Many frequent travelers take no special precautions to protect their health away from home. Sure, they might wash their hands after using the bathroom and avoid dodgy-looking street food, but they don’t radically adjust their routines or take special care to avoid potentially high-risk situations.
The COVID-19 pandemic has been a wakeup call for travelers with carefree cleanliness habits. Although the risk of developing a serious illness is relatively low for the young and otherwise healthy, the disease is devastating for the elderly and infirm. No one was immune to COVID-19 before it jumped to humans (likely from bats) in late 2019. That’s been evident in its rapid spread across the globe — a spread facilitated by asymptomatic or mildly ill travelers who either didn’t realize or didn’t care that they’d become COVID-19 carriers.
The initial outbreaks of COVID-19 prompted the postponement or cancellation of millions of non-essential trips and a wave of government-imposed travel restrictions that crippled the travel industry. Even after the pandemic peaks, the fear it sparked is likely to remain fresh in travelers’ minds. If there’s a silver lining, it’s that travelers — and members of the general public going about their daily routines — are more likely in the future to take sensible precautions to protect their health and the health of vulnerable friends and family members.
This guide outlines many of the measures you should take to reduce your risk of falling ill while traveling or of returning home with an unwelcome and potentially contagious souvenir.
Common Health Risks for Travelers
Travel-related health risks vary by destination, activity, season, and other factors. In 2020, the most common include COVID-19, the collection of gastrointestinal illnesses known as travelers’ diarrhea, and Hepatitis A. Travelers to tropical and subtropical regions face additional risks, such as malaria, Zika, and cholera.
COVID-19 is a respiratory illness caused by a novel coronavirus that originated in China in late 2019. It’s transmitted by respiratory droplets in the air and on hard surfaces. Transmission is more likely in situations involving close interpersonal contact and in crowded, confined spaces such as event halls and public transportation.
Because it’s such a new disease, we still have much to learn about COVID-19. According to the CDC, the overall case fatality rate likely ranges from ranges from less than 0.25% to 3%, depending on the age and underlying health of the affected populations and the overall quality of health care provided. Even in optimistic scenarios, it’s several times deadlier than the seasonal flu.
COVID-19 effects are generally mild to moderate in young and otherwise healthy individuals, for whom common symptoms include sore throat, fever, and persistent dry cough. Severe and sometimes fatal complications, notably pneumonia and acute respiratory distress syndrome (ARDS), are more likely in older individuals and those with underlying health conditions like hypertension and diabetes. Hospitalization was required in about 15% of Chinese cases included in a February 2020 JAMA study.
There’s currently no vaccine or cure for COVID-19. The best defense is prevention — avoiding crowded places or close interpersonal contact, such as handshakes and embraces, while traveling.
Travelers’ diarrhea is the most common disease afflicting international travelers. That’s because the term is a catch-all for a host of similar gastrointestinal illnesses caused by a dozen or more common viruses, bacteria, and parasites, including:
- E. coli
Most people have experienced illnesses caused by one or more of these pathogens. Depending on the microorganism, typical symptoms include watery diarrhea, vomiting, abdominal pain or cramping, dizziness, and a sense of urgently needing to use the restroom. In otherwise healthy people, symptoms resolve on their own in a few days with proper hydration and rest. Older and immunocompromised individuals are more likely to experience serious complications requiring hospitalization. Dehydration is a major risk in vulnerable populations.
There’s no vaccine for travelers’ diarrhea. Medical treatments vary by pathogen and severity.
Hepatitis A is a viral illness that attacks the liver. Symptoms are mild to moderate in many individuals but can be severe in patients with liver problems. Transmission typically occurs via contaminated body fluids and feces. For travelers, the most common sources of infection are unclean drinking water and food washed in contaminated water.
The best treatment for Hepatitis A is prevention — there’s an effective vaccine that you should get before traveling anywhere the disease is common.
Malaria is a potentially fatal illness caused by a parasite transmitted by mosquitoes. It’s extremely common in tropical and subtropical regions. Initial symptoms resemble influenza, with fever, chills, headache, diarrhea, and muscle pain among the most common. Left untreated, the disease can eventually cause respiratory and renal failure over a period of months.
