember to take these in their original containers, too. Take small packages containing the amount of medication you might reasonably expect to need while traveling—family-size bottles containing 500 tablets may be even considered suspicious.
Why should travelers see a physician before they leave
on a trip?
Travelers should see a physician before leaving for a trip if
they are going
to developing countries,
they are visiting sites that are not on the usual tourist routes or traveling to high altitudes,
they have
chronic diseases that could be affected by travel,
they are visiting countries that require vaccinations before they allow travelers to enter the country.
The goal of a pre-travel medical evaluation is to help travelers protect themselves against
(1) common diseases that may be mild but that will disrupt their trip, and (2) less common diseases that may be serious or even fatal. All travelers need to be up to date on routine vaccines they would normally get if they were not traveling. For example, an annual influenza vaccination (flu shot) is recommended if traveling during influenza season. Travelers should also be up to date on tetanus vaccines. If a tetanus booster is needed, your physician may elect to use the Tdap vaccine that also provides continuing protect against adult pertussis. No vaccinations are required for re-entry into the United States after travel.
What diseases occur in travelers, and how can disease be prevented?
Travelers can pick up infections from contaminated food or water, from insect
bites, animal bites, or from other people. Vaccinations, medications, and simple
precautions can reduce or eliminate the risk of many of these travel-related
infections. While infections are the most common problem for travelers, it is
important to remember that the most common cause of death in travelers is motor
vehicle accidents. Be sure to look both ways before crossing the street, don't
get in the car if the driver is drunk, and use seat belts if available both at
home and when traveling.
This review will cover diseases commonly encountered by travelers or
those for which vaccinations are recommended. For a more complete discussion,
please refer to the CDC travel medicine web site (http://www.cdc.gov).
Traveler's diarrhea
Traveler's diarrhea is the most common medical complaint in travelers, occurring in up to 50% of travelers to developing countries. It occurs when infectious organisms are inadvertently ingested by travelers, resulting in one to five days of loose stools. The stools are often watery and may be accompanied by abdominal cramps. Although not fatal, traveler's diarrhea can cause
dehydration, vomiting, low-grade fever, and discomfort to the point that some
travelers have to change their itineraries. It is important to note that traveler's diarrhea is not associated with bloody stools, severe abdominal pain,
or high fever. These symptoms are suggestive of more serious conditions and
should prompt medical attention.
Traveler's diarrhea is spread when bacteria or other infectious agents such as viruses are ingested. Traveler's diarrhea is most often spread through contaminated food or water, or by putting contaminated hands in the mouth. Even small amounts of contamination can cause infection. Although bacteria are the most common cause of traveler's diarrhea, there have been outbreaks of diarrhea on cruise ships caused by noroviruses. Noroviruses are very small (only visible on ultrathin-section electron microscopy) and spread readily from person to person.
Travelers can get diarrhea in most areas of the world, but some countries
pose a higher risk. High-risk areas include most of Asia, the Middle East,
Africa, and Central and South America. Risk is increased if the traveler is
adventurous with his or her diet, eats
foods from street vendors, or travelers to
areas off the usual tourist routes.
Protective measures may help prevent or shorten the duration of traveler's diarrhea. All travelers should wash their hands often and understand basic food and water precautions (see below). However, it has been shown that even well-informed travelers often choose to eat foods that pose an increased risk of traveler's diarrhea. Therefore, travelers at risk should carry along an antimotility agent such as loperamide (Imodium; Kaopectate II; Imodium A-D; Maalox Anti-Diarrheal Caplets; Pepto Diarrhea Cont) and start taking it if they get symptoms. Bismuth subsalicylate
(Pepto-Bismol)
is also helpful.
Many physicians also recommend that travelers carry along an antibiotic to take in case they get diarrhea. Fluoroquinolones are the most commonly prescribed antibiotic; azithromycin (Zithromax, Zmax) or
rifaximin (Xifaxan) are alternatives. Because bacteria are developing resistance to many antibiotics, many of the older antibiotics do not work well. If an antimotility agent (a drug that reduces gastrointestinal motility) and an antibiotic are started at the first sign of diarrhea, symptoms may be shortened to only a few hours instead of a few days. In rare cases, physicians might prescribe daily antibiotics or daily bismuth subsalicylate to prevent diarrhea, but this is not needed for most travelers. Affected people should stay hydrated.
