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Got The Travel Bug?

6 tips for avoiding the nasties that can ruin your vacation

by Michael Tennesen

Published in health •self_care •METRO •METRO Story | 0 Comments, Talk about this article »

As a journalist who covers both science and health, I get to travel to some exotic places. I particularly love Latin America, where I’m especially enamored of the view from Tres Cruces, a scenic outlook within Manu National Park in the Andes near Cusco, Peru. From an elevation of about 13,000 feet, you gaze out over the Amazon Basin and watch the clouds rise up from the steaming jungle to gather in a billowy mass for their rainy assault on the mountainous forests below you.

If you’re not smart, though (and I wasn’t), you can pick up a wicked case of amoebic dysentery while you’re there. I contracted this severe form of traveler’s diarrhea two days after being dropped into the Peruvian jungle by helicopter. I had it for 21 days in the jungle and 16 days after I got home. I attribute it to some not-so-fresh salsa I put on my morning eggs.

More and more Americans are adding places like Chile and Peru to their snowbird destinations, which traditionally have included Mexico, the Caribbean, and the high seas. An estimated 6 million Americans engage in hard-core adventure travel activities each year, says the Travel Industry Association, and in 2006 alone, more than 9 million took cruises, double the number who went sailing a decade ago.

They’re after sun and fun, culture and natural beauty. But they’re also at risk of bringing back some nasty souvenirs, such as noroviruses (the cruise-ship “flu”) or even malaria, if they don’t take some important precautions. If you’re planning a trip to Cancun, a rafting trip down the Amazon, or just a cruise to a tropical isle, follow the advice of the experts.

Do Some Pretrip Destination Sleuthing

Rob Jackson, a professor of biology at Duke University who visits Latin America at least once a year, consults the Centers for Disease Control and Prevention (CDC) website (www.cdc.gov, under Travelers’ Health/Destinations), asks colleagues and friends who’ve visited his destination, and visits the travel clinic on campus to find out what shots he needs. Your clinic will want to make sure you’ve had the routine vaccinations, such as measles/mumps/rubella and diphtheria/pertussis/tetanus, plus hepatitis A and B. They’ll also tell you if you need to be immunized against typhoid, yellow fever, or rabies. Don’t forget your flu shot, and seniors should ask for a pneumonia immunization. Keep your shot card up to date; it’s gold at many border crossings.

Prepare For The Tropics

Sunscreen? Check. Drugs? Check. Deet? You do have your bug spray, right? One of the real dangers of tropical vacations is the bugs, especially mosquitoes. Malaria has made a big comeback in the tropical world. “There are more than 300 million cases of malaria infection worldwide, and we have roughly 1,500 cases reported annually in the United States brought in by travelers who go outside,” says Dr. Kozarksy. What’s considered tropical when it comes to this insect-borne disease? Anyplace six hours by car south of Brownsville, Texas, all the way to Chile and southern Brazil.

If you’re heading south, you need a bug repellent containing deet. Nothing else will work, says Miles Silman, PhD, a biologist at Wake Forest University who recommends that you place a few drops on your palms and then pat down your clothing and exposed skin. Don’t lather up with it, as it can cause allergic reactions. And dress up: A hat, a long-sleeved shirt, and long pants are de rigueur at dusk and dawn when mosquitoes are most active.

You may need immunizations before your trip, and you want to make sure you get the right ones.

There is currently no vaccine for malaria, but the CDC recommends the use of a prophylactic medicine before, during, and after exposure to prevent the disease. Chloroquine (Aralen) was previously the drug of choice, but chloroquine-resistant strains of malaria have developed in large sections of the world. Mefloquine (Lariam) is used in some areas, though it can cause severe depression, anxiety, paranoia, and nightmares. Atovaquone/proguanil (Malarone) doesn’t have those side effects, but it’s expensive. I use doxycycline because, for me, it also prevents traveler’s diarrhea. But ask your doctor for advice.

See A Travel Health Specialist

“Family physicians and other healthcare providers are not always up on the diseases a traveler will encounter,” says Davidson Hamer, MD, director of the International Health Clinic at Boston Medical Center. You may need immunizations before your trip, and you want to make sure you get the right ones. You can find a travel specialist in your area by visiting the website of the International Society of Travel Medicine (www.istm.org).

Wash Your Hands—A Lot

This is especially important on a cruise ship since these days many seem to be incubating epidemics of noroviruses, which cause diarrheal disease. Si Chang, RN, the nurse at the travel clinic at the Long Beach Department of Health and Services, recommends washing your hands frequently when onboard a cruise ship. “Sing ‘Happy Birthday’ twice while washing,” says Chang, “and avoid crowded places. Outside by the pool is better.” If you have any chronic problems, contact the ship’s medical facility and make sure they have what you’ll need in case of an emergency.

While it probably wouldn’t hurt to get some travel medical insurance, I say just pack some extra mosquito repellent, a good first-aid kit, all the medicines you’ll need, and a raincoat—and don’t worry. I live in Los Angeles. I’ve been in a lot of jungles, but none were as dangerous as the freeways in my hometown.

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Watch What You Eat And Drink

Even something as seemingly innocuous as salsa, as I discovered, can really ruin your trip. To avoid traveler’s diarrhea, drink water that comes out of a sealed bottle and don’t use ice; in all likelihood, it was made from local tap water. If you have any doubt about your beverage, boil it for two minutes to kill all the nasties. You can also purify it with iodine, though that does affect the taste (you get used to it). Salad bar? Stay clear. “Only eat vegetables that are steaming hot and fruits that you peel yourself,” advises Phyllis Kozarsky, MD, a specialist in clinical tropical medicine and travelers’ health in Atlanta. “Ask other travelers or expatriates where they have successfully eaten and then try those places.”

Pack Your Own Remedies

If you’re on an adventure, you can’t count on finding a drugstore—or a doc who can write a prescription—nearby. At the very least, carry antidiarrheal medication such as loperamide (Imodium A-D) for emergencies. Dr. Hamer suggests asking your doctor to write you a prescription for antibiotics such as ciprofloxacin, levofloxacin, or azithromycin and filling it before you travel. “The disease may last for only a couple hours if you treat it right away,” he says. Depending on where you’re going, you may also need to carry drugs that kill parasites.

Freelance writer Michael Tennesen’s “away” e-mail response frequently begins with “I’m in the Amazon….”

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