The best defense against malaria is prevention. Prophylactics (malaria pills) are quite effective but not entirely guaranteed to ward off the malaria parasite. Mosquito nets, insect repellent, and other measures to stymie mosquitoes are therefore vital. Treatment is effective when the infection is caught early, so it’s important to seek medical care if you develop flu-like symptoms while traveling or soon after returning from a tropical region.
Zika is a viral illness transmitted by mosquitoes. It occurs in tropical regions, though its distribution is uneven and drastic measures to curb it have had some success. Most illnesses are mild or asymptomatic in healthy adults. However, the virus can cause serious birth defects in unborn children and nervous system disorders in some healthy adults.
Like malaria, the best defense against Zika is prevention. Pregnant women should reconsider travel to regions where it’s common and take precautions against mosquito bites when they do travel.
Cholera is a bacterial illness that typically occurs in areas with contaminated drinking water. Symptoms include nausea, vomiting, diarrhea, and leg cramps. In most healthy individuals, the disease is mild or asymptomatic and resolves on its own, but more serious cases are often fatal due to its sudden onset and profound fluid loss. Serious cases typically require intravenous fluids and other interventions to prevent catastrophic dehydration.
Southern Hemisphere Flu
In temperate regions of the southern hemisphere, peak flu season occurs during the northern hemisphere’s spring and summer months and often involves different strains of the influenza virus, rendering northern hemisphere flu vaccines more or less ineffective. If you’re traveling to the southern hemisphere or any tropical region (even one north of the equator), your care provider will likely recommend southern flu vaccination.
Tuberculosis, or TB, is a bacterial respiratory infection that can become chronic and cause severe complications. It’s spread by very close interpersonal contact, though it’s less contagious than viral respiratory illnesses such as influenza and COVID-19. TB is rare in the developed world, but travelers to poorer countries should be mindful of it.
According to public health information provided by the Government of Canada, about 90% of those infected with TB never develop symptoms. The 10% who do typically experience persistent coughing with occasional phlegm or blood production, chest pain, fever, chills, fatigue, loss of appetite, and weight loss. (“Consumption” is an antiquated and evocative term for the disease.) Left untreated, TB can affect the nervous system and other organs, causing serious and sometimes fatal complications. These risks are higher in immunocompromised patients.
Tuberculosis responds to antibiotic treatments and is considered curable.
Rabies is a viral illness that’s nearly always fatal once symptoms present. It’s transmitted by bites or scratches from infected mammals, especially bats, monkeys, and stray dogs. (In temperate regions of the developed world, rabies transmission to humans is rare, with skunks, bats, and raccoons the most common vectors.) Early symptoms are vague and include fatigue, malaise, fever, and tingling at the infection site. Later symptoms include hyperactivity, confusion, hallucinations, seizures, fear of water, and eventually paralysis and death.
Rabies’ progression can be arrested with prompt intervention before symptoms appear. When traveling, treat any mammal bite, no matter how inconsequential it seems, as a life-or-death emergency.
Typhoid or typhoid fever is a serious bacterial illness caused by a type of salmonella bacteria. It’s transmitted by water contaminated with infected bacteria, including water used to wash food and shellfish pulled from contaminated water. It’s unfortunately common in parts of the developing world.
Symptoms generally include fever, headache, diarrhea, cough, constipation, lack of appetite, and an unusual trunk rash. Serious and potentially fatal complications, such as enlarged liver and intestinal bleeding, can occur in untreated cases. Fortunately, most typhoid infections are curable with antibiotics (though the prevalence of antibiotic-resistant bacteria is increasing).
Yellow fever is a viral illness transmitted by mosquitoes, generally in tropical regions. According to the Government of Canada, about 85% of cases resolve after a period of unpleasant symptoms such as fever, intense body aches, headache, vomiting, diarrhea, and loss of appetite. Roughly 15% of cases become more serious, with symptoms like jaundice and internal bleeding. Roughly 7% to 8% of all cases are fatal.
There is an effective vaccine against yellow fever. Anyone planning to travel to regions where it’s common should get vaccinated before they leave.
