MJ HEALTH & FITNESS: The Indestructible Traveler - Prepare and avoid travel illness

The Indestructible Traveler
Don't let the hype about the new world of emerging infections keep you home. With the right advice, the right shots, and a little common sense, you can still travel the globe without fear.

You've got three weeks of vacation time lined up for this summer. But as you open an atlas to plan your world tour, an ominous New York Times headline about the global "War on Bird Flu" runs through your head. No Asia, you decide. Then thoughts arise of last year's outbreak in Africa -- Ebola's cousin, the Marburg virus -- and you cross that continent off your list. You want adventure, but an exotic infection isn't what you have in mind.

Here's the deal. The diseases that grab headlines -- SARS, Ebola, bird flu, and so on --Êare less of a threat to travelers than you might think. SARS, which infected around 8,000 people worldwide in 2003, is dormant. Ebola and Marburg are transmitted through physical contact with infectious blood. Currently bird flu mostly afflicts humans who have been in close proximity to infected birds, so stay away from farms and poultry markets. If the virus mutates and begins to spread from human to human, all bets are off. Experts predict that you'll have plenty of warning, however. "Since this strain was first noted, almost a billion tourists have traveled through Asia, and the number of cases among them is zero," says Dr. David Shlim, medical director of Jackson Hole Travel and Tropical Medicine. "Oh-for-a-billion is pretty darn low. The more exotic and untreatable the risk -- viruses like bird flu and Ebola -- the more travelers tend to obsess about it, instead of thinking about what they actually might get."

The key to infection-free travel isn't giving up your tickets; it's planning ahead and outmaneuvering parasites when you arrive. Leptospirosis, a.k.a. "swamp fever," a bacterial infection spread by animal urine in rivers and swamps, laid more than 80 adventure racers low in the 2000 Eco-Challenge in Malaysian Borneo. Swamp fever causes fever, diarrhea, and, if untreated, kidney and liver damage and sometimes death. But it's avoidable: Stay out of the swamps. With a little common sense and the right preparation, you can avoid a trip to the local clinic.

Here's the drill on disease-free travel: Visit your doctor three months before departure for vaccinations and prescriptions. The hepatitis A vaccine, a given for trips anywhere in the developing world, is administered in multiple doses, weeks apart, and if you're going to South America, sub-Saharan Africa, Central America, or certain parts of Asia you'll most likely need malaria meds. Then, when you get there, use DEET repellent on your skin (despite the carcinogenic risks) and permethrin on your clothes and bedding, and sleep under a mosquito net. Check the Centers for Disease Control and Prevention's travel site, www.cdc.gov/travel, for the latest information.

Finally, be aware of local dangers. Rabies kills nearly as many people in India as car accidents do in the U.S. So don't go petting any monkeys when you're there. Stupid is as stupid does; histoplasmosis, a respiratory infection spread through bat dung, tends to afflict gringos dumb enough to spelunk unmarked Central American caves without assessing the risks.

"No traveler can be prepared for every obscure disease," says Dr. Paul Arguin, the head of geographic medicine at the CDC. "But taking smart steps against some of the better-known diseases will lower your odds of exposure to the more obscure ones."

World Disease Hot Spots
Check your travel plans and packing list against this list of the pathogens that today's headlines don't mention.

Disease: Histoplasmosis
Recent Cases: Nicaragua
"Histo" is contracted by inhaling a fungus living in bird and bat droppings, most often in caves. While the infection is often mild, things can get ugly if you inhale a great quantity. The disease is endemic to every continent but Antarctica, but most reported cases come from Latin America. In 2001 a group of 14 spelunkers got it from a cave in Nicaragua. If you must go into the dark, ask a doctor which respiration mask to use.

Disease: Rabies
Recent Cases: India, Nepal
Transmitted by mammal bites, the virus is fatal without prompt treatment. Australia, parts of Europe, and some island nations are largely rabies-free; it's endemic everywhere else. Kathmandu's Monkey Temple is a particularly troublesome spot, but dog bites are the most common culprit. Get a vaccine, and if you get bitten by anything, clean the wound and seek medical care right away -- even if you've had your shots.

Disease: Leishmaniasis
Recent Cases: Bolivia
This disease, spread by bites from sand fleas, causes sores on the skin and in its most severe form can attack your bone marrow or cause chronic infection of internal organs. It's widespread in the developing world; South Asia, West Africa, Sudan, and the Amazon (particularly the Bolivian Amazon) are hot spots. It has been seen in a few unlucky U.S. soldiers serving in Afghanistan and Iraq, while most civilian cases in the U.S. start in Central and South America. Sleeping off the ground and using repellents on your skin, bedding, clothes, and netting are the best countermeasures.

Disease: Swamp Fever
Recent Cases: Borneo
Common worldwide but a more potent threat in the tropics, Leptospirosis, as it's officially known, is the handiwork of bacteria that lives in fresh water. In the 2000 Eco-Challenge in Malaysian Borneo, at least 80 adventure racers were infected while paddling the Segama River. At first the illness resembles a nasty flu, but within a week it can start attacking major organs. A severe form can lead to kidney damage and, in some cases, death. You can be exposed anytime you're in a contaminated body of water -- lake, pond, river, or swamp. Protective clothing that prevents cuts and scrapes and the antibiotic doxycycline both seem to ward it off.

Disease: African Tick-Bite Fever
Recent Cases: South Africa
A relative of Rocky Mountain Spotted Fever, ATBF is found throughout sub-Saharan Africa. It's relatively common among hunters and safari travelers, afflicting as many as one in 20. A scab often appears at the bite, and the symptoms are flu-like. Avoid ticks and you avoid ATBF: Tuck in shirts and pant cuffs, use repellent, and treat clothing with synthetic pyrethoid insecticide.

Disease: Dengue Fever
Recent Cases: Singapore
A rapidly expanding threat in the developing world, this virus, transmitted by mosquito bite, can cause high fever, vomiting, and headache. A rarer form can be deadly. Rio de Janeiro experienced a major outbreak in 2002, with 250,000 cases and a few dozen deaths. Cities like Singapore and New Delhi have seen recent outbreaks. Fight back with DEET on skin and permethrin on clothing and bedding, and use sleeping nets.

By: Jebediah Reed
Photograph by: Greg Von Doersten
(May 2006) <