Travel Health

Topic Overview

How can you stay healthy on your trip?

The best way to stay healthy on your trip is to plan before you go. If you are planning to travel to another country, see a doctor at least six weeks before you leave so you will have time for shots (immunizations) that you may need to get ahead of time.

Also ask your doctor if there are medicines or extra safety steps that you should take. For example, people who have heart failure may need to take shorter flights with more stops to avoid long periods of sitting. Or someone visiting Africa may need to take medicine to prevent malaria.

Where can you get the best information?

You can use the Internet to find general travel health information. Just make sure the information is up to date and from a reliable source. You can also find out if there are any problems with disease outbreaks in the places you will be visiting. Try these Web sites:

• wwwn.cdc.gov/travel/default.aspx. This is the Web site for travel information from the Centers for Disease Control and Prevention (CDC).
• www.who.int/ith/en. This Web site lists information on travel, required immunizations, and disease outbreaks from the World Health Organization (WHO).

If you are taking a cruise, you can find your ship's sanitation inspection scores on this Web site: www.cdc.gov/nceh/vsp.

Find out where you can get the best medical care in the region you are visiting. The U.S. State Department's Web site, www.usembassy.gov, lists every U.S. embassy worldwide and lists some doctors and medical facilities in those countries.

If you are traveling out of the country, take along the phone numbers and addresses of embassies in the areas you will visit. They can help you find a doctor or hospital. Find out if your insurance company will cover you. You may need special travel health insurance.

Which immunizations and medicines will you need?

Check with your doctor, the nearest health clinic, or your regional health department to see what kind of shots you should get. In the United States, most state health clinics can give you travel shots, some medicines, and healthy travel tips. If your state health clinic does not give shots for travelers, ask if there is a clinic nearby that does.

Hepatitis A vaccine is recommended for most people traveling to developing countries. Hepatitis A (or Hep A) is one of the most common diseases found in returning travelers. You can easily prevent hepatitis A by getting the vaccine.

Make sure that all routine shots are up-to-date for you and your children. These shots can protect you from diseases such as polio, diphtheria, measles, whooping cough, and rubella, which are still a problem in some developing countries.

If your doctor has told you that you should have the pneumococcal vaccine (to prevent complications of pneumonia) or a flu shot because of your age or a health condition, it is important that you have those shots before you leave.

The yellow fever vaccine is now required for travelers who plan to visit countries in South America and Africa where the disease is active.

You may need other shots, depending on where you are going, how long you will be there, and what you plan to do while you are there.

If you plan to visit an area where malaria is a risk, ask your doctor to give you a prescription for medicine to prevent malaria.

What precautions should you take while you travel?

Before you go, find out about the places you plan to visit. Is the water safe to drink? Do mosquitoes or other bugs carry disease? Is there air pollution? Will you be at a high altitude that could make you sick? Is it safe to swim in pools, lakes, or the ocean? Could you get heat exhaustion, sun stroke, or a sunburn?

Basic safety can prevent some illnesses:

• Many developing countries do not have safe tap water. When visiting these places, drink only beverages made with boiled water, such as tea and coffee. Canned or bottled carbonated drinks, such as soda, beer, wine, or carbonated water are usually a safe choice. Do not use ice if you don't know what kind of water was used to make it. And do not use tap water to brush your teeth.
• Do not eat raw vegetables, raw fruits (unless you wash them with safe-not tap-water and peel them yourself), or raw or undercooked meat and seafood. Avoid food or drink from street vendors.
• In malaria-infected areas, use DEET insect repellent on exposed skin, and use flying insect spray in the room where you sleep. Wear long pants and long-sleeved shirts, especially from dusk to dawn. Mosquito netting works well to protect yourself from bites while you sleep. Protect against ticks when you visit places where Lyme disease or Rocky Mountain spotted fever is present.
• When the weather is very hot, stay indoors during the hottest time of the day. And use sunscreen when you go outside to prevent sunburn and dangerous heatstroke.
• Air pollution in some large cities can pose a serious threat to those with asthma or other respiratory conditions. Avoid those cities when air quality is poor, or stay indoors as much as possible.
• Practice safe sex. One of the most common ways that travelers get infections is by having sex with an infected person. Using condoms can prevent sexually transmitted infections and diseases.

Getting a disease on your trip is probably what you think about when you hear about travel health. But it is important to know about other ways you can be hurt. Many travelers are hurt in car accidents. If you must drive, learn about local driving customs, such as driving on the left side of the road. Travel during daylight when you can. Always use seat belts. If you use hired drivers (such as in a taxi), don't be afraid to ask your driver to slow down or to drive more carefully.

