It’s that time of year again when many of us will be venturing out to exotic and perhaps not-so-exotic destinations for the summer. As you pack your bags, you might be wondering, just what are the risks of travel? Will I come down with O’nyong-nyong fever? Ebola? Tunga penetrans? Actually you are much more likely to be injured in an accident or be affected by more common problems such as jet lag, motion sickness, sunburn or traveler’s diarrhea than any exotic tropical disease. But, since you plan to be careful when crossing the street, religiously wear sunscreen and pile on the insect repellent, what are some of the other threats to your health that you can avoid or prevent during your vacation? Risks from Water and Food While local cuisine is certainly one of the highlights of travel, remember that all raw food is subject to contamination and care should be exercised when consuming such foods, if at all. Water and ice are other common sources of viral, bacterial, and parasitic disease. Consumption of street vendor fare has been linked to an increased risk of illness in travelers. Consuming only properly and thoroughly cooked foods, bottled beverages or beverages made with boiled water should help decrease your chances of contracting any unwanted pathogens. Swimming in contaminated waters may also result in various infections, including eye, ear, skin and gastrointestinal infections. Some organisms may even be present in chlorinated waters (hepatitis A, norovirus, e.g.).

Vaccine-preventable diseases While there are many infectious diseases out there, there are also many vaccines which can help prevent disease. A review of childhood vaccines is a good place to start to check for any missing or incomplete vaccinations. Check to see if you have had a tetanus booster within the past ten years. Hepatitis A and typhoid fever vaccines are often recommended for travelers as these diseases are quite common throughout the world and typically acquired through water or food. Rabies is a potential risk depending on location and activities planned. Extensive outdoor activities such as hiking, camping or working with animals may involve significant risk and pre-exposure vaccination may be recommended (three doses over 3 to 4 weeks). Although post-exposure vaccination is typically effective in preventing infection, there is no effective treatment once infection is established in this fatal disease. Meningococcal vaccine may be recommended for those traveling to sub-Saharan Africa with a single injection providing. Japanese encephalitis is a mosquito-borne viral infection, common in Asia. Infection may result in serious neurologic problems or death. Although risks for travelers to urban areas for short periods is felt to be low, they may be higher for those planning extensive outdoor travel such as camping or biking in rural areas. A vaccine is available (a new formulation has just been released in Japan), and three injections are recommended over a one month period to obtain initial immunity. Hepatitis B is typically transmitted by blood or blood products and risks for most travelers is felt to be low. Unprotected sex, needle sharing or work in health care related areas may increase the risk. A effective vaccine is available, given on a 2 or 3 dose schedule. Yellow fever exists in sub-Saharan Africa and tropical South America and some countries require proof of vaccination via an “International Certificate of Vaccination” prior to entry. In Japan, the vaccine and certificate is only available at quarantine offices.

Malaria Malaria is found in many regions and infection is a potential risk, though difficult to estimate in many cases. There is no vaccine, but prevention through personal protection (screens, clothing, insect repellent) and prophylactic medication. Several types of oral medications are available for prophylaxis, but most must be started prior to departure and continued after leaving the area. Medications are not 100% effective and personal protection measures are recommended regardless of the use of oral prophylactic medications. Finally, there are some unique considerations when initiating travel from Japan. Many vaccines are not licensed in Japan and therefore are not widely available. Typhoid and Meningococcal vaccines, for example, are not approved by the government. Some clinics do stock imported vaccine. Some malaria medications are also not approved, most notably Malarone® (atovaquone/proguanil), which is frequently recommended. Again this may be available at some clinics that import the product. It may take a bit more effort and cash, but adequate preparation is possible in most cases. Review your itinerary and consult your physician as far in advance of your departure as possible so that the only parasite that bugs you is the guy selling trinkets on the beach. Happy travels! http://www.pctclinic.com/