Did winter storm Stella get you like, "Later NYC. See you when it's warm again. Baiii!"
Before you grab your passport and venture to warmer weather, schedule a travel consultation to ensure that you're prepared for your trip!
Before You Leave
Questions to consider:
Where are you traveling?
What time of year?
Will you visit rural areas?
Are you pregnant?
Might you encounter wild animals?
A great resource to identify your needs is the CDC's travel website, which lists recommendations by country.
Stay healthy during your trip by anticipating and preventing illness. Purchase what medications you may need before you leave. This is the way to #TravelSmart
Vaccines--whether injectable or oral--are most effective if administered at least two weeks before a potential exposure. So plan ahead!
General Advice Regarding Medications
- Pack all medications in your carry on, never in checked luggage.
- Purchase medications (both over the counter and prescription) before you leave to avoid any communication or availability issues at your destination.
- Take enough prescription medication for the entirety of your trip, plus a few extra days worth in the event that your return is delayed.
- Carry photo copies of all prescription medications with you or have these documents saved on your phone. You may need to provide proof of prescription at the border to a customs agent or at a pharmacy to obtain additional medication. This is especially relevant for any controlled substances, such as anti-anxiety medications like Xanax or anti-pain medications like oxycodone.
- Bring a copy of your vaccination record. Proof of vaccination may be required for entry into certain countries.
Medical Concerns
Medical concerns are specific to the destination country, time of year, planned activities and your medical history. Below is an alphabetized list of common concerns while traveling. Any medication with an asterisk [*] requires a prescription.
Altitude sickness: Acetazolamide*
Are you traveling to an altitude greater than 8,000 feet (2,400 meters)? Will you arrive gradually or will you arrive by plane? Acetazolamide is the drug of choice to prevent altitude sickness: 125mg every twelve hours, beginning one day before arrival and continuing for three days thereafter. If you don't take acetazolamide before symptoms appear, a higher dose is required to treat altitude sickness. For anyone with a sulfa allergy, the steroid Dexamethasone may be the preferred agent.
Allergies: EpiPen* & Benadryl
Are you at risk of anaphylaxis if you encounter certain foods or environmental triggers? Always alert waiters and vendors to your food allergies, and, if possible, obtain this information in the language of your destination to avoid any communication barriers. Don't forget to pack your EpiPen! Benadryl is an over the counter agent effective at quelling most mild allergic reactions; however, this anti-histamine may cause drowsiness, so use with caution.
Cuts: Antibiotic ointment
Cuts and scrapes are common when traveling. Wash the cut with warm water, and soap if available. Apply an antibiotic ointment, then cover with a bandaid. The goal is to prevent a bacterial infection over the cut. Deep cuts may require sutures; proceed to an urgent care center.
Dehydration: Water with Salt and Sugar
Spending lots of time in the sun? Engaging in ample physical activity? Have a case of the runs? Drinking alcohol into the wee hours of the morning? Dehydration can be treated by consuming water with salt and sugar, which are essential to maximizing water absorption in the intestine. Pack rehydration powders which can be mixed with water and consumed orally. If unable to tolerate liquids by mouth, proceed to the nearest hospital for IV hydration.
Diarrhea: Loperamide & Ciprofloxacin*
Imagine squirming during a 12 hour bus ride with the revenge of Montezuma brewing inside you. Diarrhea can be your worst nightmare when traveling. Loperamide is an over the counter medication that provide tremendous symptomatic relief by preventing motility of the intestine thereby reducing diarrhea; however, it does not treat the underlying cause. The antibiotic Ciprofloxacin (500mg every twelve hours) is an effective treatment for moderate to severe traveler's diarrhea.
Hepatitis A: Injectable vaccine*
A nasty virus that attacks the liver, Hepatitis A can present with nausea, vomiting, diarrhea, abdominal pain and jaundice. However, these symptoms, if present, occur weeks after infection. The cause? Consuming food or water contaminated with the feces of an infected individual. Practice good hand hygiene and consume properly cooked food to avoid infection. The injectable Hep A vaccine is given as a two-part series, at six months apart. Vaccine provides protection for 25 years.
Hepatitis B: Injectable Vaccine*
Another virus wreaking havoc on the liver, Hepatitis B is contracted through direct contact with infected blood or bodily fluids (a la sexual intercourse and injectable drug use). The injectable Hep B vaccine is given as a three-part series, over the course of six months. Vaccine provides lifetime immunity, although a booster may be required in the future to increase the level of protective antibodies.
HIV: Condoms, PrEP* & PEP*
Condoms, condoms, condoms; avoid bringing any surprise souvenirs back stateside. For those taking the HIV-prevention PrEP [Pre-exposure prophylaxis] pill Truvada, make sure that you take enough medication for you entire trip (plus a few extra in the event your return is delayed... it may be difficult to obtain this medication overseas). In the event that you have unprotected sex, especially high-risk sex such as with a prostitute or anal receptive sex, consider HIV PEP [Post-Exposure Prophylaxis], which must be initiated within 72 hours to maximize efficacy. Obtaining PEP would likely entail a trip to an emergency room.
