Health Guide: Chapter 1
Overview of Travelers's Health
The Risk of Illness While Traveling
How risky is foreign travel? People tend to exaggerate dangers such as terrorism, or exotic diseases, such as Ebola virus, and disregard or minimize the more common perils of motor vehicle accidents and malaria. Disasters, like the Indonesian tsunami of December 2004, killed thousands of tourists, but such catastrophic events are infrequent and unpredictable. Large disasters often divert attention from the simple day-to-day precautions that you can take to stay healthy and safe.
The chances of acquiring certain diseases, or of having an accident, depend largely on where you travel and what you do while traveling. Out of over 30 million Americans who go abroad each year, approximately 8 million go to less developed countries where the incidences of tropical and infectious diseases are often high. Almost 7 million U.S. citizens travel to countries where there is risk of malaria. Surveys of travelers show that:
Your individual risk, however, may vary considerably. For example, if visiting the Indian subcontinent, (and particularly friends and relatives) your risk of typhoid fever may be 18 times greater than for any other geographic region. Other variables that can affect your health include (1) the duration of your trip; (2) your use (or nonuse) of antimalarial drugs; (3) your use of prevention measures against insect bites; (4) your vaccination status; (5) your risk-taking (or avoidance) behavior; and (6) your underlying health status.
Bear in mind, though, that traveling is usually good for one's physical and emotional health. Aside from seeking holiday pleasures, some people travel to improve their lifestyle, perhaps to change harmful personal habits, â€œget in shapeâ€ - or temporarily (perhaps permanently) leave a stressful job, a bad relationship, a harsh climate, or other adverse life situation.
Prevention of Illness
Preventing illness abroad involves learning as much as possible about the countries you will be visiting, consulting with a travel medicine provider to receive immunizations and medications and taking the necessary clothing, equipment, or devices (such as a water filter or mosquito net) to deal with local health conditions and climate. Your own health status should also be evaluated.
Most travel-related diseases can be prevented. Hepatitis, meningitis, yellow fever, and rabies are some of the many diseases that can be prevented by vaccination. Chemoprophylaxis, combined with protective measures against mosquito bites, can prevent virtually all cases of malaria, as well as many other insect-transmitted diseases, such as dengue fever and Japanese encephalitis. Sexually transmitted diseases, including HIV, can be avoided with behavior modification.
Diarrhea (Chapter 6) This is the most common malady affecting travelers. There is a 35% to 60% chance that you will acquire travelers' diarrhea during a month-long trip to a less-developed country. Adhering to safe food and drink practices can reduce your risk (but most travelers have trouble sticking to the guidelines). Prompt treatment with antibiotics and loperamide quickly controls most cases of travelers' diarrhea.
Malaria (Chapter 7) This mosquito-transmitted illness, which can be fatal, is the most important parasitic disease to avoid overseas. Malaria is a serious health problem in many tropical and subtropical countries, especially sub-Saharan Africa. Check your itinerary carefully to assess your risk of exposure.
Hepatitis (Chapter 12) The viruses hepatitis A and hepatitis B pose potential risks for some travelers. Although both are rarely fatal, hepatitis A can ruin a carefully planned vacation and result in weeks or months of disability; contracting hepatitis B can have serious long-term consequences, including cirrhosis of the liver and liver cancer. You can prevent both hepatitis A and hepatitis B with vaccination. Although there are no vaccines against hepatitis C and E, Chapter 12 outlines measures you can take to reduce your risk of these illnesses.
Other Illnesses Colds and respiratory infections, skin rashes, ear infections, sunburn, sprains, contusions, and superficial injuries account for the majority of less serious problems.
Although it is quite possible you will have some type of minor illness while abroad, the chance that your illness will be fatal is reassuringly small. Approximately 6,000 Americans die outside of the U.S. each year. The majority of these are long-term residents of a foreign country. The U. S. Department of State assists with the return of remains for approximately 2,000 Americans annually. Mortality abroad is due mainly to heart attacks, motor vehicle accidents, drownings, and other injuries. Cardiovascular disease causes about 50% of all deaths abroad, but most of these occur in older travelers. Cardiovascular death rates are not significantly increased by travel. Other points include the following:
Accidents are the leading cause of death among travelers younger than the age of 55. Death rates from motor vehicle accidents, according to The Association for Safe International Road Travel, are 20 to 80 times higher in some countries than in the United States, illustrating one reason why â€œexcess mortalityâ€ abroad is primarily injury related.
Table 1.1 Reported Deaths of U.S. Citizens Abroad by Cause of Death
*From October 1, 2002 to December 31, 2004
Studies have revealed that many road accidents involving tourists do not involve a collision between two vehicles but are due to loss of driver control caused by fatigue, alcohol or drug intoxication, unfamiliar road conditions, or other factors. In addition, in most developing countries vehicles are often in disrepair; roads poorly maintained; and common-sense rules of the road disregarded.
The Bethesda, Maryland-based Association for Safe International Road Travel (ASIRT; Tel: 301-983-5252; website: www.asirt.org) can provide a report on road safety conditions in 70 foreign countries. Their road travel reports also contain information about seasonal hazards; city, rural, and interstate traffic; and the most dangerous roads in various countries. ASIRT currently cites Egypt, Kenya, India, South Korea, Turkey, and Morocco as some of the most dangerous countries. (ASIRT, a nonprofit organization, requests a small donation in exchange for the information it provides.)
Preventing Traffic Accidents and Injuries
If you follow the recommendations below, you will decrease your chances of having an accident or being injured while driving overseas.
Other advice for improving your road safety:
Table 1.2 Global Road Toll Fact Sheet
From the Association for Safe International Road Travel, www.asirt.org. Used with permission
The two most important rules to follow are:
PERSONAL SAFETY GUIDELINES
Although you can't escape the remote possibility that you simply may find yourself â€œin the wrong place at the wrong time,â€ you can take steps to enhance your personal safety while traveling: plan your trip carefully, be reasonably cautious, obey common-sense rules of behavior, and don't panic! Remember that the vast majority of travelers arrive home unscathed.
The following guidelines will be helpful in ensuring your travel safety:
There are numerous publications that provide specific advice on personal safety and security. Suggested titles include The Safe Travel Book - A Guide for the International Traveler by Peter Savage (Lexington Books: 800-462-6420) and The Security Minute; How to Be Safe in the Streets, at Home, and Abroad So You Can Save Your Life! by Robert L. Siciliano (Safety Zone Press: 800-438-6223).
Risk Management Companies
In times of geopolitical turmoil and terrorist activity, corporate interests are often targeted and advising corporations on matters of safety and security has become increasingly important. The companies listed below provide a variety of services that include the following: crisis management and contingency planning; hostage-release negotiation; counter-terrorism education/training; defensive driving training; executive protection; travel advisories and warnings; country-specific political analyses and risk assessments.
International SOS Assistance, Inc.
State Department Security Advisories
You can obtain in-depth advice about specific security issues in any country by contacting the Regional Security Officer (RSO) at the embassy of the country to which you will be traveling. Here is the procedure:
The Overseas Security Advisory Council (OSAC) was established in 1985 by the U.S. Department of State to foster the exchange of security-related information between the U.S. Government and American private sector operating abroad. Administered by the Bureau of Diplomatic Security, OSAC has developed into a successful joint venture for effective security cooperation. Through OSAC, the American private sector, including colleges and universities, is provided timely information on which to make informed corporate decisions on how best to protect their investment, facilities, and personnel abroad.
BUREAU OF CONSULAR AFFAIRS
How the U.S. Government Can Help
The website of the Bureau of Consular Affairs (www.travel.state.gov) is an extensive and convenient source of information that lists passport and visa requirements, foreign country entry requirements, a listing of embassies and consulates overseas, and emergency services for U.S. citizens abroad. The Bureau of Consular Affairs Office of American Citizens Services and Crisis Management (a division within the Bureau of Consular Affairs) issues consular information sheets, travel warnings, and public announcements on more than 200 countries.
The Office of American Citizens Services and Crisis Management (ACS) serves Americans traveling or residing abroad. The ACS corresponds organizationally to American Citizens Services offices set up at U.S. embassies and consulates throughout the world. ACS has five geographical divisions with case officers who assist in all matters involving protective services for Americans abroad, including arrests, death cases, financial or medical emergencies, and welfare and whereabouts inquiries. The office also issues Travel Warnings, Travel Alerts and Country Specific Information (see above) and provides guidance on nationality and citizenship determination, document issuance, judicial and notarial services, estates and property claims, third-country representation, and disaster assistance. Services provided by ACS include help with the following:
The Canadian, British, and Australian governments provide extensive information resources for the traveler. These updated reports focus on travel advice by country, safety and security, entry requirements, health issues, travel insurance, and more. The Foreign and Commonwealth Office (FCO) in the UK is one of the best organized and concise - they even have a LOCATE service that provides emergency advice to UK nationals who register with them. The Australian Government's Smartraveler is another excellent resource. Canadian travel information is contained on two websites, Foreign Affairs Canada and Public Health Agency of Canada.
Almost all health problems related to travel are either preventable or can be minimized, but most travelers are often unaware of just what those risks may be. A travel clinic can be an excellent source for this information, but time constraints limit the amount of advice a practitioner can dispense in one or two office visits. And if the clinic hands out printed material, how much will you read or remember? And is the information you are given sufficient? It is often essential that you do additional pre-departure reading and data gathering. The Internet can provide the most current information, if you know where to find it, but books that are updated on a regular basis are also good references (and can be brought along on your trip, as well). However, it's possible that no single resource, printed or electronic, will provide all the information that you may need, so numerous resources are listed in this chapter. Be aware that these sources of information may not always be in agreement. For example, the Centers for Disease Control and Prevention (CDC) recommends that malaria prophylaxis be taken in all malarious areas, whereas many travel clinics and other information sources usually advise that low-risk, short-term travelers may rely instead on insect bite-prevention measures, or carry standby malaria treatment medication. And some literature in travel medicine advises that children with diarrhea not be treated with quinolone antibiotics, when in fact this treatment may be preferred. NOTE: Information is sometimes available from retail travel agents, tour operators, and airlines and other common carriers, but the quality of this information varies and may be unreliable.
CDC's Traveler's Health website - http://wwwn.cdc.gov/travel
Go to the website of the Centers for Disease Control and Prevention (CDC) to obtain a vast amount of travel health advice and information, such as disease outbreaks, vaccination requirements, destination risks, and much more. You can also download for free chapters from Health Information for International Travel (the Yellow Book. The Yellow Book is published every two years by the CDC as a reference for those who advise international travelers of health risks, but it is also useful for travelers who are not medical professionals. The book can also be purchased online (softcover) for $24.95 at http://www.amazon.com/ or at Elsevier Inc. at their website http://www.us.elsevierhealth.com/product.jsp?isbn=9780323048859.
Additional Online Travel Health Information
The National Travel Health Network and Centre, NaTHNaC, was created to promote clinical standards in travel medicine by improving the quality of travel health advice available to GP practices and other health care providers. The Outbreak Surveillance reports are especially useful and much more comprehensive and up-to-date than those of WHO.
"fitfortravel" is a public access website provided by the NHS (Scotland). It gives travel health information for people travelling abroad from the UK. The website is compiled by a team of experts from the Travel Health division at Health Protection Scotland (HPS). This is the only site the Health Guide could find that has malaria maps for all endemic areas.
The Australian Government maintains an excellent travel advisory and consular assistance service.
Before you depart you'll want to consult with your health-care provider if you have medical problems, are traveling to a less-developed country (where there is often the risk of tropical and infectious diseases), or planning an extended trip abroad. Specialized immunizations and prophylactic medications may be recommended or required. Although your own doctor may be able to administer some routine immunizations, most physicians' offices don't stock specialized vaccines, such as typhoid, rabies, or meningitis, and they are not authorized to stock and administer yellow fever vaccine, or issue the International Certificate of Vaccination. (Public health departments can administer yellow fever vaccines.) More importantly, your health-care provider may not have the expertise or resources to advise you about safe travel, or what to do if you get sick abroad. There are more than 220 different countries with evolving and varying disease-risk patterns, and providing travelers with accurate health information can be complex and time consuming. Most physicians are not prepared, or willing, to give this type of consultation.
Fortunately, the specialty of travel medicine has expanded rapidly over the past 15 years and there are now many physicians and nurse practitioners that either specialize in this field, or have added it to their regular practice. Although no specialty board certification is required to practice travel medicine, most travel medicine practitioners have received further training under the auspices of the International Society of Travel Medicine (www.istm.org) and/or the American Society of Tropical Medicine and Hygiene (www.astmh.org). Both of these organizations have developed specialty examinations that award a Certificate of Knowledge.
More information on the practice of travel medicine is found here.
Types of Travel Clinics Travel clinics vary in their ranges of services and professional staffing. Sometimes a medical facility is dedicated solely to this specialty, but often a travel clinic is from a doctor's private practice, an ambulatory care clinic, an HMO or group practice, an occupational health clinic, or the infectious disease department of a university teaching hospital. These clinics, unlike regular physician's offices, are almost all tied into Internet and electronic databases that provide them with updated travel/health information and conditions worldwide.
Travel clinics supervised by physicians trained in infectious and/or tropical diseases are usually better able to counsel travelers with special needs, or who have returned from abroad with a suspected or undiagnosed tropical or infectious disease. Such clinics are often, but not invariably, associated with a university hospital or a medical school.
If you need to locate a travel clinic, visit one of the websites listed below. They have extensive listings, but no one website lists all clinics currently operational. The ISTM, ASTM&H, and Travel Medicine, Inc., websites also list travel clinics in many countries worldwide. This can be helpful if a travel/tropical disease specialist needs to be contacted for an illness occurring abroad.
Travel Clinics in the United States & Canada
The International Association for Medical Assistance to Travellers (IAMAT) publishes a booklet listing English-speaking physicians and healthcare facilities worldwide. IAMAT also provides information on tropical diseases such as malaria and schistosomiasis. IAMAT is a tax-free foundation, and there is no charge for their publications; a donation, however, is requested. IAMAT, 417 Center Street, Lewiston, NY 14092; 716-754brr4883. In Canada: 40 Regal Road, Guelph, Ontario, N1K 1B5; 519-836-0102.
The Destinations section on www.travmed.com has listings of hospitals and physicians for every country.
Chapter 16 of this book will tell you how to locate medical care abroad (see link below).
Hotels and resorts can refer you to a local English-speaking doctor.
Most U.S. and Canadian embassies and consulates maintain lists of physicians and medical facilities for distribution to travelers needing medical care. The inclusion of a specific physician or medical facility does not constitute a recommendation and the Department of State assumes no responsibility or liability for the professional ability or reputation of, or the quality of services provided by, the medical professionals, medical facilities, or air ambulance services whose names appear on such lists. See U.S. Embassies and Consulates websites to access medical lists for specific countries. Lists are normally found under the American. Citizens Services section of the embassy website. Note: These lists are not always well-maintained or updated. The U.S. Department of State has not established a standard form or protocol for identifying medical in each country.
Travel insurance policies with assistance. Companies such as the International SOS (http://www.internationalsos.comand Medex (http://www.medexassist.com) provide policyholders with access to an extensive network of doctors and hospitals worldwide. Physician referrals and monitoring of hospital care are parts of the assistance package provided.
Obviously, in many emergencies, such as a heart attack, stroke, or serious motor vehicle accident, you won't be able to choose which facility you're transported to. (And in many locations there won't be alternative choices.) This is why travel medical insurance that has an "assistance" feature is so important; the assistance hotline center can monitor your medical care and decide if immediate evacuation to a more advanced medical facility, even in another country, is indicated.
TRAVEL MEDICINE PUBLICATIONS
International Travel Health Guide -13th Edition - by Stuart R. Rose, MD, FACEP and Jay Keystone, MD (Elsevier 2006. Paperback). An indispensable resource for anyone concerned with safe international travel, this best-selling book has been completely updated to provide more state-of-the-art guidance than ever before. In clear, accessible prose, authors Stuart Rose, MD and Jay Keystone, MD cover all of the essentials of healthy travel, from pre-travel vaccination and avoiding jet lag and altitude sickness to the treatment of travelers' diarrhea, malaria prevention, and more. In addition, the book's unique World Health Guide section provides essential health and risk-related information for over 200 countries.
Travel Medicine 2nd Edition: Expert Consult edited by Jay Keystone, M.D., et al (Elsevier Mosby 2008). The second edition of this popular text features a team of international experts who discuss all aspects of travel medicine - from immunizations and pre-travel advice for adults and childrenâ€¦to the latest information on cruise travel, bird flu, and SARSâ€¦to the essentials of post-travel screening. It reflects current â€˜best practices' and remains both the leading comprehensive reference text on the principles and practice of travel medicine and a rich resource of practical guidance that you can use daily. And, as an Expert Consult title, this thoroughly updated second edition comes with access to the complete contents online, fully searchable - enabling you to consult it rapidly from any computer with an Internet connection.
Travel Medicine Advisor - A comprehensive source of travel health information from an online database with bimonthly newsletter updates in both print and electronic formats. Editor: Frank Bia, MD, MPH; American Health Consultants, Atlanta, GA; 800-688-2421 - (www.ahcpub.com).
The Travel and Tropical Medicine Manual, 4th Edition Edited by Elaine C. Jong, MD and Christopher A. Sanford, MD, MPH, DTM&H (WB Saunders, Copyright 2008. Paperback; 688 pages.) Here's a handy, portable guide to preventing, evaluating, and managing diseases that can be acquired in tropical environments and foreign countries! Whether you're a physician, traveler, or both, this respected manual is your perfect source for quick, easy access to the latest travel medicine information. New updates and additional material are presented in a sleek new design that offers rapid access to the content you need. The fourth edition features more critical content than ever before - including new evidence-based recommendations and new maps and illustrations. From pre-travel advice and immunizations to the diagnosis and treatment of a full range of travel-related illnesses, you'll have all the information you need to avoid, recognize, and treat illnesses acquired away from home in a convenient, pocket size guide.
Traveler's Health - How to Stay Healthy Abroad by Dr. Richard Dawood (Random House, 2002). A well-known source of travel health information compiled primarily by British experts. Available on amazon.com.
Health Information for International Travel (The CDC's â€œYellow Bookâ€). This is a travel medicine reference manual published biannually. The paperback version of the Yellow Book can be ordered from the publisher at http://www.us.elsevierhealth.com/. Chapters from the book can be downloaded at no charge from the CDC website. The Yellow Book is written primarily for healthcare providers, but travelers will also find it useful.
Wilderness Medicine: Text with DVD (5th Edition) Paul S. Auerbach, MD, FACEP editor (Elsevier Health Sciences, 2007). Auerbach's Wilderness Medicine remains the gold standard in this field. "Unrivaled as a compendium of information regarding the practical and clinical management of wilderness illness and injury both in and out of hospital . . ." from a review in the Journal of the American Medical Association.
Field Guide to Wilderness Medicine - CD-ROM PDA Software by Paul S. Auerbach, MD, Howard Donner, MD, Eric A. Weiss, MD (Elsevier Health Science). If you consider Auerbach's Wilderness Medicine text to be "The Bible of Outdoor Medicine," then this will be a welcomed addition to your reference library. This PDA product, based upon Dr. Auerbach's Field Guide to Wilderness Medicine, 2nd Edition, focuses on information that is needed when medical situations present in the wilderness setting. Perfect for the physician on the go, the PDA for the new 2nd edition will help you diagnose and manage any outdoor medical emergency.
A Comprehensive Guide to Wilderness and Travel Medicine by Eric A. Weiss, M.D. (Adventure Medical Kits; copyright 2005). 190 paged, pocket-sized book that goes far beyond traditional first aid and embraces a new philosophy in wilderness medicine education. It brings to fruition a juxtaposition of more that 10 years of research, clinical experience, and teaching into a powerful guide for those who travel far from modern civilization. Revolutionary advances in emergency medicine knowledge, techniques, and equipment, as well as a new standard of first-aid practice, permeate the text and provide the foundation for lay people to provide vital emergency care in remote settings. The information found in these pages is intended to help you manage medical emergencies in remote environments, when professional medical care or rescue is not readily available.
A Comprehensive Guide to Marine Medicine by Eric A Weiss, M.D. & Michael Jacobs, M.D. (Adventure Medical Kits) is the next best thing to having Drs. Weiss and Jacobs on board for your next adventure on the water. More than 288 pages of text cover topics including hazardous marine life, submersion injury and dive medicine, rescue and evacuation of sick and injured, wound cleaning and closing, and much more. More than 106 illustrations, improvisational techniques and "when to worry" tips help you give pointers on medical care and guidance on when to seek professional medical help.
The Pocket Doctor: A Passport to Healthy Travel by Stephen Bezruchka, MD. Provides the traveler with a quick reference for avoiding-and treating-travel-related illness and injuries.
For a guide to hyperbaric and decompression chamber facilities worldwide, contact the Undersea and Hyperbaric Medical Society, 9650 Rockville Pike, Bethesda, MD; 301-571-1817.
Medicine for Mountaineering & Other Wilderness Activities, by James A. Wilkerson (Paperback, 2001).
Internet-Based Altitude Illness Information
- International Society for Mountain Medicine: http://www.ismmed.org
During the past decade, there have been dramatic increases in the amount of travel health information available electronically, either via the Internet or distributed on PC disks or CD-ROMs. The advantage of these systems lies in their ability to provide updated, organized, itinerary-specific information in a format that can be printed out for the traveler. This is of great help in pre-travel counseling and trip preparation. In addition, some systems can also alert overseas travelers via e-mail about evolving emergency conditions - be they medical or safety/security related. Other systems allow a company to check on an employee's whereabouts and current status - a feature especially used by corporate medical and security departments tracking overseas employees who may be at risk.
TRAVEL CARE - International SOS Assistance, Inc., 3600 Horizon Boulevard, Suite 300, Trevose, PA 19053; 215-942-8000 or 1-800-523-8930. Website: www.internationalsos.com or www.internationalsos.com/demo/travel_care for a free demonstration.
Online travel health program designed for the medical professional conducting pre-travel medical consultations. TRAVEL CARE's sophisticated but easy-to-use databases help the practitioner decide on appropriate vaccinations and malaria prophylaxis and also evaluate current health risks for any itinerary. Detailed country reports and advisories include comprehensive medical and disease-risk information, as well as nonmedical information - such as safety and security issues, cultural tips, and types of electrical plugs (including photos). Updated health and security advisories can be sent by e-mail to the overseas traveler. The â€œTraveler Locator Serviceâ€ from the International SOS consolidates a company's airline booking data into one database and allows company executives to search this data online to track employee travel. These searches can be current, prospective or historic, with data searched by continent, country, city, hotel, flight number, or country risk rating.
TRAVAX-Shoreland, Inc., 2401 N. Mayfair Road, Suite 309, Milwaukee, WI 53226; 800-433-5256; 414-290-1900; e-mail: firstname.lastname@example.org; Internet: www.shoreland.com. Basic travel health recommendations, including country-by-country disease-risk information, vaccine recommendations, and current disease outbreak alerts. Disease-by-disease fact sheets. Very detailed malaria, yellow fever, and cholera risk maps by country. Health-related entry requirements. Detailed country profiles, including geography and climate. Crime, security, and other associated information. Contact information for U.S., Australian, and Canadian embassies and consulates. List of Internet URLs for U.S. State Department resources. Itinerary maker feature considers order of travel and presents summary recommendations for entire itinerary. Printout for each country can be customized to allow physician-added comments and allows deletion of sections not of use to an individual patient.
Travax EnCompass, an expanded (detailed overseas medical facility data) wholly Internet-based version, is available to corporations under a licensing agreement.
CATIS-Computerized-Assisted Travel Information System (CATIS). Dr. David Lawee; Travel Information & Supplies; PO Box 41003, 2795 Bathurst St. Toronto, Ontario, Canada M6B 4J6. Tel/fax: 416-785-6219.
Content: Country-by-country vaccine recommendations, plus disease risk information both textual or illustrated with colored maps. Brief disease and vaccine fact sheets. Comparison maps for the CDC, WHO, CATMAT; malaria recommendations. Itinerary maker feature requires responses to a multiscreen detailed questionnaire even if patient and itinerary are uncomplicated. Requires patient to have detailed knowledge of in-country itinerary. Printout generated accounting for traveler health status. Printed prescription for malaria prophylaxis with calculation of dosage, number of tablets required, and schedule of administration. No country background or emergency contact information.
Global Dialysis is a resources for both renal patients and medical professionals. Their directory lists over 14,000 centers in 154 countries, making it the largest database of dialysis centers available in the world.
Dialysis at Sea Cruises They are largest provider of dialysis services aboard cruise ships. Tel: 800-544-7604; Website: http://www.dialysisatsea.com/about.aspx
©2014 Travel Medicine, Inc.
Table of Contents | Overview of Travelers' Health | Trip Preparation | Vaccines for Travel | Jet Lag and Motion Sickness | Food and Drink Safety | Travelers' Diarrhea | Malaria | Insect Bite and Prevention | Insect-Borne Diseases | Travel-Related Diseases | Lyme Disease | Hepatitis | Diabetes | HIV/AIDS and Sexually Transmitted Diseases (STDS) | Altitude Illness | Medical Care Abroad | Travel Insurance | Medical Transport | Business Travel and Health | Travel and Pregnancy | Traveling with Children | Home