What if you get sick while you are traveling?

Diarrhea is the most common illness to strike travelers. Travelers' diarrhea is most common in developing countries where food and water are not as safe.

Travelers' diarrhea most often begins quickly with watery diarrhea, vomiting, cramping, and a low fever. Many doctors recommend trying to eat as normally as possible. If you are vomiting, try to drink water or other clear fluids. Watch for signs of dehydration, such as a dry mouth and dark-colored urine. If possible, drink rehydration drinks to replace lost fluids and electrolytes. Most cases of travelers' diarrhea get better in one to three days without treatment. But see a doctor if diarrhea lasts longer than three days. It is also a good idea to see a doctor if you have a high fever, blood or pus in your diarrhea, or signs of dehydration.

If you become seriously ill while traveling, your country's embassy or consulate can help you find medical care. If you become ill with a fever or flu-like illness while traveling in malaria-risk areas, get medical help right away.

Should you see a doctor when you return?

If you were healthy during your trip and you feel well when you return home, you probably do not need to see a doctor.

If you were sick with a fever or severe flu-like illness while traveling, see your doctor when you get home. Also, if you get sick with a fever or severe flu-like illness for up to one year after coming home, see your doctor. Tell your doctor the places you visited and whether you think you may have gotten a disease. Many diseases do not show up right away, and some can take weeks or months to develop. Many travelers who get malaria don't have symptoms until they get home.

Other symptoms to watch for after you come back home include:

• Diarrhea that lasts a long time or that keeps coming back.
• A skin rash or sores on the skin.
• Jaundice. (Do the whites of your eyes look yellow?)
• Losing weight without trying, or feeling tired and worn out.

Frequently Asked Questions

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	Sleep problems: Dealing with jet lag

Before You Go

For general travel health information, details on current disease outbreaks, and the most current shot recommendations for different areas of the world, see:

• The U.S. Centers for Disease Control and Prevention (CDC) Web site at wwwn.cdc.gov/travel/default.aspx.
• The World Health Organization (WHO) Web site at www.who.int/en.

Preparing for a journey takes planning and time. Proper planning is the best way to stay healthy during your trip. See a doctor at least 6 weeks before you go so that you'll have time for immunizations and other health precautions you may need to take in advance. Better yet, talk to your doctor as soon as you know you will be traveling. There are some shots that need to be given more than once, and you may need more than six weeks in some cases. There are several factors to consider in preparing for a trip.

Your individual health needs

If you have any chronic diseases or other health concerns, such as birth control or allergies, see your doctor. You may need to adjust your itinerary to accommodate your health needs. For example, if you have heart failure or a history of blood clots, you may need to take shorter flights with more stops to avoid long periods of sitting. If you have asthma, chronic obstructive pulmonary disease (COPD), or other lung diseases, you may need to avoid stays in polluted cities or at high altitudes.

Evaluate whether you will be physically able to meet the rigors of your particular trip. Most travel, even if you are going on a professionally led tour, typically demands more physical effort than is required at home. Boost your fitness by starting an exercise program, such as fitness walking, in advance.

If you have health problems, carry a letter from your doctor describing your conditions, a list of your routine medications including their generic names, and written prescriptions for refills if you will be gone long. People with heart conditions should travel with a copy of their most recent electrocardiogram (EKG, ECG) for comparison should they have chest pain or other symptoms. If you have diabetes, you can take precautions to prevent problems while traveling.

Leave your prescription medications in the original containers-your name must match the name on the bottle-and pack them in a waterproof container in your carry-on luggage. Take extra amounts of your routine medications packed in checked luggage in case of theft or loss.

If you are pregnant, talk to your doctor before making any travel decisions. If you decide to travel, take some general precautions while traveling, such as notifying the airline of your condition before you fly and taking occasional walks while on a long flight to increase the blood circulation in your legs (good advice for all travelers).

Many doctors recommend that you take a first aid kit with items such as pain relievers, sunscreen, insect repellent, moleskin, antifungal and antibacterial ointments, and antidiarrheal medications, especially if you will be traveling to areas where modern medical care is not readily available.

Potential health risks

Preparing for health risks is especially important if you are visiting developing countries, such as those in most parts of Africa and Asia and many parts of South and Central America, where expert medical care may not be readily available.

