How To Prevent Traveling Infections

Traveling the world can be hard on the body. Diseases that are a distant memory in the United States may still be commonplace elsewhere. Knowing which microscopic invaders lurk at your destination and making plans to avoid them will help make your trip memorable for the right reasons. In this article, we will examine several of the more common infections that plague travelers, including:

  • Preventing CholeraEating food or drinking water contaminated with V. cholerae bacteria in a country without adequate water and sewage treatment causes cholera, which results in severe dehydration and often diarrhea. Travelers to Africa, India, and Latin America pose the greatest risk of contracting cholera, but because the disease doesn't affect the intestines' ability to absorb fluids, a full recovery is almost guaranteed.
  • Preventing HookwormsYou wouldn't think that a day at the beach, or for your child, a few hours playing in the sandbox, could lead to a disease. Yet hookworms are rarely dangerous enough to warrant treatment. Hookworms eggs found in animal feces hatch and form the larvae that causes cutaneous larva migrans, or CLM. They usually enter your skin through the toes while you are walking barefoot in the soil or sand, and form raised red spots, itchy lines, or blisters on the affected areas.
  • Preventing DengueMosquitoes pass along dengue when they bite one human who has the virus and then pass it on to their next victim, also through a bite. Dengue often develops into a rash or pain in the eyes or joints. But a more severe form of the disease, called dengue hemorrhagic fever, can cause a fever that lasts up to a week as well as bleeding or bruising issues. There is no treatment for dengue, and the illness usually clears up on its own.
  • Preventing MalariaMalaria decimates tropical countries and affects hundreds of millions of people every year. The parasite that causes the disease is carried by female mosquitoes and lives in your liver. Even if you don't show immediate symptoms of malaria, the parasite eventually invades your red blood cells and ruptures them, causing high fever, chills, head and muscle aches, fatigue, and sometimes nausea, vomiting, diarrhea, anemia, and jaundice. Yet prescription drugs, for those who have access to them, will easily neutralize malaria.
  • Preventing Traveler's DiarrheaBacteria or a parasite or virus is almost always the cause of travelers' diarrhea (Montezuma's Revenge, as it's called in Mexico). When you travel to underdeveloped countries you may come in contact with food or water that has been contaminated and not adequately purified. Diarrhea can lead to watery stools, stomach cramps, low-grade fever, and sometimes even nausea and vomiting. Though it usually clears up within a few days, diarrhea should be taken seriously because it can lead to severe dehydration.
  • Preventing TyphoidTyphoid fever lives by traveling through food and water infected with Salmonella typhi, often through contact with the feces of an infected person. Typhoid sends the body into a fever that can reach as high as 104 degrees, and sometimes forms a rash of flat, red spots. Typhoid should be treated with antibiotics, and that will usually knock out the fever within a few days. Without treatment it can kill you.
  • Preventing Yellow FeverSpread by infected Aedes mosquitoes, yellow fever is commonly called jaundice because it refers to a yellowing of the skin and eyes. While most recover from yellow fever within three to four days, the virus can cause bleeding, heart problems, liver or kidney failure, or even brain dysfunction. There is no medical cure for yellow fever, only ways to ease the symptoms. It can kill you. That's why it's smart to get a yellow fever vaccination before you to travel to an affected area, namely sub-Saharan Africa or tropical South America.

This information is solely for informational purposes. IT IS NOT INTENDED TO PROVIDE MEDICAL ADVICE. Neither the Editors of Consumer Guide (R), Publications International, Ltd., the author nor publisher take responsibility for any possible consequences from any treatment, procedure, exercise, dietary modification, action or application of medication which results from reading or following the information contained in this information. The publication of this information does not constitute the practice of medicine, and this information does not replace the advice of your physician or other health care provider. Before undertaking any course of treatment, the reader must seek the advice of their physician or other health care provider.

Preventing Cholera

Publications International, Ltd. Eating food contaminated with V. cholerae bacteria can cause cholera.

Cholera is a diarrheal illness that can cause severe dehydration; without treatment, cholera can be fatal. You can contract this disease by drinking water or eating food that has been contaminated by V. cholerae, often from the feces of an infected person.

