July 2009 Health & Wellness

Stress-free Summer Travel!

TIPS ON SAFE SUMMER TRAVEL

With summer coming upon us quickly many Iowans are making travel plans to enjoy the summer months and take in the beauty of Iowa's landscape. We all need to be alert and on the look-out for others regardless of how we travel. Long days of summer mean people are out and about from morning until night bicycling, walking, jogging, motorcycling, skating, skateboarding, and driving. Below are some travel tips/advice to help keep you and your family safe during your travels this summer.

Before you go:

• Check your car or have it serviced before any long trip (battery, tires, belts, and fluids)
• Pack an emergency kit that includes water, jumper cables, flares, a flashlight, equipment to change a tire and a first aid kit
• Fill up your gas tank at night or early in the morning to minimize the damage to the ozone layer
• Make sure child safety seats and booster seats are properly installed
• Map out your travel route and leave a copy of your travel itinerary with relatives or friends in case of an emergency and/or you lose cell phone reception

On the road:

• Require all occupants to buckle up, with children in the back seat - Every Trip - Every Time!
• Obey speed limits and all roadway signs
• Drive calmly and avoid confrontation with aggressive drivers
• Pack non-perishable snacks and plenty of juice and water (individual water bottles for each family member helps you monitor intake to avoid dehydration)
• Take frequent breaks - at least every 2 hours - and avoid driving when tired
• Be especially careful around railroad crossings
• Avoid driving in the "No Zone" around trucks. If you cannot see the truck driver in the truck's mirror, the truck driver cannot see you
• Slow down in work zones, obey all signs and flaggers and pay attention to the vehicle in front of you (most work zone crashes are rear-end collisions due to inattentive drivers)
• Move over and slow down for emergency vehicles

 

How to Stay Healthy on a Road Trip

Get tips on eating right, being comfortable, staying awake, and avoiding stress on your next road trip.Road trip! Two words that can either lift your spirits in anticipation of your upcoming travel plans or that can give you a sinking feeling of dread. With a few easy strategies in place, though, any road trip can be fun and even healthy — and something you’ll want to do again. Read on to learn how you can manage to eat well, stay comfortable, and arrive at your destination feeling energized and refreshed.

Road Trip: Eating Healthy
Thoughts of eating “on the road” typically call to mind images of vending machines and fast food. But that doesn’t have to be the case. Here are better ways to eat while you're traveling by car or bus:

• Brown-bag it. Packing your own food is a great way to eat well while you travel. “Pack drinks and snacks in the car with you,” says Heidi Reichenberger McIndoo, MS, RD, a nutrition consultant based in Boston, Massachusetts. “Great items to bring on a car trips include plain water, enhanced flavored waters like vitamin water, dried fruit, fresh fruit like apples and bananas, cheese sticks, and nuts.” Be sure to wash any produce thoroughly before you leave, and bring a cooler to keep drinks and perishable items at a chill temperature.
• Stay clear of vending machines. McIndoo warns against rest-stop food and vending machines: “They are notorious for being full of high-fat, high-salt, and high-sugar foods” — not what you need to stay healthy and energized on your road trip!
• Munch regularly. Most people's bodies are accustomed to eating something (whether a snack or meal) at least every four to five hours, and the same is true when you travel. If you go longer than that because you don’t want to stop driving, you may end up overeating later or snacking on the wrong kinds of foods.

Road Trip: Being Comfortable
Sitting in a car for hours on end can cause noticeable stiffness and muscular pain so it’s important to pay extra attention to comfort while on your road trip. The following tips can help you avoid body pain when you're on the road:

• Watch your posture. Make sure that you’re sitting comfortably at the wheel, with your seat set so that you’re not stretching to reach the steering wheel.
• Move your seat. Position the seat at about a 100-degree angle so you’re not slouching, and be sure that the small of your back, the lumbar part, is supported. You can use a small pillow or even a rolled up towel for this purpose.
• Use cruise control. On long drives, resting both feet on the floor is easier on your back and hips. Just be sure to continue paying close attention to the road ahead.
• Take a break. Be sure to stop regularly (experts recommend every 20 to 30 minutes) to get out of your car and stretch before continuing on. This is especially true if you have chronic back pain or other issues that are triggered by sitting in one position for too long.

