Staying Healthy When Traveling to High-Risk Areas

Dr. Stuart Rose Owner/CEO of Travel Medicine Inc and author of The International Travel Healthguide Online
Dr. Stuart Rose Owner/CEO of Travel Medicine Inc and author of The International Travel Healthguide Online

By Lisa Linsley

If you are traveling to lesser-developed countries, you have probably been warned by your family and friends about malaria, E. coli, and dengue fever, not to mention Delhi belly, more commonly known as travelers’ diarrhea.

“As serious as these illnesses can be, don’t let these warnings deter you from traveling” says Dr. Stuart Rose, a board-certified emergency physician and owner/CEO of Travel Medicine, Inc.

He is also the author of the International Health Guide and creator of the Web site that gives you up-dated, in-depth advice on how to stay healthy even in the most high-risk countries and challenging environments.

Dr. Rose views travel medicine as having three legs.

First leg: Trip preparation. This includes educating yourself about what disease risks you will encounter and how to avoid them. “Getting this information to travelers was the reason I wrote the first edition of the International Travel Health Guide (now online) in 1989,” says Dr. Rose.

Second leg: Seeing a health care provider (usually a specialist in a travel clinic) to get any necessary shots as well as medications you may need to prevent malaria, travelers’ diarrhea, altitude illness, or jet lag.

Third leg: Obtaining products, such as insect repellents and water purifiers, that are essential to disease prevention in countries where there is poor sanitation and the threat of tropical and infectious diseases.

Says Dr. Rose “We sell these products in our Northampton store and also online. This is a convenience for travelers — as well as their health care provider who now doesn’t have to worry about where their patients will obtain these necessary items. Insect-bite protection, for example, is extremely important and we make it easy for travelers to get the products they need for a safe trip.”

Following this advice and taking precautions outlined by Rose’s “Three Legs” will put you on the right path for a safer, healthier trip.

Do the Research: What are the Risks?

Review your itinerary to see exactly where you will be traveling and what activities you will be participating in: Will you be exposed to malaria-transmitting insects, unsafe food and water, or high altitudes? Before knowing what vaccines you should get, pills you should take, or what you should bring, you must know the answers to questions such as these.

Steripen Traveler water purifier products Keep You hydrated.
Steripen Traveler water purifier products keep you hydrated.

Rose’s web site, provides Destination Advisories for over 200 countries that detail the risks you can expect to encounter and how to avoid or treat them. (Access the Destination Advisories by clicking on “Choose a Destination” at the top of the Home Page.)

For example, the Destination Advisories for Mexico and Central America not only alert you to the common dangers of hepatitis, malaria, dengue fever, but also warn about less common risks such as angiostongyliasis, caused by a nasty little worm that burrows into your intestine and causes symptoms that resemble appendicitis. It’s picked up when you eat raw snails or contaminated vegetables. also provides a link to the Center for Disease Control and Prevention (CDC) Web site, where government country advisories are available, although not with such detail.

Prepare Yourself in Advance: Get Vaccinated and Take Preventive Medicines

Now that you know what diseases you may be at-risk for, take preventive measures by getting vaccinated or taking medications.

If visiting Belize, for example, there is malaria risk in all parts of the country except Belize City. If you are traveling outside Belize City, especially to the rain forests, you should take a weekly dose of the anti-malarial drug chloroquine.

Also take measures to prevent mosquito bites. You should apply an insect repellent to exposed skin and wear permethrin-treated clothing. Sleep under a mosquito net, preferably one that has also been treated with the fabric insecticide permethrin.

  1. Some Malaria Risks in Mexico, Central America, and the Caribbean


Risk Areas

Belize: All, except no evidence to date of a risk in Belize City.

Costa Rica: In Alajuela, Limón, Guanacaste, and Heredia provinces; no evidence to date of a risk in Limón city (Puerto Limon).

Dominican Republic: The resort areas within the province of La Altagracia (including Punta Cana and Bavaro), as well as all of the rural areas bordering Haiti.

Guatemala: Rural areas at 1,500 meters elevation and below; no evidence to date of a risk in Guatemala City, Antigua or Lake Atitlán.

Jamaica: Very limited risk in Kingston area.

Mexico: There is a risk of malaria to travelers in the southern regions bordering Guatemala and Belize. There is no evidence to date of a risk of malaria in the resort areas along the Pacific and Gulf Coasts or along the border of the United States.

Many diseases can be prevented through vaccination (also referred to as immunization). Hepatitis A, for example, is widespread throughout Central America and Mexico. If you have never previously been vaccinated, be sure to get a hepatitis A shot before leaving. Also update, if necessary, your routine vaccinations, such as tetanus and measles/mumps/rubella.

