• Safety and Health Information Bulletins /
• Safety and Health During International Travel

Purpose

The purpose of this Safety and Health Information Bulletin is to:

1. Inform employees and employers of the availability of specific travel health information including preventive measures and immunizations for employees whose work requires international travel;
2. Provide informational resources about travel health with the goal of protecting the health of workers who travel internationally; and
3. Inform employees and employers of the availability of country-specific safety and health information.

Background

In recent years there has been a significant increase in the number of U.S. residents traveling to countries where they are at risk of contracting infectious diseases.¹ Depending on the country visited, travelers are potentially exposed to hepatitis A and B, typhoid fever, malaria, meningococcal disease, yellow fever, cholera, poliomyelitis, encephalitis, rabies, and other diseases.

In 2000, 35% of international travel by U.S. residents was work-related.¹ These travelers incur the risk of exposure to infectious disease as an occupational hazard. Many of these workers may be receiving inadequate disease prevention information and medical prophylaxis. For example, 7 to 8 million U.S. residents travel annually to countries where malaria is present. In 1998, according to the Centers for Disease Control and Prevention (CDC), there were 636 cases of malaria in returning U.S. civilian travelers. CDC has data for 584 of these cases: 59% had not taken any preventive medication and 13% had been prescribed a drug not recommended for the area to which they were traveling.² Hepatitis A is another disease where prevention is possible. Travelers who visit developing countries are considered high-risk for hepatitis A, the most common vaccine-preventable disease in travelers.³

The failure of travelers to receive preventive medication results in unnecessary illness, medical expense, and the potential spread of contagious diseases within their local communities. For this reason, the Office of Disease Prevention and Health Promotion, U.S. Department of Health and Human Services, includes in its prevention agenda Healthy People 2010, the developmental objective to:

Increase the proportion of international travelers who receive recommended preventive services when traveling in areas of risk for select infectious diseases: hepatitis A, malaria, and typhoid.⁴

Resources for Disease Prevention

The Centers for Disease Control and Prevention (CDC) has developed detailed and specific travel health information including recommendations for preventive measures and immunizations for U.S. residents traveling abroad. Many diseases could be avoided by implementing these recommendations which appear in CDC's publication Health Information for International Travel and on their website www.cdc.gov/travel. The information is organized by geographic regions. Each entry contains these topics specific to the region:

• food and waterborne diseases
• infectious diseases, with reference to specific countries
• recommended vaccines
• tips on staying healthy
• tips on avoiding illness
• suggestions on helpful items to pack
• what to do after returning home
• referrals for further information

Depending on destinations, travelers may need an International Certificate of Vaccination to prove immunization for yellow fever. In the United States, vaccine is obtained from Yellow Fever Vaccine Centers designated by state health departments. This CDC website www.cdc.gov/travel/yfever.htm provides information about yellow fever vaccination requirements.⁵

The U.S. Department of State prepares a Consular Information Sheet for every country, Public Announcements, Travel Warnings, and Medical Information for Americans Traveling Abroad. This information is available at http://travel.state.gov/. The State Department also offers the pamphlets "Your Trip Abroad", "A Safe Trip Abroad," and "Tips for Americans Residing Abroad."

All Travelers Should Take the Following Precautions No Matter the Destination

• Wash hands often with soap and water.
• Because motor vehicle crashes are a leading cause of injury among travelers, walk and drive defensively. Avoid travel at night if possible and always use seat belts.
• Don't eat or drink dairy products unless you know they have been pasteurized.
• To avoid acquiring sexually transmitted diseases (AIDS, hepatitis B and C, syphilis) don't have sexual contact with people whose health status is unknown or uncertain.
• Eat only thoroughly cooked food or fruits and vegetables you have peeled yourself. Remember: boil it, cook it, peel it, or forget it.
• Never eat undercooked ground beef and poultry, raw eggs, and unpasteurized dairy products. Raw shellfish is particularly dangerous to persons who have liver disease or compromised immune systems.

Travelers Visiting Developing Areas Should Take the Following Precautions

• Drink only bottled or boiled water, or carbonated (bubbly) drinks in cans or bottles. Avoid tap water, fountain drinks, beverages with ice, ice cubes, and beverages cooled by submerging their containers in water.
• If this is not possible, make water safer by BOTH filtering through an "absolute 1-micron or less" filter AND adding iodine tablets to the filtered water. "Absolute 1-micron filters" are found in camping/ outdoor supply stores.
• If you visit an area where there is risk for malaria, take your malaria prevention medication before, during, and after travel, as directed. See your doctor for a prescription. Protect yourself from insects by remaining in well-screened areas, using repellents applied sparingly at 4-hour intervals, wearing long-sleeved shirts and long pants from dusk through dawn, and using permethrin impregnated netting around beds if not in screened or air-conditioned housing.
• To prevent fungal and parasitic infections, keep feet clean and dry, and do not go barefoot.
• Don't eat food purchased from street vendors.
• Don't handle animals, especially monkeys, dogs, and cats, to avoid bites and serious diseases, including rabies and plague.
• Don't swim in fresh water except for well-chlorinated swimming pools. Salt water is usually safer except for areas where it may be contaminated by sewage.

Recommendations

• Employers are encouraged to identify employees who may travel internationally and to refer employees to qualified health care professionals for the purpose of providing travel health information and recommended vaccinations.
• Employers and employees should implement these preventive measures with appropriate lead-time before travel so as to maximize effectiveness and to minimize health risks.
• U.S. workers who travel abroad should be familiar with the infectious diseases to which they may be exposed. With this knowledge, they may modify their behavior to avoid contracting infection, obtain necessary medication and vaccinations before travel, and recognize symptoms of disease.

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