Road Trip: Staying Awake
One safety issue that is often overlooked on road trips is that of the sleepy driver. Most people are aware of the dangers of drinking and driving but are less aware that driving drowsy can be just as fatal, according to the National Sleep Foundation. Driving drowsy can produce the same slow reaction time, decreased awareness, and visual changes that driving drunk will, especially if you’re driving at night. To combat drowsy driving,

• Get enough rest. While it may seem obvious, make sure you get plenty of sleep before you leave. This can be tough if you’re running around with last-minute preparations. If you’re driving, however, being rested is important for your reaction time and overall competence. In addition, make sure on a multi-day trip that you give yourself enough time to unwind after a day at the wheel, and get a good night’s sleep before hitting the road again the next day.
• Pay attention if you start to feel sleepy. Listen to your body and pull over if you begin to feel groggy. Take a little rest or change drivers.

Road Trip: Avoiding Stress
Some people enjoy driving, while others find it stressful. To reduce the stress driving, consider the following:

• Think ahead. Try to arrange your travel time so that you can avoid driving through congested areas during rush hour.
• Use relaxation techniques. If you're stuck in traffic, relieve the frustration by focusing your attention on breathing deeply and slowly.
• Let the music play. Bring along plenty of relaxing music to help you stay calm while driving.
• Take breaks. Pull over to stretch or walk around when you need to.
• Switch off. Change drivers often if possible.

Road trips can be fun and rewarding if you take the time to prepare for the road ahead. Being willing to go with the flow if traffic hits, weather changes, or you feel as if you need a break can make a big difference, too. So pack, prepare, and don’t forget to wear your seat belt.

 

Stress Management Strategies for Travel Mishaps

A vacation is supposed to be relaxing, but traveling today can be anything but. Here are some stress management ideas that can help you keep your cool as you deal with travel hassles that arise. Traveling, whether for vacation or business, can be a minefield of stress. Any number of unexpected events can affect your trip, from flight delays or cancellations to lost luggage and overwhelming security check-in lines at airports. And when things don't go quite according to plan, travel stress can build up quickly and potentially keep you from enjoying your vacation as much as you'd hope to. Stress management calls for some preparation and planning to keep you from feeling overwhelmed. If you are aware of what could go wrong while you're traveling and have a backup plan for each scenario, you might not get quite so upset if a mishap does occur. You will also be better prepared to handle changes in your plans. Here are some common travel issues and possible stress-relieving strategies for you to consider:

Delayed or Cancelled Flights

Problem: Especially if you have to make connecting flights, a delayed or cancelled flight can ruin a day or more of your trip if you aren't prepared.

Stress Management Strategy: Before you leave home, program your airline’s reservations phone number into your cell phone. "If your flight is delayed, every passenger is going to be lining up at that departure gate to talk to that one representative to get on a different flight,” says David Lytle, editorial director of Frommers.com. “An easier way to resolve this is to call reservations directly at their toll-free number." Another approach is to walk out of the departure area and go back into the ticketing department. Or if you have Internet access and a computer, Lytle notes that some airlines will allow you to rebook a flight on their Web site; you can also look at the flight schedule to see which upcoming flights work best for your travel plans. To minimize your risk of delays altogether, consider arranging your travel schedule in a different way. "Fly first thing in the morning,” Lytle suggests. “The earlier the flight, the better the chance of getting out on time. If there are delays later in the day, those flights back up [every flight that takes off after it].”

Long Wait Times

Problem: Nothing can be more tedious than hanging around for a flight to leave. This is especially difficult when you have kids in tow who quickly run out of patience and get bored.

Stress Management Strategy: Come prepared to wait. Lytle suggests bringing along reading materials, a DVD for your computer, or something else that will keep you and others with you entertained while you're in the airport. Flying earlier in the day and avoiding peak travel times can reduce your wait times in some cases. No one loves to fly at 6 in the morning, but it could save you a lot of hassle and stress.

Lost Luggage

Problem: This is not a happy situation, especially when you’re going to a different climate that requires special clothing or when you have an important business meeting to attend.

Stress Management Strategy: You can be prepared for this possibility by always packing your essentials in a carry-on bag, including Rx medications, a change of clothes, and a few basic toiletries (remember the three-ounce limit on liquids in carry-on).

Rude People

Problem: Traveling creates stress for everyone: you, other travelers, and airport and airline employees. All it takes is one rude person to set the stage for everyone to be irritable.