If a country has inadequate water and sewage treatment, V. cholerae bacteria can spread through rivers and coastal waters. Drinking water or eating seafood from infected sources can spread the infection. Cholera is rarely spread person to person because it takes more than a million bacteria to cause the disease. Outbreaks of cholera occur yearly, especially in Africa during the rainy season.

After they are consumed in infected water and food, whatever cholera bacteria survive the harsh acidic environment of the stomach set up shop in the small intestine, where they reproduce rapidly and create a toxin that causes watery diarrhea. However, not all V. cholerae strains produce toxin.

Some people infected by cholera have few or no symptoms, but others react more severely. Diarrhea is the disease's hallmark, but it might be accompanied by vomiting and leg cramps. Only 5 percent of people who get cholera will end up with the most severe symptoms. For those unfortunate few, rehydration is vital, but because the intestines' ability to absorb fluids is not affected, rehydration can be done orally rather than intravenously. Almost everyone who encounters cholera bacteria will recover with no complications.

The Culprit

The bacterium Vibrio cholerae causes cholera.

Who's at Risk?

Travelers to Africa and Latin America have the greatest risk for contracting cholera. Adequate water and sewage treatment has all but eliminated the disease in the United States, but rare cases occur along the Gulf Coast.

Defensive Measures

You can cut your chances of contracting cholera while traveling if you take some precautions:

  • You should wash your hands thoroughly and often to help avoid ingesting and spreading V. cholerae.
  • Make good choices when eating and drinking in a foreign country (see the travelers' diarrhea profile in this chapter for more information). The cholera bacterium spreads easily, so being careful about what you eat and drink is your best defense against it.
  • Don't bring any seafood back to the United States.
  • Africa and India have been enduring cholera outbreaks for decades. Before you travel, find out which countries might require you to take more precautions. Get the latest disease information at the Centers for Disease Control and Prevention (CDC) Web site (www.cdc.gov/travel) or call the CDC's Travelers' Health Automated Information Line at (877) 394-8747.

Read next about hookworms, which can enter your skin at unassuming places like the beach or sandboxes in the next section.This information is solely for informational purposes. IT IS NOT INTENDED TO PROVIDE MEDICAL ADVICE. Neither the Editors of Consumer Guide (R), Publications International, Ltd., the author nor publisher take responsibility for any possible consequences from any treatment, procedure, exercise, dietary modification, action or application of medication which results from reading or following the information contained in this information. The publication of this information does not constitute the practice of medicine, and this information does not replace the advice of your physician or other health care provider. Before undertaking any course of treatment, the reader must seek the advice of their physician or other health care provider.

Preventing Hookworms

Publications International, Ltd. Hookworm eggs enter the skin while at the beach or in a sandbox.

Hookworm eggs found in animal (usually dog or cat) feces hatch and form the larvae that cause CLM. These hookworms are not the same ones that cause human hookworm disease. The larvae live in warm, moist, sandy soil and are determined, sturdy parasites that can penetrate human skin, even through something as seemingly protective as a beach towel.

Much of the time, the larvae enter between the toes, so walking barefoot in soil or sand that is contaminated with animal feces is an avenue for infection. You or your children can also be infected by sitting, playing, gardening, or working in infected soil or sand.

The larvae tend to like moist, warm, shaded areas, such as sandboxes and spots underneath houses. You can come into contact with these parasites when traveling to tropical areas in the Caribbean, Central and South America, Africa, and Southeast Asia, but they are also found in the United States in the southeastern and Gulf states.

A few hours after the larvae enter the skin, they form raised red spots on the affected areas (usually the feet, hands, or buttocks). In a few days (or in some cases, a few months), the larvae move under the skin, creating itchy red lines and, occasionally, blisters. These itchy lines usually appear on top of the foot or on the buttocks but can be anywhere on the body that was in contact with the soil or sand. Because the larvae are not from human hookworm, the disease ends at the skin stage. Although it's a very itchy, frustrating infection, most people with CLM will get better without treatment.

The Culprit

Cutaneous larva migrans (CLM) is a human parasitic skin infestation of various types of hookworm larvae.

Who's at Risk?

