FAQs

Traveler’s diarrhea is the most common illness experienced by those who spend time abroad. Usually caused by bacteria in contaminated food and water, traveler’s diarrhea has a sudden onset, and typically lasts three to five days. Traveler’s diarrhea has different names in different parts of the world, such as Delhi Belly and Montezuma’s Revenge. And while the condition usually goes away on its own, if you’re on a tight itinerary, it can ruin your vacation. For this reason, we recommend bringing IMODIUM®, an over-the-counter anti-diarrheal, with you on your trip. ID Travel Care may also provide antibiotics to those who are going to areas where they are most likely to get traveler’s diarrhea and are living with an acute infection. Generally, we do not give routine preventive treatments for traveler’s diarrhea, unless your circumstances are unusual. Be sure to maintain proper hygiene and be cautious when eating and drinking abroad.

Unfortunately, malaria is more of a problem now than it has been in the last century. There are more than 500 million cases each year, and malaria claims one to three million lives around the world each year. The worldwide effort that occurred in the 1950s and 1960s to try to eliminate the mosquito vector was halted because of concerns that DDT, which was used to eliminate the vector, was causing problems with the food chain.

Malaria is present in most areas of the world outside of Western Europe, North America, Japan, Australia, and New Zealand. In Africa and India, malaria is present even inside the cities. However, in capital cities of Southeast Asia such as Bangkok, Singapore, and Hong Kong, malaria is only an issue in rural areas. Malaria is also particularly dangerous for women and young children. Therefore, it’s essential to know and understand your specific travel itinerary if you’re traveling to an at-risk country to determine whether or not malaria prevention measures are necessary.

There are three main malaria prevention treatments. Chloroquine is recommended only if one goes to areas where malaria is sensitive to chloroquine, which is an ever-diminishing area of the world including a few places in the Middle East and north of the Panama Canal in Central America. The rest of the world has resistant malaria — which means chloroquine is not effective there. The main two choices for malaria prevention in resistant areas are Lariam and Malarone. Your ID Travel Care expert will select the most appropriate approach to your malaria prevention plan based on the length of your stay and whether you have any contraindications to the medicines — or potential for any adverse reaction.

In general, it’s a good idea to bring mosquito repellent with 30–40% DEET in it to help prevent mosquito bites that can cause malaria or dengue fever (which is very common in Southeast Asia, as well as Central and South America). Mosquito repellents with higher concentrations of DEET will not give better protection; they’ll only last longer. Using permethrin (insect repellent spray) on mosquito netting and clothing is also helpful in warding off mosquitos. Remember to wear long-sleeved shirts, particularly in the evening, when the malaria-infected mosquitoes tend to bite.

Regardless of your destination, it’s important to remember to bring all of your prescription medicine. Buying prescription medicines overseas is extremely hazardous, as these drugs may be counterfeit or not manufactured to the same standards as they are in America.

If you’re traveling to a tropical country, you should pack:

• Sunscreen with an SPF of at least 30
• Polarizing sunglasses and a cap with a visor to ward off the intense glare in tropical countries — especially near water — as it can damage or irritate your corneas
• Mosquito repellent containing 30% to 35% DEET — higher percentages will not provide better protection but can last beyond the standard four to six hours — and there is usually no risk of long-term side effects if applied sparingly, even on children

If you’re going to be in a country where there is a great deal of malaria, buying permethrin is useful to spray on mosquito netting or clothes. Permethrin lasts even through the laundering of clothes.

While your medical kit will vary based on your destination, generally, your list should include:

• Antacids such as Alka-Seltzer®, Pepto-Bismol®, or TUMS® to treat upset stomachs, heartburn, or indigestion
• Anti-motion sickness medication, such as Dramamine®, to prevent nausea, dizziness, and vomiting
• Antibiotics for self-treatment of moderate-to-severe diarrhea
• Anti-diarrheal agents such as over-the-counter IMODIUM®
• Antihistamines to provide relief from allergies such as Allegra®, Claritin®, or BENADRYL®
• Antimalarial medications as applicable
• Band-Aids® or ACE™ bandages may also be useful if your travel involves adventure and the chances of a sprain or cut are high
• Decongestant to relieve nasal congestion such as Afrin®, Vicks Sinex™, or SUDAFED®
• Hydrocortisone cream to treat mild skin inflammation, rashes, itching, or discomfort
• Mild pain medicines such as TYLENOL® or Advil®
• Personal prescription medications

If you have trouble sleeping or want to regulate your sleep cycle better while traveling, you should also consider bringing a mild sedative. It’s also crucial to include addresses and phone numbers of hospitals, clinics, or even English-speaking doctors in your medical bag if you’re spending a prolonged amount of time abroad.

