Travel Health FAQs

1. What should I take with me while traveling?

We recommend you consider the following for your traveler’s medical kit depending on your destination, itinerary, baseline health problems, age, and gender:

• First-aid kit
  • Antiseptic wipes, bandages, gauze, tape, ACE bandage, cotton swabs, hydrocortisone cream, duct tape, blister protection, saline nose/eye drops

• Hygiene
  • Hand sanitizer, travel-sized soap, toilet paper, feminine hygiene products (tampons, pads, vaginal yeast cream), deodorant

• Medications
  • Personal medications
    • Prescriptions in their original container for security reasons
    • If needed, non-expired epinephrine (epi) pen
  • Traveler’s diarrhea
    • Loperamide (Imodium), Pepto Bismol, oral rehydration solution, antibiotics as prescribed
  • Stomach upset
    • Antacids, Pepto Bismol, prescribed anti-nausea medicine, heartburn medicine
  • Motion sickness
    • Meclizine (or Dramamine)
  • Fever/pain
    • Tylenol/Ibuprofen
  • Upper respiratory
    • Decongestant (Sudafed, Mucinex D), antihistamine (Benadryl, Zyrtec)
  • Rash/itching
    • Antihistamine (Benadryl, Zyrtec), hydrocortisone ointment
  • Destination-specific medications
    • Malaria
    • High-altitude medication
  • Insect avoidance
    • Mosquito repellent
    • Mosquito nets
  • Sunscreen
  • Condoms and Emergency econtraception
  • Contact card
    • Contains your emergency contact(s)
    • Primary care provider’s phone number
    • U.S. Embassy phone number (country-specific)

2. If I get ill while abroad, where do I go?

To locate health care in foreign countries, your options are:

• International Association for Medical Assistance to Travelers (IAMAT) provides many services for travelers, one of which is a list of English-speaking physicians in most countries
• U.S. embassies maintain lists of doctors and hospitals
• Referral from your travel insurance/medical evacuation insurance company
• If you do receive medical care out of the country, bring a copy of your medical treatment records back home with you to give to your health care provider.

3. What if I need emergency medical evacuation?

Medical treatment and medical evacuation by air ambulance can be very expensive. We recommend you consider the following:

• Check your health insurance for out of country coverage
• Buy travel insurance if not covered
• Buy emergency medical evacuation insurance

4. What should I do if I come home ill?

Contact your Virginia Mason Franciscan Health travel health provider. They will direct you to appropriate care.

• Note: In cases of serious infection/fever, your travel health provider may refer you to a Virginia Mason Franciscan Health infectious diseases specialist.

5. Does the anti-malaria drug have unusual side effects?

There are several options for anti-malaria drugs. Your provider can discuss the best one for you during your consultation.

6. I know what immunizations I need, why do I need a consultation?

A consultation provides you with important information, and allows your provider to review both recommended and required immunizations with your health status in mind. Your provider will review the risks of immunizations and possible interactions with other medications you currently take.

7. Do I need a consultation if I see a primary provider at Virginia Mason Franciscan Health?

Yes. This consultation is specific to your health status, immunizations that are recommended or required, and health and safety information regarding your travel destinations.

1. What do I do if I get diarrhea?

There are different levels of severity of diarrhea and each requires different treatment.

• Mild: Diarrhea that is tolerable, is not distressing and does not interfere with planned activities
  • Antibiotic treatment is NOT recommended
  • Loperamide (Imodium) or bismuth subsalicylate may be considered
     
• Moderate: Diarrhea that is distressing or interferes with planned activities
  • Antibiotics may be used to treat
  • Loperamide may be used as monotherapy or adjunctive therapy although not recommended for bloody diarrhea or fever
    
    
• Severe: Diarrhea that is incapacitating or completely prevents planned activities; all dysentery (fever or bloody diarrhea) is considered severe
  • Antibiotics should be used

2. What is the best way to prevent traveler’s diarrhea?

There are a variety of methods, each of which is very important.

• Hand Washing
• Dietary Precautions — "boil it, cook it, peel it, or forget it"

3. Should I take anything to prevent traveler’s diarrhea?

If you choose, you may take 2 tablets of Pepto Bismol chewed up to four times daily (can cause constipation, black tongue, nausea and black stools). Do not take longer than 3 weeks.

• Note: This should be avoided in travelers with an aspirin allergy, on anticoagulants, methotrexate, children under age 12, and children with viral infections.

3. Should I take anything to prevent traveler’s diarrhea?

If you choose, you may take 2 tablets of Pepto Bismol chewed up to four times daily (can cause constipation, black tongue, nausea and black stools). Do not take longer than 3 weeks.

• Note: This should be avoided in travelers with an aspirin allergy, on anticoagulants, methotrexate, children under age 12, and children with viral infections.

