Before traveling abroad, many people have questions about how to protect themselves from foreign bacterial or viral illnesses. The threat of infection can be scary for travelers, but supplied with all the right information, they can vastly improve their odds at staying safe.
The first step a traveler should take is to consult his or her primary care doctor or a travel medicine specialist to find out what area-specific vaccines and/or medications are appropriate, because many destinations require very specific preparations. Visit the Centers for Disease Control's Travel page, which breaks the information down by country and provides up-to-date health notices.
HuffPost Travel turned to Dr. Pritish Tosh, an infectious diseases physician at the Mayo Clinic and Dr. Gary W. Brunette, chief of the Travelers' Health Branch of the CDC, to answer our most burning questions about immunization before travel.
What are the most common vaccinations given to people before traveling abroad?
"When people come to a travel clinic, one of the most important things to do is review their immunization history and make sure they have gotten all of their age-appropriate routine immunizations," Tosh says via email. These include an adult booster for tetanus, diphtheria, pertussis, shingles, and measles, mumps and rubella. He also encourages an annual influenza vaccination. In addition, "ensuring that travelers are protected against hepatitis A and typhoid is important for travel to most developing nations," he says.
"Hep A and hep B are now both part of the routine childhood vaccines, but they’ve only been that for a few years, so people in their teens and up normally don't have it," Brunette adds in a phone interview. "We recommend it for people who haven’t had it."
What are some of the most area-specific, unusual vaccinations you've recommended?
"Some countries have a requirement for the Yellow fever vaccine -– typically in India, some countries in South America, and Africa," Brunette says. "Japanese encephalitis is prevalent in Southeast Asia, and I recommend it for people who are in a rural area for an extended period of time." Both diseases are mosquito-borne.
"People traveling to the Indian subcontinent need to have an adult booster for polio," Tosh adds. "And depending on the type of travel and activities someone may be doing, hepatitis B or rabies vaccinations may be considered."
The CDC includes a special mention of the Hajj Pilgrimage on its site: "Because of the intensely crowded conditions of the Hajj and high carrier rates of Neisseria meningitidis among pilgrims, outbreaks of meningococcal disease have historically been a problem during Hajj. In the aftermath of outbreaks in 2000 and 2001 that affected 1,300 and 1,109 people, respectively, the Saudi Ministry of Health began requiring all pilgrims and local at-risk populations to receive the meningococcal vaccine -- Hajj visas cannot be issued without proof of vaccination."
How far in advance should people get vaccinated before traveling?
Tosh recommends seeking advice from a travel clinic at least a month prior to travel to ensure that vaccinations and other medications -- like malaria pills -- have enough time to be effective.
Brunette advises people to see their doctors as soon as they make plans to travel, "around the time you buy your tickets -- six to eight weeks before you travel, because some medications need to be started early and some vaccines are a series of vaccines." Tetanus, Hepatitis A, typhoid, yellow fever, polio and the meningococcal vaccine are all single-dose vaccines, but Hepatitis B, Japanese encephalitis, and rabies vaccines require multiple doses, according to the CDC's Last Minute-Travelers page, which has more specific information on these vaccines.
If you depart in less than four weeks, "you should still see your doctor or travel clinic," the CDC's website states. "You might still benefit from shots or medications," and your doctor will advise you of the risk involved in taking the trip.
What medications do you recommend people take with them while traveling abroad?
Tosh advises people take "sufficient supplies of their routine medications" in their carry-on luggage. In addition, "for travel to many developing countries, having loperamide [Imodium, to treat diarrhea] as well as plenty of sunscreen and mosquito repellant is necessary," he says. Mosquitoes tend to be most active at dawn and dusk, so it's important to use repellent, cover up as much as you can (while still being comfortable), and use mosquito nets when necessary.
The CDC recommends bringing an antibiotic prescribed by your doctor -- like Cipro -- for self-treatment of moderate to severe diarrhea.
Certain destinations require additional medication. "Say you wanted to climb Mt. Kilimanjaro or go to Cuzco in Peru," Brunette adds, "you’d need to bring high-altitude medication like Diamox."
Some countries do not let visitors bring certain medicines into the country -- like narcotic-based pain medication -- so you may want to check with the U.S. embassy in the country you're visiting to make sure that your medication will be allowed in. A listing of embassies and consulates is available on the Department of State's website.
What is your most important advice in terms of caution when eating and drinking abroad?
"Making sure people eat and drink safe food and water is of paramount importance," Tosh says. "The most common cause of illness after travel is Traveler’s Diarrhea, which is preventable by eating foods that are either served steaming hot or things that you can peel open yourself." And even if the food on a street cart meets all of this criteria, it's better to avoid it, he adds.
Tosh emphasizes that travelers should ensure the water they consume is either boiled or bottled. If it's bottled, it’s much better to drink carbonated water than still water because sometimes people refill water bottles, he says. If the cap hisses, then you know it was bottled at a bottling plant.
"People can also become unknowingly exposed to local waters through consumption of things like ice cubes or salads that have been washed in tap water," he adds. Bottom line: absolutely no raw fruits or vegetables.
What are risk factors people usually don't think about before traveling abroad?
"I think it is general safety," Tosh says. "Often people will travel to unfamiliar places with unfamiliar customs where they do not speak the language." He suggests consulting the State Department for an up-to-date country-specific list of recommendations for travelers.
Brunette emphasizes road safety and water safety to all travelers: "The biggest killer of Americans overseas isn't disease -- it's road accidents and then following that is accidental drowning. For example, you put yourself at risk if you’re in Thailand and you rent a motorbike and don’t put on a helmet, or you get in a taxi and don’t put on your seatbelt. Be extra cautious -- a lot of people shouldn’t be traveling at night. If you get into a motor vehicle accident in some countries, they don’t have ambulance services like in the U.S."
Any more advice?
Tosh warns expatriates not to get too comfortable when visiting their native countries, and says they shouldn't drink local water or eat potentially unsafe foods. "The immunity they had through exposure while they lived in their home country wanes shortly after leaving the country," he says. Expatriates are just as susceptible to infection as anyone else traveling there, he adds, but are usually much less careful because they don't feel like they need to be.
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