Each year, more than 30 million Americans travel internationally by air, according to the National Travel and Tourism Office. That’s not counting those who drive or walk across the border.
But while many globetrot for work or pleasure without health incident, public health, travel and tropical medicine experts say that often a lack of preparation or awareness of the potential health risks associated with international travel may pose a danger to the individual as well as to others in the communities where that person resides.
Plan Ahead
“The first recommendation is to think in advance,” says Dr. Mirella Salvatore, an assistant professor of medicine at Weill Cornell Medicine in New York City and a travel medicine specialist who sees patients at the affiliated Weill Cornell Travel Medicine practice. She recommends seeing a health care provider for a travel-related health consult at least one to two months prior to travel. That’s because it typically takes vaccines a couple weeks before they become fully effective; and in some cases, an additional dose or doses of the vaccine, or booster shots, are needed.
Infectious disease hot spots and vaccine recommendations keep changing, so it can be a challenge to stay on top of them, even for frequent travelers. The Centers for Disease Control and Prevention has posted updated guidelines on malaria, yellow fever, cholera and polio precautions in 2019.
[See: 14 Myths and Misconceptions About the Flu Vaccine.]
Malaria, which killed an estimated 435,000 people worldwide in 2017, according to the World Health Organization, was eliminated in the U.S. in the 1950s. Yet the number of imported cases in the U.S. has crept up in recent decades. According to research in the July 2017 American Journal of Tropical Medicine and Hygiene, there were an estimated 22,029 malaria-related hospitalizations — averaging 1,469 each year — in the U.S. from 2000 to 2014.
Travelers in places where malaria is present, like West Africa, are urged to talk with their doctors about taking antimalarial medications to prevent contracting the life-threatening blood disease that’s caused by parasites and transmitted by mosquito bites. In August 2018, the Food and Drug Administration approved the drug Arakoda for malaria prevention in adults. In July 2018, the FDA approved the drug Krintafel to prevent malaria relapse in certain patients ages 16 and older.
People traveling to areas where yellow fever is a concern should be aware that production of the yellow fever vaccine in the U.S. is currently at a standstill. It’s still possible to get immunized, via waivers, with a vaccine that’s produced and approved overseas, at select U.S. sites where it’s offered. However, arranging the process will likely take extra planning time for travelers.
If a trip to Congo happens to be on your itinerary, Ebola should be on your radar. On July 17, the World Health Organization declared the Ebola outbreak there a “public health emergency of international concern.” In particular, aid workers planning to travel abroad should take note.
[See: 9 Ways to Boost Your Immune System.]
Remember Routine Vaccines, Too
The threat to health needn’t be exotic. In fact, in addition to not getting vaccines to protect against diseases like yellow fever, many travelers face added health risks when abroad because they’re not caught up on routine vaccines.
In some cases, people who aren’t current with their two doses of the measles, mumps, rubella, or MMR, vaccine contract measles — a highly contagious, dangerous viral infection — while traveling internationally and spread it to others who aren’t immune when they return home. Endemic measles was eliminated in the U.S. in 2000. But in recent years, imported cases of the viral infection have sparked a number of measles outbreaks here, says Kelly Holton, spokeswoman for the Travelers’ Health Branch of the Centers for Disease Control and Prevention. In 2019, U.S. measles outbreaks are surging.
“What we’re seeing now is phone calls from patients who are going to New York and those areas asking for the measles, mumps and rubella vaccine,” says Dr. Joseph McBride, an infectious disease specialist and clinical assistant professor with the University of Wisconsin School of Medicine and Public Health, and a practitioner at the UW Health Travel Clinic. “That is a big difference than previously, where the rates of measles were essentially zero for naturally occurring measles throughout the country, but now that’s obviously not the case. So we treat it almost as an international destination from the standpoint of their vaccine history for measles, mumps and rubella, even though they’re going to the U.S.”
