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INTERNATIONAL TRAVEL HEALTH. Staying Well While Adventuring. Catherine Ebelke PA-C. Montana State University Bozeman Student Health Service. Preparing for Your Travels. Travel Health Class  Travel Packet Travel Health Appointment  Destination issues Personal Health

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international travel health

INTERNATIONALTRAVEL HEALTH

Staying Well

While

Adventuring

catherine ebelke pa c

Catherine Ebelke PA-C

Montana State University

Bozeman

Student Health Service

preparing for your travels
Preparing for Your Travels

Travel Health Class

 Travel Packet

Travel Health Appointment

 Destination issues

  • Personal Health
  • Receive immunizations and prescriptions

 WHO International Certificate of Vaccination

(“Yellow Card”)

 Handouts

 Available any time for questions via phone or e-mail

Yellow Fever Vacc appointment

@ GCHD if needed

other preparations
OTHER PREPARATIONS

 Make copies of important documents and distribute them appropriately

 Determine insurance coverage for illnesses and accidents while abroad

 Consider evacuation insurance

travel kit
TRAVEL KIT

(AKA Stuff Not To Forget…..)

 Prescription Meds

 OTC preparations

 Contacts, more contacts, extra lens solution

 EYEGLASSES!!!

 Sunglasses

 Sunscreen

 Lip protectant w/ good SPF

  • Antiseptic hand wipes / Gel
  • Rehydration salts / Emergen-C
  • Ware purification supplies

 Thermometer

 EpiPen

 Feminine Hygiene Products

 Condoms

 Special lotions, creams, soaps

 Insect repellent (DEET)

  • Permethrin
  • Duct Tape
  • SNACKS!
safety concerns
SAFETY CONCERNS

Accidents are the leading cause of trip interruption, injuries, and death

Pedestrian

 Vehicular

 Bicycle

 Motorcycle / Moped

 Outdoor activities

personal safety
PERSONAL SAFETY

Theft and other personal crimes can occur anywhere (US or abroad) ;

do what you can to decrease your chances of it happening to you

personal safety8
PERSONAL SAFETY

 Travel with at least one other person well known to you

 Do not go out with a stranger

 Make sure others know of your specific travel plans

 Do not travel in places which are known to be dangerous

 Do not wear expensive jewelry or expensive clothes;

try not to “exhibit” your camera, i-pod, wad o’ cash……

 Use a hidden security belt

 Travel with at least one other person well known to you

 Try to look like you know just what you’re doing and where you are going, even if that may not quite be the case

 Keep your wits about you and keep thinking!

awareness
AWARENESS

Local customs / habits / laws

Cultural norms

 Possible lack of safety oversight

Traffic

 Individuals

 Law enforcement

 Infrastructure

rabies
RABIES
  • Virus that is almost 100% fatal
  • There is no treatment for the disease
  • Widespread distribution around the world but much higher in many developing countries
  • Vaccination is in short supply internationally at this time
rabies11
RABIES
  • Try to avoid contact with stray or feral animals (dogs, monkeys, etc)
  • If there is any saliva contact, it is extremely important to wash immediately with soap and water and then to seek medical care to include rabies vaccination ASAP.
  • This is usually a trip-interrupting event - but is of utmost importance
  • Vaccinations are expensive but not painful; series of 5 over a few weeks after initial Ig
substance abuse
SUBSTANCE ABUSE
  • Alcohol, street drugs, unknown substances
  • Leads to higher rates of crimes including violent crimes such as rape
  • You are under the jurisdiction of the country you are visiting
  • VERY RISKY BUSINESS!!!
air travel tips
AIR TRAVEL TIPS

 Stay well-hydrated

 Only small amounts of alcohol and caffeine

 “Travelers Thrombosis”

  • Blood clot that starts in lower leg and can migrate to lungs
  • Exercises
  • Walking around cabin very important
  • Women on estrogen-containing meds at increased risk but everyone can be at risk and needs to consider prevention important
general tips
GENERAL TIPS
  • Stay well-hydrated
  • Try to maintain a good diet
  • Get plenty of exercise
  • Try to get adequate sleep
  • Get health concerns evaluated
immunizations
IMMUNIZATIONS

ARE

AN

EXCELLENT

WAY

TO

PREVENT

MANY DISEASES!

