Travel preparation is crucial, even for healthy people. Proper preparations are inexpensive relative to the costs of getting sick or injured while away from home.

Travel Kits

Travel kits containing first-aid supplies, pain relievers (such as acetaminophen or nonsteroidal anti-inflammatory drugs), decongestants, antacids, antibiotics, and loperamide for traveler's diarrhea are useful for minor injuries and illnesses. Also, topical drugs, such as hydrocortisone 1% cream, an over-the-counter antifungal cream, and an antibiotic ointment, should be considered. Travelers should carry their travel kit, prescription drugs, extra eyeglasses or other corrective lenses (as well as a current written prescription for either), and hearing-aid batteries in a carry-on bag in case their checked baggage is delayed, lost, or stolen. People with specific dietary and medical needs should plan carefully and carry their own food and supplies. Major problems can often be prevented with common-sense precautions.

Health and Travel Insurance

Health insurance is important for travelers. Even with domestic travel, some plans limit coverage for health care away from home. Thus, travelers should know the limitations of their policies.

Coverage is more often a problem for international travel. About 1 in 30 people traveling abroad requires emergency care. Some domestic insurance plans limit coverage for vaccinations and preventive drugs for international travel, even though some vaccinations are required for entry into certain countries. Likewise, Medicare and many commercial health insurance plans are not valid in foreign countries and do not cover the cost of any treatment given outside the United States. In addition, a cash deposit or payment in full may be required in international hospitals before care is provided.

To avoid high costs or inability to obtain care, travelers should determine in advance what international coverage, if any, their health plan offers, how to seek prior authorization for international care, and how to make a claim after an emergency. Travel health insurance, including insurance for emergency evacuation, is available through many commercial agencies, travel services, and some major credit card companies. Travelers may want to purchase insurance for services such as emergency care, transportation for care within foreign countries, transportation back to the United States for care, medical equipment and personnel during transport, dental care, prenatal or postnatal care, lost or stolen prescription drugs, and medical translators.

The International Association for Medical Assistance to Travellers (IAMAT), a nonprofit organization, maintains a list of English-speaking doctors in cities around the world (www.iamat.org). Other directories listing English-speaking doctors in foreign countries are available from several organizations and web sites (see Resources for Help and Information). United States consulates may help travelers identify and secure emergency medical services. Certain infections are common when traveling to certain areas.

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Useful Contacts for People Traveling Abroad Organization Phone Numbers Web Site International Association for Medical Assistance to Travellers United States: (716) 754-4883 (Niagara Falls, NY) Canada: (519) 836-0102 (Guelph, Ontario); (416) 652-0137 (Toronto, Ontario) http://www.iamat.org Centers for Disease Control and Prevention (CDC) United States: Toll-free (877)-FYI-TRIP (877-394-8747); (404) 639-3311 (Atlanta, GA) http://www.cdc.gov/travel CDC Malaria Hotline United States: (770) 488-7788; after hours, (770) 488-7100 http://www.cdc.gov/MALARIA/ U.S. Department of State, Overseas Citizens Services United States: (888) 407-4747 (Washington, DC) http://www.travel.state.gov

Vaccinations

Vaccinations are important for travel to most developing countries and are required by some countries for entry. Ideally, travelers should visit their usual health care practitioners at least 6 to 8 weeks before their travels. An International Certificate of Vaccination is the best place to document the names and dates of all vaccinations. The certificate is easy to carry and can be obtained from many travel clinics or from the Superintendent of Documents at the U.S. Government Printing Office.

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Vaccines for International Travel*,†,‡ Infection Regions Where the Vaccine is Recommended Comments Hepatitis A Throughout the developing world Two doses are given at least 6 months apart. Protection is full after the first dose for 6–12 months and after the second dose for life. Hepatitis B Throughout the developing world (hepatitis B is particularly common in China) This vaccine is recommended for extended-stay travelers and all health care workers. Influenza Year-round in the tropics, between October and April in the Northern hemisphere, and between April and September in the Southern hemisphere This vaccine is recommended for all travelers over the age of 6 months to these destinations and for people traveling to any destination in large groups. Japanese encephalitis Rural areas throughout most of Asia, particularly in areas with rice and pig farming Two doses are given at least 28 days apart. This vaccine is not recommended for pregnant women. Meningococcal infections Northern Sub-Saharan Africa from Mali to Ethiopia (the meningitis belt) Throughout the world, especially in crowded living situations (such as dormitories) Risk is higher during the dry season (December through June). This vaccine is required for entry into Saudi Arabia during Hajj or Umrah. Rabies All countries, including the United States This vaccine is recommended for travelers at risk of animal bites, including rural campers, veterinarians, people living in remote areas, and field workers. It does not eliminate the need for additional vaccinations after an animal bite (for added protection). This vaccine is given during pregnancy only if the risk of infection is high. Typhoid fever Throughout the developing world, especially in South Asia (including India) Two forms of the vaccine are available. Single injection form: It protects for 2 years and is thought to be safer for pregnant women than the pill form of the vaccine. Pill form: One pill is taken every other day for a total of 4 pills. This form protects for 5 years and is not safe for pregnant women. Yellow fever Tropical South America and tropical Africa The disease is rare, but many countries require vaccination for entry. This vaccine is not safe for pregnant women. *See also Immunization. †In addition to the listed vaccinations, travelers should be up to date on vaccinations for measles, mumps, rubella, tetanus, diphtheria, polio, pneumococcal disease, and varicella. ‡All recommendations are subject to change. For the latest recommendations, consult the Centers for Disease Control and Prevention (www.cdc.gov).

Traveling With Medical Conditions

Traveling with a medical condition requires special preparation. People with a medical condition should visit their doctor before departure to ensure that their condition is stable and to determine whether any changes in drugs are needed. Detailed written medical information, including information about vaccinations, drugs, results of major diagnostic tests, and types and dates of treatments, may be the most valuable thing a person can have in a medical emergency. People should consider asking their doctor to prepare such information in a letter. Medical identification bracelets or necklaces are essential for people with conditions that can cause rapid, life-threatening symptoms, confusion, or unconsciousness (such as diabetes, seizures, and severe allergic reactions). Travelers should also carry proof of medical insurance. Travelers with heart disorders should travel with a copy of a recent electrocardiogram (ECG).

Drugs should remain in their original bottles so that the precise names of the drugs and the instructions for taking them can be reviewed in an emergency. The generic name of a drug is more useful than its brand name because brand names differ among countries.

Travelers should also pack an extra supply of drugs in carry-on bags in case checked bags get lost, stolen, or delayed in transit or the return trip is delayed. Because opioids, syringes, and large amounts of any drug are likely to raise the suspicions of security or customs officers, travelers should have a doctor's note explaining the medical need for the supplies. In addition, syringes should be packed together with the drugs that are dispensed in them. Travelers should also check with airports, airlines, or embassies to determine what additional documentation is helpful in making travel with these supplies go smoothly.

Last full review/revision February 2013 by Christopher Sanford, MD, MPH, DTM&H