You’ve booked a hotel, you’ve got your passport, and you found a great rate on a flight. Now, you’re counting the days until your adventure begins. There’s just one problem: If you haven’t thought about healthcare, that trip might not happen.
To travel responsibly, you need to think carefully about immunizations, prescriptions, and other medical necessities. If this is your first time leaving the country, that can be overwhelming. Fortunately, it’s actually a pretty easy process, provided that you start planning early.
We spoke with physicians to find out what travelers need to know when going abroad--and what they can do to enjoy their trips with total peace of mind.
This might seem obvious, but if you’re traveling internationally--or even domestically--you should know the likelihood of contracting serious diseases at your destination. Fortunately, the Centers for Disease Control and Prevention (CDC) make that process fairly easy.
“Beyond just what tourist destinations to visit, you want to know if there is anything medically going on in the area,” explains Frank Illuzzi, M.D. Illuzzi is a practicing board-certified physician in emergency medicine and is currently the Chief Medical Officer at CityMD, a network of urgent care centers.
“Before traveling, I visit cdc.gov, which has a section on traveler's health,” he says. “It will let you know if there are any health advisories or outbreaks in that country--such as Zika, malaria or Ebola outbreaks. It will even tell you if there is a seasonal illness, such as the flu, or a heat wave, in which case you should be aware. The CDC also lists prior immunizations you need before going visiting. This is helpful because you'll need to get any vaccinations a couple of weeks before you go.”
In particularly dangerous circumstances, the CDC will issue Level 3 warnings. Travelers shouldn’t visit an area given this designation unless it’s absolutely necessary. Level 2 warnings from the CDC are less extreme, but still quite serious. The CDC instructs travelers to “practice enhanced precautions” before traveling to these regions.
Finally, there’s Watch Level 1, which is applied to any place in the world where health risks are at normal levels. While the CDC website is an essential stop in the vacation-planning process, other sites can also provide helpful information for the health-conscious traveler.
“The other website I recommend is travel.state.gov,” says Illuzzi. “It has a tab for international travel and will give you an overview of the country--any advisories, political situations, as well as a list of major hospitals, English speaking doctors, and so on.”
Don’t assume that you’ll be able to get your immunizations in the week before you travel. Depending on where you’re going, you might need several weeks to get up to date.
“The hepatitis A vaccine is two doses, so you need to have time to fit both in before you travel. Malaria prophylaxis often starts before you leave as well,” says Monica Wood, M.D. Wood founded SectAway, a mosquito repellent system. She’s passionate about managing disease exposure--particularly malaria. “It may take time to see a travel specialist and order certain vaccines,” she says.
In theory, you could take immunizations and medications after you arrive at your destination, but that’s not always a safe plan. Antimalarial meds, for instance, should always be purchased in the United States. The CDC notes that in some countries with malaria risks, counterfeit or substandard medicines are relatively common, and they may not be effective for limiting risks.
To further complicate the matter, the CDC also recommends different antimalarial medications for different countries (you can find their current recommendations here). That’s because some strains of malaria are resistant to certain medications.
Kelly Hayes-Raitt is an author who travels full time. On a recent trip to Mozambique, she realized that medications aren’t always accessible--even for a person with decent insurance.
“There is a global yellow fever vaccine shortage, so I had to rearrange my travel itinerary to ensure I didn't travel through a country with yellow fever, or I would have been denied entry into Mozambique,” Hayes-Raitt shared. “And there are several different anti-malarial prophylactics depending on your destination. Not all of those medications are available.”
“For example, I was travelling from Mexico to Mozambique, but could not find mefloquine anywhere in Mexico! I had to make arrangements to have it brought to me from the States. Luckily, I had started researching these medications several weeks before my trip. Had I waited until the last minute, I would have been stuck.”
The takeaway is clear: To stay safe, you need plenty of time. Talk to your physician immediately after--or even before--planning your trip.
Let’s be clear: For the most part, immunizations are a good thing. However, understand that your physician will look at a variety of factors when making recommendations, including your age and medical history.
“Some recommendations vary with age,” Wood explains. “The yellow fever vaccine has increased risk with age and has to be balanced with the relative risk of contracting yellow fever while you travel. A fellow physician friend went to the Amazon recently, and he opted out of yellow fever [vaccination] because the risk of infection was low and the risk of a vaccine reaction was high.”
That doesn’t mean that you should head into your doctor’s office with a list of vaccinations that you will or won’t take--you simply need to find a physician with experience in travel vaccination schedules who can accurately explain the risks and benefits of different options. That way, you’ll be able to make educated, appropriate decisions about your medical care.
You visit the doctor regularly and you’re pretty sure you’ve been vaccinated against common diseases. You’re in the clear, right?
“The family that started the measles outbreak in Vancouver lost track of the fact that they had opted out of measles vaccines years before,” Wood says. “My biggest piece of advice is to compile your vaccination records to make sure you are up to date on all the routine ones--MMR, TDaP, Hib, flu, rotavirus, and so on. There's no sense preventing yellow fever and malaria if you bring home whooping cough!”
The CDC compiles a list of immunization recommendations by age, which is a great starting point for checking your routine vaccinations. For adults, the CDC recommends seasonal flu (influenza) and TDaP (whooping cough) vaccinations. Past 50, you should add the zoster vaccine, which protects against shingles and complications associated with the disease.