Stress Management Strategy: In response, try to be pleasant and polite yourself, and never take out your frustrations on the airline staff. It is not their fault that your flight has been delayed or cancelled, and there's nothing they can do about it. But you're going to get more help and sympathy if you're nice about it. "The airline staff is there to help you, to facilitate your travels. When there is a delay, they are delayed, too," Lytle reminds travelers. "You can be courteous — a smile goes a long way. Recognize that the person trying to help you works in a stressful environment to begin with. You want to have an ally in this."

Additional Tips for Stress-Free Traveling
Even if you've planned ahead and are prepared, traveling can still cause stress and frustration. So, if you find yourself ready to blow a gasket, you need to find some ways to help yourself relax and stay calm. Here are some tips:

• Be careful with alcohol. If you know that alcohol tends to make you angrier, and you're stuck waiting at the airport, limit yourself to one drink. Not only can alcohol lead to even more problems, but if you become too intoxicated, the airline can refuse to let you board.
• Call ahead. To avoid having to wait several hours at the airport for a flight that's been delayed, call your airline or check online to see if your flight is on time. You'll be more relaxed waiting at home.
• Plan flights carefully. When you have to book connecting flights, leave plenty of time in between so that you feel less stressed about making a close connection.

If you do get stressed or upset:

• Try some deep breathing techniques. Take in a deep breath, drawing it all the way in from your diaphragm, and then slowly let it out. Repeat until you can feel your irritation level decreasing and your tension easing.
• Use simple meditation. Repeat calming phrases to yourself, like "Relax," "It's okay," or "Don't worry about it."
• Visualize. Going on a well-deserved vacation? Try picturing yourself at your vacation destination, enjoying yourself, and feeling completely relaxed. You'll be there soon enough.
• Accept it. Sometimes, you just can't do anything about your circumstances. Don't fight what you have no control over. Remind yourself that the situation is out of your hands and that all you can do now is go with the flow.

When travel delays keep you from getting somewhere important, whether a special family event, a vacation, or a business meeting, it's easy to start feeling overwhelmed and aggravated. Planning ahead for such delays will help you keep your cool and, if you start to lose it, simple stress management techniques and relaxation tips will help you get your equanimity back.

 

Travel Doctors Can Keep Your Trip on a Healthy Track

Doctors who specialize in travel medicine are knowledgeable about conditions around the world and can give you preventive health care before you leave home. Are you planning a trip abroad? If so, it's a smart idea to get to know how a travel doctor can help you. A person in this profession can provide practical advice on how to prepare for your trip and can help you to reduce your risk of becoming ill while you’re away. Here are some frequently asked questions about travel doctors.

What Is a Travel Doctor?
A travel doctor is usually a travel-medicine specialist, someone who knows about illnesses particular to different countries and health risks that may be involved in getting there. According to William L. Sutker, MD, chief of infectious diseases at Baylor University Medical Center in Dallas, “the role of a travel doctor is to be able to assess the health risks a patient may encounter when traveling to certain geographic areas.”

Why See a Travel Doctor?
With today’s instant access to information via the Internet, some people may wonder why they should bother seeing a travel doctor. The answer: Unlike a Web page, a travel doctor can look at you as an individual, and get the whole picture, not just one aspect of your health. Travel doctors also keep current on the health issues and immunizations needed in countries worldwide. And, not only do risks vary by location, but they also differentiate depending on the health of the patient, says Dr. Sutker. “The travel doctor may also prescribe medications or vaccines that may be recommended for the trip," he says.

How Do I Find a Travel Doctor?
Finding a travel doctor may be easier in larger cities than in smaller communities, but there are a few different avenues you can take to find one. Your local public health department is a good place to start. It may have listings of doctors or nurse practitioners practicing travel medicine, or they may be able to direct you to the right person locally. Private travel medical clinics are also available to meet the needs of both the general public and the business community. If you can’t find a private clinic through word-of-mouth or using a local directory, you can contact two organizations that list many of the private care travel clinics across the country: the International Society of Travel Medicine and the American Society of Tropical Medicine and Hygiene.

When Should I See a Travel Doctor?
Once you’ve planned your trip, you should contact a travel medicine clinic or travel doctor to see if an appointment is needed and when there are openings. This shouldn’t be left until the last minute because some vaccinations and medications need to be taken four to six weeks before you leave in order to be effective.