Pregnant women and children need special advice because many of these drugs are
not appropriate for them.
Dengue fever is contracted from the bite of a striped Aedes aegypti mosquito. Symptoms of dengue include headache, fever, exhaustion, severe joint and muscle pain, rash, and swollen glands. Since dengue is caused by a virus, there is no specific medicine to treat it. Treatment instead focuses on relieving the symptoms.
Chiggers are a mite belonging to the Trombiculidae family. Chiggers are most commonly found in grassy fields, gardens, parks, forests, and moist areas around lakes or rivers. Contrary to popular belief, chiggers do not burrow into the skin. Chiggers insert a feeding structure into the skin and inject enzymes that destroy host tissue. The chiggers then feed on this dead tissue. The most common symptom of a chigger bite is itching. Treatment generally includes antihistamines and calamine lotion.
Blood clots can occur in the venous and arterial vascular system. Blood clots can form in the heart, legs, arteries, veins, bladder, urinary tract and uterus. Risk factors for blood clots include high blood pressure and cholesterol, diabetes, smoking, and family history. Symptoms of a blood clot depend on the location of the clot. Some blood clots are a medical emergency. Blood clots are treated depending upon the cause of the clot. Blood clots can be prevented by lowering the risk factors for developing blood clots.
Gastroenteritis (viral gastroenteritis, stomach flu) is an infection caused by a variety of viruses that results in vomiting and/or diarrhea. Even though it is often called the "stomach flu," it is not caused by the influenza viruses. Viruses that can cause gastroenteritis (stomach flu) include: rotaviruses, adenoviruses, caliciviruses, astroviruses, Norwalk virus, and a group of Noroviruses. Gastroenteritis is not caused by bacteria. The main symptoms of gastroenteritis include vomiting and watery diarrhea, however, headache, fever, and abdominal cramps (stomach ache) may also be present.
Typhoid fever is an illness caused by the Salmonella typhi bacteria. The illness is contracted by ingesting the bacteria in contaminated water or food. Symptoms include headaches, fever, diarrhea, lethargy, aches and pains, and poor appetite. Treatment focuses on killing the Salmonella bacteria with antibiotics.
The Eustachian tube is a membrane lined tube that connects the middle ear space to the back of the nose. Problems include partial or complete blockage which can cause popping, clicking, and ear fullness. Allergies, sinus and ear infections, or the common cold can cause this blockage, while altitude changes can cause symptoms in those persons with Eustachian tube problems. Treatment includes several maneuvers (swallowing, chewing gum, yawning etc.), which can be done to improve Eustachian tube function.
Malaria is an infectious disease transmitted by the bite of an infected Anopheles mosquito. Symptoms of malaria include chills, pain, fever, and sweating. Though mild cases of malaria can be treated with oral medication, severe cases require intravenous drug treatment and fluids.
The hepatitis B virus is a unique, coated DNA virus belonging to the Hepadnaviridae family of viruses. The course of the virus is determined primarily by the age at which the infection is acquired and the interaction between the virus and the body's immune system. Successful treatment is associated with a reduction in liver injury and fibrosis (scarring), a decreased likelihood of developing cirrhosis and its complications, including liver cancer, and a prolonged survival.
Giardiasis (Giardia lamblia) is a parasite responsible for a common form of infectious diarrhea. The parasite lives in two stages: trophozoites and cysts. People at risk for giardiasis are those that live in areas where there is inadequate sanitation or treatment of drinking water. Giardiasis also is a common cause of outbreaks of diarrhea in day-care centers. Symptoms of giardiasis include abdominal pain and cramping, bloating, nausea, and fatigue. Treatment for giardiasis is with antibiotic medication.
