Travel Tips

Travel Tips
* indicates sites containing very important resources

*Air Ambulance & Medical Insurance*
Airline Check-In Time
Airport Screening
Airline Tickets
Airlines & Aircraft Flight Following
Bedbugs
Calling Cards
Children-Safety, Vaccination, Adoption & Other
Colostomy
Celiac Disease
Dehydration & ORS
Diabetes
Disabilities
Disaster Relief Workers
Documents-Passports, Drivers License, Credit Cards
Driving
Exit Tax
Fulbright Scholarship & Other Study Programs
*Help in a Foreign Country (US State Department Site)*
Hepatitis B, Hepatitis C & HIV Exposure
Implanted Device
Luggage Carry-On
Luggage Checked
Medication
Medication-Counterfeit
Monkey Bites
Passports & Visas
Pets & Traveling
Phones-International & Satellite
Motion Sickness
*Safety Issues*
Saudi Arabia Hajj Requirements
Sleeping Pills
Studying Abroad
Tetanus Booster & Whooping Cough
Yellow Fever Vaccination Certificate

Air Ambulance & Medical Insurance
All travelers should have medical insurance and evacuation insurance. Air ambulance transport is very costly and requires cash up front. Make sure the evacuation coverage you purchase meets your needs. Air evacuation from Grenada to Miami may cost $25,000 and from Africa to the US, it will be over $100,000. This coverage may also be used for emergency transportation within the US, as part of your trip. The cost of evacuation insurance is relatively inexpensive.

Medical coverage (in addition to evacuation insurance) is important. Some hospitals will not discharge a patient until their bill is paid in full. Only the largest medical centers may accept an international credit card. While it's true medical care is less expensive in some countries, the cost depends on the duration of illness as well as seriousness.

If you have chronic medical problems, consider a travel insurance with assistance plan. Add trip cancellation insurance to the basic plan if you have children or sick family members at home or have any other reason that your trip could be cancelled. This usually doubles the price of travel insurance. Medicare does not cover out of country hospitalization or medical costs. See the broken ankle, implanted defibrillator and Nepal accident stories.

Airline Check-In Time
Airlines have minimum check-in times. (Check with your local airline.) Travelers should take check-in times seriously, as airlines are becoming increasingly strict about enforcing them. In purchasing an airline ticket, you are agreeing to these times. Your seat may be forfeited and you may be placed on stand-by, if late for check-in.

Travelers are urged to arrive at the airport:

2 hours before domestic flights
3 hours before international flights

Travelers may be denied boarding passes at check-in when less than sufficient time remains for a security check.

Airport Screening
CDC site: www.tsa.gov/travelers

Airline Tickets
Passengers holding tickets purchased from discount online companies are often the first to be bumped due to overbooking. If you do not use travel agents, consider purchasing online directly from an airline. Always keep the 1-800 number of the airline with you and try rebooking by cell phone if your flight is cancelled.

Airlines & Aircraft Flight Following
This is an easy way to know when your flight will arrive or where your loved ones or friends currently are in flight. Simply enter the tail number of the aircraft or flight number of the aircraft. Several different companies offer these services free:

http://flightaware.com (easiest to use)
www.flightexplorer.com

Bedbugs
Bedbugs are common worldwide. A resurgence of bedbugs has been reported in North America and Europe. On returning home, launder all clothes or dry clean. Check luggage for these 1/2 inch long reddish brown creatures hiding in crevices. Vacuum out and lightly fog the inside of luggage with house & garden insecticide and close up baggage.

Calling Cards
Calling cards may seem like a reasonable way to go but watch out for added fees that are hidden until you get the bill, especially when out of country. A $10 calling card could cost you over $100. Consider using an international cell phone or the internet.

Children-Safety, Vaccination, Adoption & Other
Do not give antihistamines to young children or infants which can result in short term irritability, fussiness, insomnia and hyperactivity making travel and sleeping more that a memorable event!
CDC site: "Traveling with Children: Resources"

A certified letter, from the embassy of the country of entry, may be required for a child or minor to travel in that country unaccompanied by both parents.