Can a Travel Doctor Give Me International Doctor Referrals?
The best way to get access to medical care outside of the United States is through your medical insurance or medical assistance company. Many of them, particularly the larger ones, have assistance lines for such emergencies. The coordinators of some of these companies have access to local resources and health care networks. If you have a medical condition that could cause problems while you are in a foreign country, it’s best to carry a letter from the doctor who's treating you that contains specific information about your illness and outlines the treatments you are receiving.

The Bottom Line: If you travel either for business or for pleasure, a travel doctor can be an invaluable part of your health care team. Consulting one before you go can make all the difference in whether or not your trip is successful and your memories are happy and healthy ones.

 

Keeping Up With Exercise

While You're Traveling Going on vacation doesn't have to mean you put your exercise routine on hold. Instead, you can work some workouts into your trip. Whether you’re hustling between business meetings or relaxing on vacation, your exercise routine isn't something to leave at home when you travel. There are many ways to sneak in some activity and exercise to help you stay fit while traveling, and it might even give you the opportunity to try new exercises that will mix up your workout routine a bit.

Vacation Exercise: Get Fit in Your Room
Many exercises can be done right in your room, without having to find a gym or a safe place to hit the pavement outside. "You can always do small exercises if you have limited room in your hotel room,” says David Lytle, editorial director of the travel guide Frommers.com. Squats, push-ups, and crunches don’t require equipment and are "very easily done in a small space," he says. Here are some other exercise ideas that can make it easy to workout right in your hotel room:

• Fitness to go. Pack a few small exercise accessories that can make working out in your hotel room a cinch. A jump rope, for instance, hardly takes up any space, doesn't add much weight to your luggage, and can be great for cardiovascular exercise. You can also pack resistance bands for strength training.
• Pump water, not iron. If you want to try lifting weights but don't have access to a gym (or just want to stay in your room), grab some bottles of water and do your weight-lifting sets with those.
• Walk the halls. Long hallways and corridors in your hotel can double as a great walking track. Just walk up and down the hallways when you need a little activity.
• Take the stairs. If you want to get your heart pumping, all you need is the hotel staircase. Rather than using a stair-climbing machine in a gym, try the real version right in your hotel.

Vacation Exercise: Hotel Gyms and Fitness Centers
Many hotels have their own fitness centers. They may not have all the equipment of a full gym, but there's usually enough to get a decent workout. Most hotel fitness centers will have at least a bike, a treadmill, or a stair-climbing machine. Many will also have free weights or weight-lifting machines. If your hotel has a pool, that’s even better. You can get a great cardiovascular workout, and you might even try some exercise equipment that you don't normally have access to at home. If your hotel doesn't have a fitness center, ask the front desk about what's available for travelers who want to exercise. Many hotels will offer passes to a local gym or fitness center. “Sometimes the concierge can procure free passes or negotiate a lower day rate” says Janet Lee, deputy editor of Shape. Additionally, “many gyms offer day passes, usually ranging from $10 to $50, depending on the facility,” she says. She also points out that gyms often have reciprocal arrangements with other gyms so their clients can maintain their workout routines, vacation or no vacation. Of course, if you want to be sure that you'll have access to fitness equipment while you're on your trip, it's best to look around ahead of time. Many hotel Web sites have pictures of their fitness centers and you can also read hotel reviews from other travelers to see if they've made any comments about the hotel's fitness center. Call ahead before making a reservation with the hotel to ask what kind of equipment their fitness center offers, or if the hotel has an agreement with a nearby gym. The Web site gymticket.com can be a helpful resource for finding gyms, health clubs, and fitness centers across the United States. It also lists gyms by brand name and tells you if you can get free passes or special deals.

Vacation Exercise: Get Some Exercise While Sightseeing
While you're in a new city, why not check it out — and get some good exercise in the process. Do some sightseeing on foot. You'll do a ton of walking before you've even noticed it. Hit an amusement park or a zoo. Do some research on nearby parks and trails and ask for recommendations at the front desk. You can even look up trail information on the Internet, says Lytle: "There are some Web sites that map good running paths around the world in major cities." Check those out if you're looking to hit the pavement on your vacation. No matter where your travels take you, there are lots of ways to have fun and also exercise while you're on vacation.

 

Eating Healthy Snacks During International Travel

Foreign travel doesn't mean your healthy eating habits have to take a hiatus. Some advance planning and sensible choices can make all the difference. Like many people who follow a healthy diet, you probably don’t want your international travel plans to mean that you’ll have to resort to standard junk food or unsafe food choices. Some common sense and a little research and preparation ahead of time can help keep your diet varied and you safe and well while you’re abroad.