If you’re an American citizen and you become seriously ill or injured while abroad, the U.S. Consul should be your first contact. It’s important to remember that receiving any medical care while you’re abroad may not be covered by your health insurance policy — and Medicare does not cover overseas medical care. Check with your insurance company before going abroad to learn more about your coverage. If you’re going to be in a developing country for an extended period of time, it may also be useful to look into getting evacuation insurance overseas. Three organizations, which might be of some help in this regard, are International SOS, UnitedHealthcare Global SafeTrip, and the International Association for Medical Assistance For Travelers (IAMAT).

If you’re boarding a long, intercontinental flight, it’s important to remember to get up and walk around at least every hour. Sitting with your legs bent for prolonged periods can cause blood clots in the legs — which have the potential to be life-threatening if they migrate up to your lungs. Walking around, increasing your fluid intake, taking Aspirin®, and wearing compression stockings (if you have issues with varicose veins) are a few ways you can prevent blood clots in the legs.

If you have a cold when you board the plane, bring a nasal decongestant spray — if you can’t clear your nose or ears during landing or takeoff, you could experience a great deal of pain in your ears or even a rupture your eardrum.

Motion sickness is a very individual thing. It affects only certain people, and most people usually know if they have problems with motion sickness. If motion sickness is a problem for you try fixing your eyes on the horizon and taking medications such as Dramamine® and Bonine® — both of which are available over-the-counter. However, if you suffer from severe motion sickness, our team may prescribe the Scopolamine® patch. The patch is usually effective for about three days, and while it can dry the eyes and mouth, there are other side effects that you should consider before taking it.

Jet lag means your body is having trouble adjusting to changing time zones. Symptoms usually include insomnia, fatigue, and irritability. Flights going West to East tend to be more difficult for people to adapt to than flights going from East to West. Luckily, there are simple steps you can take to try and prevent jet lag. First, decrease the amount of alcohol you drink on the flight. Although it’s easy to assume it relaxes you, alcohol actually leads to dehydration in pressurized air cabins which can make your jet lag worse. Second, if you’re traveling over many time zones, schedule a stopover for a night to start a gradual adjustment. Business travelers should consider planning one or two days of layover at their destination to help adjust to their new time zone before scheduling appointments. Finally, sleeping pills are available to help regularize your sleep patterns at night. We recommend taking a pill before travel, and then for two to three days later to get back on the schedule you have at home.

Whether you’re going skiing in Colorado or traveling overseas to a place with high altitudes such as Mexico City or Ethiopia, altitude adjustment can be a significant problem. Going to heights that are beyond 10,000 feet causes 30–40% of people to have acute mountain sickness — which includes headaches, fatigue, nausea, and insomnia. To prevent acute mountain sickness, we may prescribe Diamox®, which should be taken once a day and continued for about 48 hours after your ascent. If you’re in a mountain climbing expedition, it’s essential to sleep below the day’s maximum ascent or stay at 5,000 or 10,000 feet for a couple of days before going higher.

There are some risks associated with pregnancy and travel. Generally, women can board planes and fly up to 36 weeks of pregnancy — but it’s best to travel during your second trimester. You should also avoid getting live vaccines if you’re pregnant (such as measles, mumps, rubella, chickenpox, yellow fever, and oral polio) as these can cause a mild type of illness that could potentially cause harm to the baby. It’s also generally recommended to receive even killed vaccines in your second trimester rather than the first when crucial body parts of your baby are developing.

Malaria is a real threat to unborn babies — as such, pregnant women should avoid traveling to areas where it’s prevalent. However, if it’s absolutely necessary, a pregnant woman can take malaria pills such as chloroquine and Lariam, although no malaria medication is 100% protective.

You can bring your young infant abroad with you, but it’s important to understand that young children have specific travel needs and there are precautions you’ll need to take before making your journey. They tend to have more trouble with their ears when the plane takes off and lands, but continued breastfeeding or sucking on a bottle can be beneficial to help children clear their ears.

Motion sickness can also plague young children, and the scopolamine patch is not an option for them. They can also get dehydrated much quicker than adults, and childhood diarrhea can be life-threatening — so be sure to take the proper precautions before your travel abroad. Because young children have delicate skin, it’s crucial to bring protective clothing and sunblock to avoid sunburn. There are a variety of other specific issues related to traveling with children, so ask your physician what measures to take before going abroad.

Travel vaccines are dependent on where you’re going, how long you’ll be there, and whether or not you’re deviating from typical tourist itineraries. Longer trips in remote areas are considered to be riskier; however, vaccines prevent many diseases and are conveniently accessible through ID Travel Care.

