Travelers' Health
By Susanne Bjørner
I sat in the "international travel office" at my
local hospital recently, answering questions about where and how I would be navigating
around in Malaysia and Vietnam on my summer vacation after the IFLA
(International Federation of Library Associations and Institutions) World
Library and Information Congress in Singapore this August. The doctor
across from me--always curious whether I would be on a bus, train, boat or
plane--knew exactly where there were jungle threats or possibly infectious
bodies of water--even telling me of rivers and streams in my route that I
didn't know about yet. After he determined which inoculations and preventive
doses I should take, I asked him where he got his up-to-date detailed
information about diseases currently affecting very specific parts of the world.
Some from WHO (the World Health Organization), he said, and
some from the CDC (Centers for Disease Control and Prevention). It was all
assembled on his computer screen, which was turned away from me, and I determined
to go looking for the site when I got home. I don't think I found exactly what
he was looking at during the interview, but I found an extremely useful site
with lots of background, tips, and advice on what to do to stay safe while
traveling, and what to do if you do fall ill.
Where Are You Going?
The main page of Travelers' Health (http://wwwnc.cdc.gov/travel/), with a
new design launched in May, offers information For Travelers and For
Clinicians; you select a destination from a dropdown menu. I didn't expect to
find much risk of exotic discomforts or diseases in the highly populated
metropolitan area of Singapore,
but that's where my journey was starting out, so under For Travelers, I
selected Singapore.
I could have indicated some special conditions listed in checkboxes to receive
more targeted help:
- Traveling with Children
- Chronic Disease
- Cruise Ship
- Extended Stay/Study Abroad
- Immune Compromised
- Pregnant
- Mission/Disaster Relief
- Visiting Friends or Family
None of these applied to me, however, so I clicked Go, and a
page on Health Information for Travelers to Singapore
appeared (http://wwwnc.cdc.gov/travel/destinations/traveler/none/singapore
); it had a small map locating Singapore
among its surrounding southeast Asian neighbors. The content on this and all
destination pages is divided into five standard topics, listed to the right of
the map with internal page links:
- Vaccines and Medicines
- Stay Healthy and Safe
- Healthy Travel Packing List
- Travel Health Notices
- After Your Trip
Vaccines and Travel
Notices
Vaccines and Medicines recommends visiting your doctor for
immunizations 4-6 weeks before travel. It says that all travelers should be up
to date with routine vaccinations like MMR (measles-mumps-rubella),
diphtheria-pertussis-tetanus vaccine, varicella (chickenpox) vaccine, and a
yearly flu shot. It further recommended vaccination against hepatitis A and typhoid,
especially if you are "staying with friends or relatives, visiting smaller
cities or rural areas, or if you are an adventurous eater." (I have twice
in my life suffered the consequences of being slightly too adventurous.) Finally,
it provided information about three other diseases (hepatitis B, rabies, and yellow
fever), that might be a problem for some travelers under certain conditions.
Small colored icons in each section provide visual cues of
how to protect yourself (Get vaccinated; Eat and drink safely; Keep away from
animals; Reduce your exposure to germs; Avoid sharing body fluids; and Avoid
non-sterile medical or cosmetic equipment). Each of the diseases and vaccines
is hyperlinked to pages with more information. The Routine Vaccines page (http://wwwnc.cdc.gov/travel/diseases/routine)
is a goldmine of links and data on standard vaccines for children and for adults
(flu, Td/Tdap, HPV, shingles, pneumococcal, and meningococcal, as well as hepatitis
A and hepatitis B).
Before following up on other travel information on the Singapore destination page, I moved on to Malaysia and Vietnam to check their Vaccines and
Medicines data. Both introduced me to two diseases not mentioned concerning Singapore:
Japanese encephalitis and malaria. Basic information is given in the Vaccines
and Medicines section, but I also clicked the link on each disease to see the
extended page for each disease. Both these serious diseases can lead to death;
there is a vaccine for Japanese encephalitis, and you can take prophylactic
medicine against malaria. The best prevention for both is to avoid rural areas
and prevent insect bites.