Before you go, you should be aware of any needed immunizations or medications, disease outbreaks, food and water precautions, and any other preventive measures to take. Check your local or state health clinic at least 6 weeks before traveling so that you'll have time for immunizations and other health precautions that may need to be done in advance. Better yet, talk to your doctor as soon as you know you will be traveling. There are some shots that need to be given more than once, and you may need more than six weeks in some cases. Most of these clinics can give immunizations and prescriptions for antimalarial drugs. If not, ask to be referred to a clinic that specializes in travel health.

Make sure all of your routine immunizations are up to date for you and your children. These immunizations can protect you from diseases such as polio, diphtheria, measles, whooping cough, and rubella that have been virtually wiped out in developed nations but are still prevalent in some developing countries. If you will be traveling to a country where these infections are still common, check your immunity status. Some adults have not received all of these vaccines (especially measles, mumps, and rubella) and may be susceptible unless they have had the disease. Your tetanus immunization should be updated before traveling if you haven't received one in the last 10 years.

For more information, see the topic Immunizations or the recommended immunization schedules.

Hepatitis A vaccine is recommended for most travelers to developing countries where the disease is prevalent. It is the most widely reported disease in return travelers that can be prevented by a vaccine.¹ You can help protect yourself from hepatitis A while traveling by taking basic precautions such as boiling your drinking water, making sure food is well-cooked, and eating only raw fruits that you have washed and peeled. The hepatitis A vaccine is two shots. The second shot is given six months after the first shot. If you know you will be traveling more than six months before you leave, getting both shots is best. But if you don't have six months before you leave, it is still important to get the first shot. The first hepatitis A shot usually works in about six weeks and protects most people from getting hepatitis A. If you only had the first hepatitis A shot before you left the country, make sure you still have the second one when you get home (within three years of the first shot).

The yellow fever (What is a PDF document?) vaccine is currently required for travelers who plan to visit countries in South America and Africa where the disease is active.

Additional immunizations may be needed depending on the area you are visiting, how long you will be there, and the purpose of your journey. For example, if you will be trekking in rural Asia for more than 3 months during the summer or fall months, you may need the vaccine for Japanese encephalitis.

Ask about a prescription for antimalarial drugs if you will be visiting an area that has malaria. Malaria-risk areas of the world include large areas of Central and South America, Haiti and the Dominican Republic, Africa, the Indian subcontinent, East Asia, Southeast Asia, the Middle East, and many South Pacific islands. You may need to take one of several different preventive medications depending upon the type of mosquito inhabiting that part of the world. These medications need to be taken daily during your travels and for a specified time after you return. It is important to take all the tablets you were given. This may mean taking antimalarial tablets for several weeks after you get home.

A new vaccine for traveler's diarrhea and cholera, called Dukoral, has been approved in Canada and Europe. But it is not available in the United States.

Sanitation inspection scores for cruise ships are reported on the CDC Web site at www.cdc.gov/nceh/vsp.

Medical care in developing countries can be below standard. Before you go, get the addresses and phone numbers of embassies and consulates in the areas you will be visiting. If you get sick, these offices can help you find medical care. For a complete list of embassies and consulates, see the U.S. Department of State Web site at www.usembassy.gov. You can also obtain lists of local doctors and medical clinics.

If you have health insurance and you are traveling to another country, you may want to find out how your insurance works outside of the United States. If your insurance company does not cover you abroad, you may want to think about buying travel health insurance.

Precautions Along the Way

Traveling comes with a whole new set of things to think about. The following can help you stay healthy and enjoy your trip as much as possible.

Tips for flying

Flying is not always fun. But you can take steps to make it easier and to feel better during and after your flight.

• Pack anything that may cause problems at security-such as gels, liquids, sharp scissors, or pocket knives-in the luggage you plan to check. Leave lighters and matches at home. For an updated list of what is not allowed in carry-on luggage, see the Transportation Security Administration Web site at www.tsa.gov/travelers/airtravel/prohibited/permitted-prohibited-items.shtm.
• Wear roomy, comfortable shoes that slip on and off. These are easy to remove when you go through security at the airport. They will also be more comfortable if your feet swell on the plane.
• Get up and walk around each hour during your flight. Long airplane flights make deep vein thrombosis more likely. Many doctors recommend that you wear compression stockings during a journey longer than 8 hours. When on long flights, you should also flex and point your feet every 20 minutes while you are sitting, drink a large glass of water every 2 hours, and avoid alcohol and drinks with caffeine.
• Take steps to prevent jet lag, such as drinking plenty of liquids and changing your sleep schedule to the new time zone.