Know Before You Go: Pre-Trip Planning and Preparation
Fortune favors the prepared. Before you leave on your trip, be sure to do these things.
Research the Specific Risks in Your Destination
Once you’ve decided on a destination, study the specific health risks you could encounter there. Refer to the CDC’s Travelers’ Health website for detailed information about each country and its risks. Don’t assume you’re at high risk for exposure to every disease found in a particular country, however. Many diseases occur in rural or agricultural settings that city-bound travelers aren’t likely to encounter, or they require direct exchanges of bodily fluids to transmit.
Research Medical Services and Infrastructure in Your Destination
You don’t need to become an expert on your destination’s health care system. But you should take an hour or two to note the locations of clinics and hospitals in the cities you’ll be visiting, get a sense of the overall quality of the local health care system (including wait times), and understand how (and if) local providers charge foreigners for medical care.
When possible, refer to the World Health Organization and your destination countries’ English-language health department websites for this information. In a pinch, you can use Google Maps to find medical facilities.
Separately, determine the quality and safety of basic infrastructure in your destination. Reliable local information is often difficult to come by since national and municipal governments aren’t eager to advertise if they struggle with contaminated drinking water. Before our trip to Thailand, my wife and I went on a Googling binge to learn about Thailand’s infrastructure and came away reasonably well prepared for the journey.
Follow CDC and WHO Recommendations on Prophylactics and Immunizations
Head back to the CDC’s website for details on the prophylactic measures and vaccinations recommended for your destination country. Pay attention to recommendations for people in your risk category. For example, the CDC’s Bangladesh recommendations recommend routine vaccines (such as MMR and polio) to all travelers, Hepatitis A and typhoid to most travelers, and vaccines for rabies and Japanese encephalitis (among other diseases) to travelers visiting rural areas of Bangladesh, where they’re prevalent.
Check State Department Travel Advisories
As your departure date approaches, visit the U.S. Department of State’s travel advisories website for details on health-related travel advisories affecting your destinations. Amid the COVID-19 outbreak, the entire world is under a Level 3 (“Reconsider Travel”) advisory, and the worst-hit countries are at Level 4 (“Do Not Travel”), but this isn’t a typical situation. Usually, advisories are localized, warning of events like Ebola outbreaks in the Democratic Republic of the Congo and dengue outbreaks in Bangladesh.
Take State Department travel advisories seriously. Travel insurance companies like World Nomads usually allow cancellations due to ongoing outbreaks of serious disease in your destination. If you do choose to travel to places under State Department advisory, heed any precautions recommended by the CDC or State Department. For instance, the CDC recommends a slew of “social distancing” measures to limit COVID-19 transmission.
Pack Recommended Prophylactics and Over-the-Counter Medicines
Depending on where you’re traveling and the hazards you expect to encounter, your doctor might recommend you bring certain prophylactics. On our pre-Thailand clinic visits, my wife and I each received prescriptions for a short course of antibiotics to take in the event of gastrointestinal illness. We didn’t end up needing them, fortunately.
Separately, stock up on over-the-counter medicines that could help treat mild illnesses abroad, such as anti-diarrheal medication and fever reducers like Tylenol. These medications are available in most places around the world, but the last thing you’ll want to do if you get sick is navigate a foreign city looking for them. Consider it $10 or $15 well spent.
It’s also wise to pack a small first-aid kit with items like bandages, antibiotic ointment, and gauze.
Bring an Adequate Supply of Hand Sanitizer
Another $10 well spent: a few personal-sized bottles of hand sanitizer — though, at least for the duration of the COVID-19 pandemic, the TSA has relaxed its notorious rule barring liquid containers over 3 ounces in carry-on luggage.
It’s worth the investment. Soap and water aren’t guaranteed to be available everywhere you go, especially if you’re planning to travel off the beaten path.
Understand Your Health Insurance
Before you head out on a trip, it’s essential to know what your health insurance does and does not cover. For example, if you have to see a doctor who is out of your network, does that require a pre-approval phone call? What if it’s after hours or on the weekend? What’s the course of action for emergency care if you’re out of the country? Do you need to alert your health insurance company that you’re going abroad?
