Photo illustration by Ann Geisinger

How to Travel Disease-Free

It's a jungle out there, full of nasty germs and parasites that would love to hitchhike home in your body. Here's a three-step plan to make sure they don't.

By Sam Shelanski, M.D.

Divers will travel almost anywhere in search of pristine reefs and frequent pelagics. Unfortunately, many diving locales are also home to parasites, bacteria and viruses that can cause serious disease. Not to worry: a little planning, a dose of common sense and the right vaccinations can make even remote travel safer than a trip to Wal-Mart. Here's a simple battle plan to win the war on disease.

I'm Sick: Now What? | Sex and the Traveling Diver

Step 1: Know Thine Enemy

This is war. Fortunately, you've got the intelligence assets of the U.S. government on your side. Before you start packing, even before you finalize the reservations, pick up the phone or fire up the PC and contact the Centers for Disease Control Travel Health Hotline at (404) 639-2572 or on the web at www.cdc.gov/travel. If you have a fax machine, call the CDC's automated fax service (888-232-3228) and information can be sent to you.

The CDC has loads of current information on the diseases in the region or country you'll be visiting. They also recommend vaccines and medications to help you prevent illness. Similar information is also available at Travel Health On-Line, a private web site found at www.tripprep.com.

Step 2: See Your Doctor

Armed with the knowledge of what diseases you're likely to face, see your doctor for a routine physical and help obtaining the proper vaccines and medications. Consulting a general physician about infectious diseases is like consulting an orthopedist about heart problems, so ask for a referral to a travel medicine clinic or specialist.

Travel medicine specialists can help you determine health risks present in your specific destination and administer the correct vaccinations and pills. Look for clinics affiliated with the International Society of Travel Medicine (ISTM); other "travel medicine" clinics may be nothing more than injection mills out to make money by giving shots, whether they are necessary or not. For a list of ISTM clinics, call (770) 736-7060 or check out the listings on the web at www.istm.org/clinidir.html.

Don't wait until the last minute to seek this medical advice. Many vaccines, as well as malarial prophylaxis, require a visit to your doctor for a prescription or administration. Full immunization may require multiple doses, over days or even months.

In addition to vaccines or preventative medications for diseases specific to your destination, also make sure your childhood vaccinations are current, regardless of where you plan to travel. Specifically, check your immunization status for:

·  Tetanus: A good shot to have even if you never leave home. This vaccine boosts your body's defenses against the Clostridium tetani bacteria that can grow in infected wounds. The vaccine is good for seven to 10 years, and should be kept up-to-date.

·  Measles/Mumps/ Rubella: Most of us got this vaccination as children, but the protection fades with time. Ask for an antibody titer blood test. A titer is a measure of immunity against a specific illness and determines whether you are still adequately protected. If antibody levels are low, it's time for re-vaccination.

·  Polio: Almost everyone received this vaccine as a child. However, in many less-developed countries, especially in Central and South America, this disease is endemic. Booster shots are recommended for travelers to these areas.

·  Typhoid: Typhoid is a bacterial infection of the gastrointestinal tract that can lead to diarrhea and dehydration. Both the oral and injectable vaccine help prevent typhoid fever and are good for five years. Even with a current vaccination, follow food and water precautions to minimize potential exposure to this dangerous disease.

·  Hepatitis: Hepatitis A is a viral disease that affects the liver. It can be contracted by consuming contaminated food or water. A new vaccine called Havrix has replaced the old immune globulin vaccine protocol and is highly recommended for dive travelers.

Hepatitis B is a very serious viral illness of the liver that frequently leads to cirrhosis and even death. It's transmitted through body fluids and sexual contact and is very common in many countries. For example, one doctor in Fiji told me that half of all children there are infected by age 18. There is a vaccine available against this infection, and it's recommended for anyone spending significant periods of time in endemic areas.

Step 3: Evade the Enemy

No vaccine or medication is 100 percent effective, so it's important to understand how diseases are transmitted in order to limit your exposure. Dive travelers are most at risk from three sources.

Eat, Drink and Be Queasy: Contaminated Food and Water

·  Common Scenario: You're down in Mexico diving the Yucatan cenotes. After a few days, not only Montezuma, but all of his extended family have been exacting their revenge on your intestines.

·  Diagnosis: Traveler's diarrhea. Stay calm. This too shall pass. Traveler's diarrhea is the most common ailment afflicting divers, and it's caused by food and water containing bacteria different from those your body is accustomed to. When you swallow these bacteria, they end up in hand-to-hand combat with your native bacteria--and you wind up the loser.

While traveler's diarrhea is a self-limiting ailment, there are other diseases and parasites that you can get from consuming contaminated food and water that aren't so benign. These include cholera, typhoid, hepatitis A and amoebic dysentery.