Vaccination records from orphanages in China and other countries are often not reliable for a variety of reasons. Many experts re-vaccinate adopted children regardless of vaccination records.

Colostomy
"Travelers flying with a colostomy should wear a large bag and bring extra supplies, because bowel gas output may increase with expansion of intestinal gas during flight. Since gas expands in flight, water should be substituted for air in devices secured by air-filled cuffs or balloons, such as feeding tubes and urinary catheters."
Merck Manuel of Medical Information Second Edition Online

Celiac Disease
Gluten enteropathy can pose difficulties for travelers with this disorder. Carrying a gluten-free restaurant guide card with you can prevent problems while dining out. This card and information are available in many foreign languages here.

Dehydration & ORS
Dehydration from traveler's diarrhea may occasionally become severe, requiring oral rehydration solution (ORS) or iv fluids. ORS was developed to treat life threatening dehydration associated with cholera. It can be made from common kitchen baking items or purchased in premixed packets. ORS is not particularly tasteful and should be sipped not gulped. Recipes are available here.

Diabetes
If you have diabetes and are taking insulin syringes with you or have an insulin pump, you should look at "Traveling With Diabetes Supplies." Also see "When You Travel." Insulin can be exposed to x-rays under normal conditions but excessive exposure can be harmful. Do not leave insulin in your packed bags, as it may under go excessive temperature changes and prolonged x-rays exposure.

Disabilities
CDC site: "Special Needs Travelers"
Covers the following topics:

International travelers with disabilities
The immunocompromised traveler
Pre-conception planning, pregnancy and travel
Breastfeeding and travel
Traveling with children
International adoptions

TSA site: "Travelers with Disabilities and Medical Conditions"

Disaster Relief Workers
CDC site: "Health Recommendations for Relief Workers"

Documents-Passports, Drivers License, Credit Cards
Before your trip, pack a photo copy of your passport, drivers license, visa, yellow fever vaccination certificate, insurance numbers, medication list and person physician phone number. Leave a second copy of these with a family member or friend who can mail them to you special delivery, if needed.

Or, scan the above documents into your computer and e-mail them to yourself. (After scanning, save them as a low quality file for easily downloading and try printing them to ensure the size and quality are what you need.) If the need arises, they can be retrieved by any computer in the world and printed.

Consider mailing any sensitive and valuable documents ahead by special courier.

Inform your credit card company that your are going out of the country, as they may put a block on your card when they see out of country charges. Be prepared for a block even if you call them. See credit card loss.

Driving
Always wear seat belts. Motor vehicle accidents are common in developing countries. Roads and vehicles are often in poor condition and drivers sometimes make erratic or unexpected moves. Unless you are experienced in driving in under developed countries, do not drive yourself especially at night or if the driving lane is on the left side of the road.

Exit Tax
Many countries have an exit tax that must be paid in US dollars. An additional smaller tax may be required in local currency. Be sure to arrive at the airport of departure with the exact amount needed in both US dollars and local currency. Do not expect to make change at the airport.

Fulbright Scholarship & Other Study Programs
Fulbright Scholarship and other study programs may have very specific requirements dealing with medical issues such as vaccination or malaria prophylaxis (prevention). Not having them completed properly may delay your contract issue or departure.

Help in a Foreign Country (US State Department Site)
Covers the following topics. Click here.

Lost/Stolen US Passports Abroad
Financial Assistance for US Citizens Abroad
Arrest/Incarceration of US Citizens Abroad
Locating US Citizens Abroad in the Event of an Emergency
Medical Emergencies Involving US Citizens Abroad
Death of US Citizens Abroad/Estate Matters
General Emergency Information for US Citizens

Hepatitis B, Hepatitis C & HIV Exposure
Occupational Exposure To Hepatitis B, Hepatitis C & HIV:
Health care workers are at risk for contracting hepatitis B, hepatitis C and HIV, especially with needle sticks. Working in developing countries places an added risk.

Hepatitis C postexposure prophylaxis is currently not recommended. All health care workers should have been vaccinated for hepatitis B.