Don’t forget to look at any benefits beyond your health insurance that you may have through your employer. Some employers offer various perks through employee assistance programs, including companies that can help you coordinate emergency medical care and transport if you need it. It’s better to know what benefits you’re entitled to and never need them than to be far from home and facing an emergency you’re not prepared for.
Consider Travel Insurance
Depending on your situation and existing coverage, travel health insurance can either be a good investment against bad luck or a waste of money. By researching travel health insurance and considering whether you really need to buy it, you can save yourself money and headaches while traveling. Make sure you understand your current health insurance policy’s coverage before you leave for your trip so you don’t end up wasting money on extra insurance you don’t need.
Combat Jet Lag
Crossing multiple time zones faster than your body can adjust is a recipe for jet lag – that feeling of being out of sync with the time at your destination or exhausted long before the sun goes down. In addition to grogginess, jet lag can cause symptoms like insomnia, nausea and indigestion, headaches, and impaired judgment.
If you can train your body to slowly adjust to the time zone in your destination before you even leave home, you can ensure you get quality sleep and avoid feeling crummy and tired while on vacation.
In the days leading up to your vacation, gradually adjust your bedtime and wake-up time to your destination’s time zone. Drink plenty of water on the flight to your destination, and adjust your watch and cell phone to the new time right away to mentally prepare for the new time zone.
When you arrive, stay awake and alert until it’s bedtime there, at which point you can promptly tuck yourself in and try to get a good night’s sleep, perhaps with an eye mask and earplugs if necessary. Finally, set an alarm to wake up with the sun, and you’ll be on your way to beating jet lag and staying healthy.
Reducing Your Risk of Illness While Traveling
Once you leave home, take sensible and consistent measures to reduce your exposure to harmful pathogens. Wash your hands regularly and use hand sanitizer when soap and water aren’t an option. Wipe down surfaces in high-traffic public places, avoid unsafe water sources, and be selective about what you eat.
Wash Your Hands Frequently With Soap and Water
Wash your hands frequently, always following the CDC’s handwashing guidelines:
- Wet with warm or cold water, turn off the tap, and apply soap.
- Lather every surface of your hands, including the backs, fingertips, and under your nails.
- Scrub for at least 20 seconds — enough time to sing “Happy Birthday” twice.
- Rinse your hands under running water, completely removing soap residue.
- Dry using a clean towel (or air dry when a towel isn’t available).
Use Hand Sanitizer When Soap and Water Aren’t Available
Look for hand sanitizer with at least 60% alcohol — the concentration amount should be clearly stated on the label. Note that hand sanitizer won’t kill all microbes and isn’t effective for removing heavy soil or potentially harmful chemicals.
Wipe Down Surfaces in High-Traffic Public Places
When practical, use disinfecting wipes liberally on public surfaces you can’t avoid touching, such as airplane seats and tray tables, restaurant seats and tables, and children’s toys that come into contact with public surfaces.
Avoid Sketchy Water Sources
If you’re not sure the water is clean, don’t make yourself a guinea pig. Bottled water is expensive and bad for the environment, but it’s better (and likely cheaper) than a days-long battle with diarrhea or a multi-day stay in a foreign hospital.
Get Plenty of Sleep
It’s fun to stay up late sightseeing and enjoying the nightlife in your destination, but try to get at least seven to eight hours of sleep per night while you’re traveling. Sleep is when your body repairs itself, and staying up way too late multiple nights in a row or skipping ZZZs altogether can be a recipe for disaster. You’ll be tired, disoriented, and more vulnerable to illness.
If you’re having trouble falling asleep or staying asleep, consider natural remedies like melatonin or taking prescription medication. If you can squeeze in a nap while you’re in transit, take that opportunity as well to get as much rest as you can while also getting the most out of your trip.
Combat Altitude Sickness
If you’re traveling to the mountains from sea level, you could be at risk for altitude sickness. Also known as “acute mountain sickness,” altitude sickness is any physical distress your body experiences when it has difficulty adjusting to the lower oxygen levels found at high altitudes. It can manifest in many ways, including nausea, fatigue, headaches, shortness of breath, dizziness, loss of appetite, and trouble sleeping.