Avoiding all these diseases is really quite simple. Drink only bottled water, juices and sodas while traveling. If you must tap into the local water supply, treat it with iodine pills, a portable water filter--or both--before drinking. Another option is to boil your water for at least 15 minutes. Remember that ice is likely made with tap water, and it can also make you sick. In addition, fruits and vegetables that are washed in tap water may also carry disease-causing organisms, so stick to those fruits and vegetables that can be peeled.

The good news about simple traveler's diarrhea is that almost everyone will recover within three to five days without any treatment. I recommend that divers travel with a generous supply of Pepto-Bismol or similar medication for such occasions. It won't speed recovery, but it will lessen the severity of the symptoms.

If you experience any form of diarrhea, it's important to stay well-hydrated. You can lose a huge amount of fluid through your bowels, so make sure you offset fluid loss with large amounts of bottled water and unsweetened fruit juices. If symptoms last for more than a few days, seek medical attention.

Air Raid: Insect Bites

·  Common Scenario: Several weeks after a trip to Central America (where, Oops! You forgot to use bug spray), you experience fevers, body aches and chills.

·  Diagnosis: Malaria fever. Malaria is a parasitic disease that is carried by infected mosquitoes, and it's found all over the world. There are several types of the malaria parasite, each resistant to different anti-malarial drugs. In some regions of the world, the parasites are resistant to one or more of the most commonly used medications, so it's important to use the right prophylaxis for the country you are visiting. The most commonly prescribed drug is mefloquine, sold under the brand name Lariam. While effective, it has been known to cause serious side effects and may not be the best choice for divers. (See: "The Mefloquine Controversy,".) Stick to recommended dosages.

Diseases that are transmitted by insects are a serious problem for all travelers. Sand flies in Central American countries, for example, can carry a parasite that causes Leishmaniasis. Untreated, the disease can cause large disfiguring sores on the skin. An even more dangerous insect-borne disease is yellow fever, which is endemic to Central and South America, and parts of equatorial Africa. Not only is the vaccine recommended for visitors to regions where the disease is endemic, but proof of vaccination is usually required when traveling from such areas to countries that do not have yellow fever. The vaccine for yellow fever can only be given at specific immunization centers. Check with your local health department for more information.

The best way to avoid insect-borne illness is to avoid insect bites. This means wearing long sleeves (preferably dark colors), using insect repellents liberally, avoiding scented soaps, shampoos and perfumes, and staying inside during the peak insect feeding hours around dusk. In some areas like Papua New Guinea and southeast Asia, where there are drug-resistant strains of malaria, sleeping under mosquito netting treated with long-lasting insect repellent is also strongly recommended.

Amphibious Assault: Water-Borne Parasites

·  Common Scenario: About eight weeks ago, you were diving in Central America and took a side trip to go whitewater rafting. One day after running the river, you experienced an itchy red rash, but it went away after a few days. Now you're in bed with a high fever, chills, headache, cough and swollen glands.

·  Diagnosis: Schistosomiasis infection. Schistosomes are freshwater parasites found throughout the world, including the Great Lakes. They penetrate through the skin and enter the bloodstream. The "swimmer's itch" and rash are the result of your body's immune system killing off the parasites. If enough parasites manage to get through, they cause katayama fever. Left untreated, schistosomiasis can lead to cirrhosis of the liver, bladder cancer and anemia. The disease is easily treated, but getting the correct diagnosis is often difficult--which raises an important point: Always tell your doctor where you've been traveling if you develop an illness shortly after a dive trip.

The key to beating parasitic infection is--you guessed it--avoiding the parasites. Research your destination and if there are reports of schistosomiasis, stay out of freshwater lakes and rivers. Don't be fooled into thinking the water is safe just because the locals swim in it; most of them have probably been infected since childhood.

Another disease caused by freshwater parasites is Leptospirosis. Recent cases have been reported in Hawaii and Central America. Leptospirosis can cause meningitis and liver disease as well as generalized fevers and aches.

While there are no vaccines to prevent these types of parasitic infections, they are easily treated when properly diagnosed.

I'm Sick: Now What?

Think the war on diseases is over when you board the plane home? Think again.

Many parasites may not make you sick until weeks or even months after initial infection. They may give you some symptoms--fever, rash, stomach problems--and then go into hibernation for years.

That's why it's important to pay particular attention to any illnesses that you may have after traveling. Use common sense. If it's flu season, and everyone around you has the same symptoms, then you're probably justified in explaining away your cough, fever, headache and malaise. But when you fall ill in August, two weeks after returning from Papua New Guinea, it's a different story.

Seek medical help if you have any unexplained symptoms within six months of travel, and be sure to tell your doctor where you've been traveling.

Sex and the Traveling Diver

We can't ignore the subject of STDs: sexually transmitted diseases. If you're tempted to delve deeply into the local social scene, remember that you are at risk for HIV, as well as run-of-the-mill STDs including hepatitis B, syphilis, gonorrhea, chlamydia and herpes--all of which can do lasting damage to your health. Abstinence is the only true preventative, though condoms provide some measure of protection against STDs.