[READ: Why Adults Shouldn’t Skip Vaccines]
Measles can be spread days before the appearance of the characteristic rash, which typically starts with flat red spots. It can lead to complications ranging from diarrhea to hearing loss, pneumonia and brain swelling. Children are particularly vulnerable; about 1 or 2 of every 1,000 who contract measles will die from it, according to the CDC.
Fortunately, clinicians note that the MMR vaccine is highly effective in protecting kids and adults from getting the disease. But not everyone has received the vaccine or is immune to measles. Adults born in the U.S. before 1957 are presumed to have immunity because of the widespread nature of measles before that time and don’t need the vaccine. Others, including pregnant women, should not get the vaccine. It’s safe for most people, though experts say with all vaccines, it’s important to talk with a doctor first about the risks and benefits.
However, some travelers aren’t taking advantage of this prevention opportunity. Research published in the July 2017 issue of Annals of Internal Medicine found that more than half of travelers who were eligible for the MMR vaccine didn’t get it. Reasons varied, with nearly half of eligible patients at travel clinics refusing the vaccine.
The CDC and the Advisory Committee on Immunization Practices recommend that all international travelers be up to date on MMR vaccination prior to travel. That means having received two documented doses of the vaccine.
Of course, travelers can’t rely on vaccines alone to protect against health risks. Experts emphasize understanding all recommended precautionary measures when traveling internationally for that locale, which could range from taking prophylactic drugs — like antimalarial medications — to wearing bug repellent.
Health Resources for Travelers
You can receive appropriate vaccines, preventive medicine and/or timely information from these sources:
— CDC destination pages. To assess risk before departing, would-be travelers can look up their destinations on the CDC’s travelers’ health site to find out what vaccines or other health precautions are recommended. “We have destination pages for every country in the world, along with some places that aren’t countries,” Holton notes.
— Travel clinics. These are essentially one-stop shops for travelers who want to stay healthy. Expertise with travel vaccinations is only part of what they offer, McBride says. Clinics are also places for conversations about reducing risks from foodborne illnesses, different types of bug spray, reminders to use condoms and any changes in your medical history that could have an impact on your individual recommendations.
— Apps for travelers. The CDC also offers free apps for travelers. One, called “TravWell,” is a planning tool. You can plug in the dates of your trip and where you’re traveling and it will list recommended vaccines. You can also put in your vaccine history and set reminders, say, if you need another dose of a vaccine. It can also remind you to take your prescription medicines, like malaria drugs. There’s a customizable health packing list, and you can also store pictures of any of your important health documents. The “Can I Eat This?” app allows travelers to plug in the country they’re traveling in, along with whatever they’re about to consume, to help them make safer food and water choices.
— Primary care providers. To find out whether you and your family are up to date with routine vaccines, including flu shots, hepatitis, tetanus and MMR immunizations, check with your family doctor, nurse practitioner or pediatrician. They can immunize you as needed and also adapt regular childhood vaccination schedules as recommended, such as for infants between 6 months and 1 year old, to protect them during travel.
Consider also your own health before departing — or even when choosing your destination. Chronic conditions and other health issues should be discussed with your primary care doctor and any travel medicine specialist you see before setting out. For some, say experts — including those who may be immunocompromised or who otherwise can’t get vaccinated against diseases in an area where they plan to travel — it might be best to choose to travel elsewhere.
Don’t assume because you’re traveling to a developed country that you won’t face any health risks. “Currently, many countries are experiencing measles outbreaks. This includes many popular travel destinations like Israel, Thailand, Vietnam, Japan, Ukraine, the Philippines and more,” according to the CDC website as of July 2019.
Before you depart, talk with your health provider to make sure you’re taking all necessary precautions — whether the threats are exotic or not — for the sake of your health and others in the community to which you return.
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Travel Vaccinations: Planning Ahead and Resources originally appeared on usnews.com
Update 07/26/19: This story was originally published on an earlier date and has been updated with new information.
