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The Healthy Traveler

Untangling Advice From Web Sites

January 25, 1998|KATHLEEN DOHENY

Travelers bound for exotic locales who want to assess their health risks before departure have a wealth of expert information available.

By consulting health experts and visiting the Web sites of the federal Centers for Disease Control and Prevention (, the World Health Organization (, the Pan American Health Organization ( and others, travelers can pinpoint which health hazards might await them at specific destinations and learn how to reduce the risks through immunizations and other precautions.

Heading to, say, central Africa? The CDC's Web site suggests travelers consider the risks of malaria, yellow fever and typhoid, among many other ailments.

Sometimes, however, the information can be overwhelming, especially for novice travelers. The WHO's Web site, for example, warns visitors to Vietnam and other Southeast Asian destinations of the risk of malaria, plague, Japanese encephalitis, dengue and dengue hemorrhagic fever, cholera, diarrhea, amoebic dysentery, bacillary dysentery, typhoid fever, hepatitis A, hepatitis E, intestinal flukes and several other health hazards.

But travelers who are aware of the inherent shortcomings of Web-based travel health information, and use it with advice from travel medicine experts or their own doctors, can increase their chances of avoiding disease.

Online information is meant to apply to all travelers, regardless of variables such as mode of travel and age, said Dr. John Horton, a Westlake Village physician who specializes in the care of travelers. A 22-year-old backpacker, for instance, would face much different health risks than a senior citizen who stayed in five-star hotels at the same destination. Travelers who dine with natives have different risks than those who eat exclusively at restaurants.

That's true, agreed Roz Dewart, chief of the CDC Travelers' Health Center. On the CDC's travel health site, all available, accurate information about disease risks is included and meant to apply to a broad spectrum of the population. Its format of organizing the world by regions can make the whole process cumbersome, she added. But the agency is in the process of streamlining the information and hopes to complete the process soon. "It will be succinct. People will be able to read it and take it to their physicians."

Sometimes users have to scroll around a bit to find the desired information. On the WHO Web site, for example, begin by scrolling down to the "International Travel and Health" section.

Web sites also warn that differing traveling styles affect the degree of disease risk. According to the WHO Web site, for example: "In practice, to identify areas accurately and define the degree of risk likely in each of them is extremely difficult, if not impossible. For example, viral hepatitis A [often spread by contaminated food or drink] is ubiquitous, but the risk of infection varies not only according to area but also according to eating habits; hence there may be more risk from communal eating in an area of low incidence than from eating in a private home in an area of high incidence."

The information itself is sometimes limited, Dewart added, especially for foreign countries experiencing unrest or epidemics. "We collaborate with the World Health Organization [in gathering disease information from countries overseas]," she said, "but we don't go uninvited into other countries." Complicating the issue, "information is usually gathered during an emergency" such as an outbreak or epidemic, she said.

Relying on the Web sites of foreign tourist boards for medical information is not wise. Other countries have health standards different from those in the U.S., and many tourism board sites do not even address health issues.

Even with its limitations, online information can be invaluable if travelers use it correctly, Horton and Dewart agreed.

Travelers should take the information to their physician or to a physician who specializes in the care of travelers so it can be tailored to their individual needs and medical history, they said.

Veteran travelers should skip the temptation to ignore caveats they have heard repeatedly. A case in point, Horton said, is travelers' diarrhea. Many longtime travelers "tend to get all the needed immunizations and then throw Pepto-Bismol in their bag."

A better approach, Horton said, is to take along the prescription drug Cipro (ciprofloxacin), prescribed for infectious diarrhea, and Immodium, an over-the-counter anti-diarrheal, and to take them when symptoms begin. This method can "stop it in its tracks," reducing the misery from three or four days to just a few hours, Horton said.

The risk of hepatitis A is also often overlooked, Horton said, even though effective vaccines are now available.

Knowing the precautions and putting them into practice are often two different things, as Dewart knows firsthand. Before her sister headed to South America recently, Dewart coached her on the hazards and which immunizations were vital.

Her sister ended up with travelers' diarrhea after ignoring advice about avoiding food from street vendors. She took the antimalarial medication, but not for the length of time recommended.

"I told her, 'Stay away from monkeys,' " Dewart said. (Monkeys can transmit a variety of serious diseases to humans, according to the CDC.)

But when Dewart's sister got back, she reported gleefully that at one point "she had a monkey sitting on her head."

The Healthy Traveler appears the second and fourth week of every month.

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