Travel Medicine
Medical Author: Mary Nettleman, MD, MS
Coauthor: Kara Jacobs, MPH
Medical Editor: Melissa Conrad Stöppler, MD
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Flying with the Greatest of Ease
Carry-On Baggage Tips
Medical Author: Melissa Conrad Stöppler, MD
Medical Editor: William C. Shiel Jr., MD, FACP, FACR
 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.
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Why should travelers see a physician before they leave?
Travelers should see a physician before leaving for a trip if they are going
to developing countries, going off the usual tourist routes, or if they have
chronic diseases that could be affected by travel. Travelers should protect
themselves against common diseases that may be mild but that will disrupt their
trip as well as protecting themselves against less common diseases that may be
serious or even fatal. Some foreign countries require certain vaccinations
before they will allow the traveler to enter the country. 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 if indicated). No
vaccinations are required for re-entry into the United States for foreign
travelers.
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 seatbelts if available both at
home and when traveling.
This review will only 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. It
occurs when infectious organisms are ingested by travelers, resulting in one to five
days of loose stools. The stools are often watery and may be accompanied by
abdominal cramps. Up to half of travelers to developing countries will get
traveler's diarrhea. 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 itinerary. 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 are
ingested. It can be spread through contaminated food or water, or by putting
contaminated hands in the mouth. Even small amounts of contamination can cause
disease.
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 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 many people
will still 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 and start taking it if they get symptoms. Bismuth subsalicylate
is also helpful.
Many physicians also recommend that travelers carry along an antibiotic to
take in case they get diarrhea. Fluoroquinolones, azithromycin, or rifaximin are
those that are often used. Because organisms are developing resistance, many of
the older antibiotics do not work well. If an antimotility agent 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.
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