Children are at greater risk of CLM because of their less-than-hygienic play practices. Also at risk are gardeners, sunbathers, utility workers, and travelers to tropical areas.

Defensive Measures

The mere thought of CLM probably creeps you out, but you can keep the hookworms from getting a little too close for comfort. When visiting a beach, ask the local authorities if animals are allowed in the area. If no pets are allowed, you have a little less to worry about. And while you're out on the beach, wear shoes or sandals to keep hookworm larvae from penetrating into your feet. You may love the feel of sand between your toes, but you'll hate the feel of CLM even more.

You should also protect the rest of your body while you're on the beach. The parasites that cause CLM can penetrate some objects, so it's a good idea to sit on two or more beach towels, or, better yet, a lounge chair. Finally, stay away from moist, shady, sandy areas because these are the most likely places for parasites to gather.

In our next section, we will learn about dengue fever -- a more exotic disease than hookworms because mosquitoes in tropical climates carry it from one person to the next.

This information is solely for informational purposes. IT IS NOT INTENDED TO PROVIDE MEDICAL ADVICE. Neither the Editors of Consumer Guide (R), Publications International, Ltd., the author nor publisher take responsibility for any possible consequences from any treatment, procedure, exercise, dietary modification, action or application of medication which results from reading or following the information contained in this information. The publication of this information does not constitute the practice of medicine, and this information does not replace the advice of your physician or other health care provider. Before undertaking any course of treatment, the reader must seek the advice of their physician or other health care provider.

Preventing Dengue

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Dengue is passed from person to person through mosquito bites.

Dengue (den-GEE) is spread when a mosquito bites an infected person and then carries the virus to a noninfected person, passing it on through a bite. After about four to seven days, the person with the virus begins experiencing symptoms that can include headache, backache, fever, nausea, and vomiting. A person with dengue may also develop a rash and complain of joint or eye pain. Younger children tend to have a milder version of the infection than older children and adults.

The viruses that cause the milder dengue infection can produce a more severe form of the disease, called dengue hemorrhagic fever (DHF). People with DHF have a fever that lasts two to seven days and obvious bleeding issues, such as easy bruising, bleeding from the nose or gums, and sometimes internal bleeding. This occurs mostly after second or third infections with dengue strains.

Although there is no treatment for dengue, the illness usually clears up on its own. If any bleeding occurs, be sure to avoid any medications that contain aspirin or ibuprofen to manage dengue-associated fever.

The Culprit

Any of four dengue virus strains (DEN-1, DEN-2, DEN-3, and DEN-4) transmitted by infected mosquitoes cause dengue. The Aedes aegypti mosquito is the most common carrier of dengue viruses.

Who's at Risk?

An estimated 100 million cases of dengue occur around the world every year. Anyone visiting a high-risk country could possibly be exposed to a dengue virus. In general, you're more likely to contract dengue in the South Pacific, Asia, the Caribbean, Central America, South America, and Africa. Dengue-carrying mosquitoes are also more likely to gather in urban areas. But even if you travel to a high-risk area, your chances of being infected with a dengue virus are slight.

Defensive Measures

Your best bet to avoid getting dengue is to protect yourself against the mosquitoes that carry the virus. Follow these tips if you're going to be in a high-risk area:

  • Cover as much of your body as possible while you're outdoors because the Aedes mosquito feeds day and night.
  • Use a mosquito repellent that contains DEET and apply it to your body and your clothes.
  • Stay in a hotel that has air conditioning or at least screened doors and windows.

A much more common infection carried by mosquitoes is malaria. Learn about malaria in the next section, which is carried by female mosquitoes, and even more dangerous than dengue.This information is solely for informational purposes. IT IS NOT INTENDED TO PROVIDE MEDICAL ADVICE. Neither the Editors of Consumer Guide (R), Publications International, Ltd., the author nor publisher take responsibility for any possible consequences from any treatment, procedure, exercise, dietary modification, action or application of medication which results from reading or following the information contained in this information. The publication of this information does not constitute the practice of medicine, and this information does not replace the advice of your physician or other health care provider. Before undertaking any course of treatment, the reader must seek the advice of their physician or other health care provider.

