Health Hints for Travelers
Travel to developing countries by
Americans is growing. More than 8 million
people in the U.S. travel worldwide each
year. Those who return to their home
country are also at risk for malaria and other
diseases. This handout will help you be
healthy during your travels.
Some countries require tourists to get certain
vaccines. Although vaccines are not
required by law for most countries, they can
help to ensure good health during your trip.
Consult your health care provider for more
facts about special travel vaccines. Be sure
to check if your routine vaccines are current
and get the flu vaccine when it is offered.
Traveler's diarrhea (TD) affects 10 – 60% of
those who travel to developing countries.
This makes it the most common illness from
travel. People with TD have a two-fold or
greater increase in unformed bowel
movements. The most common symptoms
are abdominal cramps, diarrhea, nausea,
bloating, urgency, fever, and malaise.
The illness most often begins quickly within
the first week. It may also occur any time
during or after travel. More than one attack
of TD can occur in a single trip. If it is not
treated, TD will often last 3 to 4 days. Sixty
percent of those with TD get better within 2
days. Diarrhea lasting more than a few
months is rare.
TD can be caused by eating food and water
that has been infected with bacteria, viruses,
and parasites. Fresh grown leafy greens,
fruits and vegetables, uncooked meat or
meat not stored in a proper manner are often
Prevent TD before it starts!
Be careful when choosing your food
Eat only cooked food and
fruits that can be peeled.
Avoid food from street vendors.
Avoid unpasteurized dairy
Use purified carbonated
drinks when you can.
Drink bottled water, soda,
beer, or wine. Make sure the
bottle is sealed.
Avoid tap water and ice
Drink liquids that can be
heated (coffee, tea).
Avoid brushing teeth with
water that may be tainted.
If you can’t boil it, cook it, or peel
it, then forget it.
Ways to help make drinking water safe
1. Boil water. Bring water to a full boil for
1 minute. Boil longer at high altitudes.
Cool to room temperature. This is the
best way to make sure water is safe for
2. Purify water. If you can’t boil the water,
chemicals can be added to make the
water safe to drink. Purifiers are better
at killing viruses (like hepatitis) than
A. 2% Tincture of iodine. (Do not
use for a long time or if you are
For clear water
Add 5 drops* per quart or liter
For cold or cloudy water
Add 10 drops* per quart or liter
*1 drop = 0.05 ml
Let stand for 30 minutes; the water
should then be safe for use. Very
cloudy, muddy or cold water may
take longer. Let it stand up to 2-3
hours before use. You can add 50mg
of Vitamin C to a liter of water and
shake briefly to get rid of the iodine
taste and odor.
B. Tetraglycine hydroperiodide
tablets (glodaline, potable agua,
Coghlan's). The tablets can be found
at drugstores and sporting good
stores. Follow the guidelines on the
3. Filter water. There are a number of
filters on the market. They can help
protect against protozoa like Giardia
and bacteria like E. coli, but do not
trap viruses well. You can learn
more about them from stores that sell
camping supplies or through catalogs
that sell travel supplies (Sawyers,
Magellans, etc.). Practice using the
filter before your trip.
Things you can do if you get TD (Travelers
1. Replace fluids and electrolytes.
This is the first and most crucial step.
Fruit juices, caffeine-free soft
drinks, broths, and bouillon are good
sources. The table below shows a
plan for treating TD. You can also
eat rice, toast, or salted crackers.
Formula to Treat TD
In glass # 1, mix:
8 ounces of orange, apple, or fruit juice
(rich in potassium)
2 teaspoons of honey or corn syrup
(contains glucose needed for absorption)
A pinch of table salt (contains sodium and
In glass # 2, mix:
8 ounces of water (carbonated or boiled)
¼ teaspoon baking soda (contains sodium
Take turns drinking from each glass until
your thirst is quenched. You can also
have carbonated drinks and water or tea
made with boiled or carbonated water.
Avoid solid foods and milk products
until you feel better. Infants should
breast-feed and/or receive water while
taking these mixtures.
2. Avoid dairy products, caffeine, very hot
or cold liquids, spicy or fatty foods, and
high fiber foods. They may make
3. Use medicines, as needed.
Pepto-Bismol® and Imodium® have been
shown to be useful in the treatment of
TD. If you have diarrhea, start with
Pepto- Bismol® tablets. Talk with a
member of your health care team about
using it if you are allergic to aspirin or
take aspirin or compounds which contain
aspirin. Stop taking it if symptoms
persist after 1 to 2 doses. If Pepto-
Bismol® doesn’t work, take Imodium®
plus an antibiotic. Do not use Imodium®
if you have blood in your stools or a
ξ Antibiotics have been shown to
shorten the length of TD. They
are most often used if no
response is obtained from Pepto-
Bismol® or Imodium®.
