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Protecting Your Family Against Travel-Related Illness The trip of a lifetime, be it a romantic honeymoon or the momentous journey taken at the beginning of retirement, requires time and planning. Unfortunately for many travelers, unplanned illness can derail the best of vacations. A study from the Journal of Travel Medicine found that one-third of travelers to developing countries and Eastern Europe experienced some form of illness during the trip. With 45 million Americans traveling abroad each year, travel-related illness is a topic of greater focus. One study showed that on a variety of two-week trips, travelers lost an average of three days to illness. While diarrhea and upper respiratory infections are the most commonly reported conditions, one-half of deaths in U.S. travelers result from cardiovascular disease and more than one-quarter result from accidents. Assessment Before Travel Abroad The key to health care for traveling abroad is planning ahead, says Alexander Kisch, M.D., Section Chief of Infectious Diseases for the Department of Medicine at Saint Barnabas Medical Center. "By visiting a physician at least six weeks before departure, the traveler can allow the necessary time for initial or booster immunizations, such as tetanus, hepatitis, measles, mumps, rubella, polio and influenza, to provide the highest protection," says Dr. Kisch. For those with an ongoing health problem, medications should be gathered to last the length of the trip and beyond in case of delay. Travelers should carry extra prescriptions for medicine and eyewear and find out about health insurance coverage if a visit to a physician abroad is required. The American Embassy or Consulate can usually provide names of hospitals, physicians or emergency medical service agencies. Dr. Kisch emphasizes that travelers should take the appropriate physician-prescribed preventive medicine beginning before departure, during the trip and for four weeks after returning home. Travelers' Diarrhea Travelers' diarrhea is acquired through ingestion of contaminated food or beverages. Risky foods include raw or undercooked meat and seafood, raw fruits and vegetables, tap water, ice and unpasteurized dairy products. Steaminghot, well-cooked food is usually safest, and risk is often highest for food obtained from street vendors. In addition to taking appropriate food and beverage precautions, there are medications that may potentially be used to prevent or treat travelers' diarrhea, says Robert Ruffini, M.D., Section Chief of Gastroenterology for Saint Barnabas. Dr. Ruffini advises travelers to take two tablets or 2 oz. of bismuth (Pepto Bismol®) four times a day while traveling to reduce risk of developing diarrhea. Also, taking an antibiotic such as Cipro® for diarrhea that lasts beyond 24 hours can dramatically reduce the duration of travelers' diarrhea from four or five days to only one when the antibiotic is taken at the onset of diarrhea. Dr. Kisch recommends that specific antibiotic treatment be reviewed with a physician prior to the trip. Hepatitis A Vaccine Hepatitis A is the most common travel-related disease that can be prevented by vaccination, says Dr. Kisch. According to The American Academy of Family Physicians, five of every 1,000 short-term travelers and two of every 100 long-term travelers (staying more than two months) contract hepatitis A. The CDC recommends hepatitis A vaccination for all international travelers except those going to Canada, Australia, New Zealand, Japan and western Europe. It takes four weeks for the vaccine to reach maximum protection. Accident Prevention According to Conde Nast Traveler, the major cause of serious disability Fires are also a major cause of injury and death in foreign countries. Kathe M. Conlon, B.S.N., R.N., Community Nurse Educator for the Saint Barnabas Burn Foundation, says travelers should look for hotels with smoke detectors and sprinkler systems and have a plan for escape in case of fire. In an emergency, she relates, travelers should remember to escape a fire by crawling low under smoke. "A good travel tip is to count the number of doors your room is from the stairwell," says Ms. Conlon. Cardiovascular Incidents According to the American Heart Association, scientists have noted a relationship between coronary heart disease risk and stress. An action-packed vacation, while enjoyable, could also be a source of stress for many sedentary individuals. "People with known cardiac problems should consult their physician if they plan to take a trip that might isolate them from access to medical care," says Gary Rogal, M.D., Chief of Cardiology Services for the Saint Barnabas Health Care System. "They should also speak to their physician if they will be spending significant time at high altitudes or in areas with extremes of temperature." Dr. Rogal cautions those with heart disease to have a full physical before undertaking an extensive foreign vacation and to remember that rest is an important component of any trip. "People with cardiac illness need to schedule time for rest and recovery," says Dr. Rogal. "Rest is essential because it gives the heart a chance to accommodate to new surroundings and circumstances." Another note, drinking too much alcohol can raise blood pressure, create irregular heart rhythms and lead to dehydration, which may result in the worsening of a patient's cardiac condition. Travelers with heart disease might consider tempering their alcohol intake, relates Dr. Rogal. With a little advanced preparation, travelers can decrease their risk of trip-related illness and help to make their excursion the trip of a lifetime. THINGS TO INCLUDE IN A FIRST-AID KIT:
Travel Medicine Internet Sites Glenn Fink, M.D., Department of Emergency
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