Finding Healthy Snacks and Meals
If you are concerned about choosing healthy snacks and foods while traveling, following these tips can help:

• Look for foods you eat at home. Stick to simple, fresh, and natural foods like fresh fruits, vegetables, and lean meats. Fresh fruits are still a great alternative to caloric junk food for healthy noshing; you just need to choose wisely and prepare them correctly. It’s a good idea, for instance, to wash all produce thoroughly in bottled water and, for added protection, remove any peel or skin.

• Cook your own food. If you're nervous about the way your food will be prepared, for either sanitary or dietary reasons, cooking it yourself is an easy way to take control of what you're eating, even during international travel. By buying fresh products at a grocery store, you will have control over how your food is prepared and will know that it's both safe and healthy to eat. Some hotel rooms, inns, or hostels may have a kitchen area where you can prepare your own food. If this is something you're interested in, inquire about the cooking accommodations before you book your reservation.

David Lytle, editorial director for Frommers.com also suggests considering options beyond hotels — a rental apartment, where you can cook healthy snacks and meals in the kitchen might be a good fit for you and your fellow travelers, and in some cases it can even save you money.

• Do some research in advance. If you are a health-conscious eater and want to stay away from junk food or high-fat foods, do a little research before your trip and ask for local recommendations. That's how Pamela Melton, vice president and director of operations at Marketing Resources Inc. in Elmhurst, Ill., manages to maintain a healthy diet during the international junkets her job often requires.

"I always ask the hotel staff to recommend restaurants that have healthy options and that may offer menus in English," Melton says. "I also tend to stick with what I know and order chicken or beef." Melton says she usually looks up words she needs to know to communicate her dietary needs before she leaves and writes them down or brings along a dictionary for reference. When it comes to eating healthy, she says, "It is pretty easy to learn the words for these foods in any language."

On the Menu: Food Safety
While you do need to be concerned about food safety during international travel, a little common sense can help you steer clear of unsanitary foods. "For eating healthy in countries where the water quality may be questionable, I stick to produce that has a thick skin," says Melton. "Oranges and bananas are good examples. Cooked vegetables are usually safe, but I use caution when buying or ordering raw produce.” Eating healthy and safe foods during international travel is absolutely possible, Lytle confirms. "For any sort of travel, it is just a matter of doing some preparation," he says. "Often where people make a mistake is eating fresh produce in a country when it hasn't been properly washed first. You have to be aware of the country's rules and health regulations." Here are a few key food safety suggestions to follow:

• Make sure food is thoroughly cooked. Avoid anything that looks like it hasn't been cooked all the way through or isn't served steaming hot.

• Use only bottled water. If you're going to a location that may have water quality issues, opt for bottled water and beverages and skip the ice, which is usually made from tap water. Also, remember to use bottled water when brushing your teeth.

• Eat at reputable restaurants. Resist the tempting fare offered by vendors or at kiosks on the street — street vendors may not be as conscious about sanitation as restaurants are. For restaurants that cater successfully to foreign travelers, ask your hotel for recommendations or research them before your trip.

• Practice seafood safety. If you aren't sure about local sanitation regulations, steer clear of raw or undercooked seafood during international travel.

• Think twice about dairy. Don’t eat or drink any unpasteurized dairy products. You should also be cautious about pasteurized milk as foreign processing methods can differ from those in the United States.

• Stick to fruits with peels. Don't eat fruits that are already peeled, and for further protection, make sure to remove the peel yourself.

While there aren't any international signs and symbols that make food labels easy to understand across the world, finding the foods you want is possible with a little research and a translation dictionary on hand. If you stick to reputable restaurants and large grocery stores, you should be able to find fresh and familiar foods as well as a variety of healthy snacks to help you maintain your regular good eating habits while you’re traveling abroad.

 

Your Survival Guide to Safe and Healthy Travel

Every year more and more Americans are traveling internationally — for vacation, business, and volunteerism, and to visit friends and family. Whatever your reason for traveling, the information on this page will help you to be

Proactive, Prepared, and Protected when it comes to your health—and the health of others—while you are traveling.

BE PROACTIVE!

Take steps to anticipate any issues that could arise during your trip. The information in this section will help you plan for a safe and healthy trip.

