A lingering infection is not the souvenir you want to bring home from your foreign vacation. Here are the basics you need to know to make your decision or whether to get vaccinations for yourself and your loved ones before you take off for your next international trip. It's a long article and not especially interesting reading, but the decisions you make regarding travel health safety may save not just your vacation but your life.

Anthrax has occurred worldwide, but it is most common in cattle-raising areas of Chad, Ethiopia, Zambia, China, and Mongolia. Although pulmonary anthrax is extremely dangerous, most infections result from handling infected cattle hides and only affect the skin. One of the rare reports of a traveler contracting anthrax concerned a Belgian tourist who had indirect contact with dead antelopes and a hippopotamus. Birds do not carry anthrax.

Anthrax vaccinations are not widely available. The initial symptom of cutaneous anthrax is an itchy round black bump about 1 inch (2-3 cm) across, typically on the upper half of the body. With medical treatment, over 99 per cent of people who contract cutaneous anthrax recover.

Cholera is a potentially serious form of diarrhea caused by a toxic reaction to bacteria usually entering the body through contaminated beverages or raw shellfish. Just a few seconds of exposure to boiling water or similar heat, however, kills the germ, and even when cholera bacteria are swallowed, stomach acid usually kills it. For generations doctors have advised travelers, "Boil it, cook it, peel it, or forget it." Following this simple advice almost completely eliminates risk of the disease.

Every year, nonetheless, a very few travelers contract cholera. Travelers who are most susceptible to cholera are those who take antacids or proton pump inhibitors or any other medications for GERD. Reducing the acidity of the stomach increases the likelihood of the bacteria's survival to reach the intestine. In addition, people with blood type O are more likely to contract the disease. The risk of travelers from developed countries developing cholera, however, is very small, approximately 1 case among every 500,000 travelers.

Of all the infectious diseases that strike travelers, influenza is the one for which they are most frequently immunized. The scientific literature suggests, however, that prevention is possible with simple hygiene. A recent article in BMC Health notes that not even a mask is necessary for avoiding the flu. Even if you get the virus on your hands, it will be dead in 5 minutes. Where you need to be careful is handling steel or porcelain surfaces, where the flu virus can survive for up to 48 hours (Bean et al, 1982). So, first, plan to take some clean wipes.

Then consider antibiotics. It's important to remember that antibiotics never relieve the symptoms of influenza, although they may be helpful for secondary bacterial infections.

It's almost impossible to know for sure that an illness is influenza on the basis of symptoms alone. The cough, runny nose, headache, high fever, loss of appetite, muscle pain, and extreme fatigue of the flu can also be caused by a bad cold, by bacterial infections such as sinusitis or pneumonia, and by dengue, malaria, and typhoid. If you experience flu-like symptoms in the tropics, consider all the possibilities with a local physician, if possible.

Hepatitis is a catch-all phrase meaning inflammation of the liver. There are many causes of hepatitis, including alcohol, medications, aflatoxins from improperly stored corn, food sensitivities, and autoimmune disease, but far and away the most common is viral infection with hepatitis A. In hepatitis A infection and other forms of hepatitis, early symptoms include lack of energy, loss of appetite, nausea, vague aches and pains, dark urine, and pale stools. It's not unusual for people with hepatitis A to develop a strong aversion to cigarette smoke. In some cases there is a yellowing of the skin, or jaundice, after several days. Infectious hepatitis can be distinguished from non-infectious hepatitis by fever.

Hepatitis A virus (HAV) is spread through contaminated water, raw shellfish, and uncooked fruits and vegetables washed with contaminated water. The virus is shed with the stool dissolved invisibly in untreated tap water. HAV can also be spread person-to-person by infected kitchen workers.

The symptoms of hepatitis A usually aren't noticed until 10 to 50 days after infection. Persons who have been exposed to HAV can infect others before symptoms are noticed and until about a week after the development of jaundice. In children, there may be no symptoms at all.

Even when you know you have been exposed to HAV, infection is not inevitable. The CDC estimates that approximately 1 in 10,000 cases of HAV results in serious consequences to health, usually to children under 5 or adults over 50, and usually where there is existing liver disease. The good news for 9,999 out of 10,000 who do not develop serious symptoms is that hepatitis A is mild, usually resolves itself without treatment, and confers lifetime immunity. Once you get hepatitis A, you will never get it again. With very little effort, you will not develop the disease at all.

Hepatitis B affects 1 out of every 3 people on earth. The WHO estimates that over two billion people worldwide are infected the hepatitis B (HBV) virus, and 350,000,000 infect others. HBV is spread through the same routes as HIV, but is much more infective.

HBV is passed not only through sexual contact, but also through sharing of needles (both needles in syringes and tattoo needles), razors, and even toothbrushes (when one user has bleeding gums). HBV is not passed on by hugging, kissing, or shaking hands, sharing food and rink, eating from the same serving dish, or by using the same toilets, towels, or cutlery.

