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With the increase in global travel, no disease is beyond the reach of any population. Traveling patients should be advised to follow food and water precautions and encouraged to receive the recommended immunizations. Travel medicine plays a vital role not only in limiting the morbidity of travel-related illnesses but also in limiting the spread of diseases. This article addresses the common issues related to travel, reviews the care of the immunocompromised traveler, and updates the available vaccinations and prophylactic regimens available to limit sickness abroad.
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The extent of travel in this day and age is unprecedented. About 2.5 billion people passed through airports in 1996 alone. The greater range of travel is associated with increased risks of diseases and outbreaks in areas not usually associated with the disease. More than two-thirds of cases of typhoid fever in the United States follow foreign travel. More than 30 million people living in industrialized countries travel to regions where hepatitis A is highly endemic, and hence, they are at risk of contracting the disease. Many diseases prevalent in developing countries are food- and water-borne, making them easily transmissible to visitors. Following food and water precautions and getting vaccinations against the common diseases associated with travel, however, can minimize the risks of acquiring travel-related illnesses.

Very few vaccinations, such as the yellow fever vaccination required for travel to many countries in Africa and tropical South America, are required for travel. Many traveling patients, however, are unaware of the vaccine recommendations for travel and thereby expose themselves to substantial risks by traveling unprotected.

General Advice to Travelers

• Appointments to travel medical centers should be made four to six weeks before travel. Immunocompromised travelers, patients with chronic cardio-respi-ratory problems, and travelers wishing to relocate to a different country should be seen much earlier to assess the risks associated with travel and receive appropriate vaccinations. Atomoxetine online
• Carry an updated vaccination certificate, the address and telephone number of your physician in the
  United States, and, for cardiac patients, a copy of an old EKG with other required travel documents. Prescription medications should be transported in carry-on luggage. In addition, travelers should carry written prescriptions for generic name medications in case additional medications are needed. Keep prescription medications in their original bottles.
• Carry a standard first-aid kit with thermometers, sterile cotton, tweezers, adhesive tapes, bandages, antiseptic solutions, sunscreens with a minimum SPF >15, analgesics, antihistamines, and medications for motion sickness. Dimenhydrinate (Dramamine) and scopolamine are effective medications that can be used prophylactically for motion sickness. Levaquin 500
• Prepackaged oral rehydrant solutions can also be carried to treat dehydration associated with diarrhea.
• Follow the recommended food and water precautions.

Medical Assessment of a Traveler

• While waiting to be seen, traveling patients should be asked to complete a questionnaire that includes a detailed medical history, list of all medications with allergies to medications, immunization history, date of last menstrual period, and itinerary with detailed travel plans including outdoor activities.
• Health advice regarding food and water precautions (Table 1), a travel kit, and accessibility of health care abroad are essential. Patients should be advised to clarify their existing coverage with the insurance companies, and if needed, purchase additional insurance including evacuation insurance. This may be especially important for the immunocompromised traveler.

TABLE 1 — Food and Water Precautions During Travel
Food and water precautions Avoid salads.
Use bottled water at all times.
Avoid eating from street vendors.
Do not add ice cubes to beverages.
Eat fruits with thick skins that can be peeled.
Avoid improperly cooked items such as shellfish.
Preferably use bottled water to brush teeth.

• Patients should be advised how to get medical assistance abroad in case of any emergency (Table 2). United States Consulates and some credit card companies can be of assistance. The International Association for Medical Assistance to Travelers (IAMAT) prints an updated worldwide list of membership doctors and health institutions and is a valuable guide to travelers needing medical assistance overseas. canadian cialis

TABLE 2—Some Important Travel Related Information Resources
International Association for Medical Assistance to Travelers (IAMAT). 417 Center Street, Lewiston, NY 14092. Telephone: (716) 754-4883. http://www.cybermall.co.nz/NZ/IAMAT/	Publications include detailed information on tropical diseases, vaccination, climate charts, and the directory of IAMAT physicians, which guides members to travel centers and English-speaking participating physicians in 125 countries and territories.
Travel Medicine Advisor published by American Health Consultants 3525 Piedmont Road NE Suite 400, Atlanta, GA 30305. http://www.ahcpub.com/jtcd.html	Travel information includes an eight-page, bimonthly update and a CD-ROM library containing extensive travel information, country maps with immunization information and travel precautions, lists of international health providers, and an international drug reference.
http://www.cdc.gov/	Home page of the Centers for Disease Control and Prevention (CDC). Comprehensive information on travel medicine including reports of recent epidemics.
http://www.who.org/	Home page of the World Health Organization.
http://www.open.gov.uk./cdsc/	Communicable diseases surveillance-UK updated information about recent epidemics.
http://www.tripprep.com/clinics/clindex.htm or AOL Key word Travel	Travel Health online. Provides list of travel clinics throughout the United States and around the world.
http://travel.state.gov/	US Department of State. Travel advisories regarding personal safety.

• Information about vaccine recommendations is now available on the Internet and is easily accessible.
• The final immunization program depends on the traveler’s destination, availability of time before departure, length of trip, health status, and planned activities. Viagra Professional
• Patients with complex travel plans, pregnant travelers, immunocompromised patients, travelers with history of severe cardiopulmonary disease, and returned travelers with fever or diarrhea should be referred to travel medicine specialists.