Inflammation of the inner lining of the colon is referred to as colitis. Symptoms of the inflammation of the colon lining include diarrhea, pain, and blood in the stool. There are several causes of colitis including infection, ischemia of the colon, inflammatory bowel disease (Crohn's disease, Ulcerative colitis, or microscopic colitis). Treatment depends on the cause of the colitis.
Leprosy (Hansen's disease) is a disfiguring disease caused by infection with Mycobacterium leprae bacteria. The disease is spread from person to person through nasal secretions or droplets. Symptoms and signs of leprosy include numbness, loss of temperature sensation, painless ulcers, eye damage, loss of digits, and facial disfigurement. Leprosy is treated with antibiotics and the dosage and length of time of administration depends upon which form of leprosy the patient has.
There are many types of E. Coli (Escherichia coli ). Pathogenic E. coli can cause urinary tract and bladder infections, or lead to sepsis. E coli O157:H7 (EHEC) causes bloody diarrhea and colitis. Complications of E. coli infection include hemorrhagic diarrhea, hemolytic-uremic syndrome, and thrombotic thrombocytopenic purpura. Symptoms include severe abdominal pain and bloody diarrhea. E coli O157:H7 commonly is due to eating raw or undercooked hamburger or raw milk or dairy products.
Hepatitis is most often viral, due to infection with one of the hepatitis viruses (A, B, C, D, E, F (not confirmed), and G) or another virus (such as those that cause infectious mononucleosis, cytomegalovirus disease). The main nonviral causes of hepatitis are alcohol and drugs. Many patients infected with hepatitis A, B, and C have few or no symptoms of illness. For those who do develop symptoms of viral hepatitis, the most common are flu- like symptoms including: loss of appetite, nausea, vomiting, fever, weakness, tiredness, and aching in the abdomen. Treatment of viral hepatitis is dependant on the type of hepatitis.
Bird flu (avian flu, avian influenza) infection in humans may result from contact with infected poultry. There is a vaccine to prevent human infection with the H5N1 strain of the avian flu virus.
Motion sickness, often referred to as car sickness, sea sickness, or air sickness, is a very common disturbance of the inner ear that is caused by repeated motion. The cause of motion sickness is complex. Symptoms of motion sickness include vomiting, nausea, dizziness, vertigo, sweating, and a feeling of malaise. Treatment of motion sickness include antihistamine medications such as meclizine (Bonine, Antivert, Dramamine), and scopolamine (Transderm Scop) a skin patch.
Jet lag (desynchonosis) is a temporary disorder that results from travel across time zones. Symptoms include anxiety, constipation, headache, nausea, dehydration, diarrhea, confusion, sweating, irritability, and even memory loss.
Ticks are known transmitters of disease to humans and animals. Tick-borne diseases include Lyme disease, Rocky Mountain spotted fever, Q fever, tularemia, babesiosis, and Southern tick-associated rash illness. Infected ticks spread disease once they've bitten a host, allowing the pathogens in their saliva and mouth get into the host's skin and blood. Tick bites are typically painless, but the site of the bite may later itch, burn, turn red, and feel painful. Individuals allergic to tick bites may develop a rash, swelling, shortness of breath, numbness, or paralysis. Tick bite treatment involves cleaning and applying antibiotic cream.
Cholera is an infectious disease characterized by intense vomiting and profuse watery diarrhea and that rapidly lease to dehydration and often death. Cholera is caused by infection with the bacteria Vibrio cholerae, which may be transmitted via infected fecal matter, food, or water.
Travelers' diarrhea is generally contracted by eating contaminated food or drinking contaminated water. Food is the primary source of travelers' diarrhea. Enterotoxigenic E. coli is the cause of up to 70% of all cases of travelers' diarrhea. There are five unique classes of E. coli that causes gastroenteritis. Other bacteria responsible for travelers' diarrhea include
Campylobacter, jejuni, shigella, and salmonella. Viruses such as rotavirus and Norwalk virus (norovirus) and giardia lamblia a parasite may cause travelers' diarrhea. Prevention is careful eating and drinking of water.
