Problems After Arrival
Problems after arrival are especially important in international settings. Though many people are most concerned about infection when considering a trip overseas, heart disease is the most common cause of death among international travelers. Heart disease is the most common cause of death among nontravelers as well, suggesting that proper attention to health before leaving home is the best way to prevent illness while away.
Injuries
Injuries are the second most common cause of death overseas, most often due to motor vehicle or water accidents. Commonsense measures can be taken to prevent many such injuries. For example, people uncomfortable with unfamiliar traffic patterns (such as driving on the left side of the road in England versus the right side in the United States) can take public transportation or hire drivers familiar with local roads and traffic laws. Travelers should avoid overcrowded taxis, ferries, or other transports and avoid nighttime driving and swimming in poorly lit areas. Travelers should wear seat belts even as passengers. Also, alcohol should never be consumed before driving or swimming, even where laws do not formally prohibit such actions or where laws that do exist are not enforced.
Many cities are unsafe after dark, and some are unsafe even during the day. A traveler should avoid walking alone on ill-lit or deserted streets in such cities, especially in countries where the traveler is obviously a stranger.
Traveler's Diarrhea
Traveler's diarrhea (see Section 9, Chapter 122) is one of many infectious diseases that affect international travelers. Traveler's diarrhea may be prevented by drinking and brushing the teeth with bottled, filtered, boiled, or chlorinated water; avoiding ice in drinks; eating freshly prepared foods heated to steaming temperatures; eating only those fruits and vegetables that can be peeled or shelled; avoiding food from street vendors; washing the hands frequently; and avoiding all foods likely to have been exposed to flies.
In most cases, traveler's diarrhea subsides by itself and requires only the steady intake of fluids to prevent dehydration. Other measures, though not always necessary, may be helpful. Bismuth subsalicylate taken 4 times a day may both prevent and treat traveler's diarrhea, though it should not be used by children and by people taking aspirin. Traveler's diarrhea can also be treated with the antidiarrheal drug loperamide (which is available without a prescription), the antibiotic ciprofloxacin or ofloxacin (which requires a prescription), or both. Children with traveler's diarrhea are given the antibiotic trimethoprim-sulfamethoxazole.
Powdered rehydration mixes are available for travel. If these are unavailable, rehydration solutions can be made with small amounts of salt, baking soda, and sugar or honey mixed in water.
Malaria
Malaria (see Section 17, Chapter 196) is common in Africa, Southeast Asia, and some parts of South America. The best treatment is prevention. Malaria is prevented by wearing long-sleeved shirts and long trousers (especially at dawn and dusk, when mosquitoes are most active), sleeping under a mosquito net, and wearing clothing impregnated with permethrin. Insect repellants that contain diethyl-methylbenzamide (DEET) are also important and can help prevent other mosquito-borne diseases such as dengue and yellow fever. Even with these measures, antimalarial drugs (such as mefloquine, chloroquine, or atovaquone/proguanil) are necessary before, during, and after travel.
Schistosomiasis
Schistosomiasis is a common and potentially serious infection caused by a parasite that lives in still water in Africa, Southeast Asia, China, and eastern South America. Schistosomiasis can be prevented by wearing footwear and socks when walking through water and by avoiding freshwater activities in areas in which schistosomiasis is common (see Section 17, Chapter 196).
Lice and Scabies
Lice and scabies are common in crowded or underdeveloped accommodations and can be treated with permethrin, malathion, or lindane lotions (see Section 18, Chapter 210 and Section 18, Chapter 210). However, these lotions should not be used preventively.
Sexually Transmitted Diseases
Sexually transmitted diseases, including HIV, gonorrhea, syphilis, trichomoniasis, and sometimes hepatitis B, are more common in developing countries. All can be prevented through abstinence or with proper, consistent use of a condom (see Section 17, Chapter 200). Because HIV and hepatitis B are also transmitted through blood and needles, an international traveler should never accept a blood transfusion without assurance that the blood has been tested for infection. Also, injections should be accepted only through one-time-only disposable needles.
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