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With vacation time here, this sixth article regarding warm weather hazards deals with preventing travel associated diseases and avoiding the pitfalls of traveling with children.
As in any other area of endeavor, preparation will pay off with a safe, healthy and enjoyable trip. When traveling with your child(ren) bring along some favorite games, books or toys to keep your child occupied during the journey. Pack some favorite snacks and drinks, as well. If your child is not toilet trained, bring disposable diapers, wipes and other toiletries. If your child has a favorite blanket or stuffed animal, make sure you bring it in your CARRY-ON luggage and have a back-up.
Sedating your child for travel may have some risks and is generally not recommended. Ask your doctor if you have any questions about medication for travel.
Cash always seems to disappear on vacation, especially if you are using foreign currency. Have your bank issue you an internationally accessible ATM card. ATM terminals are commonly available in foreign urban centers. They will dispense cash in local currency while deducting it from your account in U.S currency at a favorable exchange rate. Also, carry your health insurance card and identification, preferably a photograph driver’s license, in addition to your passport. Make a photocopy of each person’s passport and keep it separate from the original.
Prevention of travel associated medical problems falls into two broad categories, safe behaviors and immunizations. Safe behaviors, especially with children, demand childproofing every environment you encounter and always assuming your child will find the most ingenious way to get into trouble. If you take this approach, you are more likely to anticipate things your child can do and to be prepared for contingencies. Often, when families are on vacation, they sacrifice safety for convenience. How many of us use a seat belt when riding in a taxi cab? Or remember to bring our infant’s car seat along on a vacation that requires an airplane trip? We know we should maintain the same level of vigilance on vacation that we do at home, but being on vacation makes us want to relax and forget our responsibilities. The following is a list of precautions to take while on vacations. Of course, some will be more relevant than others depending on the age of your child(ren) and on where you travel. Consider each point carefully and remember to use sunscreen, wear a bike helmet and use your seat belts!
If you plan to rent a car, find out from the rental agency whether the agency supplies age-appropriate auto restraints for your child(ren). If in doubt bring your own. If you plan to bicycle, use the same approach for helmets.
Check with your insurance company to be sure your medical coverage extends to your foreign destination. If it does not, consider short term trip health insurance. Check ahead (hotels, airports) regarding facilities available for any disabled members of your travel party.
Avoid swimming in fresh water that may harbor parasites, especially in tropical climates. If in doubt, stick to swimming pools with chlorinated water.
Make sure children wear closed shoes (not sandals) when they are outdoors. Do not allow your child(ren) to play in dirt where toileting facilities are generally not available. Insist on careful handwashing before and after preparing foods, coming in from outdoors and after toileting or changing diapers.
If you travel to an area where insect borne-diseases are prevalent, exposure can be minimized by modifying patterns of activity or behavior. Avoid outdoor activity during times when mosquitoes are most active (dawn and dusk). Avoid perfumes and brightly colored clothing as these may attract mosquitoes. Wear long sleeved shirts, long pants and a hat to reduce skin surface available for bites. Shirts should be tucked in and repellent applied to clothing, tents, mosquito netting and other gear. When accommodations are not adequately screened or air conditioned, bed-nets are essential to provide protection. Bed-nets should be tucked in under the mattress and sprayed with repellent (permethrin works best). Especially in rural areas, use insect repellents containing a 10% solution of N,N-diethyltoluamide, or DEET sparingly on the skin. Wash it off when returning indoors. Do not apply DEET repellents to broken skin or to portions of children’s hands that are likely to contact their eyes or mouth. Minimize use of these products in pregnancy (or consider rearranging your trip).
When you get to your lodging, do a quick but thorough inspection for safety hazards. Childproof the area when possible--barricade glass doors with chairs, make sure balcony doors are locked, etc. Never leave young children unattended.
In areas where chlorinated tap water is not available or where hygiene and sanitation are poor, drink only beverages made with boiled water (tea, coffee, soup) or canned/bottled carbonated beverages. Ice should be avoided. Avoid brushing your child(ren)’s teeth with contaminated tap water.
All raw food is subject to contamination. In areas where hygiene and sanitation are inadequate, avoid salads, uncooked vegetables, unpasteurized milk and milk products, and eat only foods that have been cooked and are still hot or fruit that you have peeled yourself. Undercooked and raw meat, fish or shellfish may carry parasites and viruses. Cooked food that has been allowed to stand for several hours at room temperature may allow bacterial growth and should be thoroughly reheated before eating. Meticulous attention to food and drink will minimize the chance of developing gastrointestinal disturbances.
Pack a medical kit, including the basic items listed below under "recommended". The second list, "optional", covers things that may be useful in special situations. Keep the medical kit in your carry-on luggage, in case your checked luggage ends up at a different destination!
-A medical card describing each traveler’s age, weight, height, medical conditions, routine medications, allergies and blood type (especially if traveling to a developing country). If your child has a complex medical condition, ask us for written information. (S)he should carry or wear a card, tag or bracelet identifying any physical condition that may require emergency care.
-Antibacterial skin ointment, such as bacitracin, Neosporin®, Mycitracin® or Polysporin®.
-Benadryl® (diphenhydramine) or equivalent antihistamine for itching and colds/allergies
-Motion sickness medication (Bonine® or Dramamine® for children)
-Acetaminophen or ibuprofen for pain or fever.
-Insect repellent (Permanone® and, if disease-causing insect exposure is expected, a 10% DEET preparation).
-1% hydrocortisone cream.
-Sunscreen (SPF at least l5).
