Health advice for international travel

Air Travel and High-Altitude Destinations Commercial air travel is not a risk to the healthy pregnant woman or to the fetus. The higher radiation levels reported at altitudes of 10,500 m (35,000 ft) should pose no problem to the healthy pregnant traveler. Since each airline has a policy regarding pregnancy and flying, it is best to check with the specific carrier when booking reservations. Domestic air travel is usually permitted until the 36th week, whereas international air travel is generally curtailed after the 32nd week.

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Gastrointestinal Illness Decreased levels of gastric acid, abnormal gastrointestinal mucosal immunity, other complications of HIV infection, and medications taken by HIVinfected patients make travelers' diarrhea especially problematic in these individuals. Travelers' diarrhea is likely to occur more frequently, be more severe, be accompanied by bacteremia, and be more difficult to treat. Although uncommon, Cryptosporidium, Isospora belli, and Microsporidium infections are associated with increased morbidity and mortality in AIDS patients.

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Diabetes Mellitus Alterations in glucose control and changes in insulin requirements are common problems among patients with diabetes who travel. Changes in time zone, in the amount and timing of food intake, and in physical activity demand vigilant assessment of metabolic control. The traveler with diabetes should pack medication (including a bottle of regular insulin for emergencies), insulin syringes and needles, equipment and supplies for glucose monitoring, and snacks in carryon luggage. Insulin is stable for ~3 months at room temperature but should be kept as cool as possible.

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Fever Fever in a traveler who has returned from a malarious area should be considered a medical emergency because death from P. falciparum malaria can follow an illness of only several days' duration. Although "fever from the tropics" does not always have a tropical cause, malaria should be the first diagnosis considered. The risk of P. falciparum malaria is highest among travelers returning from Africa or Oceania and among those who become symptomatic within the first 2 months after return.

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Harrison's Internal Medicine Chapter 117. Health Advice for International Travel Health Advice for International Travel: Introduction According to the World Tourism Organization, the number of international tourist arrivals in 2004 reached an all-time record of 763 million. This number represents an increase over the 2003 figure of almost 11%—the highest and the only double-digit percentage increase since 1980, when these statistics were first collected. Not only are more people traveling; travelers are seeking more exotic and remote destinations. ...

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Rabies Domestic animals, primarily dogs, are the major transmitters of rabies in developing countries (Chap. 188). Several studies have shown that the risk of rabies posed by a dog bite in an endemic area translates into 1–3.6 cases per 1000 travelers per month of stay. Countries where canine rabies is highly endemic include Mexico, the Philippines, Sri Lanka, India, Thailand, and Vietnam. The three vaccines available in the United States provide 90% protection.

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Prevention of Gastrointestinal Illness Diarrhea, the leading cause of illness in travelers (Chap. 122), is usually a short-lived, self-limited condition; however, 40% of affected individuals need to alter their scheduled activities, and another 20% are confined to bed. The most important determinant of risk is the destination. Incidence rates per 2-week stay have been reported to be as low as 8% in industrialized countries and as high as 55% in parts of Africa, Central and South America, and Southeast Asia. Infants and young adults are at particularly high risk.

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Immunizations for Travel Immunizations for travel fall into three broad categories: routine (childhood/adult boosters that are necessary regardless of travel), required (immunizations that are mandated by international regulations for entry into certain areas or for border crossings), and recommended (immunizations that are desirable because of travel-related risks). Vaccines commonly given to travelers are listed in Table 117-1.

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