Preventing Malaria

Publications International, Ltd. Though the symptoms can be serious, prescription drugs can easily combat malaria.

Female mosquitoes of the genus Anopheles spread malaria-causing parasites to people, and the parasites take up residence in your liver. You may show no symptoms of malaria for days, months, or even a year, but the parasite will eventually invade your red blood cells. The cells then rupture, allowing the malaria parasite to invade other red blood cells.

As the red blood cells burst, they release chemicals that cause high fever, chills, headache, muscle aches, and fatigue. Some people might end up with nausea, vomiting, diarrhea, anemia, and jaundice. P. falciparum triggers what is considered the most severe manifestation of the disease, which includes seizures, coma, and kidney failure.

If you start having flulike symptoms after visiting a high-risk malaria area, see your physician as soon as possible. Although malaria can be quite dangerous if left untreated, it can be taken care of with prescription drugs. Most people recover fully with treatment and experience no complications.

The Culprit

Any of four single-celled parasites, Plasmodium falciparum, Plasmodium vivax, Plasmodium ovale, and Plasmodium malariae, can cause malaria, a disease of the blood.

Who's at Risk?

Malaria is a serious threat around the globe. According to the World Health Organization, between 350 million and 500 million people acquire malaria every year. The vast majority of these cases happen in the high-risk areas of Central America, South America, Africa, India, the Middle East, Southeast Asia, Hispaniola (the island shared by Haiti and the Dominican Republic), and Oceania (the large region of islands that includes Australia, New Zealand, Indonesia, and Papua New Guinea). Young children, pregnant women, and people with weakened immune systems are most likely to have the worst problems with malaria.

Defensive Measures

Some antimalarial drugs kill the malaria parasite while others prevent you from being infected in the first place. If you're traveling to a high-risk area, see your physician four to six weeks before your scheduled departure to get a prescription for antimalarial drugs (and other vaccinations). These drugs work best if you take them on a precise schedule and don't miss any doses.

As with any mosquitoborne disease, your best protection bet is to avoid the critters that carry the infection -- in this case, the night-feeding Anopheles mosquitoes. Follow the tips in the dengue profile in this chapter to avoid meeting one of these insects.

One of the more common infections that affect travelers in a foreign land and climate is traveler's diarrhea. Learn more about this affliction in the next section.

This information is solely for informational purposes. IT IS NOT INTENDED TO PROVIDE MEDICAL ADVICE. Neither the Editors of Consumer Guide (R), Publications International, Ltd., the author nor publisher take responsibility for any possible consequences from any treatment, procedure, exercise, dietary modification, action or application of medication which results from reading or following the information contained in this information. The publication of this information does not constitute the practice of medicine, and this information does not replace the advice of your physician or other health care provider. Before undertaking any course of treatment, the reader must seek the advice of their physician or other health care provider.

Preventing Traveler's Diarrhea

Publications International, Ltd. Drinking contaminated tapwater is the most common cause of traveler's diarrhea.

Although travelers' diarrhea can be a result of stress due to traveling, jet lag, or change in diet or altitude, the chance is slight. A bacterium, parasite, or virus will almost always be at the root of your traveling tummy troubles. Most people pick up the disease after eating food or drinking water that has been contaminated by feces and not adequately purified. Travelers' diarrhea usually leads to watery stools, stomach cramps, low-grade fever, and sometimes nausea and vomiting.

Most symptoms will clear up without treatment within a couple of days. If a bacterium causes a case of travelers' diarrhea and the diarrhea persists, antibiotic treatment might be necessary. Travelers' diarrhea rarely leads to any kind of life-threatening condition; the most serious complication is dehydration.

The Culprit

Travelers' diarrhea has a diverse set of causes. Some form of bacteria (most commonly Enterotoxigenic Escherichia coli) causes 85 percent of travelers' diarrhea cases; parasites are to blame for about 10 percent of cases; and about 5 percent of infections can be traced back to viruses.

Who's at Risk?