-First-aid supplies (bandages, tape, gauze, elastic bandage wraps, alcohol wipes, a good pair of tweezers.
-Any currently prescribed medications, including antimalarial agents. Take enough for the entire trip plus a few extra days in case of unexpected delays or lost doses, especially for children with chronic diseases. If you or a family member suffer from anaphylactic reactions, take your automatic adrenaline injector (Epipen® or Ana-Kit®).
-packets of Hydralyte® or Kaolectrolyte® powder (to be mixed with water to make an electrolyte solution to give children with vomiting or diarrhea) if traveling to tropical zones with children under 2 years old.
-Medication for traveler’s diarrhea (Immodium AD®, Children’s Kaopectate® or Diasorb®).
-extra pair of prescription eyewear
-car lock de-icer
-Rhulli Gel®, Itch-X® or Caladryl® (topical anesthetic for stings and itches)
-Moleskin® for blisters on the feet
-A small sterilizing filter pump or Iodine tablets if camping away from potable water sources
-chemical cold packs for sprains
-Blistex® cream or lip balm
-Lactaid® drops or pills for those who are lactose intolerant
-Tums® or Pepto-bismol® for heartburn
Animals for the most part pose the same types of hazards in other areas that they can cause at home. Do not allow children to approach animals that are not known to be domesticated and immunized for rabies. Certain parts of the world are known for specific animal hazards. A partial list includes Nepal (rabies from bats); developing countries in Africa, Asia and Latin America (rabies from dogs); Southwestern United States (Hantavirus from rats); and Australia, southern Asia, the Middle East and the Americas (poisonous snakes). Immunizations are available for pre-exposure protection from certain animal-transmitted diseases (rabies), but not all.
Direct exposure to animals is not necessary to acquire certain diseases that are found more commonly in certain parts of the world. The presence of these diseases may be good enough reason to alter your itinerary. Some mosquito-borne diseases(for example, malaria and mosquito-transmitted forms of encephalitis) are vaccine preventable, others (e.g., Dengue or most forms of arboviral encephalitis) are not. Yellow fever, a mosquito-borne disease for which there is a vaccine, is common in Africa and South America. Typhoid fever is caused by salmonella bacteria, found wherever sewage treatment facilities are lacking. The majority of typhoid is found in Mexico, Peru, India, Pakistan, Chile and Haiti. Careful food preparation is critical in prevention efforts for Typhoid. It is also vaccine preventable. New Zealand has 10 times the incidence of acute rheumatic fever (usually caused by strep throat) than that in the United States. Meningococcal infections, usually caused by group B of these germs is also common in New Zealand. The meningococcal vaccine contains groups A, C, Y and W, but not B. Sub-Saharan Africa from June to December, Mecca and Nepal, however are known for the vaccine-preventable group C meningococcal infections. Summer and Fall in Asian countries are the high seasons for mosquito transmission of the Japanese encephalitis virus. There is a vaccine for this infection. Hepatitis A is ubiquitous. It can be food or water borne, as well as acquired directly from another person. It is vaccine preventable.
Without animals or mosquitoes, how are the other mentioned diseases spread? They are spread by contact with that most dangerous animal of all--humans. Person to person contact is responsible for strep throat, meningococcal infections, tuberculosis (prevalent in Africa and Asia, as well as in certain areas of U.S. urban centers), polio (especially in the middle East), hepatitis A and B and Diphtheria (now frequently found in Eastern Europe). These disease with names that most of us recall only from history books or conversations with our grandparents are routinely prevented in the United States by virtue of usual childhood immunizations. Thus it is imperative that routine immunizations be completed before any foreign travel. This includes polio, diphtheria, whooping cough (pertussis), tetanus, measles, mumps, rubella, hemophilus influenza type b and hepatitis B. Hepatitis A vaccine is recommended for most travelers outside the U.S. and western Europe. A baseline tuberculin test should be obtained before travel to high risk areas and a follow up screen 6-8 weeks later after . This allows early detection and treatment of infection. Other vaccines and medication depend on your itinerary.
Check with your physician at least two months in advance of anticipated foreign travel to allow adequate time for research and administration of appropriate immunizations. Remember, too, that the symptoms of most of these disease take up to 6 weeks to appear after infection. Malaria can take from 6 months to one year. Since no vaccine is perfect, report any symptoms up to a year after foreign travel to your doctor. Remind the doctor of your travel itinerary and dates to help the doctor arrive at a diagnosis.
Avoiding environmental effects can be tricky. Simple things such as seeking non-smoking areas in airports, hotels and restaurants can be adopted as a matter of course. More difficult are avoiding the hazards of travel on unpaved roads (dust inhalation), travel at high altitudes (malaise, nausea, headache, insomnia, fatigue and altitude sickness) and travel to or through areas of toxic or radioactive spills. The CDC can give you information on potential trouble spots (see below).
Avoiding areas of political upheaval and violence is equally as important as avoiding medical health hazards. By calling the Department of State (see below) you can obtain information on world hot spots.
For further information, contact the following sources:
The International Association for Medical Assistance to Travelers (a non-profit organization that offers listings of English speaking doctors overseas and publishes updates on immunization requirements, malaria and other tropical diseases) 1-716-754-4883.
US State Department Overseas Travel Advisory, provides up to date information on travel conditions, visa requirements, political situations, etc. 1-202-647-5225.
The Centers for Disease Control (http://www.cdc.gov/flu/) 1-404-332-4559 or 1-888-232-3228, fax 1-404-332-4565.
The American Association of Poison Control Centers (www.AAPCC.org).
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