International Travel:

When traveling international, you always have to be careful about your health. It is important to learn what is bad for your health when traveling to a specific country. Each country is different so you have to do special research.

Travelers to a foreign country need certain documents in order to be allowed in and out of the country. The most necessary of credentials is the passport. This is a formal document issued by governments to their citizens. It establishes the carrier's identity and nationality and authorizes travel outside the country. A United States passport is valid for either five or ten years. To obtain one an individual needs proof of citizenship, two recent identical photographs 2 by 2 inches (5 by 5 centimeters), proof of identity, and a fee payable to Passport Services. These must be accompanied by a signed application form. Passports may be obtained from passport offices in 13 cities, from some post offices, and from some clerks of federal or state courts.

Some countries also require travelers to show a vaccination certificate. Vaccination requirements vary, but common diseases against which visitors need immunity are cholera and yellow fever. Local health departments normally inform prospective travelers of infected areas in all parts of the world. Vaccination certificates can be obtained from passport offices. Individuals who plan to drive in foreign countries may need an international driver's license, usually available from automobile clubs. Travelers should also be aware of currency regulations, conversion rates, and customs regulations of countries to be visited.

There are some important things to be concerned about when traveling internationally. I will list some of the most popular things to look out for with your international travels below.

• Who gets travelers' diarrhea?: Travelers' diarrhea (TD) is the most common illness affecting travelers. Each year between 20%-50% of international travelers, an estimated 10 million persons, develop diarrhea. The onset of TD usually occurs within the first week of travel but may occur at any time while traveling, and even after returning home. The most important determinant of risk is the traveler's destination. High-risk destinations are the developing countries of Latin America, Africa, the Middle East, and Asia. Persons at particular high-risk include young adults, immunosuppressed persons, persons with inflammatory-bowel disease or diabetes, and persons taking H-2 blockers or antacids. Attack rates are similar for men and women. The primary source of infection is ingestion of fecally contaminated food or water.
• What preventive measures are effective for travelers' diarrhea?: Travelers can minimize their risk for TD by practicing the following effective preventive measures:
  1. Avoid eating foods or drinking beverages purchased from street vendors or other establishments where unhygienic conditions are present
  2. Avoid eating raw or undercooked meat and seafood
  3. Avoid eating raw fruits (e.g., oranges, bananas, avocados) and vegetables unless the traveler peels them.
  If handled properly well-cooked and packaged foods usually are safe. Tap water, ice, unpasteurized milk, and dairy products are associated with increased risk for TD. Safe beverages include bottled carbonated beverages, hot tea or coffee, beer, wine, and water boiled or appropriately treated with iodine or chlorine.
• Risks from Food and Drink: Contaminated food and drink are common sources for the introduction of infection into the body. Among the more common infections that travelers can acquire from contaminated food and drink are Escherichia coli infections, shigellosis or bacillary dysentery, giardiasis, cryptosporidiosis, Norwalk-like viruses, and hepatitis A. Other less common infectious disease risks for travelers include typhoid fever and other salmonelloses, cholera, rotavirus infections, and a variety of protozoan and helminthic parasites (other than those that cause giardiasis and cryptosporidiosis). Many of the infectious diseases transmitted in food and water can also be acquired directly through the fecal-oral route.
  
  To avoid illness, travelers should be advised to select food with care. All raw food is subject to contamination. Particularly in areas where hygiene and sanitation are inadequate, the traveler should be advised to avoid salads, uncooked vegetables, and unpasteurized milk and milk products such as cheese, and to eat only food that has been cooked and is still hot or fruit that has been peeled by the traveler personally. Undercooked and raw meat, fish, and shellfish can carry various intestinal pathogens. Cooked food that has been allowed to stand for several hours at ambient temperature can provide a fertile medium for bacterial growth and should be thoroughly reheated before serving. Consumption of food and beverages obtained from street food vendors has been associated with an increased risk of illness.
  
  Water that has been adequately chlorinated, by using minimum recommended water treatment standards used in the United States, will afford substantial protection against viral and bacterial waterborne diseases. However, chlorine treatment alone, as used in the routine disinfection of water, might not kill some enteric viruses and the parasitic organisms that cause giardiasis, amebiasis, and cryptosporidiosis. In areas where chlorinated tap water is not available or where hygiene and sanitation are poor, travelers should be advised that only the following might be safe to drink:
  1. Beverages, such as tea and coffee, made with boiled water.
  2. Canned or bottled carbonated beverages, including carbonated bottled water and soft drinks.
  3. Beer and wine.
  Where water might be contaminated, travelers should be advised that ice should also be considered contaminated and should not be used in beverages. If ice has been in contact with containers used for drinking, travelers should be advised to thoroughly clean the containers, preferably with soap and hot water, after the ice has been discarded.
• International Travelers with Disabilities: U.S. air carriers must comply with the U.S. laws and regulations regarding access for travelers with disabilities. Foreign airlines have varying regulations for access, which must be ascertained in detail from the carrier in advance of travel. Service animals are not exempted from compliance with quarantine regulations and so may not be allowed to travel to all international destinations. U.S. companies or entities conducting programs or tours on cruise ships have obligations regarding access for travelers with disabilities, even if the ship itself is of foreign registry. Extra services and accommodations for disabled travelers, often protected by legislation, are generally available in North America, Western Europe, and Australia and New Zealand, but very irregularly elsewhere.

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