Insect bites: Repellent & Hydrocortisone cream
The best way to avoid insect bites is wearing long-sleeved clothing, applying insect repellent and staying within screened or netted areas. Avoid scratching insect bites, which can introduce bacteria from your nails into the skin, resulting in a supra-bacterial infection (in which case, apply an antibiotic ointment). Bring an over-the-counter 1% hydrocortisone cream, which will relieve itching.
Insomnia: Benadryl, Trazodone* & Ambien*
Whether trying to catch some ZZZ's on your flight or adjusting to a significant change of time zones, sleep can be a major issue when traveling. For most, Benadryl can ease you into sleepy time. However, for those taking trans-oceanic flights, a prescription-strength medication may be preferred. Trazodone (50mg) or Ambien (5mg) are both effective sleep aids.
Jet lag: Sunlight
Jet lag is caused by a disturbance to your body's circadian rhythm, often in the setting of rapid east-west or west-east travel. The most effective way to avoid jet lag is to put yourself on the timezone of your destination as soon as you step foot on the plane. This can mean staying up when you would be going to bed or trying to sleep when you would be awake. After arriving at your destination, it's essential to spend time outside and get exposed to sunlight. Sunlight is a zeitgeber, literally "time giver" in German, a sensory input that helps regulate your internal clock. Avoid taking a nap if it's daytime; this will only worsen your jet lag.
Malaria: Malarone* or Mefloquine*
Like Yellow Fever and Zika, the key to preventing malaria is avoiding mosquito bites by wearing long-sleeved clothes, using repellants, and sleeping with mosquito nets. The prophylaxis drug of choice is based on the species of malaria and the antibiotic resistance of the country. Malarone is a daily medication and Mefloquine is a weekly medication. Doxycycline is an alternative daily medication; however, this antibiotic can cause photo-sensitivity, which means it's not ideal for sunny destinations. To find out if you need prophylaxis against malaria visit the CDC's website.
Measles: Injectable Vaccine*
Measles is an airborne virus producing fever and cough followed by a rash beginning on the face then spreading to the rest of the body. The injectable MMR [Measles, Mumps & Rubella] vaccine is usually administered in childhood. However, if you've never been vaccinated and if you're traveling to a location with active Measles infection, strongly consider this injectable vaccine administered as a two-part series, spaced one month apart.
Nausea: Meclizine or dramamine
Motion sickness from planes, boats and land vehicles can be the worst. Take 25-50mg of meclizine one hour before any nausea-inducing activity; benefits will last for 24 hours. Dramamine will also do the trick, but must be dosed every 4-6 hours. If purchasing a different motion sickness medication, ensure that it is the non-sedating formulation. Benadryl will alleviate your sea sickness but will also put you to sleep!
Pain: NSAIDs or Tylenol
Have a headache? Bump your knee? NSAIDs [Non-steroidal anti-inflammatory drugs]--like ibuprofen, Aleve, Motrin--are very effective at reducing inflammation that causes pain. Tylenol [acetaminophen] is an effective alternative, however it doesn't treat inflammation.
Rabies: Injectable vaccine*
Monkeys, dogs and raccoons! Might you encounter a rabid animal during your adventure? Rabies is a life-threatening neurologic disease caused by a virus and transmitted through the saliva of an infected animal. This injectable vaccine is administered as prophylaxis in a three part series, over the course of one month. The rabies vaccine can be successfully administered after infection with the virus if administered within 72 hours from being bitten. Would you be able to get to a hospital within three days of wherever your traveling?
Sunburn: Sunscreen and Aloe Vera
Broad spectrum (meaning both UVA and UVB) coverage of at least SPF 30 will do the trick. Remember to reapply frequently, especially if engaging in water sports. Aloe vera can provide symptomatic relief after sunburn has occurred.
Trauma: seat belts, helmets and travel health insurance
Motor vehicle accidents are the most likely cause of traumatic injury while traveling. Always wear a seatbelt and helmet when available. Ensure that your health insurance provides coverage while out of the country. If it does not, consider purchasing travel health insurance. The best policies will include air evacuation in the event your injury requires immediate intervention.
Typhoid: Oral or Injectable Vaccine*
Typhoid fever is a common diarrheal illness encountered in most regions of the world, except industrialized countries. There are two vaccine options against Typhoid. The oral vaccine [Vivotif] consists of four pills taken every other day over the course of one week and provides immunity for up to five years. The injectable vaccine [Typhim] is a single injection that provides immunity for up to two years.
Yellow Fever: Injectable Vaccine*
Yellow fever is a mosquito-transmitted viral infection. If traveling to a country with Yellow Fever, prevent infection by avoiding mosquito bites and getting vaccinated. The injectable yellow fever vaccine is administered as a single injection. Immunity is generally lifelong.
Zika: Avoid Mosquitos
Currently, there is no vaccine available to prevent Zika. The key to preventing infection is avoiding mosquito bites, the main mode of transmission. Zika can also be spread through sexual contact; condoms can reduce risk of transmission. Pregnant or thinking about getting pregnant in the next 6 months? If so, it's best to delay travel to any areas with known Zika outbreak. Find out if you're traveling to a region with active Zika and read more about the virus on the CDC's website.
Resources
https://www.uptodate.com
https://wwwnc.cdc.gov/travel/destinations/list/
https://wwwnc.cdc.gov/travel/page/pack-smart#travelhealthkit