Copyright © 1996,1998 by Cynthia Teeters. All rights reserved.

Pre-Travel Immunizations
Traveler’s Diarrhea
Malaria
Pre-Travel Medical Advice
Travel Tips

Pre-Travel Immunizations

While it is true that you will find individuals who did not take extra precautions and were able to travel to adopt without pr oblems, the stress which often accompanies adoption and especially adoption travel will lower a person's resistance to disease. For many of us, we have no experience with the diseases described below but they all represent illness which at best could significanntly hinder your ability to parent a newly adopted child and at worst could seriously threaten your life.

There is really no excuse not to explore the necessity of receiving pre-travel immunizations with a qualified physician experienced in infectious diseases or, even better, a travel clinic. Parents adopting internationally should consider immunization protection for all members of the family. This may include both those traveling and those who will be subsequently in contact with the adopted child.

The Centers for Disease Control, CDC, does not require protecting yourself before traveling. However, it does recommend healthy adults consider the following inoculations.

• Hepatitis A
• Hepatitis B
• Diphtheria/Tetanus (DT) booster within the last 10 years
• Typhoid
• Polio booster
• All recommended childhood immunizations

(If you are planning to travel with children, older adults, or someone with a known medical condition please use extra caution and the assistance of a qualified physician in making sure they are completely protected.)

Hepatitis is an inflammation of the liver caused by a virus. In developing countries hepatitis A, HAV, is transmitted in contaminated drinking water, on improperly handled food, and from intimate contact with an infected individual. Providing primary care to a child is considered intimate contact. The average incubation period for hepatitis A is 30 days with a range of 15 to 45 days. The severity of the disease increases with increasing age of the infected individual. In many developing countries where sanitation is poor, children less than 9 years of age typically show evidence of prior HAV infection. Infe cted children under the age of 5 may show no symptoms at the time of their infection.

You can either receive the vaccine (if you have 4 or more weeks) or the immune globulin (IG) shot prior to traveling. The hepatitis A vaccine licensed in the United States, HAVRIX®, is an inactivated vaccine and, for adults, is a series of two shots. The second is given at six months to a year later. Immunity is obtained 4 weeks after the initial injection, although the second dose is necessary for long-term protection. For children, it is a three shot series with the second given one month after the first. Immune globulin is recommended for children less than two years old or for persons desiring only short term protection. While most vaccines can be administered simultaneously, the administration of IG may interfere with other immunizations if given at the same time. Many physicians recommend the vaccine as the IG injection does not provide long term protection as does the vaccine.

Hepatitis B is a ver y serious blood-borne viral infection of the liver contracted from intimate contact. The immunization protocol is a three-shot, six month process with the second shot being administered one month after the first. The vaccination is not a treatment for someone who is already infected with hepatitis B. When given to family members and close contacts, it will provide some protection after the second injection and full protection after the third.

More and more adoptive families are choosing immunization for Hepatitis A and B prior to adoption because of the unknown health status of the child they wish to adopt. I strongly recommend starting these immunizations even if you are unable to complete the series before you travel. I have heard anecdotal stories of adoptive parents who have contracted Hepatitis B not knowing that their newly adopted child was infectious. Even if a child has been tested negative for Hepatitis B, the test results may be wrong or the child could have been exposed to the virus af ter the test was administered. When approaching health insurance companies requesting coverage, it may be prudent to stress that this is being done because of the potential risk of infection from the adopted child. Local health organizations such as your county health department may also provide the immunizations at no or reduced fees.

Typhoid vaccination is recommended for travelers going to areas of developing countries such as Latin America, Asia, and Africa, even though it is not 100% effective. The vaccination is particularly recommended for those who will be traveling to smaller cities or rural areas. Since the typhoid vaccination is not completely effective, care must still be taken with food, water and other drinks.

Along with receiving the above vaccines, make sure that all of your own childhood immunizations are complete and also make sure your diphtheria/tetanus (DT) booster is current. There has been a reported outbreak of diphtheria in parts of the former Soviet Union. Protec tion against tetanus makes sense for all individuals but especially since you will be traveling to locations where it is possible to receive an injury but where you would be reluctant to seek a DT shot.

Polio is on the rise in many parts of the world and adopting a child puts you at risk for exposure to the wild polio virus. Consider, therefore, requesting a booster shot. This may also be a concern for older members of your extended family whether they travel or not as children given the oral vaccine can shed the virus and be slightly infectious.

If it is the time of year to do so, you may also wish to consider receiving a vaccination against influenza. Yes, you would probably survive the flu but do you really want to be suffering from it soon after your adoption?

The CDC does not routinely recommend receiving a cholera vaccination. Cholera shots are painful and not very effective. It should, though, be considered for people who have ulcers or who plan to visit an area where cho lera is currently endemic. Other diseases such as dengue fever, Japanese encephalitis, yellow fever and rabies may also be endemic in the area you are expecting to travel. Typically the risk of these diseases will be low but getting specific advice from a qualified physician or from the CDC is recommended.