• Learn about your destination.
• See a doctor before you travel.
• Think about your health status.
  • Are you too sick to travel? (Recent illnesses, injuries, or surgeries)
  • Do you have any special health needs? (Babies and small children, pregnant women, people with disabilities, people with weakened immune systems)

BE PREPARED!

No one wants to think about getting sick or hurt during a trip, but sometimes these things happen. You may not be able to prevent every illness or injury, but you can plan ahead to be able to deal with them.

• Pack smart.
• Plan ahead for illnesses or injuries during your trip.
• Know what to do if you become sick or injured on your trip.
• Know and share important information about your trip.

BE PROTECTED!

It is important to practice healthy behaviors during your trip and after you return home. This section outlines how you can protect yourself and others from illness during your trip.

• Pay attention to your health during your trip.
  • Use sunscreen and insect repellent as directed.
  • Be careful about food and water
  • Try not to take risks with your health and safety.
  • Limit alcohol intake, and do not drink alcohol and drive.
  • Wear a seatbelt.
  • Wear protective gear when doing adventure activities.
  • Respect your host country and its people by following local laws and customs.
• Pay attention to your health when you come home.

 

Pack Smart

The following things will be useful to have during your trip.

• Copies of your passport and travel documents. Place a copy of your passport and travel documents in each piece of luggage, in case you lose the original documents. Don’t forget to leave a copy with a friend or relative at home.
• Items that might go in your travel health kit.

Check the Transportation Security Administration website for updates on permitted and prohibited items, including medicines that you are allowed to carry onto an airplane. Some items may not be allowed in other countries. It is a good idea to check the Customs and Import Restrictions section of the U.S. Department of State Tips for Traveling Abroad. What to Pack in Your Travel Health KitUse this list to help you think of things to pack in your travel health kit. Be sure to think about where you are going and whether you will have access to health items and supplies. Medicines

• Prescription medicines you usually take
  • If you have a severe allergy and epinephrine has been prescribed by your doctor, bring your Epinephrine auto-injector (for example, an EpiPen).

• Special note about prescription medicines
  • Pack your prescription medications in your carry-on luggage.
  • Pack copies of all prescriptions, including the generic names for medications.
  • Pack a note on letterhead stationery from the prescribing physician for controlled substances and injectable medications.
  • Leave a copy of your prescriptions at home with a friend or relative.
  • Check with the American Embassy or Consulate to make sure that your medicines will be allowed into the country you are visiting. Some countries do not let visitors bring certain medicines into the country.
• Special prescriptions for the trip
  • Medicines to prevent malaria, if needed
  • Antibiotic prescribed by your doctor for self-treatment of moderate to severe diarrhea
• Over-the-counter medicines
  • Antidiarrheal medication (for example, bismuth subsalicylate, loperamide)
  • Antihistamine
  • Decongestant, alone or in combination with antihistamine
  • Anti-motion sickness medication
  • Medicine for pain or fever (such as acetaminophen, aspirin, or ibuprofen)
  • Mild laxative
  • Cough suppressant/expectorant
  • Cough drops
  • Antacid
  • Antifungal and antibacterial ointments or creams
  • 1% hydrocortisone cream

Other important items

• Supplies to prevent illness or injury 
  • Insect repellent containing DEET (30%-50%) or picaridin (up to 15%)
  • Sunscreen (preferably SPF 15 or greater) that has both UVA and UVB protection
  • Antibacterial hand wipes or alcohol-based hand sanitizer containing at least 60% alcohol
  • Lubricating eye drops
• First-aid supplies
  • First aid quick reference card
  • Basic first-aid items (bandages, gauze, ace bandage, antiseptic, tweezers, scissors, cotton-tipped applicators)
  • Moleskin for blisters
  • Aloe gel for sunburns
  • Digital thermometer
  • Oral rehydration solution packets
• Health insurance card (either your regular plan or supplemental travel health insurance plan) and copies of claim forms

Other items that may be useful in certain circumstances

• Mild sedative or other sleep aid
• Medicine to prevent altitude sickness
• Water purification tablets
• Commercial suture/syringe kits to be used by local health-care provider. (These items will also require a letter on letterhead stationery from the prescribing physician.)
• Latex condoms
• Child safety seats
• Bicycle helmet

 

Pre- and Post-travel General Health Recommendations

Risks from Food and Water (Drinking and Recreational)