Missionary health care workers, such as surgeons, nurses and others with potential needle exposure should consider carrying at least three days of HIV postexposure prophylaxis (PEP) medications with them. The preferred regimen for PEP most frequently uses combivir (AZT+lamivudine) and lopinavir/ritonavir (Kaletra). Unfortunately, Kaletra cannot be stored at room temperature for a long period. Nelfinavir is thus preferred in most tropical settings. So far, resistance has not been a serious issue in most developing countries, which do not significantly use HAART (highly active antiretroviral therapy).

Efavirenz (Sustiva) can be used in PEP but caution is recommended if the traveler is on mefloquine (Lariam) because of an additional risk of neuropsychiatric side-effects.

"Updated U.S. Public Health Service Guidelines for the Management of Occupational Exposures to HBV, HCV, and HIV and Recommendations for Postexposure Prophylaxis." MMWR June 29, 2001

"Updated U.S. Public Health Service Guidelines for the Management of Occupational Exposures to HIV and Recommendations for Postexposure Prophylaxis." MMWR September 30, 2005

Nonoccupational Exposure To HIV:
Travelers may rarely be exposed to infectious body fluids of a suspected or infected HIV person. This can occur through accidental needle sticks from discarded needles in public settings i.e., parks & buses, sexual intercourse with commercial sex workers, sexual assault and injection-drug use.

A 28-day course of HAART (highly active antiretroviral therapy) is recommended for persons who have had nonoccupational exposure to blood, genital secretions, or other potentially infected body fluids of a persons known to be HIV infected, when that exposure represents a substantial risk for HIV transmission and when the person seeks care within 72 hours of exposure. When indicated, antiretroviral nPEP (Nonoccupational Postexposure Prophylaxis) should be initiated promptly.

"Antiretroviral Postexposure Prophylaxis After Sexual, Injection-Drug Use, or Other Nonoccupational Exposure to HIV in the United States." MMWR January 21, 2005.

If you are a physician or concerned traveler not experienced in PEP, keep the phone number and e-mail with you of persons who are experienced in PEP or see hotline below. Contact immediately if needed. PEP must be done within 24 to 36 hours to be effective.

CDC Hepatitis Hotline:
Hepatitis Branch, Mailstop G37
Division of Viral and Rickettsial Diseases
National Center for Infectious Diseases Center for Disease Control and Prevention Atlanta, GA 30333
(404)-332-4555
Hepatitis B, Hepatitis C & HIV PEPline for Physicians:
The National Clinicians' Post-Exposure
Prophylaxis Hotline
Phone: 1-888-448-4911
Hours: 24 hours/ 7 days a week

Implanted Device
When passing through security with an implanted electronic device, such as an AICD (automatic implantable cardiovertor defibrillator) or a permanent pacemaker, you should carry a Pacemaker Identification Card or a signed letter from your doctor. This should be on his official letterhead clearly showing his phone number and explaining what device is implanted. (These documents are probably of more value to you than the TSA.) The current recommendation is to explain which implanted device you have and do not use the walk through screener or hand wand, instead ask for a pat down.

Orthopedic devices, such as artificial hips, artificial knees can also alarm. A similar letter or card as above should be carried in these cases. During security screening explain your case and ask for a wand check.

Non-implanted silicone breast prostheses have caused detainment. A similar letter or card as above should be carried in these cases. These should not alarm during wand or walk through screening

Luggage - Carry-On
What is allowed as a carry-on varies somewhat with each airline. It is recommended that you check with your airline.

Always carry on:

Electronic equipment, cameras, film
Cash and jewelry
Medication, prescriptions and keys

Luggage - Checked
Things to consider:

Special items, such as scuba gear, bicycles and surfboards, require extra time to check-in and a special handling charge.
Air carriers in Asian and Latin American countries may allow a total weight of only 44 pounds baggage.
Many foreign airlines allow only one checked bag and a very small carry on.
Some international departure locations will not allow any over weight baggage.
Many airlines are now charging a fee for each checked bag

Airline rules depend on your membership in special programs and whether you paid full fare for your ticket. For example, flying first class usually entitles you to more pieces of luggage and a higher weight limit. Never assume that being "a few pounds over limit" will not cost you. Those two bottles of hot sauce from Mexico could cost you $50 in over weight fees! Check with your airline.

