When Traveling Internationally, Infectious Disease Expert Says to Err on the Side of Caution

“Remember that most diseases are transmitted by food, water and insects,” says John A. Sellick, Jr., DO, University at Buffalo associate professor of medicine and hospital epidemiologist at Veterans Affairs Western New York Healthcare System. “So get vaccinated, keep insects off you as much as possible and be careful with what you put in your mouth.”

Sellick is a member of the Infectious Diseases Division of the UB School of Medicine and Biomedical Sciences. He also is staff physician at the UB Student Health Services, where he counsels UB students on staying healthy while traveling, whether they are studying or volunteering abroad or they are international students going home for a visit.

“Many providers will tell you that most international travel is no big deal and requires no special precautions,” says Sellick, “but I always have some students who come back to UB with infections after traveling abroad. Most are not life-threatening but why take the chance?”

Most physicians in the U.S. have no reason to stock vaccines that will rarely be used, he notes. That’s why Sellick recommends that people contemplating international travel should contact a travel clinic. The clinics specialize in providing appropriate immunizations and counseling about precautions and risks in specific regions of the world.

“If you’re staying in a five-star hotel downtown, the risks may be lower but they still exist,” he says. “The risks go up considerably if you’re traveling to a remote region or hiking in the rainforest. People who hike the Inca Trail in Peru will be about 10,000 feet above sea level. At those altitudes, they don’t have to worry about malaria but they do need to take precautions against acute mountain sickness, which can strike if the ascent is taken too quickly.”

While pre-travel medications may be prescribed to prevent malaria, there are no vaccinations or medications available to prevent other insect-borne illnesses, such as dengue and chikungunya fever, which are widely distributed in tropical areas. To prevent these illnesses, Sellick advises travelers to use insect repellant containing DEET (35-50 percent) and to cover their skin as much as possible. It also may be advisable to treat clothing with permethrin, an insect repellant, or to purchase clothing that has been pre-treated with it. If sleeping quarters are not screened-in, he says that a bed net treated with permethrin should be used.

Even those traveling to major tourist destinations in the Caribbean and Latin America, locations where many UB students travel to volunteer, should check with a travel clinic, Sellick says.

“Outside of the U.S., Canada, western Europe, Japan, Australia and New Zealand, hepatitis A and typhoid fever are present in much of the world,” Sellick adds. Both are typically spread by contaminated food and water.

“If students are going to Hispaniola (Haiti and the Dominican Republic) or Mexico, I make sure they are vaccinated against hepatitis A and typhoid fever, as recommended by the Centers for Disease Control and Prevention,” he says. Malaria also is present in most of Hispaniola and some areas in Mexico.

“I tell our students who travel to these areas: ‘Do not put a drop of local water in your mouth,’” he says.

Along with hepatitis A virus and typhoid bacteria, many other infectious agents are transmitted by water.

“Consume only boiled, bottled (major brand) or carbonated beverages,” Sellick says. Freezing does not kill infectious agents so do not drink anything with ice.

“In most cases, you won’t die from typhoid fever but it can cause severe illness,” Sellick says. “The best thing to do is get vaccinated. That’s especially important if you are taking immunosuppressing drugs, such as steroids, or medications for rheumatoid arthritis, because in those cases, typhoid fever could be lethal.”

Sellick sums it up: “Go on your vacation. Have a great time. Don’t come back sick.”

Source: University at Buffalo