Altitude sickness is fairly common and occurs in people of all ages and physical fitness levels, so it’s worth being aware of if you’re on your way to a place that sits high above sea level. You can combat altitude sickness by getting plenty of sleep, avoiding alcohol, drinking plenty of water, and taking a pain reliever such as ibuprofen.
Be Smart About What You Eat
Foodborne illness can strike anywhere, including in the developed world. My sole bout with travelers’ diarrhea to date occurred as I was traveling in Europe. I’ve since been to Costa Rica and Thailand without any gastrointestinal trouble.
When choosing a street vendor or food stall, pick one where people are wearing gloves to handle food and aren’t handling food with the same hands they use to conduct cash transactions. Cash is notoriously grimy and germy, and you want to avoid getting those germs on the food you’re about to ingest. If you’re eating from a street cart or other non-restaurant vendor, try to choose one where you can see the food being prepared when you order it. This reduces the amount of time bacteria has to grow, compared with food that’s been sitting out for hours at room temperature.
Avoid uncooked foods like salads and fresh fruit if you’re not confident they’ve been washed or prepared with noncontaminated water. When in doubt, err on the side of caution and only choose produce with peels or that has been cooked or canned.
Limit Alcohol Intake
It can be tempting to drink more alcohol than you’re used to when you’re on vacation. However, it can compromise your immune system, which already takes a beating while you’re traveling. Consider indulging less, or abstaining completely, from alcohol while you’re on vacation.
If this doesn’t sound like fun to you, then make an effort to balance how much you’re drinking with other healthy activities, such as eating well, getting plenty of sleep, and drinking lots of water. Staying hydrated, especially if you’re in the sun a lot or walking around more than usual, will go a long way toward mitigating alcohol’s dehydrating effects. If you find yourself getting dehydrated, switch to water or a drink with electrolytes in it, such as a sports drink or coconut water.
Travel itineraries that are jam-packed from sunup to sundown can be a recipe for disaster. As tempting as it may be to cram in as much as you can when you’re on vacation, carve out some time for relaxing and resting. If you’re not a napper, find a local coffee shop or park where you can at least sit for a while and rest your feet.
Sightseeing is one of the best parts of vacation, but not if you’re too tired and sick to enjoy the sights. Especially during the first few days at a new destination, when everyone is recovering from jet lag and getting into the swing of vacation, allow a bit of time in the schedule to rest and recover. Your immune system will thank you.
Immediately Seek Emergency Care for Mammal Bites
Seriously, don’t delay and don’t worry about the cost. When rabies is a concern, hours matter — not least because post-exposure treatment isn’t always widely available in rural or underdeveloped areas. This advice also applies if you wake up to find a bat in your room, even if you’re not sure you’ve been bitten or scratched. Bat bites are very difficult to see with the naked eye, so you’re better off safe than sorry.
Know What to Do If You Get Sick
If you find yourself completely knocked out by illness while you’re on the road, it may be time to ask for help. Start with the front desk if you’re staying at a hotel and ask if they can recommend a doctor or hospital that takes foreigners and last-minute patients. If you’re staying in accommodations that don’t have a front desk, look online to see if there’s a local physician or clinic nearby that might be able to see you.
Alternatively, you can see if your primary care physician at home can give you some care suggestions or refer you to a clinic remotely via phone, video chat, or email. If you have a travel buddy who isn’t sick, you can send them to a pharmacy or store to stock up on supplies, including any medications you may not have with you in your travel kit.
If you’ve been sick for more than 24 hours, have an extremely high fever (above 102 F), or if you have flu-like symptoms and are visiting an area that’s known for malaria, it may be time to call in the big guns. Contact your insurance provider and see what they recommend based on your symptoms and coverage. You can also contact the local U.S. Embassy or Consulate for assistance through the U.S. Embassies, Consulates, and Diplomatic Missions website.
Finally, if you have travel health insurance, contact the provider to see what they can do to help, whether that’s getting you in at a local hospital or figuring out how to arrange transport back home.
Common Myths About Travel-Related Illness
Not all illness-avoidance advice is helpful. Some myths do more harm than good.