Checked baggage recommendations:

Do not lock your baggage
Place your name and address on the inside as well as the outside of your baggage
Creams, lotions and liquids should be kept in Zip-lock bags

Medication
During airline check-in, do not check your medicines with your baggage. Keep all medicine in your carry-on.

Security agents will only allow medications at carry-on if the name on the label matches the passengers' ID. The same rules apply for liquid medications.

Tightly fitting snap caps on any bottle may pop off as the airplane reaches higher altitudes. Medicine bottles and pre-filled daily medicine dispensers with these caps should have a small slit cut in the cap to allow air equalization, thus preventing medicines from bursting out into bag.

Medication-Counterfeit
Travelers from Western countries often take for grant that the medicines they buy at home are reasonably safe and will do what they are intended to do. One should not take this approach in a developing country which may have serious counterfeit medicine problems. Always purchase the medicines you will need for your trip at home and bring two weeks worth extra, in case of delays and unexpected itinerary changes.
http://wwwn.cdc.gov/travel/contentCounterfeitDrugs.aspx

Monkey Bites
Monkey bites in travelers is common. This poses a serious problem because monkeys carry Cercopithecine herpesvirus 1 (referred to as the herpes B-virus) and sometimes rabies. Also, serious bacterial infections may result from the bite. Though herpes B-virus infection is rarely reported in tourists and rabies from monkey bites is extremely rare, they are fatal diseases that can be prevented by antiviral therapy with acyclovir and rabies vaccination, respectively.
http://www.cdc.gov/ncidod/eid/vol4no1/ostrowsk.htm
http://www.cdc.gov/ncidod/EID/vol12no06/06-0030.htm

Passports & Visas
Many countries require passports to be valid for six months after entry.

Keep passports and yellow vaccination certificates together. After your trip place them in a Zip lock bag in your refrigerator freezer door. It will be fire proof and in a location easily remembered.

If your child or spouse is traveling to another country, have a valid passport and visa yourself, in case you need to travel for an emergency.

Emergency travel to a country which requires a visa prior to entry can be difficult. Find the country embassy or consulate issuing visas in your location of the US and call them immediately to arrange obtaining an emergency visa. Call your congressman immediately if you have difficulties.

The US State Department has extensive information for international travelers, including medical, visa and passport information.

Pets & Traveling
CDC site: "Importation of Pets, Other Animals and Animal Products into the US"

Phones-International & Satellite
If you are leaving loved ones behind, consider purchasing cell phones at your destination or renting an international cell phone or satellite phone. US cell phone companies sell packages with everything you need for international travel. Check with your cell phone provider.

Or, do a Google search for "sat phone" and you will find numerous providers that ship the phone to your home and provide shipping packages for return. Rent one for your group and split the cost.

Many cities and airports around the world have shops that sell ready to use cell phones with prepaid time. A very convenient and no hassle way to have phone service when traveling.

Motion Sickness
Motion sensitive travelers should keep in mind that the trip may not be over after landing at your destination. Driving on winding mountain roads, ocean excursions, hot bus trips and short small plane hops should be prepared for with motion sickness prevention medicines.

Safety Issues

Drugging food, beverages, cigarettes or gum is an increasingly common method of robbery and assault; regardless of your gender, never accept any of these items from strangers, no matter how sincere they appear.
Never leave drinks or food unattended, particularly in bars.
Avoid traveling alone, especially after dark or in remote areas.
Women should not travel with or accept escort from any man they are not thoroughly knowledgeable about.
Do not open hotel doors to anyone you do not know personally.
Never travel showing signs of affluence, such as wearing expensive clothes or jewelry.
All cities have experienced increased crime toward tourists which are considered easy marks.
Never share taxi rides or car rides with passengers that are not personal acquaintances.
Recreational drugs can be tampered with or can be highly potent and designed to incapacitate users.