Contaminated food and water are common sources for the introduction of pathogens into the body. Among the more common infections that travelers can acquire from contaminated food and drink are Escherichia coli infections, shigellosis or bacillary dysentery, giardiasis, cryptosporidiosis, noroviruses, and hepatitis A. Other less common infectious disease risks for travelers include typhoid fever and other salmonelloses, cholera, rotavirus infections, and a variety of protozoan and helminthic parasites (other than those that cause giardiasis and cryptosporidiosis). Many infectious diseases transmitted through food consumption and drinking water can also be acquired directly through the fecal-oral route. Accidental consumption of recreational water from lakes, rivers, oceans, and inadequately treated swimming pools can spread these same diarrheal diseases as well as ear, eye, skin, respiratory, and neurologic infections.

Food:

To avoid illness, travelers should be advised to select food with care. All raw food is subject to contamination. Particularly in areas where hygiene and sanitation are inadequate, the traveler should be advised to avoid salads, uncooked vegetables, and unpasteurized milk and milk products such as cheese, and to eat only food that has been cooked and is still hot or fruit that has been washed in clean water and then peeled by the traveler personally. Undercooked and raw meat, fish, and shellfish can carry various intestinal pathogens. Cooked food that has been allowed to stand for several hours at ambient temperature can provide a fer-tile medium for bacterial growth or be recontaminated by food-handling techniques so should be thoroughly reheated before serving. Consumption of food and beverages obtained from street vendors has been associated with an increased risk of illness. Travelers should be advised that these recommendations also include eating eggs that have been thoroughly cooked, alone or in sauces, and washing their own hands or using hand gel with more than 60% alcohol prior to eating, after using the bathroom or changing diapers and after direct contact with preschool children, animals or any feces.

The easiest way to guarantee a safe food source for an infant younger than 6 months of age is to have the infant breastfeed. If the infant has already been weaned from the breast, formula prepared from commercial powder and boiled water is the safest and most practical food.

Cholera cases have occurred in people who ate crab brought back from Latin America by travelers. Travelers should be advised not to bring perishable seafood with them when they return to the United States from high-risk areas. Moreover, travelers may assume incorrectly that food and water aboard commercial aircraft are safe. Food and water may be obtained in the country of departure, where items may be contaminated.

Water:

Swimming

A variety of infections (e.g., skin, ear, eye, respiratory, neurologic, and diarrheal infections) have been linked to wading or swimming in the ocean, freshwater lakes and rivers, and swimming pools, particularly if the swimmer’s head is sub-merged. Water may be contaminated by other swimmers and from sewage, animal waste, and wastewater run-off. Diarrhea and other serious waterborne infections can be spread when disease-causing organisms from human or animal feces are introduced into the water. Accidentally swallowing small amounts of fecally contaminated water can cause illness. Travelers should be warned to try to avoid swallowing water while engaging in aquatic activities. All travelers who have diarrhea should refrain from swimming to avoid contaminating recreational water.

Travelers who swim at freshwater or marine beaches should be advised to avoid swimming or wading 1) at beaches that may be contaminated with human sewage or animal feces (e.g., cattle, sheep, dogs); 2) near storm drains; 3) following heavy rainfall; 4) in freshwater streams, canals, and lakes in schistosomiasis-endemic areas of the Caribbean, South America, Africa, and Asia; 5) in bodies of water that may be contaminated with urine from animals infected with Leptospira; and 6) with open cuts or abrasions that might serve as entry points for pathogens. In certain areas where fatal primary amebic meningoencephalitis has occurred after swimming in warm freshwater lakes or rivers, thermally polluted areas around industrial complexes, and hot springs, travelers should avoid submerging the head and should wear nose plugs when entering untreated water to prevent water containing the pathogen from getting up the nose and causing infection.

Generally, for infectious disease prevention, pools that contain chlorinated water can be considered safe places to swim if the disinfectant levels and pH are properly maintained. However, some organisms are moderately (e.g., Giardia, hepatitis A, norovirus) to highly (i.e., Cryptosporidium) resistant to chlorine levels commonly found in chlorinated swimming pools, so travelers also should avoid swallowing chlorinated swimming pool water. Poorly maintained swimming pools or spas may not only spread disease from fellow swimmers but may allow amplification of environmental contaminants, such as Pseudomonas or Legionella, to levels that may cause disease. Travelers may choose to take test kits or strips to check pool chlorine and pH levels when traveling.

