Travelers facing diseases overseas


If you have an international trip ahead this summer, you may have been warned about the usual suspects when it comes to dangerous diseases - malaria, hepatitis, typhoid and yellow fever.

But depending on your destination, there may be ailments on this year's list that you haven't heard about, according to the U.S. Centers for Disease Control and Prevention and the World Health Organization.

For example, health officials this year are warning about measles outbreaks in countries as far-flung as Germany, Venezuela and Kenya, while the dangerous Chikungunya fever has popped up in India and nearby island nations.

"I think the most important thing for travelers is that they realize there are things they should do," said Judy Baker, program manager of the Johns Hopkins University Travel Medicine Consultations and Immunizations Clinic. "People need to find out what the risks are and anything they can do to prevent them."

Baker keeps racks of information sheets about health issues and immunization requirements around the globe - including a grim article of tips about what to do if a traveler dies abroad.

But the walls of the clinic - decorated with ethnic fabrics, African masks and enlarged pictures of deceptively harmless-looking mosquitoes - are designed to encourage travelers, said Baker, who worked for 13 years as a medical officer in Africa and Asia, overseeing volunteers for the Peace Corps and nongovernment organizations.

She urges visitors to get all the shots recommended by the CDC and the WHO for the areas they are visiting. But she often settles for the required shots - many vaccines are expensive and not covered by medical insurance policies.

"For a lot of people, the cost of immunizations becomes an issue, but they can look under [travel Web sites] and plan accordingly," Baker said. "People should plan at least a month in advance."

For example, rabies vaccine is about $190 per shot and, like hepatitis A and B, requires a series of three shots over a period of weeks or months. So experts say travelers must leave enough time to schedule their immunizations.

Carolyn and Rebekah Hiskey of Annapolis are planning to visit Uganda next month. Mother and daughter made the first of several visits to the University of Maryland's Travelers' Clinic last week in preparation for a mission trip with the Bay Area Community Church to a rural village outside of the capital city of Kampala. They will spend two weeks there helping villagers build homes and providing AIDS counseling.

This is the third mission trip for Rebekah, 18, who has already been to the Dominican Republic and Guatemala and has some idea of what to expect in Uganda.

"We have to sleep under mosquito nets and spray on a lot of bug spray," she said. "Also, we're not allowed to drink any of the water."

When the two were called into the consultation room with the clinic director, Dr. Robert Edelman, they found out that using bug repellent was just a small part of staying healthy in Uganda.

"Everything over there is fecally contaminated. You may not see it, but it's there. Any swelling, aching, nausea or gas means that something's going on in there," Edelman said, pointing to his stomach.

He told the Hiskeys to cook their food until it's too hot to touch and to take anti-diarrheal medication from the day they board the plane - although he warned that 15 percent of gastrointestinal problems in Uganda are caused by parasites and viruses resistant to medication.

Both Hiskeys were prescribed vaccines for typhoid and yellow fever, as well as anti-malarial tablets. The elder Hiskey, 43, who had traveled to China and Japan without being vaccinated, was told to get a hepatitis A shot.

"People think that shots are required, and most are not required," Edelman said. "But they are like an insurance policy."

Elsewhere this year, travelers to Germany have been warned about a measles outbreak in the North Rhine-Westphalia region, where many of the World Cup Games were held. Measles outbreaks have also been reported in Venezuela, Australia, Denmark, Kenya and Greece, among other places.

If you are headed to one of those areas, health officials say, check your medical records. Those born after 1957, and who received a single measles-mumps-rubella shot before doctors recommended two doses of the drug in the 1980s, should get a second dose. That's because about 5 percent did not acquire an immunity to measles after receiving the first dose, according to Kip Baggett, a medical epidemiologist for the CDC.

People born before 1957 are assumed to have been exposed to measles and therefore are immune. They are not required to receive the vaccine.

Although authorities declared that homegrown measles were eliminated in the United States in 2000, the New England Journal of Medicine reported that an outbreak in Indiana last year was caused by a 17-year-old unvaccinated girl who had visited a Romanian orphanage and then returned home infected. That outbreak was the largest since 1996.

Measles cause a rash and may result in ear infections, diarrhea and lung infections such as pneumonia. Serious infections may lead to death.

India, meanwhile, has seen an outbreak of Chikungunya since April in the states of Karnataka, Maharashtra and Andhra Pradesh. The disease has also been reported on the islands of Mayotte, Mauritius and the Seychelles in the Indian Ocean.

Chikungunya fever, like malaria, is a mosquito-born viral disease that causes fever, chills, headache, nausea, vomiting and joint pain. According to the WHO, travelers returning with Chikungunya infections have already been reported in France, Germany, Italy, Norway and Switzerland.

Outbreaks of Chikungunya have been mixed with cases of dengue fever, another mosquito-borne illness, in some affected areas.

There are no preventive medicines or vaccines for Chikungunya fever, so health officials recommend that travelers wear long-sleeved shirts and pants outside and use a bug repellent containing DEET. They also recommend staying in well-screened hotels with air conditioning to minimize exposure to mosquitoes.

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