Note: Be sure to get immunized against seasonal flu, when available. Discuss with your doctor, or check with the CDC, about current H1N1 flu vaccine recommendations.

Typhoid and rabies are two diseases that many adventure travelers may be exposed to in Mexico and Central America. Typhoid vaccine is recommended by the CDC for all unvaccinated people traveling to or working in Mexico and Central America, especially if visiting smaller cities, villages, or rural areas and staying with friends or relatives where exposure might occur through food or water.

Traveler ER Flash Drive stores Your medical information.
Traveler ER Flash Drive stores tour medical information.

Rabies vaccine is recommended for travelers spending a lot of time outdoors, especially in rural areas, involved in activities such as bicycling, camping, or hiking.

Also recommended for travelers with significant occupational risks (such as veterinarians), for long-term travelers and expatriates living in areas with a significant risk of exposure, and for travelers involved in any activities that might bring them into direct contact with bats, carnivores, and other mammals.

Children are considered at higher risk because they tend to play with animals, may receive more severe bites, or may not report bites.

Staying Healthy During the Trip: What to Buy and Bring

You’re off the airplane, have unpacked your bags, and are ready to have fun and see all there is to see. But, you are having trouble doing so due to fear of diarrhea and those mosquitoes swarming around you.

Travelers’ diarrhea is the most common travel-related disease. According to Dr. Rose, it affects about 60 percent of travelers. Eighty percent of cases are due to bacteria, especially E. coli.

All travelers should carry antibiotics to treat themselves and your health care provider should prescribe one for you (e.g., Cipro, Zithromax, or rifaximin). If you take Imodium with the antibiotic, you’ll get better faster, usually in one or two days.

Be sure also to protect yourself against those nasty critters that bite and pack an insect repellent with 30%-50% DEET. Dr. Rose recommends the long-acting Ultrathon or Sawyer’s non-DEET Picaridin. Bring long-sleeved shirts, long pants, and hats to wear outdoors.

Remember that dusk and dawn are the peak biting periods for malaria-transmitting mosquitoes, but also be aware that dengue fever is transmitted by day-biting mosquitoes. Spray your room with flying insect spray (sold in hardware stores) and treat your clothing and gear with permethrin spray or solution (available online at

If you are visiting an area where bottled water will not be available bring a water purifier so that you can stay hydrated. offers a variety of water purifiers in all price ranges.

The Steripen Traveler Handheld Water Purifier, at $99.95 uses ultraviolet light to destroy waterborne microbes, including viruses.

For the more thrifty travelers, the Micropur MP-1, at $16.95 meets EPA guidelines and removes all harmful microorganisms from water.

Another gizmo Dr. Rose recommends is the Traveler ER. The Traveler ER is a portable flash drive that carries your medical information. It can store your medical history, emergency contact information, health insurance information, and allergies.

Dr. Rose recommends purchasing a traveler’s insurance policy that pays for emergency medical evacuation. This can be a real lifesaver.

If you become sick or injured in a remote or medically underserved area these policies can arrange transport back to a medical facility in the U.S., if necessary. Evacuation out-of-pocket costs can be $50,000-$75,000, so these policies can also be money savers. Find out more about travel insurance and medevac insurance on GoNOMAD.

The Importance of Safety

“The most common cause of death while traveling is car and motorcycle accidents and drowning,” says Dr. Rose. Road safety is important. Dr. Rose explains that many people drive when they are unfamiliar with the roads, can’t read the road signs, drive at night, or drive while under the influence of drugs or alcohol.

Taking proper precautions such as not driving drunk, wearing a seatbelt, knowing the roads, and not driving at night will help you avoid accidents. It is usually is better to rent a vehicle with a qualified driver rather than renting your own vehicle.

A high number of deaths occur from drowning. “People go to beaches they are not familiar with. They underestimate the currents and often their own ability as swimmers. Sometimes they are also intoxicated,” says Dr. Rose.

Summing up, Dr. Rose says, “ although travel, overall, is extremely safe, people need to take common sense precautions.”

The 2009 International Travel Health

The International Health Guide was first published in 1989 by Dr. Stuart Rose to keep both travelers and travel health professionals updated in the field of travel medicine. The Health Guide is now available online at no charge. It contains twenty-two chapters and is updated biweekly.

Lisa Linsley

Lisa Linsley is an intern at GoNOMAD and a journalism major at the University of Massachusetts. She also updates Travel News Notes.

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