I had to scroll down to see special Travel Health Notices on
each destination page. There were no notices for Singapore,
and the one notice for Malaysia,
for sarcocystosis, pertained to a limited geographic area that I am not getting
close to at all. Vietnam
is a different story: "As of November 4, 2012, the Vietnam Ministry of
Health has confirmed that approximately 134,929 people in 63 provinces have had
hand, foot, and mouth disease (HFMD) since the beginning of 2012." The CDC
has placed a Watch Level 1 warning, advising to "Practice usual
precautions." The usual precautions, plus the cause and symptoms of HFMD,
are detailed on an expanded page (http://wwwnc.cdc.gov/travel/notices/watch/hand-foot-mouth-disease-in-vietnam),
linked from the warning.
Staying Healthy and
Packing Right
The redesign of the CDC Travelers Health site in May moved
some very helpful information to more prominent places on each destination
page. The Stay Healthy and Safe section offers advice relating to nine key behaviors:
- Eat and drink safely
- Prevent bug bites
- Stay safe outdoors
- Keep away from animals
- Reduce your exposure to germs
- Avoid sharing body fluids
- Know how to get medical care while traveling
- Select safe transportation
- Maintain personal security
I clicked Prevent Bug Bites to open that section and found
that I am right in assembling a long-sleeved and long-legged white and beige wardrobe
for this trip. I also found specifics on tick and mosquito repellent, including
specific brand names of several that meet the recommendations. Permethrin-treated
clothing was mentioned as worth consideration, with a link to a page (http://npic.orst.edu/pest/mosquito/ptc.html)
from the National Pesticide Information
Center informing that the U.S.
military has been pre-treating clothing with this pesticide for 20 years, and
giving details on its proper use.
Each of the topics above can be opened or closed for
viewing, and the resulting customized page copied or printed for individual
study. Also on each destination page is a Healthy Travel Packing List with a
handy checklist for Medicines and Medical Supplies (for existing conditions,
special prescriptions for the trip, and OTC products), Supplies to Prevent Illness
or Injury (with specifications on sunscreen and water purification tablets),
First-Aid Kit, and the all-important Paperwork. You probably won't need all the
items listed, the CDC acknowledges, but it doesn't hurt to consider them.
Other Navigation and
More Data
So far we have only looked at the For Travelers section and
some places to which it is linked. There is also a For Clinicians section,
directed to healthcare professionals, but freely available to anyone. The
destination pages here are very similar to those in the For Travelers view, but
with a section on Non-Vaccine Preventable Diseases, some more detail, and more
of an advisory focus.
At the very top of Travelers' Health is an A to Z list so
you can open an index of topics available; and at the top right is a search box
where you can limit a search to Travelers' Health or expand it to All CDC
Topics.
A left column on the home and most other pages also contains
important links by which you can approach the data differently: There are
Destinations, Travel Notices, Find a Clinic, Disease Directory, and Information Centers for travelers, clinicians, and
travel industry.
There is also a link to the Yellow Book homepage (http://wwwnc.cdc.gov/travel/page/yellowbook-home-2012).
This title is published by CDC and issued in print every two years; it is the comprehensive
resource that collects most of the information that is reproduced elsewhere. Travelers'
Health does such a good job of repackaging the data in useful doses that I
thought the full book would be of interest only to professionals. I was wrong.
A detailed table of contents
links to specific information about myriad topics, including
altitude illness, jet lag, motion sickness, and travelers' diarrhea--all under
the "self-treatable conditions" chapter. But there are other
interesting specialized topics covering a variety of situations, including:
- Medical Tourism
- Obtaining Health Care Abroad for the Ill Traveler
- Travel Health Insurance & Evacuation Insurance
- Air Travel
- Death during Travel
- International travel with animals
- Immigrants Returning Home to Visit Friends and Relatives (VFRs)
- US Military Deployments
Whether you are off to exotic places for your summer vacation,
or just want to know what insect repellent or hand sanitizer to buy, the first
place to check is CDC Travelers' Health. And that map that my travel medicine
specialist was using at the hospital, which I thought was for professionals
only? I may just have found it, referred to in an appendix of the Yellow Book. Check out HealthMap (www.healthmap.org).
Susanne Bjørner
provides editorial services to publishers, librarians, authors, and researchers.
Contact her at bjorner@earthlink.net or www.bjorner.info.
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