House Call - 2018


Prescription for Healthy Travel Abroad

By Dr. Shefali V. Parmar

India is a popular destination for many of my patient families in the coming months. Annual festivals, weddings, and reconnecting with family are few of the many draws of India, making the long journey worth your while. However, traveling to the Indian subcontinent comes with health risks, too. With careful preparation and a quick visit to your doctor, you can better ensure a safe journey and healthy return home.

Vaccination is critical in preventing significant illness. Your doctor will first review and counsel regarding your vaccination status. In addition to routine immunizations, families should specifically ensure protection from Typhoid. Typhoid fever is a serious illness caused by eating food and water contaminated with the bacteria Salmonella Typhi. Typhoid fever often causes significant weakness, fever, abdominal pain and headache. Washing hands, safe eating and drinking practices, and vaccination are key to staying healthy. Two different types of typhoid vaccines are available and your doctor will determine which one is best suited for you and/or your child. And, depending on the timing of your visit, your doctor may prescribe a flu vaccine.

Other important immunizations to consider when traveling to India may include Tdap, Hepatitis A, Hepatitis B, Polio, Measles Mumps Rubella, and Varicella. In special circumstances, vaccines for preventing Japanese encephalitis, cholera, and rabies may be additionally recommended. Taking the time to consult with your physician regarding your vaccinations prior to travel is one of the easiest and most cost-effective ways to prevent a major health setback.

Second, preventing mosquito-borne illness should be a priority, too. Malaria, Dengue, Chikungunya, Japanese encephalitis, and Zika are all serious health conditions transmitted by the bite of mosquitos. Fever, headache, joint pain, and weakness may signal mosquito borne infection days to weeks after a mosquito bite. Additionally, Dengue, Chikungunya and Japanese encephalitis can be life threatening and treatment options are limited. Preventing mosquito bites by wearing proper clothing and applying mosquito repellant are effective strategies. Minimize areas of exposed skin by wearing long-sleeved shirts, long pants, boots/closed shoes, and hats. For exposed skin, apply DEET (up to 30 percent is safe) containing spray or lotion. I recommend purchasing your repellant prior to travel; common store shelf repellants include those made by OFF!, Cutter, and Repel.

In addition to using mosquito repellant, discuss with your doctor which malaria preventive medication is best for you and/or your child. Depending on the person's age and duration of journey, your doctor may select a once daily or weekly preventive medicine. Avoid areas with standing water and know that mosquitos are more active in early morning and evening. Lastly, use common sense. Anticipate mosquitos if you will be attending an evening outdoor wedding function and be sure to reapply repellents as protection wanes and mosquitoes start to bite.

Food and water safety precautions are important in avoiding the often termed and experienced “Delhi belly." Washing hands, drinking bottled water or beverages from sealed cans/bottles, and being selective about food consumption helps avoid vomiting and diarrhea. When hand washing is not possible, use alcohol-based hand sanitizer with > 60% alcohol to clean hands. When bottled water is not a choice, boiling water is an acceptable method of disinfection (boiling for one minute or more ensures margin of safety). However, boiling does not prevent recontamination during storage. Further, avoid ice, raw food, and street food, especially pani puri and sugar cane juice. Eat only freshly cooked hot meals and avoid unpasteurized milk products.

If diarrhea does develop, focus on hydration. Infants and younger children with traveler's diarrhea are at higher risk for dehydration, which is best prevented by the early initiation of oral rehydration. I generally advise my patient families to travel with Pedialyte sachets. The World Health Organization also provides packaged oral rehydration salts widely available for purchase at stores and pharmacies in India. Oral rehydration solution is then prepared by adding one packet to the indicated volume of bottled, boiled or treated water—generally one liter. If there is bloody or severe watery diarrhea or fever, seek professional medical care. Know how and where to obtain health care should the need arise.

Lastly, do not forget the simple safety rules like buckling your seatbelt. Take car seats for your children. Wear a helmet if riding a scooter and be extra careful about the traffic. Avoid all stray animals. Travelers should avoid touching, handling, or feeding animals, including pets since domestic animals may not be vaccinated for rabies. Avoid heavy sun, wear sunblock and ensure ample hydration.

I wish you and your family a most enjoyable visit to our homeland. Taking the above precautions and seeing your doctor before travel will ensure a healthy journey and safe return home.

Reference and Resources:

wwwnc.cdc.gov/travel
www.cdc.gov/vaccines/schedules/hcp
www.cdc.gov/westnile/prevention

Look for more articles from Dr. Parmar in upcoming editions of Saathee as well as online.

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Dr. Parmar is a Duke trained Pediatrician at Cornerstone Pediatric & Adolescent Medicine in Cary, NC. Email: shefali.v.parmar@gmail.com