Antibiotics can be taken along
ξ Antiperistaltic agents (like
lomotil) do not prevent TD and
may hide symptoms of diarrhea.
This may lead to complications.
ξ There is no vaccine offered in the
United States for TD at this time.
But there are some being
4. Caution: If TD doesn't seem to
improve with the above treatments or
if you have a high fever, abdominal
pain, or bloody diarrhea, seek medical
help. Also, call your health care clinic if
TD lasts longer than 1 week after you
return from your trip.
The risk of Hepatitis A for those who travel
abroad varies. It depends on your living
conditions, the rate of Hepatitis A in the
places you visit, and the length of your stay.
When your travel is short and involves
tourist routes in developed countries, you
may be at no greater risk than when you
travel in the U.S. Those who stay in the
tropics or in countries where Hepatitis A is
common and where they may be exposed are
at greater risk of getting Hepatitis A. The
Hepatitis A vaccine with its booster shot
will protect you from Hepatitis A.
Consider getting the Hepatitis B vaccine if
you will be in the tropics or developing
countries for at least 1 month, are doing
medical work there, plan to be sexually
active with people who are native to the
area, or will be doing things that put you at
risk for accidents. Getting tattoos,
acupuncture or other medical procedures
while abroad will also put you at risk for
developing Hepatitis B. The Hepatitis B
vaccine consists of three shots given over 6
For those who need Hepatitis A and B, a
combined vaccine can be given. If you have
questions about other types of hepatitis, ask
a member of your health care team.
If Medical Care Is Needed Abroad
Travel agents of the American Embassy or
Consulate may be able to provide names of
hospitals, doctors, or emergency service.
The International Association for Medical
Assistance to Travelers (IAMAT) can
provide a list of English-speaking doctors
(716-754-4883). Contact your insurance
company before you leave home to check
what will be covered during travel. Even if
you are covered, you may have to use cash
for these bills and be repaid later. Not all
foreign medical centers accept credit cards.
Traveler’s health insurance can be purchased
and is strongly advised if you have a chronic
illness or are over 65.
Consider buying medical evacuation
insurance, especially if you have a chronic
disease, will be doing activities that increase
risk for accidents or are traveling to a rabies
You can try to avoid motion sickness or sea
sickness by taking anti-motion-sickness
medicines before you get in the car, boat or
airplane. Many can be bought over-the-
counter. Some need to be prescribed.
Discuss options with your health care team.
Health Problems for Pregnant Women
Discuss your travel plans with your doctor or
midwife. The problems that a pregnant
woman might face are mostly the same as
those of other travelers. To prevent any
problems, plan ahead. Some vaccines and
medicines may not be taken by pregnant
There are many internet sites and books
about travel with disabilities. Examples
include: www.disabled-world.com and
If you are flying, you can also contact your
airline for more help.
Sexually Transmitted Infections (STIs or
Be aware that the risk of STIs (such as HIV,
Chlamydia, and gonorrhea) is high in some
areas of the world. AIDS and HIV have
become a global health problem. Their rates
in high-risk groups keep rising. The high-
risk groups may differ throughout the world.
If you choose to have sex, you should
practice safe sex to reduce your risk. To
practice safe sex, you should:
ξ Use latex condoms.
ξ Avoid having sex with more than
one partner, anonymous partners, and
ξ Avoid having sex with persons who
have more than one sex partner.
ξ Avoid having sex with someone who
is an IV drug user.
1. Common concerns. You may have
stresses that make you prone to illness,
such as a change in your eating and
drinking habits, crowding, and time
changes. “Jet lag” may disturb your
sleep pattern and wake cycles. These
stresses can lead to nausea, indigestion,
fatigue, and insomnia. Getting used to
these stresses may take a week or more.
If you’re concerned, ask for more facts
on jet lag.
2. Altitude. Travel at high altitudes
may lead to headache, insomnia, and
nausea, even in young healthy
people. It may cause more severe
distress to those with heart or lung
disease. It is hard to predict who will
suffer from altitude problems such as
acute mountain sickness. At greatest
risk are those who ascend quickly to
higher altitudes. There are medicines
to help with this problem. Drink
plenty of fluids. Talk to your health
care provider if you feel you are at
risk for getting acute mountain
3. Sun. The ultraviolet (UV) rays of
the sun can cause severe sunburn,
mainly in lighter skinned persons.
