Tips for International Travel

Am Fam Physician. 2016;94(8):online

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Accidental Injuries

Accidental injuries, including motor vehicle crashes and drowning, are the most common causes of travel-associated deaths in people traveling outside of the United States.

To reduce your risk of an accident:

Use seat belts whenever possible.
Avoid riding on motorcycles and motor scooters. If you do ride them, wear a helmet.
Don't ride in the back of a truck or on the roof of a bus.
Stay off the roads at night or during bad weather.
To prevent drowning, learn to swim and use a life jacket when in the water. Don't go into the water after drinking alcohol, and become familiar with local surf conditions. You should enter any body of water feet first.

Immunizations

Ask your doctor about what vaccines you need before traveling. You should be up to date on the routine vaccines that everyone gets. You may also need extra vaccines, like typhoid fever, yellow fever, Japanese encephalitis, and rabies. Your doctor can decide which vaccines you need based on where you are going, how long you are staying, and what activities you plan to do.

Diseases Spread Through Insect Bites

Malaria is a life-threatening illness. You can get it in some tropical countries from mosquitoes. Symptoms include fever, sweats, and chills. To prevent malaria, travelers should take a medicine called an antimalarial when going to places where malaria is present. Your doctor can prescribe an antimalarial.

Some other diseases caused by insect bites are dengue fever and Zika virus. Dengue fever is becoming more common, and there is no vaccine in the United States. Symptoms include fever and joint pain.

To lower your risk of insect bites:

Use an insect repellent. The best repellents have 20% to 50% DEET or 20% picaridin. Oil of lemon eucalyptus and IR3535 are also effective. Insect repellent should be applied two or three times a day. Put it on skin not covered by clothes, but don't use it under your clothes.
Wear clothes treated with the insect repellent permethrin. One application of permethrin will protect you from mosquitoes for more than a month, despite washing your clothes multiple times. Use on outer clothing, but not on underwear.
Sleep under a bed net that has been treated with permethrin. This isn't as important if you are staying in a room with air-conditioning. The risk of malaria isn't as high if the temperature is kept cool.
Wear long sleeves and pants, and tuck your pants into your socks.
Wear closed-toe shoes.

Traveler's Diarrhea

Traveler's diarrhea is the most common illness in travelers to poor countries. Symptoms include diarrhea and stomach cramping. Travelers are often told to avoid drinking tap water and not eat ice, food from street stands, or raw food while traveling. This has not been proven to prevent traveler's diarrhea. The best way to keep from getting sick is to wash your hands often. You can use soap and water or hand sanitizer.

Traveler's diarrhea usually gets better without medicine after three to seven days. Your doctor may prescribe an antibiotic to bring with you on your trip. The antibiotic can make you feel better sooner, but you should take it only if you get severe diarrhea. If you have “warning signs” with the diarrhea, like a fever, blood in your stool, or bad stomach pain, you should see a doctor. If you have diarrhea without warning signs, you can take loperamide (one brand: Imodium) to feel better.

Other Tips

Many international travelers have new sex partners while traveling. It is important to practice safe sex by using latex condoms.
Travelers who will be out in the sun, especially those with fair skin, should use sunscreen that is SPF 15 or higher and protects against UVA and UVB rays. Put sunscreen on first, then an insect repellent. Don't use sunscreen that also has insect repellent in it.
To help prevent theft, put important items (like money, credit cards, or your passport) in a money belt. This can be worn around your neck or waist, under your clothes.
Although serious crimes against American travelers are rare, you can keep track of government warnings about dangers in other countries by going to http://www.travel.state.gov/content/passports/en/alertswarnings.html.
If you get very sick or hurt, it can cost many thousands of dollars to get treatment overseas and for transportation back to the United States. Many companies offer travel medical insurance to help cover the costs. Three examples are Medex, International SOS, and Divers Alert Network.