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Family Health Magazine - PREVENTION

Travel to the Sun
Health tips for visiting Mexico, the Caribbean and Arizona

You’ve booked your dream vacation and look forward to sun, sand and fun. But have you thought about the health risks? Even at a fancy resort, you can get sick or injured. Tourists seeking adventure in remote areas face even more hazards. The key is to visit a travel health specialist before your trip to get the vaccines, medicines and advice you need to stay healthy. Travel health specialists are trained to help travellers who may encounter exotic illnesses. Most Canadian cities have clinics offering these services.

If possible, book a travel health appointment six to eight weeks before your trip, earlier for ‘complicated’ trips. Even if your trip is last minute, a visit will enable you to get whatever vaccinations and advice you can; better some than none at all. Here are health risks and prevention advice for three destinations popular with Canadians.

Destination #1: Mexico
Land of salsa, sombreros, and so much more. Over 735,000 Canadians visited Mexico in 2001.

Food and water

DESPITE STRONG EFFORTS BY THE TOURISM INDUSTRY IN DEVELOPING COUNTRIES, MICRO-ORGANISMS IN FOOD AND WATER REMAIN THE NUMBER ONE CAUSE OF DISEASE IN TRAVELLERS. WITH A LITTLE CAUTION, TRAVELLERS CAN AVOID EATING UNSAFE FOODS. HOWEVER, TEMPTING SMELLS FROM STREET VENDORS CAN LURE EVEN THE MOST HYGIENE-CONSCIOUS TOURIST. MOST MICRO-ORGANISMS CAUSE MINOR ILLNESS SUCH AS TRAVELLERS’ DIARRHEA. SOME, LIKE HEPATITIS A, CAN CAUSE SERIOUS, EVEN LIFE-THREATENING DISEASE. CONTRARY TO POPULAR BELIEF, IT IS FOOD, NOT WATER, THAT IS USUALLY THE CULPRIT. THE REASON? MOST TRAVELLERS CAN CONTROL WHAT THEY DRINK, BUT NOT HOW LOCAL COOKS PREPARE AND HANDLE FOOD. TAKE, FOR EXAMPLE, A MEXICAN COOK WHO LIVES IN A SIMPLE HUT WITHOUT PLUMBING. HE COMES TO WORK AT THE HOTEL RESTAURANT AND WITH UNWASHED HANDS PREPARES SOME DELICIOUS DISH. JUST BEFORE SERVING, TO TEST THE TEMPERATURE, HE STICKS A FINGER IN. AS A FINISHING TOUCH, THE COOK ADDS UNCOOKED SALSA AND UNWASHED LETTUCE. THE UNLUCKY TOURIST WHO EATS THIS OFFERING MAY GET MORE THAN A TASTY MEAL.

There are ways to avoid food and water-borne bugs:

• Wash, wash, wash your hands. For occasions when clean water is not available, carry a 70 per cent alcohol hand cleanser.
• Get vaccinated! A safe and effective vaccine can protect you against hepatitis A. Health Canada recommends hepatitis A vaccine for all travellers to Mexico.
• The simple rule ‘cook it, peel it, or leave it’ sums up the travellers’ best approach to food. Eat only steaming hot, freshly cooked foods, and wash and peel all fruits and vegetables. Don’t add spices or sauces.
• Drink only commercially bottled beverages or steaming hot drinks. Be sure all water is boiled, chemically disinfected, filtered or bottled.
• Boiling water: According to Health Canada, bringing water to a full rolling boil is sufficient to disinfect it at any altitude.
• Filtering: Choose a filter with a pore size of one micron or less. To remove viruses, the filter must also have a chemical agent (iodine). Carbon filters absorb bad odours, but do not kill micro-organisms.
• Chemical disinfection: Agents include iodine, chlorine bleach or chlorine dioxide. Follow product instructions for adding to water.
• Bottled water: A bottle does not guarantee safety. Choose a well-known brand and always break the seal yourself to be sure that it wasn’t filled under a kitchen tap.
• Order drinks without ice cubes and brush your teeth with safe water.
• Don’t eat from street vendors.
• Avoid smoked, raw or marinated fish dishes like ‘ceviche,’ unpasteurized milk products, buffets, ice cream and anything made with custard, cream or mayonnaise.
• Don’t worry, you won’t starve - every country has plenty of safe food.

Medications

PACK IMODIUMTM TO COMBAT MILD DIARRHEA. ANTIBIOTICS MAY BE NECESSARY FOR SEVERE SYMPTOMS.

