Everything

A traveler, new to our clinic, called me about a month ago and asked me to call in prescriptions for her for malaria without seeing her. She had gone to the CDC web site for Thailand and so knew what she needed. She went to her primary care provider, who gave her the shots she asked for based on what she read on the web site, but he wouldn’t prescribe the malaria pills.

I asked her what she got for this 2 week trip and he gave her hepatitis A and B, a tetanus booster (don’t know what kind), rabies shots and Ixiaro, to prevent Japanese encephalitis. “Did he give you a flu shot? “ I asked. “No.” Then I asked where she was staying and what she was planning to do for activities there.

She asked , “What has that got to do with anything?”

And I said, “Everything .”

A backpacker planning on visiting a refugee camp on the Thailand – Cambodian border has very different needs than the company executive staying at a high end hotel in Bangkok whose needs are entirely different than the couple on their honeymoon at the beaches. The CDC web site is a great reference but it consists of one size fits all information not tailored to individuals.

She was planning a trip with a tour group and visiting the traditional tourist sites. She didn’t need the Ixiaro or the rabies vaccines, which cost her almost $1,000. She’s not sure her insurance company will pay for that, either. She did need a flu shot for that long plane ride during peak flu season, cost $25. So I gave her an appointment where we also discussed jet lag, dengue fever and traveler’s diarrhea prevention, gave her the flu shot and a prescription for malaria and azithromycin for $125.

She’s planning a trip to see her daughter in Peru next summer. She’s planning on coming to us first, for that trip.

Norovirus

It’s in our community now, it’s on cruise ships and it’s in the news. Norovirus is its real name although many people call it the “stomach flu”. And it’s no fun.

It’s well known for its sudden onset of symptoms- vomiting, diarrhea and stomach pain mostly and sometimes fever, chills, and muscle aches. It spreads quickly, especially in crowded enclosed places, schools, cruise ships, and hotels. Some people shed the virus before the onset of symptoms but most at the onset of symptoms and for up to 3 days after. It’s spread by contact with contaminated food, beverages, and by touching contaminated surfaces such as elevator buttons, door knobs, etc.

It hits fast and fortunately doesn’t last long. There is no vaccine or specific treatment. Antibiotics don’t work because it is a virus not a bacteria. The very young, elderly and people with other health issues are more suspect able to complications.

To prevent it, wash your hands! Keep your hands and fingers out of your mouth. If you are traveling take Oral Rehydration Solution packets with you to help you stay hydrated if you get ill.

Now What?

“I just booked a trip to(a great destination outside the USA - fill in the blank)and I
don't want to get sick or injured. There is so much information out there. I don’t want to be paranoid or foolish and I don’t want to spend a fortune. What do I do?”

Research a little first. Get some information about your destination and think about some of the activities you might do there. The CDC web site is compact, user friendly, complete and current. Start a folder either paper or electronic and keep your information all together. Get a current copy of all your immunizations.

Visit a travel clinic before you see your PCP. Travel health is a lot more than just shots. You may need some immunizations and sometimes they must be given in a certain order to be effective. At Travel Health of NH, we review the required, recommended and routine vaccinations and make a plan- which ones you actually need, a schedule to receive them and the least expensive way to do this. You will also get prescriptions for malaria prevention and self treatment of many common travel related health problems individualized for you and your trip.

Get travel health insurance. At least emergency evacuation insurance. Most US health plans don’t cover travel related health expenses at all or very poorly. To compare options go to www.insuremytrip.com. What might seem like a simple problem here, isn’t in many other countries. Accidents and injuries are the leading cause of serious health problems for travelers.

Pack a basic first aid kit. Consider water purification system (SteriPen), sea sickness acupressure bands, analgesics, antacids, think about common products you use that may be nonexistent where you are going.

Make a list of important numbers. Make a file and scan a copy of your passport, include emergency travel health information, past medical history and med list, immunization record, international phone number to report loss or theft of a credit card and email it to yourself. You can access email almost anywhere in the world. There are programs like mail2web.com to retrieve email if you don’t use a major account such as Gmail or yahoo.

Plan ahead, prepare and you’ll have a lot less to worry about when you travel.