Although HBV vaccination has become common, there is little reason to take the shots just for travel abroad. If you are concerned about the possibility of needing transfusions or blood products while abroad, consider joining the Blood Care Foundation.

Hepatitis C is a similarly dangerous viral infection found in as many as 170,000,000 people worldwide. Although the hepatitis C virus (HCV) can also be spread by sexual contact, it is more commonly spread by shared needles or blood transfusions. There is no HCV vaccine.

Japanese encephalitis is a viral infection spread by Culex mosquitoes in areas farmers grow rice and raise pigs. Infection with the virus is most common just after the monsoon. Avoiding mosquito bites preventions infection, and, only 1 in 250 people infected with the disease develops symptoms.

Among those who develop symptoms, however, the disease is usually severe: weight loss, stiff neck, drowsiness, and aversion to light, with long-term neurological problems. Approximately 1 in 10 people who develop symptoms dies even in advanced treatment facilities; with limited treatment, mortality rates approach 40 per cent for adults and 50 per cent for children. Because of the severity of the disease, vaccination may be a good idea for travelers who know they will be exposed to it. Outbreaks of Japanese encephalitis just after the monsoon season occur in Bangladesh, Bhutan, Brunei, Cambodia, China, Japan, Laos, Nepal (especially the Terai region), the area of Russia near Vladivostok, Taiwan, Thailand, and Vietnam. Extreme northern Queensland and the islands of the Torres Strait in Australia have also suffered outbreaks.

The vaccine for Lyme disease, Lymerix, was taken off the market in 2007.

Once almost a rite of passage for elementary school aged children, measles no longer occurs in the US (the approximately 150 cases a year occurring among travelers returning from abroad, but continues to infect children even in developed countries in Asia and Latin America. Symptoms of measles range from the benign (a rash without itching or fever) to the deadly (pneumonia and brain damage), but the disease is preventable by vaccination (usually required for admission to public schools). If you are not immune to measles, and your child has not been and will not be vaccinated, try to avoid contact with infected persons and fortify your diet with additional vitamin A-rich foods. The yellow and orange fruits and vegetables contain the carotenes the body needs to make the vitamin; cream, butter, and oily fish are a direct source of the vitamin. Inadequate vitamin A increases risk of severe symptoms.

Despite worldwide efforts to eradicate polio carried out for over 40 years, the polio virus still infects small numbers of people in Afghanistan, Angola, Cameroon, Chad, Ethiopia, India, Indonesia, Myanmar, Namibia, Niger, Nigeria, Pakistan, Somalia, and Yemen.

The polio virus is spread by direct contact with the feces of an infected individual (typically, changing diapers without sufficient hand washing afterwards) or through contaminated drinking water. Children under 5 are the most vulnerable to the disease, although it can strike at any age. Even though most infections with polio do not lead to symptoms, the disease is incurable and untreatable. Vaccination, nowadays given by injection, is recommended for anyone who plans to travel to any country where the disease still exists.

Rabies does not occur everywhere. It is not found in Bermuda or Hawaii, most of the Caribbean, or Uruguay, and does not occur in Australia or New Zealand. It is unknown in Western Europe, Hong Kong, Japan, Kuwait, Lebanon, the Sabah province of Malaysia, Qatar, Singapore, and the United Arab Emirates. There is no rabies in Antarctica. In the rest of the world, however, rabies in endemic both to wild animals and domestic pets.

Rabies treatment no longer requires painful injections to the abdomen, but it must be started as quickly as possible. Symptoms of infection may not occur for one to even three months after exposure. There can be slight or general paralysis, and painful spasms of the throat can occur after sight, sound, taste, or even thought of water (hence the term, hydrophobia. Once symptoms commence, there is no treatment, and only one person has ever been documented to survive the disease.

Tetanus is serious disease caused by infection with the bacterium Clostridium tetani. The bacillus that causes tetanus is most often introduced to the body through wounds contaminated with dirt, dust, feces, or saliva, or through crushing wounds or burns. In the United States, however, tetanus has been documented in cases involving clean superficial cuts and scrapes, dental procedures, surgery, insect bites, and intravenous drug use. The symptoms of tetanus occur 3 days to 3 weeks after infection, sometimes after the wound has healed. The first symptom is usually "lockjaw," or trismus, followed by painful spasms spreading down the neck, trunk, and extremities. In children, seizures are common. Complications of intravenous feeding and bedsores are common during treatment.

Tetanus occurs in every country in the world. Even in the United States and Europe, 10 to 20 per cent of cases result in death, even with the hospital care. At a minimum, any wound that may have been contaminated by dirt or feces should be carefully cleaned, and dead tissue removed during the course of healing. Since the disease is almost entirely preventable by vaccination, regular tetanus shots should be carefully considered.

Avoid Dehydration on the plane and find out more about Traveler's Diarrhea than you ever knew you needed to know. Robert Rister is author of nine books and over 2,000 articles on natural health.
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