Planning for Healthy Travel

International travellers can take a number of simple steps to avoid potential health problems before and during travel. International travellers should contact their physicians, local health departments, or private or public agencies that advise international travellers at least 4 to 6 weeks before departure to schedule an appointment to receive current health information on the countries they plan to visit, obtain vaccinations and prophylactic medications as indicated, and address any special needs.

It is wisest for persons to postpone travel if they are not feeling well, particularly if they have febrile illnesses. By delaying travel, persons who are ill avoid potential emergencies and are courteous toward other travellers who may not wish to be exposed to someone with a transmissible illness. Trip cancellation insurance is available from a variety of sources.

Handwashing is one of the most important practices in preventing illness from infections while travelling. Travellers should wash their hands often with soap and water or an alcohol-based hand rub to remove potentially infectious materials from the skin and help prevent disease transmission.

New risks to international travellers may arise that are not detailed in this book. These new risks may result from unanticipated outbreaks of infectious diseases in an international travel destination or emerging infectious diseases.

Emerging infectious diseases are diseases of infectious origin the incidence of which in humans has increased within the past two decades or threatens to increase in the near future. Many factors or combinations of factors can contribute to disease emergence and outbreaks. New infectious diseases can emerge from genetic changes in existing organisms; known diseases can spread to new geographic areas and populations; and previously unknown diseases can appear in humans living or working in changing ecologic conditions that increase their exposure to insect vectors, animal reservoirs, or environmental sources of novel pathogens. A good example is the emergence of the severe acute respiratory syndrome (SARS). SARS is a viral respiratory illness caused by a coronavirus (SARS-CoV). SARS was recognised as a global threat in March 2003, after first appearing in Southern China in November 2002. Over the next few months, the illness spread to more than two dozen countries in North America, South America, Europe, and Asia. Although the 2003 global outbreak was contained, person-to-person transmission of SARS-CoV may recur. Although there is no evidence that direct contact with civets or other wild animals from live-food markets has led to cases of SARS, viruses very similar to SARS-CoV have been found in these animals. In addition, some persons working with these animals have evidence of infection with SARS-CoV or a very similar virus.

Reemergence can occur because of the development of antimicrobial resistance in existing infections (e.g., gonorrhea, malaria, and pneumococcal disease) or breakdowns in public health measures for previously controlled infections (e.g., cholera, tuberculosis, and pertussis).

Travellers should be aware of the occurrence of any disease outbreaks in their international destinations. Current travel notices on diseases of international concern are posted on the Travellers' Health home page on the CDC website at www.cdc.gov/travel/.

CDC issues different types of notices for international travellers. As of May 20, 2004, these definitions were refined to make the announcements more easily understood by travellers, health-care providers, and the general public. Each type of notice describes the level of risk for the traveller and recommended preventive measures. Guidance is posted on the CDC Travellers' Health website as outbreaks occur, in four levels:

In The News, the lowest level of notice, will provide information about sporadic cases of disease or an occurrence of a disease of public health significance affecting a traveller or travel destination. The risk for an individual traveller does not differ from the usual risk in that area.

Outbreak Notice provides information about a disease outbreak in a limited geographic area or setting. The risk to travellers is defined and limited, and the notice will remind travellers about standard or enhanced travel recommendations, such as vaccination.

Travel Health Precaution provides specific information to travellers about a disease outbreak of greater scope and over a larger geographic area so they can take measures to reduce the risk of infection. The precaution also provides guidance to travellers about what to do if they become ill while in the area. CDC does not recommend against travel to a specific area but may recommend limiting exposure to a defined setting, such as poultry farms or health-care settings.

Travel Health Warning recommends against nonessential travel to an area because a disease of public health concern is expanding outside the areas or populations that were initially affected. The purpose of a travel warning is to reduce the volume of traffic to affected areas, thus limiting the risk of spreading the disease to unaffected areas.

A complete description of the definitions and criteria for issuing and removing travel notices can also be found at www.cdc.gov/travel/outbreaks.htm .

Table 2-1.Travel notice definitions

1The term "scope" incorporates the size, magnitude, and rapidity of spread of an outbreak.
2Risk for travellers is dependent on patterns of transmission, as well as severity of illness.
3Preventive measures other than the standard advice for the region may be recommended depending on the circumstances (e.g., travellers may be requested to monitor their health for a certain period after their return, or arriving passengers may be screened at ports of entry).

-Patricia M. Simone