Traveler’s Diarrhea

Traveler's diarrhea (TD) has symptoms that include diarrhea, cramps, bloating and nausea. It is usually resolved in a few days to a week. TD may be prevented by taking careful precautions against infection from contaminated food and drinks. The risk from food contamination is lowest in private homes and highest for food from street vendors. Untreated tap water, raw fruits and vegetables, ice and shell-fish are also potential sources of infection. Strict personal hygiene when changing diapers (you may wish to bring gloves) and assisting children with their personal hygiene is strongly encouraged.

The CDC does not recommend water filters for the elimination of water-borne disease. They recommend that tap water be boiled, then allowed to cool. You may also wish to use bottled water if it is more convenient. Be careful of the source of bottled water. The carbonated kind is more likely to be uncontaminated. Do not allow ice to be added to drinks unless you know that it has been prepared from boiled or bottled water. They also caution that raw fruits, vegetables, salads and shell-fish not be consumed. Hot foods and hot drinks are probably safe. Fruits that are peeled such as oranges and bananas are also safe. Use safe water when brushing teeth and other precautions so that untreated tap water is not consumed .

Dehydration is the greatest concern for sufferers of diarrhea. Clear drinks, fruit juices, soft drinks, and saltine crackers can be given to adults. If a child is suffering, immediately try to prevent dehydration by giving soups, thin porridges, and other uncontaminated b everages that the child will accept. Avoid milk and milk products. Infants should be given an oral rehydration solution (ORS). Pedialyte® or Kao Lectrolyte™ are both commonly found in stores here in the US. Either can be included in your packed medicines and used for this purpose. Kao Lectrolyte™ has the advantage that it comes as a powder and is therefore easy to pack and has a long shelf life. Generic ORS is also widely available abroad as a powder. If you are using the powder, it should be prepared using boiled or treated water. Alternately, you can create a cereal-based ORS by mixing 1/2 cup of infant rice cereal with 2 cups boiled water and 1/4 teaspoon of table salt.

For all the individuals suffering from diarrhea, give small amounts of the fluids being used to prevent dehydration as frequently as possible. Also, while you are attempting to prevent dehydration, consult a physician about further treatment. If there is bloody diarrhea or more than 8 diarrheal stools in 8 hours; fever above 102° F; persistent vomiting, or signs of dehydration such as no wet diaper for more than 8 hours, dry mouth, or crying that produces no tears; seek immediate medical assistance.

Malaria

Malaria occurs in Central and South America, Africa, India, and Southeast Asia. Symptoms include sequential chills, fever and sweating; headache; muscle pains; and anemia; and can occur months after returning home. Individuals who have symptoms of malaria should seek immediate medical assistance. Because malaria is transmitted by mosquitoes, the risk can be reduced by wearing insect repellent containing DEET, staying in well-screened accommodations, using mosquito nets, and covering most of the body with clothes. Use proper procedures when applying the insect repellent, especially to children.

The use of anti-malarial medication may also be indicated. Since there are drug-resistant forms of malaria, the choice of the specific drug must be made knowing which part of the world is being visited. Typically, an anti-malarial drug regimen is begun before you travel and continued after you return home.

Pre-Travel Medical Advice

Discuss both with your physician and pediatrician when and how you should self-treat either yourself or your child (either the one traveling with you or your newly adopted child) while in the foreign country. Impress upon them that you may not wish to use medical services within that country and review with them the list of medicines you are planning to take. Specifically mention diarrhea and ear infections to your pediatrician and request instructions for treatment. You might ask to get a prescription for a general broad-spectrum antibiotic, to be self-administered if needed, from your physician or pediatrician. Some will and some will not give you one.

Be aware that your newly adopted child will be flying on a plane for the first time. Discuss with your pediatrician what might be appropriate to give to the child before flying. Ask about decongestant and sea sickness pills. You also may find them useful along with suggested methods to minimize jet lag.

A good travel clinic associated with a major teaching hospital will be most current on what diseases are prevalent for the part of the world to which you are traveling. Additionally, they may assist with immunizations, prescriptions and other travel advice.

The best way to know what the CDC (http://www.cdc.gov/travel/index.htm) is recommending is to read their fact sheets yourself. There are fact sheets containing general information about traveling and fact sheets specifically detailing health concerns to people traveling to specific places. They also have fact sheets describing their recommendations for children's immunizations.

The CDC also provides these fact sheets to anyone having access to a fax machine. Their number is 404-332-4565 and is a touch tone menu system. You call and they send to your fax machine a list of available fact sheets. You then choose the ones you want, call again and they send those to you. You will be told how long to wait before receiving your fax.

Travel Tips

• Obtain suggested immunizations in advance of other travel planning.
• Check that your health insurance covers medical attention while traveling or otherwise obtain additional coverage.
• Decide before traveling, or shortly after arriving, how, if needed, you would obtain emergency medical attention.
• Consider seeing a dentist before traveling.
• Bring in carry-on luggage an adequate supply of prescription medicines along with copies of all prescriptions.
• Bring another pair of glasses along with a copy of your optical prescription.
Bring the phone number and address of the US embassy as well as contact information of your physician and a close relative or friend.
• Bring a basic first aid kit.
• Use precautions with food and drinks.
• Use precautions with personal hygiene.
• Use precautions to prevent insect bites.
• Use precautions against accidental poisonings of children with medicines stored in luggage.
• Abstain or be very careful with alcohol consumption.