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Problems at the Destination

By Christopher Sanford, MD, MPH, DTM&H, Associate Professor, Family Medicine, Global Health, University of Washington

Health issues at the destination are especially important to prevent and avoid in international settings. Certain infections are common when traveling to certain areas, and many people are most concerned about infection when considering a trip overseas. However, motor vehicle crashes and heart disease are the most common causes of death among international travelers. Heart disease is the most common cause of death among nontravelers as well, suggesting that attention to health before leaving home is the best way to prevent illness while away.

Injuries and Death

Injuries caused by motor vehicle crashes are the most frequent cause of death among younger and middle-aged travelers. Another common cause of death while traveling is drowning. Common-sense measures can be taken to prevent many such injuries. For example, people uncomfortable with unfamiliar traffic patterns (such as driving on the left side of the road in England versus the right side in the United States) can take public transportation or hire drivers familiar with local roads and traffic laws. Travelers should avoid overcrowded taxis, ferries, or other transports and avoid nighttime driving and swimming in poorly lit areas. People should wear seat belts even as passengers and should use a helmet when cycling. Travelers should avoid motorcycles and mopeds and avoid riding on bus roofs or in open truck beds. Also, alcohol should never be consumed before driving or swimming, even where laws do not formally prohibit such actions or where laws that do exist are not enforced. People should also avoid beaches with turbulent waves, particularly when lifeguards are not present.

Many cities are unsafe after dark, and some are unsafe even during the day. A traveler should avoid walking alone on poorly lit or deserted streets in such cities, especially in countries where the traveler is obviously a stranger.

Did You Know...

  • The most common cause of death among younger and middle-aged travelers is injury.

Traveler’s Diarrhea

Traveler’s diarrhea (turista) is the most common health problem among international travelers.

The risk of traveler’s diarrhea may be reduced by the following measures:

  • Drinking and brushing teeth with bottled, filtered, boiled, UV-treated, or chlorinated water

  • Avoiding ice

  • Eating freshly prepared foods only if they have been heated to steaming temperatures

  • Eating only fruits and vegetables that people peel or shell themselves

  • Avoiding food from street vendors

  • Washing hands frequently

  • Avoiding all foods likely to have been exposed to flies

Taking certain antibiotics can also prevent traveler’s diarrhea. However, such use has a risk of side effects and may increase the chances that bacteria will develop resistance to antibiotics. Thus, many doctors recommend preventive antibiotics only for people who have an immune deficiency disorder.

In most cases, traveler’s diarrhea subsides by itself in about 3 to 5 days and requires only the steady intake of fluids to prevent dehydration. Ordinary clear liquids (without caffeine or alcohol) are adequate for most people. Young children and older people may benefit from powdered rehydration mixes or an oral rehydration solution. Other measures, though not always necessary, may be helpful.

People who have moderate to severe symptoms (3 or more loose stools over 8 hours) should consider taking an antibiotic, especially if they have vomiting, fever, abdominal cramps, or blood in the stool. Azithromycin is appropriate for most countries and is recommended for children and pregnant women. Ciprofloxacin and levofloxacin are alternatives for nonpregnant adults in certain parts of the world. People should contact their doctor for an antibiotic prescription before travel. If people are 6 years of age or older and have no bloody stools, fever, or abdominal pain, they can also be treated with the antidiarrheal drug loperamide (which is available without a prescription).

For older adults and young children, powdered rehydration mixes are available for travel. If these mixes are unavailable, rehydration solutions can be made by adding 6 teaspoons of sugar and 1 half teaspoon of salt to 1 liter of water. However, solutions should be prepared carefully because young children can become seriously ill or die if they drink much of a solution that has been incorrectly mixed (for example, if a rehydration mix has not been fully diluted).


Malaria is common throughout the tropics. Malaria is prevented by avoiding mosquito bites and taking an antimalarial drug.

Mosquito bites are prevented by the following measures:

  • Wearing long-sleeved shirts and long trousers (especially at dawn and dusk, when mosquitoes are most active)

  • Sleeping under a mosquito net

  • Wearing clothing impregnated with the insecticide permethrin

  • Using insect repellants that contain diethyltoluamide (DEET)

Insect repellants can also help prevent other mosquito-borne diseases such as dengue, Zika, and yellow fever.

Antimalarial drugs

Even when people take measures to avoid mosquito bites, it is still necessary to take a drug to prevent malaria (such as mefloquine, chloroquine, doxycycline, or atovaquone/proguanil) when travelling to many parts of the world. Information about specific areas is available from the Centers for Disease Control and Prevention (CDC: Malaria and Travelers).

Pregnant women should consider delaying travel to areas where malaria is common because malaria is more likely to be serious and life threatening among pregnant women than among women who are not pregnant, even when preventive drugs are used. Pregnant women who cannot postpone travel must weigh the risks of taking protective drugs, the effects of which on pregnancy are not well known, against the risks of traveling without protection.


Schistosomiasis is a common and potentially serious infection caused by a parasite that lives in fresh water in Africa, Southeast Asia, China, and eastern South America. The risk of schistosomiasis can be reduced by avoiding freshwater activities in areas where schistosomiasis is common.

Lice and Scabies

Lice and scabies are common in crowded accommodations, underdeveloped areas, and places where hygiene measures are poor. They can be treated with permethrin, malathion, or lindane lotions. However, these lotions should not be used preventively.

Sexually Transmitted Diseases

Sexually transmitted diseases (infections), including human immunodeficiency virus (HIV) infection, gonorrhea, syphilis, trichomoniasis, and hepatitis B, are more common in developing countries. All can be prevented through abstinence or with correct, consistent use of a latex condom (see How to Use a Condom). Because HIV and hepatitis B also are transmitted through blood and needles, an international traveler should not accept a blood transfusion without assurance that the blood has been tested for infection. Also, injections should be accepted only through one-time-only disposable needles.

Zika Virus

Zika virus infection causes few or only mild symptoms in adults. However, Zika infection during pregnancy can cause serious birth defects in the baby.

Zika virus infection is spread by mosquitoes and also by sexual contact and transfusion of blood from an infected person. The disease has spread widely through South and Central America and has recently reached the southern United States. The Centers for Disease Control and Prevention (CDC) recommends that pregnant women consider postponing travel to areas where Zika virus infection is common (see CDC: Zika Virus: For Pregnant Women and CDC Zika Travel Information).

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