Planning an international vacation this summer? Here is key information you can use to stay healthy and safe before, during, and after your vacation.

Before you go – Most travel agencies and agents will give you information about health risks at your destination, but it’s up to you to make sure you get any vaccines or medicines you need before you go. If you need travel vaccines or medicines, make an appointment with your healthcare provider to get them at least six weeks before you leave. This is to allow the vaccines enough time to become effective. If you will need vaccines, when you make the appointment, ask your medical provider or their office staff if they have all the specific vaccines you need. You may need to get some of them at a pharmacy, and some (such as yellow fever vaccine) are available only at specialized travel clinics.

The Centers for Disease Control ( recommends all international travelers be up-to-date on routine vaccines, such as influenza (flu), tetanus, and measles. There are currently measles outbreaks in many popular destinations – don’t go unprotected!

Areas of special concern

Carribean: Zika virus, aftermath of hurricanes – Women should avoid the Caribbean area if there is any possibility they might be pregnant now (regardless of stage of pregnancy) or may become pregnant within three months of leaving the Caribbean. Many popular summer destinations throughout the Caribbean, Central and South America, the Pacific Islands, and Mexico still have a risk of Zika. Because Zika can cause serious birth defects (microcephaly), if a woman is infected during pregnancy, travelers should take precautions before and after traveling to areas with risk of Zika. Zika is primarily spread through mosquito bites, but it can also be spread through sex. To avoid sexual transmission of the Zika virus, women should use condoms for three months and men should use condoms for six months after leaving the area of Zika risk. On CDC’s “Zika Travel Information” page, you can find out if there is a risk of Zika at your destination and how to protect yourself and others during and after your trip.

Travelers to the Caribbean should be aware that some islands may not have recovered from the damage caused by the 2017 hurricanes. See the “Hurricanes Irma and Maria travel notice” on the CDC website for more information.`

Europe: measles – There are outbreaks of measles in popular destinations in Europe (England, France, Italy, Greece), as well as in Indonesia and the Philippines. Measles spreads rapidly and can lead to serious complications. Don’t put yourself at risk. Make sure you are up to date on the MMR (measles, mumps, and rubella) vaccine before you go.

Brazil: yellow fever – There is a deadly outbreak of yellow fever in Brazil. Travelers to Brazil (including popular destinations like the cities of Rio de Janeiro and Sao Paolo) should protect themselves by getting the yellow fever vaccine at least ten days before travel.

During your trip (anywhere)

Eating / drinking – Travelers’ diarrhea is the most common travel-related illness. If you are traveling to a developing country, you are at very high risk.

Tempting as it can be, do not eat food from street vendors. Even if the vendor has clean hands, he or she is constantly touching contaminated paper money from customers, picking up bacteria and viruses which are transferred to the food that’s served to you. Street food is an extremely common way people get infected with diarrhea!

Food that is cooked and served hot is safest. Salads, fruits, and vegetables can be safe in hotels and larger tourist oriented restaurants. Try a little bit one day, then you can have more the next day if you have no nausea or diarrhea. The safest fruits and vegetables are those you have washed in safe water or peeled yourself.

Don’t ever drink tap water. Carry water with you. Drink water, juices, sodas, or sports drinks that are bottled and sealed, or very hot coffee or tea. Only use ice if it is made with bottled or disinfected water- some hotels and large fancier restaurants do this.

Sun-related sickness and general advice – Avoid hot temperatures and sun exposure. Wear hats with brims that go all the way around, not billed caps. Wear SPF 15 or higher sunscreen and reapply it after swimming or sweating. If you are using insect repellant, apply sunscreen first, then insect repellent.

Always wear seat belts and choose safe transportation. Motor vehicle crashes are the number-one killer of healthy US citizens in foreign countries.

After you return – Some travel-related illnesses may not make you feel sick until after you get home. If you are not feeling well after your trip and it lasts more than a few days, you may need to see your health care provider. Be sure to tell your provider about your travel, including where you went and what you did on your trip, and any new sexual contacts. This will help your provider know which infections to consider that are rarely found in the US. If your health care provider lacks experience in international medicine, you can find a travel medicine specialist or clinic on the CDC website.

After-travel illness that may be serious

Fever / malaria – If you have been in a country where there is known malaria and you develop a fever within a month after you leave, see a doctor immediately. Most fevers are caused by less serious illnesses. But because malaria is a medical emergency, your doctor must first rule it out. A fever could still be malaria even if you took antimalarial medicine, because the medicine is not 100% effective. Most malaria develops within 30 days, but rare cases can lie dormant for a year or longer. So always tell your doctor about any travel you have done, even if it was months ago. The diagnosis of malaria is made through a blood test which is most accurate if done when the person has fever.

Persistent diarrhea – Most cases of diarrhea go away by themselves in a few days. See your doctor if you have diarrhea that lasts for two weeks or more. Persistent diarrhea can make you lose nutrients and can be caused by parasitic infections that must be treated with special drugs.

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Dr. Eva Hersh, MD
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