Mosquito bites

EXOTIC ILLNESSES LIKE MALARIA AND DENGUE FEVER RESULT FROM MOSQUITO BITES. NIGHT-BITING MOSQUITOES CARRY MALARIA IN SOME RURAL AREAS OF MEXICO, INCLUDING RURAL RESORT AREAS. SYMPTOMS INCLUDE HIGH FEVER, CHILLS, SEVERE FATIGUE, ABDOMINAL PAINS AND HEADACHE. MALARIA CAN BE FATAL AND HEALTH CANADA RECOMMENDS PREVENTIVE MEDICATION. DENGUE FEVER-SPREADING MOSQUITOES PREFER URBAN, SHADY AREAS AND ATTACK MOST OFTEN DURING THE COOL OF THE DAY. NOT USUALLY FATAL, DENGUE SYMPTOMS INCLUDE FEVER, SEVERE HEAD AND MUSCLE ACHE, PAIN BEHIND THE EYES, AND RASH. NO VACCINES EXIST TO PROTECT AGAINST THESE DISEASES.

Here are some tips for preventing mosquito bites and illness.

• Wear insect repellent. Adults need a 25 to 30 per cent DEET repellent. On children age six months to 12 years, use 10 per cent DEET or less. Always apply DEET sparingly and avoid children’s hands and faces. Never use DEET on infants under six months of age. Note: it is a myth that the higher the percentage of DEET, the better protection obtained. The percentage of DEET in a product simply tells you how long it provides effective protection. Products with more than 30 per cent DEET and repellent and sunscreen combinations will not be available in Canada after August 2004. Citronella and lavender oil repellent products are not recommended. These are not advised for children under age two and provide protection for only 30 to 60 minutes. DEET is the only product that gives adequate protection.
• Dress in light-colored, loose fitting clothes that cover the skin. Some insects will crawl under clothing. Use tape or elastic bands to keep sleeves closed, and tuck pant legs into socks.
• Avoid scented products, such as perfumed sunscreens or hair sprays; mosquitoes love them!
• Sleep in air-conditioned rooms or under permethrin-treated mosquito netting. Place netting over carriages and strollers when taking children outdoors.
• Stay in air-conditioned or well-screened areas as much as possible
• Take malaria medication if staying overnight in risk areas.

Rabies

MANY DEVELOPING COUNTRIES REPORT HIGH RATES OF RABIES. FATAL WITHOUT PROPER TREATMENT, RABIES IS PASSED THROUGH CONTACT WITH THE SALIVA OF AN INFECTED ANIMAL. IN MANY COUNTRIES, GETTING TREATMENT CAN PROVE DIFFICULT. PREVENTION INCLUDES AVOIDING ALL ANIMALS, EVEN THE MONKEY SOMEONE OFFERS TO PUT ON YOUR SHOULDER FOR A SOUVENIR PHOTO, OR THAT CUTE LITTLE STREET DOG. ALWAYS SEEK IMMEDIATE MEDICAL ATTENTION FOR ANY BITE, SCRATCH OR LICK (ESPECIALLY ON BROKEN SKIN) AND HAVE THE WOUND RE-EXAMINED AFTER RETURNING TO CANADA. LONG-TERM OR HIGH-RISK TRAVELLERS (CAVE EXPLORERS, ANIMAL HANDLERS) SHOULD CONSIDER HAVING RABIES VACCINATION BEFORE LEAVING CANADA.

Destination #2: Caribbean Islands

The blue water and friendly islanders attracted over one million Canadians in 2001. This destination poses many of the same health challenges as Mexico, with a few differences.

Malaria

EXCEPT FOR HAITI AND RURAL AREAS OF THE DOMINICAN REPUBLIC, THE CARIBBEAN IS MALARIA-FREE.

Yellow fever

MOSQUITOES IN RURAL AREAS OF TRINIDAD HAVE BEEN KNOWN TO CARRY THIS FATAL DISEASE. A SAFE AND EFFECTIVE VACCINE IS AVAILABLE TO PROTECT AGAINST YELLOW FEVER. THE CENTERS FOR DISEASE CONTROL AND PREVENTION RECOMMEND VACCINATION FOR ALL TRAVELLERS WHO GO OUTSIDE URBAN AREAS IN TRINIDAD AND TOBAGO.

