It goes without saying that travel in the Covid era remains tricky to say the least. With ongoing outbreaks in different countries and new variants emerging, make sure you are as protected as possible, understand the Covid guidelines of the places you are visiting, and have a plan in place in case you happen to test positive while away. The CDC advises full vaccination before any travel, particularly abroad – and maintaining social distancing, hand sanitizing and masking where mandated throughout your trip:
https://www.cdc.gov/coronavirus/2019-ncov/travelers/international-travel-during-covid19.html
https://www.cdc.gov/coronavirus/2019-ncov/travelers/travel-during-covid19.html
But while it’s hard to keep in mind after the last year and a half, Covid is not our only risk. Traveling can increase risks to general health and wellbeing – and these risks should be understood and properly prepared for when planning travel, particularly to unfamiliar, distant or remote areas with different medical care, behaviors and customs. Taking appropriate precautions before beginning a trip is essential for reducing these risks – along with ensuring an effective plan is in place in the event that you are injured or suffer from another health condition when away from home.
Travelers often experience abrupt and dramatic changes in environmental conditions, which may have detrimental effects on health and well-being. Travel may involve major changes in altitude, temperature and humidity, and exposure to microbes, animals and insects. The negative impact of sudden changes in the environment can be minimized by taking simple precautions.
- altitude
- heat and humidity
- ultraviolet radiation from the sun
- foodborne and waterborne health risks
- traveler’s diarrhea
- recreational waters
- animals and insects
- intestinal parasites
Am I at risk of infectious diseases while traveling?
Depending on the travel destination, travellers may be exposed to a number of infectious diseases; exposure depends on the presence of infectious agents in the area to be visited. The risk of becoming infected will vary according to the purpose of the trip and the itinerary within the area, the standards of accommodation, hygiene and sanitation, as well as the behaviour of the traveller. In some instances, disease can be prevented by vaccination, but there are some infectious diseases, including some of the most important and most dangerous, for which no vaccines exist.
General precautions can greatly reduce the risk of exposure to infectious agents and should always be taken for visits to any destination where there is a significant risk of exposure, regardless of whether any vaccinations or medication have been administered.
Modes of transmission and general precautions
The modes of transmission for different infectious diseases and the corresponding general precautions are outlined in the following paragraphs.
- foodborne and waterborne diseases
- vector-borne diseases
- zoonoses (diseases transmitted by animals)
- sexually transmitted diseases
- bloodborne diseases
- airborne diseases
- diseases transmitted via soil
What if I require a blood transfusion while traveling?
Blood transfusion is a life-saving intervention. When used correctly, it saves lives and improves health. However, blood transfusion carries a potential risk of acute or delayed reactions and transfusion-transmissible infections and should be prescribed only to treat conditions associated with significant morbidity that cannot be prevented or managed effectively by other means.
For travellers, the need for a blood transfusion almost always arises as a result of a medical emergency involving sudden massive blood loss, such as:
- accidental injury, such as road traffic accident
- gynaecological or obstetric emergency
- severe gastrointestinal haemorrhage
- emergency surgery.
The safety of blood and blood products depends on the following key factors:
- A supply of safe blood and blood products through the careful selection of voluntary unpaid blood donors from low-risk populations who donate regularly, testing all donated blood for transfusion-transmissible infections, and correct storage and transportation at all stages from collection to transfusion within an adequate quality system.
- Appropriate prescription (only when there is no other remedy), proper cross-matching between the blood unit and the recipient, and safe administration of the blood or blood product at the bedside, with correct patient identification.
In many countries, safe blood and blood products may not be available in all health care facilities. In addition, evidence from every region of the world indicates considerable variations in patterns of clinical blood use between different hospitals, different clinical specialities and even between different clinicians within the same speciality. This suggests that blood and blood products are often transfused unnecessarily.
While blood transfusions given correctly save millions of lives every year, unsafe blood transfusions – as a result of the incompatibility of the blood, the volume transfused or the transmission of infections such as hepatitis B (HBV), hepatitis C (HCV), HIV, malaria, syphilis or Chagas disease – can lead to serious reactions in the recipients.