immunizations yellow fever
IMMUNIZATIONS :YELLOW FEVER

The only immunization that can ever be a requirement is Yellow Fever Vaccination

Regions with Yellow Fever include Africa and some South American countries

Cost is approx $100

Vaccination lasts 10 years

Appointment needed for this at GCHD or other facility

immunizations hepatitis a
IMMUNIZATIONS :Hepatitis A

 Transmitted via food and water

 Very stable virus

 Outbreaks common throughout the world

 Vaccination is a series of 2 shots

 Now a recommended vaccination for all

children in the US

 Very highly recommended to all !

immunizations hepatitis b
IMMUNIZATIONS :Hepatitis B

Transmitted via blood, body fluids

 Lifelong very serious disease

 Treatment very difficult, expensive, and

success rates poor

 Vaccination is a series of 3 shots

 Now a required childhood immunization in the US

 Very highly recommended to everyone!

hepatitis c
HEPATITIS C
  • Transmitted via blood
  • Increased risk with tattoos, piercings, barber shop / street shaves, blood transfusions, IV Drug Abuse
  • No vaccine available……prevention very important!
immunizations22
IMMUNIZATIONS

Tetanus / Diphtheria / Pertussis

Within the last 5 – 10 years

Typhoid Vaccination : Oral or Injectable

For developing countries

Meningitis : for certain destinations and situations

Polio : for certain destinations only; one adult booster lasts a lifetime

immunizations23
IMMUNIZATIONS

Occasionally we may recommend:

 Influenza Vaccination

 Japanese Encephalitis Vaccination (3)

 Pre-exposure Rabies Vaccination (3)

 Varicella (chickenpox) (2)

 Pneumococcal Vaccination

 PPD (TB skin test) upon return

sexually transmitted diseases
SEXUALLY TRANSMITTED DISEASES
  • Hepatitis B
  • HIV / AIDS
  • Herpes
  • Chlamydia
  • Gonorrhea
  • Syphilis
  • Genital Warts
  • Others
sexually transmitted diseases25
SEXUALLY TRANSMITTED DISEASES

Studies have shown

that there is greater

sexual promiscuity

and often a “disconnect”

between reality at home

and reality abroad

when traveling internationally

psychological aspects of international travel
PSYCHOLOGICAL ASPECTS OF INTERNATIONAL TRAVEL

International Travel

may uncover

or intensify

underlying psychological or psychiatric

conditions

psychological aspects of international travel27
PSYCHOLOGICAL ASPECTS OF INTERNATIONAL TRAVEL
  • Completely new experience on many levels for most people
  • Homesickness common; loneliness is not unusual
  • Very important to stay in good touch with folks back home as well as being open to new friends; a diverse community of support is vital
  • Reach out to others if you feel they are struggling, or if you are having troubles yourself
for travel to developed countries
For Travel to Developed Countries........

You’re

All

Set !!!

HAPPY TRAILS!!!!!

special considerations
SPECIALCONSIDERATIONS

Food and Water

Borne Illnesses

&

Insect Borne

Illnesses

food and water borne illnesses
FOOD AND WATER BORNEILLNESSES
  • Infectious diarrhea
  • Food poisoning
  • Hepatitis A
  • Typhoid
  • Polio
  • Cholera
  • Others
food and water borne illness prevention
FOOD AND WATER BORNE ILLNESS PREVENTION
  • Wash hands with clean water or use antimicrobial handwipes or hand sanitizer
  • Brush teeth with bottled / clean water
  • Try to use clean, dry utensils and dishes
food and beverage precautions
FOOD AND BEVERAGEPRECAUTIONS

 Cook It

 Boil It

 Peel It…..

 Or Forget It !!!

cook it
COOK IT !

 Eat hot foods piping hot

 Do not eat raw or undercooked foods

 Street vendor food may be risky

boil it
BOIL IT !!!
  • Drink bottled water from sealed bottles
  • Arrange an effective water treatment plan
  • Iodine / chlorine tx + Vit C
  • Drink canned or bottled beverages (juice, soda, beer, wine)
  • Hot drinks are usually OK
  • Avoid ice cubes!
peel it
PEEL IT !!!
  • Buy cleanable fruits at markets, shops, stalls, bicycle vendors
  • Clean thoroughly, dry and then peel, using clean hands and utensils
  • If it can’t be peeled, consider not eating it
travelers diarrhea
TRAVELERS DIARRHEA
  • Experienced by >60 % of travelers during visits to developing countries
  • Causes : primarily bacteria; may also involve viruses, parasites, toxins
  • Sources: fecal contaminated food and water, dirty hands
travelers diarrhea not
TRAVELERS DIARRHEA… not!