1. How can I avoid getting insect bites from mosquitos, ticks, and flies?

You can use both physical and chemical protection:

• Physical
  • Appropriate footwear (avoid sandals, flip flops, etc.)
  • Pants and long-sleeved, tucked-in shirts
  • Socks pulled over pant cuffs
  • Light-colored clothing
• Chemical
  • Repellents: When applying
    • Avoid lips and eyes
    • Avoid children’s hands - N, N-diethylmetatoluamide (DEET) can cause neurological toxicity if ingested
    • Avoid open cuts or inflamed or irritated skin
    • Do not apply under clothing
    • Use as directed — most last 3-4 hours, and then reapply
    • Reapply more often if sweating or getting wet from rain
    • Apply sunscreen first, then insect repellent
  • DEET: Repellent containing DEET are the most effective and widely used
    • Adults — 25-50 percent DEET most effective
    • Children (age 2 months-17 years) — up to 30 percent DEET most effective
  • DEET alternatives
    • Picaridin
    • Permethrin
      • Kills insects that land on treated fabric; lasts through multiple washings — treat clothing prior to packing)
      • Safe: Human toxicity is limited to occasional skin irritation; biodegradable
      • Does not soften or melt plastic or synthetic materials (clothing)
      • Available as a spray at outdoors stores
      • Can purchase pre-treated clothing
    • Mosquito nets
      • Can make a significant difference for protection from night feeding mosquitos (malaria). Use a larger mesh net that has been treated with permethrin.
    • Natural methods
      • Oil of lemon and eucalyptus cannot be recommended due to lack of data

2. Why do I need malaria protection?

It is a serious disease and may be fatal.

3. Which medication should I take to prevent malaria?

All medications have pros and cons and possible side effects. Choice of medication is based on location of travel, cost, daily versus weekly dosing, possible side effects and contraindications (such as age, pregnancy, medical conditions).

• Doxycycline (age 8 and up; avoid if pregnant or breast-feeding)
  • 1 tablet daily starting 1-2 days before entering area of malaria risk and continued daily until 4 weeks after leaving the area of malaria risk
  • Precautions: Increases sun sensitivity (wear sunscreen); increases risk of vaginal yeast infection; possible heartburn
• Malarone (atovaquone/proguanil) — indicated for all ages weighing 22 lbs. (10kg) or greater
  • 1 tablet daily with food or milk product starting 1-2 days before entering area of malaria risk and continued daily until 1 week after leaving the area of malaria risk
  • Precautions: Can interact with some prescription medications
• Mefloquine (previous brand name Larium)
  • Rarely used due to possible side effects
• Chloroquine or hydroxychloroquine
  • Only for limited areas of the world with chloroquine-sensitive malaria
• Anti-Malaria medications for pregnant women
  • It is our strong recommendation that pregnant women should not travel to areas of malaria risk due to high risk of serious illness and fetal and maternal death if malaria is acquired

1. Do I need a rabies vaccine?

• The following should be discussed with your travel health provider:

• Animal bites in developing countries carry risk of rabies
• Dog bites carry the largest risk, but monkeys and other mammals may also carry rabies, even if the animal appears healthy
  • Note: Educate children about avoidance of animal contact
• Rabies is a fatal disease, but can be prevented by prompt post-exposure vaccine series after a bite
• Pre-exposure rabies vaccine is especially recommended for long-term travel, travel in remote areas, bicycling, working with animals, or anyone wanting maximum protections, or less disruption of their trip if an animal bite occurs
• Rabies vaccine series (3) can cost up to $1,000. Check with your insurance company for coverage.
• If an animal bite occurs:
  • Wash the wound immediately with soap and water
  • Seek emergent medical attention, even if you’ve received the rabies vaccine

Find helpful details about high-altitude travel.

1. What is high-altitude illness?

A spectrum of diseases that occur as a result of time spent at high elevation (9,000 ft. or higher). It is caused by lack of oxygen — the higher the elevation, the less oxygen in the air to breathe. Physical fitness is not a predicable indicator of risk of illness. There are varying degrees of illness:

• Acute mountain sickness: Headache is the main symptom and may be accompanied by insomnia, fatigue, decreased appetite, nausea, dizziness, and/or shortness of breath
• High altitude cerebral edema (HACE; brain swelling): Symptoms include abnormal gait, altered consciousness, confusion, drowsiness, stupor, and/or coma. This is a serious and potentially fatal condition.
• High altitude pulmonary edema (HAPE; fluid in lungs): Symptoms include shortness of breath at rest, dry cough, confusion, or decreased consciousness. This is the most common cause of death related to altitude.

2. Why should I consider preventative treatment for high-altitude travel?

High-altitude illness could be fatal.

3. How can I prevent high-altitude illness?

There are 3 key recommendations:

• Gain altitude gradually
  • If you live below 5,000 ft., avoid sleeping above 9,000 ft. on the first night
  • If you go above 9,800 ft., do not ascend more than 1,600 ft. per day
  • Climb high, sleep low
  • Do not over exert yourself during the first few days at altitude
• Stay well hydrated
  • Drink plenty of non-alcoholic fluids (80 oz. or more each day, especially if physical exertion)
  • Caffeine is safe at high-altitudes and stopping it suddenly can cause headaches
• Preventive medication (acetazolamide-diamox)
  • Can reduce the severity of symptoms, speeds up acclimatization, and can help prevent high altitude cerebral edema and pulmonary edema
  • Start 24 hours prior to ascent and continue for 48 hours or until you reach the highest elevation of your trip.
  • Caution with history of sulfa allergy
  • Can cause tingling in fingers, more frequent urination, and alters taste of carbonated beverages

4. What should I do if I start to feel ill while at high altitude?

It is recommended that you stop the ascent and travel to a lower altitude immediately as this may lessen your symptoms and decrease risk of serious complications. Take Tylenol or ibuprofen for headache. Take acetazolamide (diamox) twice a day.