Avoid excess contact with the sun to
prevent sunburn and heat exhaustion.
Choose a sun block with the proper
SPF level and one that covers both
UVA and UVB rays. Apply the sun
block to cool, dry skin before going
out. You may need to re-apply later.
Bonding base formula sunblocks
work best. Products that do not
dissolve in water should be used if
you are going to be swimming. It’s
best to use a separate insect repellant.
Sun block should be applied before
the insect repellant. Some medicines
increase your risk of getting sunburn.
Talk to your health care provider to
see if you are taking any of them.
Car and other accidents lead the list of major
causes of severe injury or loss of life when
one travels. Defensive driving is the best
way to prevent any problems. Always use
safety belts. Avoid driving after drinking or
riding with someone who has been drinking.
Try to avoid nighttime driving. Never drive
at night in unknown regions. Check rental
cars to be sure the headlights work and there
is enough fuel. Prepare ahead by learning
the rules of the road for the places you plan
to visit. You should wear helmets while
biking or on motorcycles.
Swimming in dirty water may result in skin,
eye, ear, and certain intestinal infections,
especially if one's head is submerged.
Schistosomiasis, which is caused by a
parasite, is more common in some countries.
Symptoms begin as soon as 2 to 3 weeks
after being exposed. Seek medical care if
you think you have been exposed.
Symptoms can include: itching, abdominal
pain, diarrhea, and bloody, frequent or
painful urination. A rule of thumb is that
only pools that have been treated with
chlorine can be thought of as safe places to
In places where rabies exists, domestic dogs,
cats, or other animals (such as monkeys)
should not be touched. Avoid contact with
wild animals. Talk with your health care
provider about whether you need the rabies
vaccine before your trip. If you get bitten by
an animal, wash the wound out vigorously
with soap and water and seek health care
right away. You may need to receive
injections to prevent getting rabies.
The bites and sting of some insects may
cause bad reactions and transmit diseases
(such as yellow fever, malaria, dengue fever,
and Japanese encephalitis). Some insects
are active during the day and some are active
during the night. Some insects can bite and
transmit disease without the person being
aware of the bite. Use insect repellents,
protective clothing, and mosquito netting
should be used in many parts of the world.
Poisonous snakes are hazards in many
places. Boots should be worn when
walking, especially at night when snakes
tend to be more active. Inspect and shake
clothing and shoes before putting them on.
Always do this in the morning.
Cruise Ship Sanitation
The U.S. Centers for Disease Control is in
charge of a vessel sanitation program
designed to decrease the chances for disease
outbreaks. A list of cruise ship inspection
results and/or the last report of a certain
cruise boat may be obtained from the Office
of the Chief, Vessel Sanitation Activity,
Center for Environmental Health and Injury
Control, 1015 North American Way, Room
107, Miami, Florida 33132.
Malaria in humans is spread through the bite
of an infected mosquito. The risk of getting
malaria varies. Symptoms include
ξ Intermittent fever and flu-like
ξ Headache, muscle aches, and pains.
ξ Heart, kidney failure, and death can
Symptoms of malaria can begin as early as 8
days after first being exposed in places
where malaria exists. It can occur as late as
months after leaving. The best way to cure
malaria is to treat it early in the course of the
disease. Do not delay treatment. Those with
symptoms of malaria should seek prompt
Reduce contact with mosquitoes
Because the mosquitoes that transmit
malaria feed at night, your chance of being
bitten increases between dusk and dawn. To
reduce contact during those times, you
ξ Remain in well-screened areas.
ξ Use mosquito nets. The best are
those infused with permethrin. You
may also want to treat your clothes
with permethrin before you travel.
Permethrin kills mosquitos, lyme
ticks, and some other insects on
ξ Wear clothes that cover most of your
ξ Avoid bright colors.
ξ Use insect repellant on exposed skin.
The best ones contain N, N
diethylmetatoluamide (DEET). The
percent of DEET in them varies
(ranging up to 95%). Experts now
advise using DEET between 10 and
30% and not using DEET stronger
than 50 to 55%. Severe adverse
effects from DEET are rare.
ξ Purchase a flying insect spray to use
in living and sleeping areas during
evening and nighttime hours. It is
best to purchase these agents before
your trip. Check www.tsa.gov for up
to date information on what needs to
be in checked luggage and what you
can take in your carryon.
