Medical Advice for Travelers

NY/HELP Honduras

Developing countries, such as Honduras, have many health problems common to all the Third World. Many of these can afflict travelers, especially those who visit rural areas. These health problems range from the relatively minor (which can still make your trip uncomfortable) to the possibly life-threatening. Most, however, can be prevented by proper preparation before you go, and by sticking with simple hygienic practices while in the Third World.

TRAVELERS' DIARRHEA is a common problem, but can be largely avoided by following a few simple rules: Eat ONLY food that is served hot, fruit that you peel yourself, or drinks that are either served HOT (like coffee or tea) or that come in an official bottle (such as Coke, Pepsi, beer, or bottled water). A few exceptions: bread and candies that appear clean are generally safe; ice cubes and raw vegetables (including lettuce and tomatoes!) are NOT!

Treatment for Travelers' Diarrhea involves taking in plenty of fluids. For severe diarrhea (such as cholera) oral rehydration salts are available. For acute episodes, it is helpful to take medications such as Imodium to control the diarrhea, plus an antibiotic such as Cipro 500 mg, taken twice a day for three days. Most experts don't recommend taking antibiotics to try to prevent travelers' diarrhea, because of potential side effects. However, Pepto-Bismol, 2 tablets 4 times a day, may help prevent this problem if you wish to try it.

IMMUNIZATIONS can help to prevent many serious diseases (which tend to spoil your trip or its aftermath!). Even if you stay home, you should have a TETANUS-DIPHTHERIA (Td) shot every 10 years. Anyone born after 1956 (and who has not had two doses of measles vaccine or documented immunity) should have a single dose of MEASLES or MEASLES-MUMPS-RUBELLA (MMR) vaccine. This should be given at least two weeks before an immune globulin shot. POLIO is another disease for which your immunizations should be up-to-date. Everyone should have a primary series, and travelers to developing countries outside the Western Hemisphere should have one booster dose of ENHANCED INACTIVATED POLIO VACCINE .

Travelers to rural areas should be immunized against HEPATITIS A. One shot of Havrix should be given at least 2 weeks before departure. For travelers who will be making repeated trips, a booster dose 6 to 12 months later is needed. Vaccination against HEPATITIS B is important for health-care workers and for people traveling to certain areas other than Honduras.

In rural areas, TYPHOID is also a possibility. A live oral vaccine (Vivotif Berna), which provides excellent protection, is now available; it should be taken at least two weeks before you go. (Antibiotics should not be taken for at least two weeks after the oral vaccine.) A booster dose every 5 years is recommended. Alternatively, an injectable vaccine (Typhim Vi) may need to be used, with a booster dose every 2 years. CHOLERA is present in Central and South America, but immunizations are not very effective (and therefore not recommended). However, the same precautions as suggested for Travelers' Diarrhea should be followed!

YELLOW FEVER is a problem in much of South America and in Africa south of the Sahara, but has not been reported in Central America north of Panama. Immunizations are required for travel to these areas, and can be gotten at authorized centers, including the Travel Clinic at Children's Hospital of Buffalo (878-7372).

RABIES is present in many developing countries. Unless you are working with animals or staying for a long while, immunization is not recommended. HOWEVER, YOU SHOULD NOT PLAY WITH THOSE CUTE DOGS, CATS, OR MONKEYS! Take a picture from a distance, and avoid any bites or scratches.

MALARIA is present in many areas, especially rural ones. To reduce the risk of contracting malaria, prophylaxis is strongly recommended. For Central America north of Panama, and for much of the Middle East, CHLOROQUINE (Aralen) 500 mg (300 mg base) every week, is sufficient. In other tropical areas, MEFLOQUINE (Lariam) 250 mg once a week, is recommended. You should start the appropriate medicine one week before departure and continue for 4 weeks after you return. (The latest advice on areas requiring malaria prophylaxis can be obtained from the Travel Clinic at Children's Hospital, 878-7372.) The use of mosquito repellents containing DEET (such as Off or Cutters), long sleeved shirts and long pants during the evening hours, and screens and mosquito nets when available, can reduce the chance of catching any insect-borne diseases, including malaria and DENGUE. None of these measures are 100% effective; be sure to see a doctor (and tell them where you've been!) if you have an illness with a high fever while traveling, or for up to a year afterwards.

SUNBURN is a common problem for many of us, and using a good sunscreen lotion can be very helpful. If you are taking any PRESCRIPTION MEDICINES, be sure to bring enough for your entire stay, in properly labeled bottles. Since AUTO ACCIDENTS are common, and rescue squads scarce, be sure to drive carefully, wear your seat belt, and avoid traveling while holding on precariously or perching on top of vehicle loads!

Remember the above, and enjoy your journey!

Centers for Disease Control, Recommendations for International Travelers.

The Medical Letter, "Advice for Travelers," 40:47 (April 24, 1998)

Gordon F. Comstock, MD
Medical Advisor
NY/HELP Honduras

March 1, 2003