Most vaccines are optional. However, the yellow fever vaccine is required — only for certain parts of Africa and South America. If you’re going to one of these areas, you’ll need a specific sticker verifying that you received the vaccine to enter the country. ID Care has several offices throughout New Jersey that are approved Yellow Fever Vaccination Centers — where you can obtain the vaccine and your sticker.

Hepatitis A is probably the most useful vaccine to receive if you’re going to a developing country. The vaccine is almost 100% effective and has a protective lifespan of over 30 years once the two initial doses are given. Hepatitis A is also found in the United States, so receiving the vaccine will not only protect you from foreign exposure to the virus but domestic exposure, too.

The Hepatitis B vaccine is now required for all children in the United States, but most adults haven’t been vaccinated. Although the virus usually spreads through blood or sexual contact, if you have plans for a prolonged stay overseas or believe you’ll need medical assistance for chronic conditions while abroad, it’s advisable to receive the Hepatitis B vaccine. There is also a combination vaccine, Twinrix, which protects against Hepatitis A and Hepatitis B, all in one shot.

While the meningococcal vaccine is a requirement for college students to enter a school, there are certain parts of the world where there are yearly outbreaks of this type of fatal meningitis — particularly in sub-Saharan Africa. If you’re traveling to these areas, this vaccine is recommended.

The rabies vaccine is usually only necessary if a great deal of adventure travel is planned, or if you’re going to be working with animals who may have rabies. It’s important to remember that many domestic cats and dogs are not vaccinated against rabies in other countries — try to avoid contact with them.

Although there has been a worldwide eradication effort of polio in place for the last several years, two new areas with polio outbreaks are Yemen and Nigeria. Determining when to get the polio vaccine is an ever-changing debate, but if you’re going to Africa or Asia, one booster shot as an adult is all that’s required.

Finally, if you’re going to the tropics, Alaska over the summer, or the Southern Hemisphere during their winter (our summer), you should also receive the flu shot. The vaccine is usually available through June in the United States, but if you’re in a very high-risk group, you can also receive the vaccine when you arrive at your destination.

It often takes about two weeks for vaccines to begin to protect you, and some vaccines require multiple doses before you’re close to being 100% protected. Therefore, before you travel abroad, you should allow at least four to six weeks to begin the process of getting pretravel consultations and vaccines. Overseas travel is also an excellent opportunity, particularly for adults, to update the vaccines necessary in America. These include diphtheria and tetanus vaccine (given routinely every ten years), and a pneumonia vaccine (typically provided to those over the age of 65 and those under the age of 65 with chronic medical conditions).

In general, it’s best to avoid eating at roadside stands or stalls in developing countries. You should also avoid eating food that’s been sitting out for much of the day as it’s likely to be harboring bacteria. Try only to eat food that’s warm.

It can be challenging to avoid salads in tropical countries where fruits and vegetables are especially enticing — but if they’ve been washed with local water, it’s very likely they’ve been contaminated. Try to stick to foods that have been cooked all the way through, and only eat fruit that’s been peeled or washed with clean water.

It’s also important to remember that ice is water and freezing water does not kill organisms inside it — ice can also transmit disease. In most countries, it’s easy to get carbonated drinks, hot tea, or bottled water. And we recommend using bottled water even for simple things like brushing your teeth.

Dairy products can also pose a health problem, particularly if milk or cheeses have not been pasteurized. You can usually check to see whether dairy products have been pasteurized and you should be sure to do so before consuming them.

If you develop significant diarrhea, it’s important to remember to drink plenty of fluids so you don’t become dehydrated — this is particularly important for young children as dehydration can be life-threatening. The World Health Organization (WHO) produces rehydration packets which can be mixed with clean fluids to help replete chemicals lost in diarrheal stools. A rough approximation of the WHO formula is to fill a liter bottle with clean water and then add eight capfuls of sugar and two capfuls of salt — mix and then consume. An alternate formula would be one liter of clean water with one teaspoon of salt and two to three tablespoons of sugar.

If you’ve been abroad for an extended period of time or if you’re adopting children overseas, a post-travel evaluation from our team is beneficial, as it’s crucial to rule out any parasitic diseases and tuberculosis to ensure you and/or your new family member is safe and healthy.

However, infections in travelers returning from short trips can also be a problem. Remember, “common things occur commonly.” Even though it’s easy to think you may have an exotic tropical disease when you return home, common illnesses like bronchitis, sinusitis, and upper respiratory infections are most often the conditions patients seek treatment for after traveling.