According to the CDC, ten million travelers end up with a case of travelers' diarrhea each year, and people who visit developing countries in Latin America, Africa, the Middle East, and Asia are most susceptible. For reasons that aren't understood, young adults between 21 and 29 are at a higher-than-normal risk for developing travelers' diarrhea. Children and people with weak immune systems, those with diabetes or inflammatory bowel disease, and people who take acid blockers or antacids (stomach acid destroys bacteria, so without the presence of acid, harmful bacteria can take root) are also more susceptible. Traveling during the summer and during rainy seasons also increases your chance of encountering a nasty bug.

Defensive Measures

Although it's not always possible to avoid harmful bugs while you're traveling, these tips should help you keep from getting sick so you can enjoy the sights:

  • Follow the rules. The general travelers' rule for eating is: Boil it, cook it, peel it, or forget it. In other words, if you must drink local water, boil it; only eat foods you know have been thoroughly cooked; and stick to fruits with thick skins, such as bananas, that you peel yourself.
  • Don't drink the water. This old standard is worth noting because you have to worry about more than just sticking a glass under the tap. Be aware of less-obvious water hazards, such as consuming ice cubes or fruit juices made with tap water, taking a shower, going swimming, or brushing your teeth. Skip anything that may have been washed in contaminated water, such as salads or raw vegetables.
  • Stick to the bottle. Bottled water, carbonated drinks, beer, or wine in their sealed containers should be okay to drink.
  • Beware the local fare. Avoid beverages and foods sold by street vendors.
  • Be wary of the unsanitary. Be sure all food is cooked well and served steaming hot. In addition, don't eat moist foods left at room temperature, and avoid buffets.
  • Think pink. Bismuth subsalicylate (the main ingredient in Pepto-Bismol) can reduce your risk of developing diarrhea, but there are certain precautions and some strange side effects (like a black-colored tongue). Talk with a health-care professional if you think you might want to take a little pink prevention on your vacation.

Contracting typhoid, which you'll read about next, also poses a greater risk when travelling to developing regions like India, Asia, Africa, the Caribbean, Central and South America. But typhoid, which spreads through contaminated food and water, is much more serious and sends the body into a fever that can reach 104 degrees. If not treated with antibiotics, typhoid can be fatal.This information is solely for informational purposes. IT IS NOT INTENDED TO PROVIDE MEDICAL ADVICE. Neither the Editors of Consumer Guide (R), Publications International, Ltd., the author nor publisher take responsibility for any possible consequences from any treatment, procedure, exercise, dietary modification, action or application of medication which results from reading or following the information contained in this information. The publication of this information does not constitute the practice of medicine, and this information does not replace the advice of your physician or other health care provider. Before undertaking any course of treatment, the reader must seek the advice of their physician or other health care provider.

Preventing Typhoid

Publications International, Ltd. The best defense against typhoid is frequent and thorough hand washing.

Typhoid fever bacteria are usually spread when food or water has been infected with S. typhi, most often through contact with the feces of an infected person. Once the typhoid bacteria enter the bloodstream, the body begins to mount a defense that causes a high fever (as high as 104 degrees Fahrenheit), headache, stomach pains, weakness, and decreased appetite. Occasionally, people who have typhoid fever get a rash that looks like flat red spots.

Typhoid fever can be effectively treated with antibiotics. Once treatment begins, improvements start in a few days. Without treatment, the fever can continue for weeks or months, and the infection can lead to death.

The Culprit

The bacterium Salmonella typhi causes typhoid fever.

Who's at Risk?

The CDC gets about 400 reports of typhoid fever in the United States each year. However, an estimated 22 million people worldwide get the disease annually. The chances of contracting typhoid fever in the United States are very low; people who travel to developing countries where there is little or no water and sewage treatment or where hand washing is not a common practice are at the highest risk. Prime typhoid fever areas are in India, Asia (especially Tajikistan and Uzbekistan), Africa, the Caribbean, Central America, and South America.

Defensive Measures

Because many people who carry typhoid fever appear perfectly healthy and may spread the disease unknowingly, taking extra precautions when you are traveling is essential.

  • Wash your hands well and often to prevent the possible spread of bacteria.
  • Refer to the travelers' diarrhea profile in this chapter to read the precautions for eating and drinking in developing countries.
  • If you are going to be in a country at high risk for typhoid fever or in a rural area where food choices may be limited, typhoid fever vaccines are available. Speak with your physician about getting one and refer to the CDC's Travelers' Health Web site at www.cdc.gov/travel for more information.
  • People who have had typhoid fever should not prepare food or drinks for anyone until their stool tests negative for the contagious bacteria.

