Foreign travel can be exotic, fun -- and sickening, if you're not properly prepared

Detroit Free Press (MCT) - Before they ever stepped on the plane to Tanzania last month, Linda and Chuck Blaksmith got their shots.

Yellow fever. Hepatitis A and B. Tetanus. Polio booster. Typhoid. A flu shot. They packed antibiotics, Imodium and Pepto-Bismol. They started their anti malaria pills.

Then the Michigan couple flew off and had a fabulous time on safari.

"I can't imagine what would top this wonderful experience," says Linda Blaksmith. "We made my dream come true."

The recession may be slowing U.S. travelers down, but the overall trend in the world is that more people than ever are traveling abroad. More than 903 million people traveled internationally in 2007, according to the United Nations World Travel Organization, up from 457 million in 2004. By 2020, the number is expected to be 1.6 billion.

That means more people visiting family and friends, studying, working and enjoying themselves in every corner of the globe _ including lots of spots where exotic diseases and travel health nuisances flourish.

But researchers say that many travelers don't take precautions seriously _ particularly people who are traveling back to the country of their birth to visit family or friends and assume they're immune.

The World Health Organization estimates that only 34 percent of Americans visiting areas high in hepatitis A get immunized. Only 8 percent of international travelers to malaria-prone countries take pills to prevent it _ and 30,000 travelers come down with malaria each year.

Dr. Jeffrey Band, chief of infectious diseases and director of the InterHealth travel clinic at Beaumont Hospital in Royal Oak, Mich., says he once had a whole family refuse typhoid immunizations although they were visiting a high-risk area in Africa. Most of the family came back fine, except for the teenage son, who ate street food, drank the water and contracted typhoid _ a serious illness that can cause high fever and delirium.

There also are lesser-known illnesses causing problems in parts of the world.

"Right now, the big worry is Chikungunya fever," says Band, who used to work at the U.S. Centers for Disease Control and Prevention in Atlanta.

Chiku-what? Turns out it's a virus spread by mosquitoes, similar to Dengue fever, that is found in Africa and parts of Asia _ with current outbreaks in Indonesia, Malaysia, Singapore, Sri Lanka and even Italy. Flu-like reactions, rash and joint pain are symptoms. There is no immunization for it _ you protect against it with strong DEET mosquito repellant.

However, of all the things to worry about while traveling, Chikungunya fever probably shouldn't be at the top of your list. Worry more about travelers' diarrhea, by far the most common travel illness.

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A survey by the GeoSentinel Surveillance Network, which estimates the risk of illnesses in various parts of the world, found that 60 percent of all visitors to developing countries get travelers' diarrhea because of bad bacteria in food and drinks, no matter how many precautions they take.

The Blaksmiths both got it in Tanzania but were able to treat it with Cipro antibiotic and anti-diarrheal medicines. Linda Blaksmith felt better quickly.

"I took it right away and I was only sick for a few hours," she says. "My husband waited and did not feel well for three days."

Along with travelers' diarrhea, mishaps most likely on a trip are sunburn, jet lag, motion or altitude sickness, respiratory infections and accidents.

"For some reason, many of us when we travel see our common sense go out the window," Band says. And the main cause of death while traveling? A pre-existing health problem like heart disease.

So he doesn't want to scare off travelers from their adventures.

"I've not seen yellow fever," he says. "I have about five or six patients a year with malaria. I've treated maybe 60,000 travelers, and no more than three people decided to avoid a destination for fear of illness or immunizations."

On the other hand, if pressed, he admits he's seen some unusual cases _ from a patient with a weird parasitic disease caused by eating unpasteurized cheese to a traveler who contracted rabies from a puma bite.

When people travel, diseases travel, too. Think SARS. HIV. Measles. Polio. TB. Flu. Colds. Meningitis.

After a worldwide meningitis uptick in 2001 was traced back to people who had visited Mecca in 2001, Saudi Arabia began requiring that every one of the estimated 2 million pilgrims coming for the Hajj each year prove they've been vaccinated against the disease.

Band describes himself as a medical detective. He helped solve the riddle of toxic shock syndrome in the early 1980s. He points out that not all travel illnesses come from exotic countries _ Martha's Vineyard, the upscale vacation island in Massachusetts, has a high risk of Lyme disease. The Southwest has something called valley fever.

But fewer than half of travelers get pre-trip counseling and advice, and very often, they receive the wrong advice, says Band. He'd like that to change.

"I spend a lot of time talking people out of immunizations they don't need. So many people treat travel medicine like it's a cookbook _ you find online what you need. But it needs to be personal," depending on the traveler's age, health conditions, he says.

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The other thing that worries him is that physicians back home may not bother to ask a sick patient if they've been out of the country recently, which is critical in correctly diagnosing illnesses like malaria or hepatitis that have been picked up abroad.

"Things are so connected now that rare and unlikely diseases are literally a plane ride away."

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WHERE TO GET SHOTS

At least six weeks before your trip, check with the U.S. Centers for Disease Control and Prevention to see which vaccines or medicines you need for the country you will be visiting. Go to www.cdc.gov/travel or call the hotline at 877-394-8747.

Ask your doctor whether he or she can provide any immunizations that are covered by insurance. Vaccinations are obviously cheapest if your health insurer will pay for them _ but don't expect it to cover anything beyond routine shots.

Next cheapest are county health departments, but they don't offer all shots that travelers to exotic destinations may need. Travel clinics are more expensive, but also comprehensive.

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© 2009, Detroit Free Press.