International Travel Frequently Asked Questions

What vaccinations do I need?

There are three types of immunizations: routine, required and recommended. Recommended vaccinations are of particular importance to the international traveler.

  • Routine: Certain vaccines, such as Tetanus and Diphtheria, should be updated at least every 10 years.
  • Required: Proof of immunization for Yellow Fever and Meningococcus is required for entry to some countries.
  • Recommended: These vaccinations may range from Hepatitis A to Japanese B Encephalitis. We tailor our recommendations to your itinerary, planned activities, health status, medications, and previous immunizations. We guide you through specific country recommendations to ensure your travel is safe and worry-free.

What should I know about food and water safety?

Water — Ensure your water is purified

  • Drink only boiled or bottled beverages.
  • Avoid ice cubes that are not made from purified water.
  • Filtration alone is not recommended.
  • Brushing teeth should also be done with purified water. If it's not available, use hot tap water.

Food — Consume well-cooked food

Poor sanitation, unhygienic food handling and the heat and humidity of tropical climates all contribute to the growth of bacteria that contaminate food. While you'll want to experience local cuisine, it's wise to ensure food has been properly prepared and cooked to avoid illnesses, such as diarrhea, hepatitis A or infestation by parasites.

  • Ensure all food is well cooked -- especially meat and seafood.
  • Serve food hot. Bacteria grow quickly as food cools.
  • Don't eat leftovers, food from street vendors, or unpasteurized dairy products.
  • Never eat raw shellfish.
  • Avoid cold cuts, salads, watermelon and puddings.
  • Don't eat canned food if the tin appears "blown" or "swollen."

Can I eat raw fruits and vegetables?

Fresh fruits and vegetables may often be contaminated from the soil in which they grow.

  • Eat only fruits and vegetables that you properly wash and peel yourself.
  • Cook or bake fruit and vegetables that can't be peeled or washed.

Health tip - don't forget to wash your own hands carefully before eating or preparing food.

What is malaria?

Malaria is a serious, sometimes fatal, disease caused by a parasite. There are four kinds of malaria that can infect humans: Plasmodium falciparum, P. vivax, P. ovale, and P. malariae.

Where does malaria occur?

Malaria occurs in over 100 countries and territories. More than 40% of the people in the world are at risk. Large areas of Central and South America, Hispaniola (Haiti and the Dominican Republic), Africa, the Indian subcontinent, Southeast Asia, the Middle East, and Oceania are considered malaria-risk areas.

How common is malaria?

The World Health Organization estimates that 300 to 500 million cases of malaria occur each year and more than one million people die annually of malaria. About 1,200 cases are diagnosed in the U.S. each year, mostly immigrants and travelers returning from malaria-risk areas. A few cases result from blood transfusions, as passed from mother to fetus during pregnancy, or are transmitted by locally-infected mosquitoes.

How do you get malaria?

Humans get malaria from the bite of a malaria-infected mosquito. When a mosquito bites an infected person, it ingests microscopic malaria parasites found in the person's blood. The malaria parasite must grow in the mosquito for a week or more before infection can be passed to a person. If, after a week, the mosquito then bites another person, the parasites go from the mosquito's mouth into the person's blood. The parasites then travel to the person's liver and enter red blood cells; this may take as little as eight days or as long as several months. Once inside the red blood cells, the parasites grow and multiply. The red blood cells burst, freeing the parasites to attack other red blood cells. Toxins from the parasites are also released into the blood, making the person feel sick.

What are the signs and symptoms of malaria?

Symptoms of malaria include fever and flu-like illness, including shaking chills, headache, muscle aches and tiredness. Nausea, vomiting and diarrhea may also occur. Malaria may cause anemia and jaundice (yellow coloring of the skin and eyes) because of the loss of red blood cells. Infection from P. falciparum, if not promptly treated, may cause kidney failure, seizures, mental confusion, coma and death.


For most people, symptoms begin 10 days to four weeks after infection, although a person may feel ill as early as eight days or up to one year later. Two kinds of malaria, P. vivax and P. ovale, can relapse; some parasites can live in the liver for several months and up to four years after an infected mosquito bites a person. When these parasites come out of hibernation and begin invading red blood cells, the person will become sick.

How is malaria diagnosed?