Finally, you'll read about yellow fever, another disease that can be fatal if not treated soon after it is contracted. Carried by an infected mosquito, yellow fever only exists today in sub-Saharan Africa and South America. Jaundice, the yellowing of the skin and eyes, is the tell-tale sign of yellow fever.This information is solely for informational purposes. IT IS NOT INTENDED TO PROVIDE MEDICAL ADVICE. Neither the Editors of Consumer Guide (R), Publications International, Ltd., the author nor publisher take responsibility for any possible consequences from any treatment, procedure, exercise, dietary modification, action or application of medication which results from reading or following the information contained in this information. The publication of this information does not constitute the practice of medicine, and this information does not replace the advice of your physician or other health care provider. Before undertaking any course of treatment, the reader must seek the advice of their physician or other health care provider.

Preventing Yellow Fever

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The yellow fever vaccination is your first line of defense against contracting  the infection.

You will begin showing symptoms of yellow fever about three to six days after being bitten by an infected mosquito. These symptoms include fever, chills, backache, nausea, headache, and vomiting. Jaundice, or yellowing of the skin and eyes, is the hallmark of the infection and gives it its name.

Most people recover from yellow fever in three to four days. In more severe cases, the virus might cause bleeding, heart problems, liver or kidney failure, or brain dysfunction. Yellow fever can be fatal. People with the disease may be able to ease their symptoms, but there is no specific medical treatment.

The Culprit

Yellow fever is caused by the yellow fever virus, which is spread by infected Aedes mosquitoes.

Who's at Risk?

Yellow fever occurs only in Africa and South America, so only travelers who are destined for these regions need to be concerned about it. The World Health Organization estimates there are 200,000 cases of yellow fever every year (although the organization says the vast majority of cases are not reported), and 30,000 of those cases are fatal. The elderly are at highest risk of developing the most severe symptoms of the infection.

Defensive Measures

If you are traveling to high-risk areas of sub-Saharan Africa or tropical South America, you can take some precautions to help keep yellow fever at bay. First, and most importantly, you should get a yellow fever vaccination. Talk with your physician about the vaccine at least two weeks before you travel. The vaccine is only available at authorized locations; call your local health department or visit www2.ncid.cdc.gov/travel/yellowfever to find the one nearest you.

The traveling infections you've read about here -- cholera, hookworms, dengue, malaria, diarrhea, typhoid and yellow fever -- are not as prevalent now in the developed world as they were hundreds of years ago, but they can still ruin your vacation, or worse. So study up on traveling diseases and know how to protect yourself.

ABOUT THE AUTHOR:

Laurie L. Dove is an award winning Kansas-based journalist and author whose work has been published internationally. A dedicated consumer advocate, Dove specializes in writing about health, parenting, fitness and travel. An active member of the National Federation of Press Women, Dove also is the former owner of a parenting magazine and a weekly newspaper.

ABOUT THE CONSULTANT:

Dr. Larry Lutwick is a Professor of Medicine at the State University of New York - Downstate Medical School in Brooklyn, New York and Director of Infectious Diseases, Veterans Affairs New York Harbor Health Care System, Brooklyn Campus.  He is also Bacterial Diseases Moderator for the real time online infectious diseases surveillance system, Program for Monitoring Emerging Diseases (ProMED-mail) and has authored more than 100 medical articles and 15 book chapters. He has edited two books on infectious diseases.

This information is solely for informational purposes. IT IS NOT INTENDED TO PROVIDE MEDICAL ADVICE. Neither the Editors of Consumer Guide (R), Publications International, Ltd., the author nor publisher take responsibility for any possible consequences from any treatment, procedure, exercise, dietary modification, action or application of medication which results from reading or following the information contained in this information. The publication of this information does not constitute the practice of medicine, and this information does not replace the advice of your physician or other health care provider. Before undertaking any course of treatment, the reader must seek the advice of their physician or other health care provider.

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