Myth #1: Restaurant and Hotel Food Is Always Safer Than Street Food
It’s all about the water. In many developing-world metropolises, the fanciest five-star hotels get their water from the same potentially tainted municipal sources as the lowliest street food vendors. Hotel buffets can be especially dangerous since they often keep food in the “danger zone” — the temperature range within which harmful microbes thrive — for hours on end.
Myth #2: Wearing a Mask Prevents Respiratory Illness
Surgical masks aren’t designed to be comfortable. Wearing one as you go about your business gets awkward pretty quickly. And while it’s not actively harmful to your health, donning a mask whenever you go out isn’t guaranteed to prevent respiratory illness. The CDC doesn’t mention wearing a mask among its recommendations to prevent influenza exposure or infection (although it doesn’t recommend against it, either). Because respiratory illnesses caused by coronaviruses are also transmitted via respiratory droplets, it’s fair to surmise this neutral stance extends to COVID-19 and common colds caused by coronaviruses (which are about 25% of all colds).
Myth #3: Standard-Strength Insect Repellent Is Adequate to Prevent All Mosquito Bites
Cheap insect repellent might ward off some insects, but it’s not enough in tropical settings where one bite could land you in the hospital. The CDC recommends insect repellents with DEET, picaridin, oil of lemon eucalyptus, or IR3535 as active ingredients. In my admittedly subjective experience, picaridin and oil of lemon eucalyptus are less offputting than DEET, which has a strong chemical odor. Regardless of which active ingredient you choose, aim for the highest possible concentration.
Myth #4: Garlic (and Other Folk Cures) Can Ward Off Biting Insects
A 2005 University of Connecticut study of the anti-mosquito properties of garlic pills “did not provide evidence of significant systemic mosquito repellence,” according to its authors. Insect repellent containing one of the CDC’s four preferred active ingredients mentioned above remains your best bet.
Myth #5: Not All Mammals Carry Rabies
As a tourist in the developing world, you’re more likely to encounter a rabid stray dog than, say, a rabid lemur. But lemurs can and do carry rabies. If one assails you as you traipse through the Madagascan jungle, you’d best treat the situation like the emergency it is. The same goes for cats, bats, monkeys, and any other furry creatures you encounter in your travels around the world.
Myth #6: Alcohol Kills Unfriendly Gut Microbes
If only preventing foodborne illness were so easy. Most commercially available adult beverages fall far short of the proof needed to kill microbes — at least 120 proof, or 60% alcohol. Your dinnertime glass of wine is maybe 12% to 14% alcohol; your after-dinner cocktail is 40% to 45% at most.
Myth #7: You Won’t Get Seriously Ill in Developed Countries
It’s safe to assume you won’t contract dengue in Chicago or malaria in Copenhagen. But you could still come down with a nasty case of foodborne illness that leaves you hospitalized or worse. In 1992 and 1993, an E. coli outbreak caused hundreds of hospitalizations and four deaths in four Western states, according to the CDC. The outbreak was eventually traced to tainted and undercooked hamburger patties sold at Jack in the Box restaurants in Washington, Idaho, California, and Nevada. No doubt some unfortunate travelers hungry for the familiarity of a quick-serve burger fell victim to this outbreak.
Earth is a germy place. Most of the lifeforms on this planet are too small to be seen with the naked eye. These microscopic organisms — single-celled bacteria and archaea, simple eukaryotes, and viruses — vastly outnumber more complex organisms like vascular plants and vertebrates. Most of Earth’s microbiome goes about its business without giving humanity a second thought. Some microscopic organisms actively work to our benefit, like the gut bacteria we depend on to extract nutrients and energy from our food.
Not all microscopic entities play nice, though. Virtually every frequent traveler has an uncomfortable and perhaps gross story about getting sick far from home. Some have more harrowing tales of falling gravely ill in unfamiliar lands. Though no amount of planning, preparation, or caution can completely eliminate the risk of travel-related illness, every traveler can take common-sense steps to reduce their exposure.
Have you ever fallen ill while traveling? How did you handle the situation? Have you changed your travel habits or behavior because of your experience?