Schistosomiasis

When humans infected with schistosomiasis pass urine in fresh water, these parasites enter the water where they invade and multiply in snails. The snails then pass the parasites back into the water where they look for a new host. Anyone swimming, bathing or wading in infected fresh water is at risk. Travellers should plan to swim only in salt water and properly chlorinated pools. Symptoms vary depending on what body organs the parasites lodge in. Medication can treat the disease but not prevent it. (Note: there is no schistosomiasis in Anguilla, the Caymans, Saint Kitts-Nevis, Saint Vincent and the Grenadines, Trinidad and Tobago, Turks and Caicos, and the U. S. Virgin Islands.)

Ciguatera

A TYPE OF FISH POISONING, CIGUATERA RESULTS FROM EATING AFFECTED FISH. IT IS FOUND ACROSS THE CARIBBEAN. OVER TIME, FISH BECOME INFECTED FROM INGESTING A TOXIN PRODUCED BY TROPICAL WATER PLANTS. NO TESTS CAN DETECT THE TOXIN, AND IT IS NOT DESTROYED BY COOKING OR FREEZING. COMMON SYMPTOMS OF CIGUATERA INCLUDE ABDOMINAL PAIN, VOMITING, DIARRHEA, REVERSAL OF THE SENSATION OF HOT AND COLD TEMPERATURES, NUMBNESS AND TINGLING AROUND THE MOUTH AND LIMBS, SLOWED HEART RATE, SEVERE ITCHING, AND MUSCLE PAIN. SYMPTOMS LAST FROM TWO WEEKS TO SEVERAL YEARS. THERE IS NO SPECIFIC TREATMENT.

There are ways to reduce the risk of ciguatera.

• Avoid eating predatory reef fish like grouper, snapper, jack, king and barracuda.
• Eat fish that measure smaller than your forearm. The bigger the fish, the more toxin may be in its tissue.
• Eat only in restaurants with a good reputation.

Destination #3: Arizona

Canadian snowbirds flock to Arizona to escape winter health problems. Even this “safe” destination has some risks. Never leave Canada without purchasing travel insurance, even for trips to the U.S. Seniors can also purchase insurance and it is worth the extra cost. Anyone over age 65 or who suffers from chronic health problems should also be sure their flu and pneumonia shots are up-to-date.

Coccidioidomycosis

ALSO KNOWN AS DESERT FEVER OR POSADA’S FEVER, THIS ILLNESS AFFECTS BETWEEN 25,000 TO 100,000 AMERICANS EACH YEAR. THE DISEASE IS CAUSED BY A FUNGUS THAT LIVES IN DESERT SOIL - MOSTLY IN SOUTHERN CALIFORNIA, ARIZONA, NEVADA, NEW MEXICO AND WEST TEXAS. IN 2001, ONE CASE OCCURRED IN AN EDMONTON TRAVELLER TO ARIZONA. WHEN WINDS STIR UP DRY SOIL, PEOPLE BREATHE IN THE FUNGUS. IN MOST PEOPLE IT CAUSES A MILD PNEUMONIA, BUT SOME DEVELOP SERIOUS, EVEN FATAL, DISEASE. PREVENTION INCLUDES DUST CONTROL MEASURES AND STAYING INDOORS ON WINDY DAYS.

Motor Vehicle Collisions

One final bit of advice for all countries you visit - know the rules of the road. Worldwide, traffic collisions cause the most injuries and deaths in travellers. Before you drive, spend time learning about driver etiquette in your host country. It could save your life. In many countries drivers never stop to help at a traffic accident, whether or not they were the cause. A mob at the scene might kill them. Instead, go to the nearest police station and give a report. You might not agree with the logic, but these are the rules. If using public transportation, stick to well-known taxi or bus companies. Also travel during the day - thieves lie in wait for night traffic.

Cruises

A cruise to Mexico or the Caribbean is a popular choice for many tourists. While staying on the ship may be just like travelling in Canada, remember that once you step on shore you must take all the precautions for that destination. Flu shots are also recommended for cruise ship passengers, especially those over 65 or with chronic health conditions that might lead to complications. Among others, these conditions include well-controlled asthma, heart and lung conditions and diabetes.

On your next trip, travel wisely. Talk to a travel health specialist about your destination. Then relax and have a great time!

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While effort is made to reflect accepted medical knowledge and practice, articles in Family Health Online should not be relied upon for the treatment or management of any specified medical problem or concern and Family Health accepts no liability for reliance on the articles. For proper diagnosis and care, you should always consult your family physician promptly. © Copyright 2019, Family Health Magazine, a special publication of the Edmonton Journal, a division of Postmedia Network Inc., 10006 - 101 Street, Edmonton, AB T5J 0S1    [CH_FHd02]