Trichinosis is a food-borne disease caused by ingesting parasites (roundworms) in undercooked pork or wild-game meat. Symptoms of trichinosis include diarrhea, nausea, muscle aches, itching, fever, chills, and joint pains. Trichinosis usually resolves without treatment, but more severe cases are treated with thiabendazole, albendazole, or mebendazole.
Hyperthermia is the overheating of the body. Heat-related illnesses like heat stroke, heat exhaustion, heat cramps, heat rash, and sunburn are all hyperthermia conditions. Treatment of these conditions depends upon the condition, environment, and circumstances. Heat stroke is a medical emergency, and may result in death if not treated promptly. Heat exhaustion may lead to heat stroke if not treated properly.
Shigellosis is a disease caused by the Shigella bacteria. Bloody diarrhea, stomach cramps and fever are common symptoms. Mild infections usually resolve on their own. Antibiotics are used to treat more severe cases.
Hepatitis means inflammation of the liver. Hepatitis A is one type of liver disease caused by a virus. Since hepatitis A is a virus, it can pass from person to person from eating or drinking contaminated food or coming into contact with contaminated materials containing the virus. Symptoms of hepatitis A include stomach pain, diarrhea, dark yellow urine, jaundice, and more. There is a vaccine to prevent contracting hepatitis A.
Hepatitis A and hepatitis B are the two most commnon viruses that infect the liver. Hepatitis A and Hepatitis B can be prevented and treated with immunizations (vaccinations) such as Havrix, Vaqta, Twinrix, Comvax, Pediarix, and hepatitis b immune globulin (HBIG).
Cryptosporidiosis is an intestinal disease caused by the Cryptosporidium parasite. Symptoms include watery diarrhea, stomach cramps, nausea and vomiting, fever, weight loss, dehydration, and weight loss. Antibiotics are used in the treatment of cyptosporidiosis.
Yellow fever is an infectious disease transmitted by infected mosquitoes. Side effects are rare with the yellow fever vaccine. Symptoms include fever, chills, back pain, nausea, vomiting, and headache. Treatment is aimed at relieving symptoms.
Yaws is an infectious disease that mainly occurs in the tropical areas of South and Central America, Asia, Africa, and the Pacific Islands. The disease is caused by a bacterium called Treponema pertenue, which causes lesions that look like bumps on the skin of the feet, hands, face, and genital area. Yaws is treated with penicillin or another antibiotic.
Monkeypox is a viral disease that causes symptoms such as fever, sweating, and a rash with papules and pustules on the face and chest. PCR, ELISA, or Western blot tests are used to diagnose monkeypox. Treatment usually involves administering a smallpox vaccination, cidofovir, and possibly vaccinia immune globulin.
Viral hemorrhagic fever(s), or VHFs are a group of illnesses caused by distinct families of viruses. Many of these viruses are life-threatening, and classified as biosafety level four (BSL-4) pathogens. Viral hemorrhagic fever viruses are caused arenaviruses, filoviruses, bunyaviruses, and flaviviruses. The viruses are carried in rodents and transmitted through urine, fecal, saliva, or other body excretions from the infected rodents. Symptoms of viral hemorrhagic fever include marked fatigue, dizziness, muscle aches, loss of strength, fever, and exhaustion. Severely ill patients may also suffer shock coma, seizures, delirium, kidney failure, or nervous system malfunction. There is no established cure for viral hemorrhagic fever.
Cholera is an acute infectious disease caused by a
bacterium, Vibrio cholerae (V. cholerae), which results in a painless, watery
diarrhea in humans. Some affected individuals have copious amounts of diarrhea
and develop dehydration so severe it can lead to death. Most people who get the
disease ingest the organisms through food or water sources contaminated with V.
cholerae. Although symptoms may be mild, approximately 5%-10% of previously
healthy people will develop a copious diarrhea within about one to five days after
ingesting the bacteria. Severe disease requires prompt medical care. Hydration
(usually by IV for the very ill) of the patient is the key to surviving the
disease.
The term cholera has a long history (see history section below) and
has been assigned to several other diseases. For example, fowl or chicken
cholera is a disease that can rapidly kill chickens and other avian species
ra...