Drinking

Water that has been adequately chlorinated according to the minimum recommended water treatment standards used in the United States will afford substantial protection against viral and bacterial waterborne diseases. However, chlorine treatment alone, as used in the routine disinfection of water, may not kill some enteric viruses and the parasitic organisms that cause giardiasis, amebiasis, and cryptosporidiosis. In areas where chlorinated tap water is not available or where hygiene and sanitation are poor, travelers should be advised that only the following may be safe to drink: beverages, such as tea and coffee, made with boiled water, canned or unopened bottled beverages, including water, carbonated mineral water, soft drinks, beer, and wine.

Where water might be contaminated, travelers should be advised that ice should also be considered contaminated and should not be used in beverages. If ice has been in contact with containers used for drinking, travelers should be advised to clean the containers thoroughly, preferably with soap and hot water, after the ice has been discarded.

It is safer to drink a beverage directly from the can or bottle than from a questionable container. However, water on the outside of beverage cans or bottles may also be contaminated. Therefore, travelers should be advised to dry wet cans or bottles before they are opened and to wipe clean surfaces with which the mouth will have direct contact. Where water may be contaminated, travelers should be advised to avoid brushing their teeth with tap water and that locally prepared fruit juice may also contain tap water.

Treatment of Drinking Water:

Travelers should be advised of the following methods for treating water to make it safe for drinking and other purposes.

Boiling

Boiling is by far the most reliable method to make water of uncertain purity safe for drinking. Water should be brought to a vigorous rolling boil for 1 minute and allowed to cool to room temperature; ice should not be added. This procedure will kill all common waterborne pathogens. Adding a pinch of salt to each quart or pouring the water several times from one clean container to another will improve the taste.

Chemical Disinfection

Chlorine, in various forms, can also be used for chemical disinfection. However, its germicidal activity varies greatly with the pH, temperature, and organic content of the water to be purified; therefore, it can produce less consistent levels of disinfection depending on the water quality (e.g., turbid water). In addition, some forms of chlorine disinfectant may not be stable through long-term storage or at high temperatures.

Chemical disinfection with iodine, which is not as sensitive as chlorine to pH shifts, is an alternative method of water treatment when it is not feasible to boil water. However, using iodine cannot be relied on to kill Cryptosporidium. Cloudy water should be strained through a clean cloth into a container to remove any sediment or floating matter, and then the water should be treated with iodine. Two well-tested methods for disinfection with iodine are the use of tincture of iodine and tetraglycine hydroperiodide tablets (e.g., Globaline, Potable-Aqua, or Coghlan’s). These tablets are available from pharmacies and sporting goods stores. The manufacturer’s instructions should be followed. If water is cloudy, the number of tablets used should be doubled; if water is extremely cold (<41°F), an attempt should be made to warm the water, and the recommended contact time should be increased to achieve reliable disinfection. Iodine treatment of water is intended for short-term use only to avoid over exposure to iodine. When the only water available is iodine treated, it should be used for only a few weeks.

Water Filters

Portable filters currently on the market will provide various degrees of protection against microbes but are generally meant to be used in conjunction with disinfection for greatest protection from pathogens. Reverse-osmosis filters provide protection against viruses, bacteria, and protozoa, but they are expensive and larger than most filters used by backpackers, and the small pores on this type of filter are rapidly plugged by muddy or cloudy water. In addition, the membranes in some filters can be damaged by chlorine in water. Microstrainer filters with pore sizes in the 0.1- to 0.3-µm range can remove bacteria and protozoa from drinking water, but they do not remove viruses. To kill viruses, travelers using microstrainer filters should be advised to disinfect the water with iodine or chlorine after filtration, as described previously. Some filtration kits come with an additional filter effective against viruses. Protozoa can be highly (Cryptosporidium) to moderately (Giardia) resistant to halogen treatment, particularly in cold or turbid water. As a result, filtration or boiling should be considered as a safer alternative to chemical disinfection. A travelers’ guide to buying water filters for preventing cryptosporidiosis and giardiasis can be found at URL: http://www.cdc.gov/crypto/factsheets/filters.htm. Increased protection can be obtained by using a filter that removes Giardia and Cryptosporidium that is combined with an iodine-impregnated resin which is more effective against bacteria and some viruses.

As a last resort, if no source of safe drinking water is available or can be obtained, tap water that is uncomfortably hot to touch might be safer than cold tap water; however, proper disinfection and filtering, or boiling is still advised.