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Am Fam Physician. 1999;59(11):3165-3168

Taking precautions to avoid contaminated food and water, and receiving necessary vaccinations can minimize health risks when traveling to underdeveloped regions of the world. Rizvon and associates review the common issues and preventive measures for international travel.

The authors advise travelers to seek health care advice about foreign travel four to six weeks before departure. Health-related documents to take along on the trip include an updated vaccination certificate, a list of medications and a copy of any other important medical information, such as an electrocardiogram for patients with cardiac disease. In addition to a standard first-aid kit, which should include medications such as analgesics, antihistamines and motion sickness agents, prepackaged oral rehydrant solutions can be taken along to treat dehydration if travelers' diarrhea occurs. Health advice regarding food and water precautions and accessibility of health care abroad are essential. Patients should be advised to learn what their health insurance will cover. Coverage that includes evacuation insurance may be important.

Prophylaxis against malaria is important for travel to Mexico and Central America. Chloroquine, in a dosage of 500 mg once weekly, can be taken for malaria prophylaxis. Prophylaxis should begin one week before travel and continue for four weeks after return. Mefloquine, in a dosage of 250 mg once a week, can be used in patients who are traveling to areas of chloroquine-resistant disease. Doxycycline, in a dosage of 100 mg once daily, can be used as an alternative in patients who cannot take mefloquine. Mefloquine should be avoided in patients with a seizure disorder and in patients taking drugs that delay cardiac conduction.

Use of an insect repellent that contains 25 to 30 percent deet (N,N-diethyl-3-methyl-benzamide) can reduce the risk of acquiring malaria. Children, however, should use deet in a concentration of 10 percent or less. While it cannot be applied to skin, permethrin on clothing may help reduce exposure to mosquito bites.

The accompanying table summarizes vaccination recommendations for foreign travel. Hepatitis A vaccine, given in two doses, provides long-term protection, while immune globulin can be given for short-term protection. Yellow fever vaccine may be a consideration for travelers to tropical Africa or South America. Typhoid fever vaccine is available in both oral and injectable forms. Adhering to the precautions for avoiding contaminated food and water may also reduce the risk of exposure to typhoid. The cholera vaccine is rarely used in preparation for foreign travel. The risk of cholera in American travelers who follow food and water precautions is low, and the vaccine is only 50 percent effective. Vaccinations for meningococcal meningitis, Japanese B encephalitis, rabies, tick-borne encephalitis and anthrax are available for travelers visiting endemic areas. Other immunizations should include hepatitis B, poliovirus, measles-mumps-rubella (MMR), diphtheria and tetanus.

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