ξ Picaridin at 20% or greater may also
be helpful. It has been used in the
U.S. since 2005. Some studies show
that it works as well as DEET, but its
long term safety is not known.
These measures will also help protect
against dengue fever, yellow fever, and
chikungunya which are passed by infected
day-time biting mosquitoes and Japanese
encephalitis which is passed by an infected
evening-time biting mosquito.
People who go to parts of the world where
malaria exists are advised to use the
proper drug treatment.
Malaria chemoprophylaxis is the use of
drugs to prevent getting the disease.
Treatment begins 2 to 14 days before travel
and extends for 1 to 4 weeks after leaving
depending on the drug being used. You
must keep taking the medicine after you
leave the area to prevent infection in the
liver. Your doctor or nurse will discuss this
with you and help you decide what would
work best for you based on your travel plans
and health history. You can get malaria
even if you are taking these medicines. If
any illness with fever occurs, you need to get
help right away. Mefloquine (Larium®),
doxycycline, and atovaquone/proguanil
(Malarone®) are used in places where
chloroquine isn’t effective.
If you are pregnant, breastfeeding, or
traveling with children, you may also want
to consult your healthcare provider for both
you and your children before you travel. An
overdose of these drugs can be fatal. They
need to be stored in childproof bottles out of
the reach of children.
After you leave the area and finish your
medicine, a delayed malaria attack may
occur within a few months or up to a year.
Seek care if you are sick with a fever after
leaving an area where malaria exists. Be
sure to tell your health care team where you
traveled in order to help decide if you may
have malaria. The CDC 24-hour hotline
number (404) 639-1610 may be used to
update you on malaria facts.
Drink plenty of fluids and limit alcohol and
caffeine when taking long plane trips. To
prevent blood clots (DVT’s, Deep Vein
Thrombosis), do leg stretches often and get
up and move around the plane when you
can. Some people may use compression
stockings to help the blood flow in their
Many people have a false sense of security
in foreign countries. Theft may be common
in some places. Check with hotel staff,
police, expatriates, or the American
Embassy or Consulate staff about any
dangers. Travel in groups to avoid
problems. There are certain places where
Americans may be at risk for terrorist
attacks or being kidnapped. The State
(202) 647-5225 will provide callers with a
travel advisory about any country. They can
also give safety tips for foreign travel, and
the names, addresses, and phone numbers of
Foreign Services. Leave valuables at home.
Be sure someone at home knows your full
People who have chronic illness should
carry each of their medicines with them
instead of in their checked luggage. Keep
them in their original bottles and take extra
pills. Carry a list of your medicines; include
A complete physical exam may also be
worthwhile before travel. Make sure you’ve
also seen your dentist before you leave.
Watch your diet, stress level, activity level,
and use of alcohol during your trip.
You may not be able to find medical
supplies in many countries. Take along a
medical kit. Include cold and pain
medicines, Band-Aids®, an antiseptic and a
Avoid unsterile injections. In most
countries, also avoid blood transfusions.
Take an extra pair of glasses or lens
prescription. Contact lens users should take
along enough cleaning solution and carry a
pair of eyeglasses. You may wish to just
Carry a card, tag, or bracelet listing any
illness which may need emergency care. A
letter from a member of your health care
team or a copy of your EKG may also be
Contact lens users should take along enough
cleaning solution and carry a pair of
eyeglasses. You may wish to just wear
Even healthy travelers need to get the flu
vaccine, especially if going on a cruise ship.
brand and generic names.
Centers for Disease Control and Prevention www.cdc.gov/travel
International Society of Travel Medicine www.istm.org
Travel Health Online www.tripprep.com
World Health Organization www.who.org
After Your Trip
Some diseases may not be obvious right away. If you become ill after you return home, call your
health care clinic to report any travel in the past 12 months.
Advice for Travelers. Medical Letter, June 1, 2012, 10):45-56.
Health Information for International Travel, 2014. U.S. Department of Health and Human Services, Public Health
Service, Centers for Disease Control.
Your health care team may have given you this information as part of your care. If so, please use it and call if you
have any questions. If this information was not given to you as part of your care, please check with your doctor. This
is not medical advice. This is not to be used for diagnosis or treatment of any medical condition. Because each
person’s health needs are different, you should talk with your doctor or others on your health care team when using
this information. If you have an emergency, please call 911. Copyright © 7/2016 University of Wisconsin Hospitals
and Clinics Authority. All rights reserved. Produced by the Department of Nursing HF#4294.