  Dealing with jet lag

If you have a fear of flying, talk to your doctor. He or she may recommend medicines, hypnosis, or breathing, visualization, and relaxation exercises to help you feel less afraid.

Water and food safety

Contaminated water and food are the most common cause of illness in travelers. These illnesses range from an inconvenient case of travelers' diarrhea and the norovirus (Norwalk virus) seen on cruise ships to severe cholera.

Since it's difficult to know if tap water is properly treated, most doctors recommend avoiding tap water if there is any doubt. Safe beverages include drinks made with boiled water, such as tea and coffee. Otherwise, drink only canned or bottled carbonated beverages (including carbonated bottled water and soft drinks) and beer and wine. Ice should also be considered contaminated and should not be used in beverages. Dry the opening of wet cans or bottles before taking a drink. Remember not to brush your teeth with tap water.

Travelers to backcountry areas of North America should also take precautions with water. Even though the water in high mountain lakes looks sparkling clear, it may be contaminated with Giardia intestinalis, the parasite that causes giardiasis. Take simple precautions to avoid this illness, such as boiling the water.

Likewise, swimming in contaminated fresh water, such as ponds or rivers, can expose you to a variety of diseases. Even swimming pools with inadequate chlorination pose a risk. Talk to your doctor if you plan on doing recreational water sports-such as white-water rafting, adventure racing, or kayaking-in tropical and backcountry regions.

Take precautions with food by avoiding raw fruits (unless you wash and peel them yourself), raw vegetables, and raw or undercooked meat and seafood. Steaming hot, well-cooked food is usually the safest. Although tempting, don't eat food or drink from street vendors. Make sure dairy products have been pasteurized.

For more information, see the topic Food Poisoning and Safe Food Handling.

To prevent fungal or parasitic infections and injuries, do not go barefoot. Try to keep your feet as clean and dry as possible.

Although sea water is usually safe from disease, swimming or diving in sea water can still be dangerous. Avoid swimming or wading in sea water near a river, estuary, or other outlet from inland. In developing countries, sea water around big cities and other populated areas may not be safe. For more information, see the topic Marine Stings and Scrapes.

Insect-borne disease

Mosquitoes, flies, fleas, and ticks all spread disease, including malaria, Japanese encephalitis, Lyme disease, West Nile fever, South African tick-bite fever, yellow fever, and dengue fever.

Malaria is the insect-borne disease of most concern to travelers in tropical and subtropical regions. Although antimalarial medications kill the malaria parasite in the bloodstream, this protection is not complete and mosquito bites should be avoided. To ward off mosquitoes, travelers should take protective measures along with the antimalarial medication. Here are some tips:

• Use DEET or other insect repellents on your skin.
• Use flying insect spray in the room where you sleep.
• Wear light-colored and loose-fitting long pants and long-sleeved shirts, especially from dusk to dawn, when mosquitoes that spread malaria bite. Insect repellent applied to clothing is effective for longer than it may be on the skin.
• Permethrin or deltamethrin insecticide sprayed on bed nets will protect against mosquitoes for weeks to months.
• Mosquito coils can also help keep mosquitoes away.
• Home remedies like eating garlic, rubbing garlic on your skin, or taking vitamin B do not prevent bites.

Ticks inhabit many regions, including Europe, Canada, and the United States, and carry many diseases, including Lyme disease, Rocky Mountain spotted fever, tularemia, ehrlichiosis, relapsing fever, Colorado tick fever, South African tick-bite fever, and babesiosis. Although it is rare for travelers to contract diseases from ticks, many of these diseases are serious. For information on how to prevent tick bites, see the Prevention section of the topic Tick Bites.

Sun and heat exposure

Many travelers underestimate the sun's strength and overestimate the amount of protection their sunscreens offer. This can add up to at least an uncomfortable sunburn and, at worst, life-threatening heatstroke.

To avoid these complications:

• Stay out of the sun during the middle of the day, when ultraviolet light (UV) is greatest. In most areas, this is between 10 a.m. and 4 p.m.
• Apply sunscreen blocks for both UVA and UVB rays with a sun protection factor (SPF) of at least 15. Use liberally on areas of the body not protected by clothing and reapply frequently, especially during midday and when you're swimming or sweating. For more information, see the topic Sunburn.
• Wear UV-protective sunglasses.
• Wear a broad-brimmed hat, long pants, and loose-fitting, long-sleeved shirts.
• Watch for signs of dehydration, most importantly little and/or dark-colored urine.
• Limit exertion and drink plenty of fluids. If possible, use rehydration drinks to replace lost fluids and electrolytes.