Malaria is diagnosed by looking for the parasites in a drop of blood. Blood will be put onto a microscopic slide and stained so that the parasites will be visible under a microscope. Any traveler who becomes ill with fever or flu-like illness while traveling or up to one year after returning home should immediately seek professional medical care. You should tell your health care provider that you have been traveling in a malaria-risk area.

Who is at risk for malaria?

Persons living in, and travelers to, any area of the world where malaria is transmitted.

What is the treatment for malaria?

Malaria can be cured with prescription drugs. The type of drugs and length of treatment depend on which kind of malaria is diagnosed, where the patient was infected, the age of the patient, and how severely ill the patient was at the start of treatment.

How can malaria be prevented?

Visit your health care provider four to six weeks before foreign travel for any necessary vaccinations and a prescription for an anti-malarial drug.

  • Take your anti-malarial drug exactly on schedule without missing doses.
  • Prevent mosquito and other insect bites.
  • Use DEET insect repellent on exposed skin and flying insect spray in the room where you sleep.
  • Wear long pants and long-sleeved shirts, especially from dusk to dawn -- this is the time when mosquitoes that spread malaria bite.
  • Sleep under a mosquito bed net that has been dipped in Permethrin insecticide if you are not living in screened or air-conditioned housing.

What is altitude sickness?

Altitude sickness, which can have serious consequences and can be fatal, can be caused by rapid ascent to altitudes over 9,000 ft. It's important to discuss altitude sickness and its prevention with your travel health care professional, who may prescribe prophylactic medications.

What can I do?

  • Make your ascent gradually. If mountain climbing or hiking, take a one- or two-day break at an appropriate altitude during ascent.
  • Drink extra fluids.
  • Don't overexert yourself.
  • Avoid sedatives, codeine and alcohol.

What should I know about jet lag?

Travel across three or more time zones disrupts the body's natural rhythms. Your internal clock, which regulates your sleep-wake cycle, becomes out of sync with the time at your new locale.

What are the symptoms of jet lag?

Jet lag has a variety of symptoms including headaches, sinus irritation, insomnia or other disturbed sleep, fatigue, muscle soreness, irritability, loss of appetite, nausea and other stomach problems, disorientation, clumsiness and weakness.

What can I do to prevent jet lag?

  • For a few days before your departure, change your sleep patterns -- go to bed an hour earlier if traveling east, or an hour later if heading west.
  • Get plenty of rest the night before your trip.
  • Try to get a good sleep on the plane.
  • Exercise as much as you can. Stroll at the airport between flights, walk up and down the aisle of the plane, or do stretching exercises in your seat.
  • Drink enough fluids to reduce the effects of dehydration from the dry air of the plane cabin, avoiding alcohol and caffeine.

How can I recover from jet lag?

Each person's body responds differently to jet lag, but some common suggestions for recovery include:

  • Once you reach your destination, try not to sleep until nighttime.
  • Adapt to your new routine -- meals, activities, rest -- as soon as possible.
  • Use natural light to reset your internal clock.
  • Consider taking the dietary supplement Melatonin a half hour before going to bed (unless you have epilepsy or take medication to prevent blood clotting). A recommended dose is 2 to 5 mg (depending on body weight).

What should I know about preventing injuries while traveling?   It is important to note that more travelers are injured in foreign countries, than come down with travel –related illness. Travel-related mortality most often occurs from heart attacks, motor vehicle accidents, and other injuries. To reduce your risk and maintain safety, follow these guidelines: Always wear a seatbelt Bring a car seat for infants, and place them in the back seat Consider hiring a qualified guide or driver Do not be afraid to tell your driver to slow down or use more caution Lease a larger rather than smaller vehicle Know the meaning of all street and traffic signs Be sure to have collision/liability insurance Remember that a driver approaching a traffic circle must yield the right of way to those already in the circle Know the route to your destination Do not drive or travel at night, especially in rural areas Do not ride a motorcycle, moped, or bicycle (even if you are experienced) Carefully select swimming areas and don’t swim alone, don’t swim intoxicated or at night Avoid small, nonscheduled airlines in less developed countries Do not hitchhike or pick up hitchhikers Do not sleep in a car or RV, unless in a legal campsite Review hotel fire safety rules and locate nearest exits If possible, book a room between the second and seventh floors- high enough to prevent easy entrance by intruder Keep hotel room locked at all times Keep valuables and travel documents in your room or hotel safe Avoid excursions into remote areas of countries known to have drug trafficking Don’t accept rides or drinks from someone you just met Familiarize yourself with local laws and customs and abide by them