Saudi Arabia Hajj Requirements
Meningitis Vaccine:
Vaccination with a quadrivalent vaccine (serogroups A, C, Y and W135) such as Menomune® or Menactra® is required for entry into Saudi Arabia by all persons over the age of 2 years traveling to Mecca for pilgrimage (Hajj or Umra) or for seasonal work. Vaccination must be at least 10 days before entry. Saudi Arabia requires a booster every 3 years for Menomune®. Their requirements for Menactra® boosters are unknown at this time.

Menomune® or Menactra® are not recommended for children under the age of 2 years. Children between the ages of 3 months and 2 years of age must be given two doses of the meningitis serotype A vaccine with a 3-month interval between the two doses.

Yellow Fever Vaccine:
All travelers arriving from countries known to be infected with yellow fever must present a valid yellow fever vaccination certificate in accordance with the International Health Regulations.
World Health Organization [WHO] Weekly
Epidemiological Record

Polio Vaccine:
Sandi Arabia requires proof of immunization from all individuals <15 years of age who are traveling from countries reporting will poliovirus into Saudi Arabia for any reason, including the Hajj; up-to-date proof of polio vaccination is required of these persons to obtain visas for entry. In addition, irrespective of proof of previous polio immunization, persons <15 years of age traveling from countries reporting wild poliovirus are required to receive an oral polio vaccine upon entering Saudi Arabia.

Although not required of US citizens traveling for pilgrimage to Mecca for Hajj, immunizations to prevent hepatitis A and B, typhoid, polio and flu are highly recommended.

All Hajjis should be well informed before pilgrimage to Saudi Arabia. Informational links for Hajji and Umrah pilgrims.

Sleeping Pills
Do not take Ambien, Lunesta, Rozerem or other sleeping pills until your flight has taken off. Weather or mechanical problems after boarding, may require you to deplane and return to the boarding area or ticketing area while you are highly sedated and incompetent to make important decisions.

Do not take these medications on flights of less that eights hours duration. Always take a test dose of a sleeping pill at home before use during a flight.

Studying Abroad
CDC site: "Travel Health Tips for Students Studying Abroad"

Tetanus Booster & Whooping Cough
Tetanus & whooping cough (pertussis) boosters are often forgotten in adults. This can cause difficulties when minor injuries occur, and the traveler cannot find a clinic for a tetanus booster or does not know their vaccination status. Vaccinate before your trip, and ask for the new tetanus combination booster which contains both tetanus and acellular pertussis vaccine for whooping cough.

Adults and adolescents are commonly infected with pertussis, not aware that their irksome, barking cough, for the past four weeks is pertussis. Previous vaccination or infection as a child does not give lasting immunity.

Tetanus known as "lockjaw" and pertussis are serious illnesses. Pertussis is highly infectious and can be fatal for unvaccinated infants. Both illnesses occur worldwide. Tetanus is rare or never reported in travelers but pertussis is more common than realized.

In March of 2006, the CDC published it's recommendation that adolescents receive one dose of Tdap to prevent pertussis infection and outbreaks.
www.cdc.gov/mmwr/PDF/rr/rr5503.pdf

In December of 2006, the CDC published it's recommendation that adults, in particular certain groups, such as health care workers, receive one dose of the newly licensed Tdap vaccine to prevent pertussis infection and outbreaks.
www.cdc.gov/mmwr/PDF/rr/rr5517.pdf

All unvaccinated travelers are at risk for pertussis. See a video clip of an infant with whooping cough at this site:
www.pertussis.com

Yellow Fever Vaccination Certificate
Yellow fever certificates are supplied to you at the yellow fever vaccination site. This certificate must be signed by you, and stamped and signed by the vaccinating clinic to be valid. It also has a section for recording other adult or travel vaccinations.

Always keep this certificate with your passport for safe keeping and bring it with you to your next travel doctor visit. YF vaccination is required 10 days before the certificate is valid and every 10 years.