Accidents

Although disease presents a big risk while traveling, you should also be aware of potential sources of injury. Shoddy roads, poor driver training, and crowded roadways often make driving in other countries an unwanted adventure. Motor vehicle accidents are a leading cause of injury among travelers. Be familiar with local driving customs, road signs, and how to navigate unfamiliar traffic patterns, including driving on the left side of the road and using roundabouts or traffic circles. If possible, travel during daylight, and always use seat belts. If you are hiring a driver (such as in a taxi), don't hesitate to ask the driver to slow down or drive more carefully if you feel unsafe. When riding motorcycles or bicycles, wear helmets and protective clothing.

Take care around dogs and other animals. Dogs in developing countries are often not tame and may bite. Rabies is more common in tropical and subtropical regions. If bitten by an animal, wash the bite with soap and water and seek medical attention immediately.

Most wounds sustained in developing countries carry a higher risk of becoming infected. If you get even a minor wound, clean the wound as soon as possible with large amounts of warm water and soap. Apply antibiotic ointment and a bandage. But it is good to know that in some people, antibiotic ointments (such as Neosporin) can cause an allergic reaction that looks just like a wound infection that is getting worse.

If you haven't had a tetanus shot in 5 years, a booster dose is recommended following an animal bite or an injury that results in a break in the skin.

Altitude

Altitude sickness poses a threat to anyone traveling over 1,500 meters, or about 5,000 feet. Initial symptoms may feel like a hangover, with a headache, fatigue, loss of appetite, nausea, and vomiting. If symptoms become worse or include confusion, an unsteady gait (ataxia), or faintness, a traveler must go to a low altitude as fast as possible to avoid death. To avoid getting altitude sickness:

• Do not fly directly from low altitudes to high altitudes. Try to schedule at least a 1-day stopover at an in-between altitude. Examples of high-altitude cities are Cuzco, Peru; La Paz, Bolivia; and Lhasa, Tibet. After arrival, avoid overexertion, large meals, and alcohol.
• When trekking, climb gradually to high altitudes, allowing for periods of adaptation.
• If you have heart or lung disease or anemia, ask your doctor's advice before deciding to travel to a high altitude.
• Medicines such as acetazolamide (AK-Zol, Diamox) or dexamethasone may be prescribed by your doctor along with instructions on how to use them.
• Eat a lot of carbohydrate. This includes breads, cereals, grains, and pasta.

For more information, see the topic Altitude Sickness.

Scuba diving safety

Safety is an important part of scuba diving. You will learn all about safety in your scuba diving certification class. If you plan to get certified while traveling, find an experienced, certified teacher that you feel comfortable with. Several organizations, including the Professional Association of Diving Instructors (PADI) and the National Association of Underwater Instructors (NAUI), certify instructors and dive shops all over the world.

There are many important safety precautions for divers. If you are a new diver, it is best to go with an experienced guide, also called a dive master. Most accidents and problems occur when divers ignore the rules and push their limits. Some general diving rules include:

• Only dive if you feel comfortable.
• Use equipment that you are familiar with and that is in good repair.
• Know what to do if something goes wrong.
• Always dive with a buddy.
• Go down and come up slowly. Do not hold your breath.
• Know and follow recommended depths and time limits.
• Allow enough time between your last dive and your flight home.

Motion sickness

People can feel sick from the motion of cars, planes, trains, boats, or ships. Once you start to feel sick, it can be hard to feel better until the motion has stopped. If you know you get motion sickness, pack medicines to prevent it. There are both prescription and over-the-counter medicines for motion sickness. For more information, see the topic Motion Sickness.

What To Do if You Get Ill

If you become seriously ill while traveling, your country's embassy or consulate can help you find medical care. For a complete list of embassies and consulates, see the U.S. Department of State Web site at www.usembassy.gov. You can also obtain the contacts for local doctors and medical clinics. If you become ill with a fever or flu-like illness while traveling, seek medical attention immediately.

Travelers' diarrhea is the most common illness when traveling. It typically begins abruptly with watery stools, vomiting, cramping, and a low fever. Most doctors recommend trying to keep to your normal diet as much as possible. If you are vomiting, this may be hard. Try drinking clear liquids. Watch for signs of dehydration, such as a dry mouth and dark-colored urine. If possible, drink rehydration drinks to replace lost fluids and electrolytes. Before you go, buy dry packets of oral rehydration mix at a drugstore.