If you’re 65 or older, you’ll also need pneumococcal vaccines, which protect against infections in the lungs and bloodstream. Once again, talk to your physician; assumptions can put you at risk, and vaccination records can be checked with relative ease.
Once you’ve sorted out your immunizations, make sure that you’ve got your other prescriptions sorted out.
“If you have a complicated medical history, write it down so it's easy to translate,” Illuzzi suggests. “I have family members with heart problems and recommend they take a photo of their most recent EKG and shrink it down to a wallet size.”
That way, if a foreign physician needs to see the EKG, it’s ready. Illuzzi says that a bit of preparation can go a long way if you somehow lose your prescriptions overseas.
“Write out your medication list and put it on your phone, including the generic name, which is helpful in other countries,” he says. “Make sure to also include allergies to medications and foods, along with the name, number, and email of your primary care doctor. I like when my patients tell me they are going away so I can help troubleshoot if they have issues while abroad.”
Finally, don’t assume that your planned travel time will be your actual travel time.
“If you have medications, bringing enough prescriptions on the trip for several extra days,” Illuzzi says. “Assume your plane will get delayed on the way back, or you'll get snowed in while [in] Paris or Rome.”
If you need to see a doctor while you’re traveling internationally, you might have to pay for the privilege. Some insurers cover out-of-country expenses, but unless you’ve checked, you shouldn’t assume that your insurance will work anywhere.
“Keep both your insurance information handy as well as an emergency contact state-side,” Illuzzi says. “Go online or call your health insurance provider and find out what is covered. Some plans will not cover anything that happens outside the U.S.”
If your insurance carrier doesn’t cover international claims, consider other means of coverage.
“Some homeowner or umbrella policies have international or medical coverage, and some of the higher-end credit cards also offer international medical insurance,” Illuzzi says. “Once you know what is and is not covered, you'll need to make a decision whether to purchase travel insurance.”
Travel insurance policies can be inexpensive--basic plans often cost less than $100--and they’re usually a worthwhile investment.
“Ask yourself: Do you have medical problems? Are you hiking in the Andes and may get hurt?,” Illuzzi says. “If you do, there are companies that offer medical insurance abroad. Just know that there are different types of travel insurance, and you want to see what the line item is for medical insurance.”
If you do need healthcare in another country, you’ll need to keep good records.
“Generally, you have to pay upfront,” Illuzzi says. “Save the receipts, and [your insurer] will reimburse you when you get back.”
That said, Illuzzi emphasizes that “you need to be prepared to have enough money accessible in case of an emergency,” and that preparation will differ from country to country. “Some may have socialized medicine, and you may never get charged.”
Once again, the CDC’s Travelers' Health site is a great resource for checking healthcare access in your destination country.
“In most places in the Western world, it's easy to access medicine,” Illuzzi says. “You can often speak to the concierge at your hotel who can direct you to a clinic or hospital. If you are in a more remote area, it will be more challenging. Lean on your resources, such as your travel or hiking guide.”
Of course, you don’t want to find yourself thumbing through the Yellow Pages (or your destination country’s local equivalent) when you’re having a medical emergency. Through travel.state.gov, you can find the locations and contact information for your local U.S. embassy or consulate, which can be vital information.
“I recommend that my patients and family members print that information and keep [it] with their wallet or passport where it can easily be accessed,” Illuzzi says.
If you come down with a cold or a minor flu, you can probably head to any local physician for help. If your situation is more serious, however, your quality of care matters.
“If I'm in a remote destination or a developing [area], I like to know where the teaching hospitals are, because they often have the most advanced equipment as well as English-speaking providers or other international providers,” Illuzzi says.
“Some countries have hospitals just for foreigners. When I was in China, there were two hospital systems: the public hospital system and foreign hospitals, which were staffed with international physicians.”
The CDC recommends checking the qualifications of health care providers. Foreign health care facilities often have different standards than facilities in the United States, but accrediting bodies like Joint Commission International, DNV International Accreditation for Hospitals, and the International Society for Quality in Healthcare can help you find reputable facilities throughout the world.
You’ve got your immunization records, you’ve got your prescriptions renewed, and you know where to go for medical care. Now what?
“Prevention isn't just vaccines and medications,” Wood says. “Simple things--like proper hand washing, using filtered water, fully cooking food, wearing a mask [as needed], and using protective clothing and repellents against insects--can also reduce your risks.”
Wood emphasizes proper hand washing because, well, most people don’t wash their hands correctly. The CDC recommends scrubbing your hands with soapy water for at least 20 seconds (as opposed to simply lathering and rinsing).
Depending on your destination, buy filtered water or boil your water when necessary. Avoid going barefoot, particularly on beaches that might be hiding parasites or animal waste in the sand. Supervise young children at all times, and make sure they’re practicing proper handwashing, too.
So, how dangerous is traveling abroad? By one estimate, about 8 percent of travelers working or vacationing in developing areas become sick enough to seek medical care either while abroad or shortly after returning home. Most of those problems are mild, however, and risks vary greatly by destination. Fewer than 1 percent of travelers are hospitalized abroad, and preventative measures greatly limit your risks.
Stay safe, but don’t let health concerns discourage you from taking the trip of your dreams. By planning ahead--and making sure you know what to do in the unlikely event of an emergency--you can enjoy yourself without worrying.