The initial management of major hemorrhage is the prevention of further blood loss and restoration of the blood volume as rapidly as possible in order to maintain tissue perfusion and oxygenation. This requires infusing the patient with large volumes of replacement fluids until the hemorrhage can be controlled. Some patients respond quickly and remain stable following the infusion of crystalloids or colloids and may not require blood transfusion.In malaria-endemic areas, there is a high risk of acquiring malaria from transfusion. It may be necessary to administer the routine treatment for malaria to the transfused patients.
Accidents on Trips:
Is there a higher risk of road traffic accidents when traveling?
Road traffic collisions are the most frequent cause of death among travelers. The risks associated with road traffic collisions and violence are greatest in low- and middle-income countries, where trauma care systems may not be well developed.
Worldwide, an estimated 1.2 million people are killed each year in road traffic crashes and as many as 50 million more are injured. Projections indicate that road traffic fatalities will be the fifth leading cause of death by the year 2030 unless urgent action is taken to address the issue.
In many low- and middle-income countries, traffic laws are inadequately enforced. The traffic mix is often more complex than that in high-income countries and involves two-, three- and four-wheeled vehicles, animal-drawn vehicles and other conveyances, plus pedestrians, all sharing the same road space. The roads may be poorly constructed and maintained, road signs and lighting inadequate and driving habits poor. Travelers, both drivers and pedestrians, should be extremely attentive and careful on the roads.
There are a number of practical precautions that travelers can take to reduce the risk of being involved in, or becoming the victim of, a road traffic collision.
Precautions:
- Obtain information on the regulations governing traffic and vehicle maintenance, and on the state of the roads, in the countries to be visited.
- Before renting a car check the state of its tyres, seat belts, spare wheels, lights, brakes, etc.
- Know the informal rules of the road; in some countries, for example, it is customary to sound the horn or flash the headlights before overtaking.
- Be particularly vigilant in a country where the traffic drives on the opposite side of the road to that used in your country of residence.
- Do not drive after drinking alcohol.
- Drive within the speed limit at all times.
- Always wear a seat-belt where these are available.
- Do not drive on unfamiliar and unlit roads.
- Do not use a moped, motorcycle, bicycle or tricycle.
- Beware of wandering animals.
In addition, travelers driving vehicles abroad should make sure that they carry their personal driving license as well as an international driving permit and that they have full insurance cover for medical treatment of injuries.
How can I prevent violence against me when traveling?
Interpersonal violence is a significant risk in many low-and middle-income countries. Of the approximately 600,000 murders each year, more than 90% occur in low- and middle-income countries. For every murder, scores of people sustain non-fatal injuries requiring medical attention, and hundreds experience more insidious forms of violence and abuse leading to long-term physical and mental health consequences, behavioral disorders and social problems. While there are no epidemiological studies to date that examine how traveling for holiday purposes may increase or reduce involvement in violence, there is emerging evidence to show how it substantially increases known risk factors for violence, including alcohol and illicit drug use among young adults.
Precautions:
- Stick to moderate consumption of alcohol and avoid illicit drugs.
- Avoid becoming involved in verbal arguments that could escalate into physical fighting.
- Leave the scene if you feel threatened by the mood and tone set by other people’s behavour.
- Avoid going to someone else’s private home or hotel room until you know them well.
- Be alert to the possibility of muggings during the day as well as at night.
- Keep jewelry, cameras and other items of value out of sight and do not carry large sums of money on your person.
- Avoid isolated beaches and other remote areas.
- Use taxis from authorized ranks only.
- Avoid driving at night and never travel alone.
- Keep car doors locked and windows shut.
- Be particularly alert when waiting at traffic lights.
- Park in well-lit areas and do not pick up strangers.
- Employ the services of a local guide/interpreter or local driver when traveling to remote areas.
- Vehicle hijacking is a recognized risk in a number of countries. If stopped by armed robbers, make no attempt to resist and keep hands where the attackers can see them at all times.
Any safe travel today requires proactive, strategic preparation and good contingency planning – particularly if you are traveling to less-than-First-World environments: