Recommendations for preventing traveler's illnesses before packing

In recent years, the number of people making long-distance trips across the globe has increased significantly. Specifically, more than 50% of international trips take place to tropical or subtropical regions, which, according to Dr. Ignacio Barbolla Díaz , an internal medicine specialist and attending physician in the Family Medicine Unit at Ruber International Hospital , results in "a significant number of people exposed to emerging and re-emerging infectious diseases, posing a risk to their health."

In fact, he emphasizes that " infections are the leading cause of morbidity during or upon return from travel and account for up to 2-3% of mortality." However, in many cases, these infections are preventable, so it is important for travelers to understand the risks in order to adopt appropriate preventive measures . In this sense, both infectious disease specialists and vaccination centers, he adds, "play a fundamental role in providing comprehensive care to citizens, focusing on the area visited, the time of year, the duration, type of trip, and each person's unique characteristics."

Among the most common travel illnesses is diarrhea, with an incidence ranging from 10 to 70% and generally caused by the enterotoxigenic Escherichia coli (ETEC) bacteria . "It typically appears in the first week of travel in environments with poor sanitary practices due to contact with contaminated food or water, and is more common in Southeast Asia and during warmer, more humid seasons," explains Dr. Barbolla.

It is defined by the presence of three or more loose or liquid stools in a 24-hour period, for three or more days, and may be accompanied by fever, abdominal pain, nausea and vomiting, tenesmus, and blood or mucus in the stool . As the expert points out, "episodes are almost always benign and self-limiting, but dehydration can be severe."

Fever , for its part, is one of the main reasons for consultation and hospitalization among travelers. It encompasses both minor illnesses and fatal or high-risk illnesses, and usually appears during the trip or two weeks after returning. "The differential diagnosis includes infections ranging from universally distributed to tropical diseases, and the most common causes are arboviruses, that is, diseases caused by viruses transmitted by arthropods (mosquitoes or ticks), with dengue being the most common. Other causes include malaria and rickettsiosis," he notes.

Malaria is a disease caused by parasites of the Plasmodium genus, transmitted by the bite of Anopheles mosquitoes. According to Dr. Barbolla, "any traveler who has been to an endemic area and develops an unexplained fever in the weeks following travel should be urgently evaluated to rule out this condition."

To prevent these conditions, the internal medicine specialist considers pre-travel planning essential. In this regard, he recommends the following:

Consult a doctor four to six weeks before traveling.

Purchase international travel health insurance and bring a basic first-aid kit containing pain relievers, insect repellent, disinfectant, antibiotics, chemoprophylaxis, oral rehydration salts, and personal medication.

Vaccination: Update vaccination schedules (tetanus, diphtheria, measles, influenza, COVID-19, hepatitis B, and polio) and consider destination-specific vaccines, including hepatitis A, cholera, typhoid fever, yellow fever, rabies, meningococcal meningitis, Japanese encephalitis, and tick-borne encephalitis.

Chemoprophylaxis or drug prevention : When indicated by the destination and risk, it is essential to prevent malaria by taking antimalarial medications before, during, and after travel. Furthermore, according to the physician, "emergency antibiotics are generally not recommended to prevent traveler's diarrhea."

On the other hand, Dr. Barbolla emphasizes planning during the trip, highlighting some tips such as:

Take precautions with water and food, thus avoiding diseases such as traveler's diarrhea, hepatitis A, typhoid fever, and cholera, among others. "Contaminated food and beverages are the most common cause of illness in travelers," he maintains. To achieve this, people should follow some basic preventive measures such as personal hygiene, frequently washing their hands with soap and water and using hydroalcoholic gel; not drinking tap water; treating potentially dangerous water by boiling, chlorinating, or using purification tablets; not eating raw or undercooked foods, meats, fish, and shellfish; drinking packaged milk and being careful with sauces; washing fruits and vegetables thoroughly or peeling them; and avoiding eating at unhygienic street stalls.

Avoid contact with animals , bites, contaminated bodily fluids or feces, or consumption of foods of animal origin, especially meat and dairy products.

Do not bathe in stagnant fresh water.

Do not walk barefoot and wear closed shoes

Avoid insect bites . To do this, it is recommended to wear long-sleeved clothing at dusk and dawn; avoid dark colors and strong perfumes, as these can attract mosquitoes; use repellent; sleep under insecticide-treated mosquito nets, especially in rural areas; use mosquito sprays, streamers, and vaporizers containing pyrethrins; and use air conditioning or screens on windows and doors.

Sexually transmitted infections (STIs): According to Dr. Barbolla, these infections have been on the rise in recent years, including hepatitis B, HIV/AIDS, syphilis, monkeypox, and Zika. Therefore, he emphasizes the importance of being careful "not only with sexual practices, but also with utensils, tattoos, and acupuncture."

In short, to minimize the impact of a possible infection during travel, this attending physician from the Internal and Family Medicine Unit at Ruber International Hospital believes it is "essential to carry out adequate pre-planning in advance with a specialist consultation," during which key elements of the traveler's medical history will be evaluated, such as relevant personal history, previous illnesses and vaccinations received, medication the traveler is taking, and pregnancy status.

In addition, the countries and regions to be visited will be analyzed, as well as the risk factors associated with the destination, and information will be provided on current outbreaks in the destination. It is also important to consider both the date of travel and the length of each stay, and the risk exposures of the activities to be undertaken will be discussed. As Dr. Ignacio Barbolla concludes, "preparing the trip with a qualified specialist helps reduce the impact of a potential illness and improve the quality of the trip."