Mild Symptoms

  • Increased number of loose stools
  • Feeling fine
  • No treatment necessary
  • Make sure to stay well-hydrated
travelers diarrhea41
TRAVELERS DIARRHEA

Moderate to Severe Symptoms :

 Abrupt Onset

 Many loose to explosive stools

 Occasionally bloody stools

 Body aches, fever, abdominal cramping

 Usually no vomiting

travelers diarrhea42
TRAVELERS DIARRHEA

For Moderate to Severe Symptoms :

 Take antibiotic (Cipro or Azithro) as prescribed

 Rest

 Eliminate caffeine, greasy, spicy foods, and alcohol

 Stay well-hydrated!!!

travelers diarrhea43
TRAVELERS DIARRHEA

The use of bowel paralytics

(Imodium, Lomotil)

is NOT recommended

unless travel without facilities

is essential

travelers diarrhea44
TRAVELERS DIARRHEA

Make sure to get checked out :

 If symptoms do not resolve in a relatively short amount of time

 Significant belly pain

 Vomiting

 Dehydration

food poisoning
FOOD POISONING

Caused by ingested toxins

 Abrupt onset of violent, severe vomiting and diarrhea

 Usually occurs 4 – 12 hours after eating “suspicious” food

 Self-limited; resolves on its own within 6 – 12 hours

!!! Hydrationvery important !!!

typhoid fever
TYPHOID FEVER
  • Food and water borne

bacterial illness (Salmonella)

  • Increased risk in developing countries
  • Vaccination (oral or injectable)

recommended for extended stays, adventurous eating, rural travel

polio
POLIO

‡ Food and water borne virus

‡ Devastating lifelong illness

‡ Outbreaks exist in many parts of the world

‡ One-time adult booster recommended if traveling to those parts of the world with Polio

insect borne diseases
INSECT BORNE DISEASES

 Malaria

 Dengue Fever

 Yellow Fever

 Sleeping Sickness

 Leishmaniasis

 Many others…

insect protection
INSECT PROTECTION

This is the single most important thing to do in areas with insect borne disease !!!

insect protection51
INSECT PROTECTION
  • Avoid exposure at appropriate times
  • Wear protective clothing
  • Wear light colors
  • Always wear shoes and socks
  • Impregnate clothing and netting with Permethrin – soak or spray
  • DEET
  • Avoid perfumes, scented oils etc
  • Use mosquito netting when appropriate
malaria
MALARIA
  • Extremely prevalent worldwide
  • > 300 million cases per year
  • 1 – 3 million deaths per year
  • major public health focus
malaria53
MALARIA
  • Anopheles mosquito bites from dusk to dawn
  • Symptoms include very high fever, body aches, possibly death
  • Antimalarial medications are prescribed to be used preventatively while in malarious area and for a period of time thereafter
  • Illness may occur long after departure from malarious area
malaria54
MALARIA

Very important to remember after possible exposure :

“A fever is

MALARIA

until proven

otherwise”.

yellow fever
YELLOW FEVER
  • Transmitted by a daytime-biting mosquito
  • Very serious, often fatal disease
  • Occurs only in certain parts of the world
  • Vaccination may be required for entering or exiting certain countries
  • International Certificate of Vaccination (“Yellow Card”) becomes official document
  • If vaccination is needed, must schedule at Health Department
dengue fever
DENGUE FEVER
  • Caused by a virus
  • Transmitted by a daytime-biting mosquito
  • Very widespread distribution internationally
  • Incidence increasing significantly
  • Extremely miserable illness
  • No treatment available
  • Insect protection vital
leishmaniasis
LEISHMANIASIS
  • Transmitted by sandflies
  • Symptoms vary with species
  • Very widespread internationally
  • Treatment very long and difficult
  • Prevention includes shaking out towels, clothing, blankets
  • Do not have direct skin- to bare-ground exposure
crawly things
CRAWLY THINGS….. 
  • Lice
  • Crabs
  • Scabies
  • Ticks
  • Spiders et al
  • Creeping eruption…..
  • and oh so many more…
slide59
And

In

Conclusion………………

safe travel tips
SAFE TRAVEL TIPS….

 Don’t get bit

 Don’t get hit

 Don’t get lit

 Don’t do “it”

 Don’t eat s…..

most of all
Most of All…….

Have an

Exciting,

Safe,

and Rewarding

Adventure

Abroad!