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Travel Bits and Bites
(Immunization and Common Sense)

By Dr. Peter W. Kujtan, B.Sc., M.D., Ph.D.

Article printed in the March 15-16, 2008 issue of The Mississauga News
under the feature: Health, Wellness & Beauty, Medicine Matters.
Portrait of Dr. Peter W. Kujtan, supplied 2005
Dr. Peter W. Kujtan

What is the biggest health risk facing the young healthy holiday traveler heading to a known tourist destination for some 5-star poolside R&R? Scorpions? Malaria? Hepatitis? The answer is violence and traffic accidents, especially after sundown. Diarrhea, influenza and sexually transmitted diseases follow close behind. Just when you have your trip booked and bags packed, along comes a direct to consumer TV ad that suggests your destination is teaming with filth and purchasing their product is the only salvation. Assessing your travel risks by watching TV commercials will only lighten your wallet and bruise your arms. Medicinal products for travel are a small market, but targeting leisure travelers multiplies the profits. There are at least twenty different types of needles and numerous medicinal regimens available to "travelers". What you require depends largely on where you are going and what you are going to be up to. Few Doctors will advise against getting any relatively safe shot. But that advice is not free, and strangely not covered by OHIP. Even OHIP does not know why. Most family doctors feel that keeping their patients healthy while abroad is essential and so they keep their fees minimal. If you book in with your doctor solely for travel advice you will be responsible for the visit fee.

Imagine visitors arriving at Pearson for a short tour of Toronto in mid-January, wearing mosquito nets and rubbing arms still sore from rabies shots, because TV ads back home portrayed Ontario as a cesspool of Rabies and West Nile activity. Caribbean cruise ship personnel get the same chuckle when Canucks order drinks by the pool rubbing arms still sore from Hepatitis shots. When a friend informed me that our travel agent suggested Hepatitis shots for a Caribbean trip, I insisted on being switched to a cleaner ship. Cruise ships are inspected regularly and the scores posted on the Internet. Prevention is still better than prophylaxed submission. Many tropical and third world diseases do not have immunizing shots. A shot in the arm is no reason to let your guard down. Most people traveling to a Cuban resort, Mexican Riviera Hotel, Florida or Caribbean cruise need only a little knowledge and common sense to enjoy their holiday. As a general rule, travel companies and cruise-lines tend to avoid destinations with mandatory immunization requirements, no matter how beautiful they are.

Prepare for your trip by determining how much traveling you are going to do in the next few years. It is more economical to consider a long-term plan. Ensure that your own immunizations are up to date. We should all have some immunity or immunization for Tetanus, Diphtheria, Polio, Measles, Mumps, Rubella and Influenza. Many of us should also be up to date with Hepatitis B, Tuberculosis, Meningococcal and Pneumococcal immunity. For a specific upcoming trip, list all the major ports, airports, cities and islands that you plan to visit by name. Appreciate the difference between relaxing in the sun and building schools, digging latrines and so forth in highly rural areas. The more time you spend directly in contact with sewage, jungles, garbage and accompanying bugs, the higher your risk. For example, malaria is a problem currently in small areas of Dominican and Jamaica. Think of a flu shot, before asking for other pills. Most southern 5-star resorts bend over backwards to maintain clean water and spray extensively for mosquitoes. I recall a trip where I was enjoying a mint julep very late into the night and feeling smug that I have not even seen a mosquito. Shortly afterwards, a beat up old pick-up came waltzing down the lane billowing fogs of insecticide, the driver masked with a bandana. It turns out that spray was DDT, a carcinogen long ago banned in Canada, but a cheap way to wipe out flying pests. Malaria prevention is very wise, but malaria can be treated. Toxin exposure was a rude awakening in my travel experience. Visit any of our local travel clinics or www.cdc.gov, which is run by the Centers for Disease Control and Prevention in Atlanta, Georgia. It is just a tad more reliable than TV ads. Follow the link to Travelers' Health, which allows you to check all destinations on your itinerary for recommended preventative measures.

Perspective is the key. When I travel on medical missions, I assess the hazards and choose my protection, but for leisure trips in the sun, I tend to switch destinations when told to roll up my sleeve. My message is simple: common sense should rule and be careful after dark! Donít walk on dark roads and assume that all drivers are drunk. It might save your life.

Related resources:
Before You Go. Advice for Canadian travellers from Foreign Affairs and International Trade Canada.
Travel Reports and Warnings.
Travel Updates and Global Issues.
Travellers' Health by Centers for Disease Control and Prevention (CDC).
Travel Notices.
Diseases Related to Travel.
Cruise Ship Travel by Kiren Mitruka. Travelers' Health - Yellow Book, CDC.

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