The over-the-counter remedy bismuth subsalicylate (such as Pepto-Bismol, Bismatrol, or Bismed) can sometimes prevent traveler's diarrhea.² For diarrhea, take 1 fluid ounce or two tablets every 30 minutes for up to 8 doses in a 24-hour period, which can be repeated.

Products such as Pepto-Bismol have several side effects, including causing your tongue and stools to turn black. These products should not be taken by people who should not take aspirin, such as people who have gout or those younger than age 20 who are recovering from chicken pox or another illness with flu-like symptoms. Read the label directions carefully before taking. If diarrhea persists for more than 48 hours, travelers should be evaluated by a doctor.

Antidiarrheal medications, such as Imodium A-D (nonprescription) and Lomotil (prescription), offer relief from cramping and frequent stools. But you should not take them if you have a fever or blood or pus in your stools. Be aware that they can cause a serious complication called toxic megacolon, in which the colon swells to many times its normal size.

Most cases of travelers' diarrhea resolve within 1 to 3 days without medical treatment. See a doctor if diarrhea doesn't subside or you have a high fever, blood or pus in your stools, or signs of dehydration. Watch closely for signs of dehydration in children, because with diarrhea they can quickly become seriously dehydrated.

If you are traveling to an area where modern medical care is not readily available, your doctor may give you antibiotics to take in case of diarrhea. Azithromycin (Zithromax), ciprofloxacin (Cipro), ofloxacin (Floxin), or rifaximin (Xifaxan) can be taken at the onset of diarrhea to reduce the number of days you have it. But some bacteria that cause diarrhea have developed resistance to some of these antibiotics and others, including trimethoprim-sulfamethoxazole and doxycycline. This may limit how well these antibiotics work.

Because antibiotics can increase a traveler's susceptibility to resistant bacteria and they provide no protection against either viruses or parasites, they should not be taken to prevent traveler's diarrhea. Antibiotics should only be taken if you have symptoms.

For more information, see the topics Traveler's Diarrhea, Food Poisoning and Safe Food Handling, Giardiasis, Diarrhea, Age 11 and Younger, and Diarrhea, Age 12 and Older.

Post-Travel Care

Most travelers return home in good health with a few souvenirs and lasting memories. But if you've been ill, especially while traveling to regions where disease is prevalent, or if you develop symptoms after you return, you may have brought more than just handicrafts home with you.

Many diseases do not show up immediately. Some take weeks to months to develop. For example, 90% of travelers who get malaria do not become ill until after they return home.³ If you become ill with a fever or flu-like illness while traveling or up to 1 year after returning home, see your doctor. Tell your doctor the regions you visited and about any exposure to disease.

In addition to a fever, the returned traveler should be aware of other symptoms. You should see your doctor if you have persistent or intermittent diarrhea, a skin rash or sores, jaundice (typically most noticeable when the whites of the eyes appear yellow), unexplained weight loss, shortness of breath, or fatigue.

If you have been healthy during your trip and feel well when you return home, you probably don't need to see a doctor.

Other Places To Get Help

Organizations

Related Information

• Diarrhea, Age 11 and Younger
• Diarrhea, Age 12 and Older
• Food Poisoning and Safe Food Handling
• Hepatitis A
• Immunizations
• Malaria
• Sunburn
• Tick Bites

References

Citations

1. Spira AM (2003). Preparing the traveller. Lancet, 361(9366): 1368-1381.

2. Keystone JS, Kozarsky PE (2005). Health advice for international travel. In DL Kasper et al., eds., Harrison's Principles of Internal Medicine, 14th ed., vol. 1, pp. 725-731. New York: McGraw-Hill.

3. Spira AM (2003). Assessment of travellers who return home ill. Lancet, 361(9367): 1459-1469.

Other Works Consulted

• Centers for Disease Control and Prevention (2002). Yellow fever vaccine: Recommendations of the Advisory Committee on Immunization Practices (ACIP), 2002. MMWR, 51(RR-17): 1-11.

• Centers for Disease Control and Prevention (2005). Yellow Book: Health Information for International Travel, 2005-2006. Available online: http://www2.ncid.cdc.gov/travel/yb/utils/ybBrowseO.asp.

• Weller PF (2005). Health advice for international travelers. In DC Dale, DD Federman, eds., ACP Medicine, Clinical Essentials, chap. 7. New York: WebMD.

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