- The Washington Times - Tuesday, August 27, 2002

Globe-trotter Cynthia Hultquist, 46, of Baltimore rarely gives much thought to her health before she embarks on one of her many journeys. "When I was younger, we'd be cautioned, 'Don't drink anything except bottle water, don't eat local produce unless you could peel it," says Ms. Hultquist, of the extent of her preparations.
When she began planning for a trip to South Africa with her parents, which begins Thursday, she decided she better ask her doctor if she should prepare for any health contingencies.
Good thing she did.
Traveling to foreign lands can be adventurous and mind-expanding. It also can be dangerous even deadly. Foreign lands offer more than rich landscapes and civilizations to explore. They can harbor diseases like yellow fever, malaria and tuberculosis, which can turn a vacation into a nightmare.
Preparation, typically in the form of a battery of inoculations, can keep such horrors at bay.
Ms. Hultquist was referred by her doctor to the Center for Wilderness and Travel Medicine at Mercy Medical Center in Baltimore. The center, led by Drs. Michael Zimring and Ben Koppel, provides patients with pre- and post-travel consultations and immunization shots. Travelers are told the health risks associated with each country they plan to visit.
For Ms. Hultquist, that meant shots for tetanus and hepatitis A.
"I did get the feeling that some of [the advice] could be overkill. Western medicine tends to overdo all the precautionary stuff," Ms. Hultquist says.
Dr. Zimring, the center's medical director, doesn't deny that he errs on the side of safety. He knows what is at stake.
"Sometimes maybe we're overcautious, but I'd rather be overcautious then have [the families] pay five grand to have their family members [fly home] to them in a box," he says.
Inoculations cannot guarantee a healthy trip they offer protection in the 90 percentile range but they can give some peace of mind.
Travelers will feel the pinch in their wallets, too. Most insurance companies won't pick up the tab, unless the trip is for business reasons.
A traveler will pay an average of $200 to $300 for the necessary shots, though a series of three rabies inoculations can cost up to $600.
Inoculations have different periods of effectiveness.
A yellow fever vaccine can last 10 years, while a shot for hepatitis A might protect someone for up to three years. But, if the person receives a second hepatitis A shot within a year of the first injection, the duration time jumps to 10 years.
For a trip to, say, Tanzania, doctors might suggest a battery of injections from yellow fever to hepatitis A, typhoid fever, rabies and influenza.
The shots also can leave patients ill for a while as their bodies adjust to the medication.
The treatment recommended by a center like Dr. Zimring's also depends in what order various countries will be visited.
"If you go to Ecuador, you won't need a yellow fever shot," he says. "But if you come from an area where yellow fever is endemic, they [Ecuador officials] won't let you in without a shot."
It also matters what kind of trip you take, and the places you intend to visit, Dr. Zimring says.
"Are you out there in the urban areas? Are you going to go out there taking care of people? It tells us what shots we should give you," he says.
One local university recently began a program to improve existing vaccines, including for meningitis and malaria.
The University of Maryland School of Medicine Center for Vaccine Development (CVD) won a five-year, $22 million federal research contract toward the creation and testing of new vaccines.
Inoculations are only part of the preparation some travelers take before leaving the country.
Travelers whose existing insurance doesn't cover out-of-country health care costs can buy insurance from companies specializing in overseas trips.
One such group, Baltimore's Medex Assistance Corp., covers a variety of costs, from medical treatment to emergency evacuation, up to $100,000.
Clients pay $4 a day for the service, with a seven-day minimum and must pay a $25 deductible.
It is a small price when the alternatives are considered, says Dr. Zimring, who serves as a regional medical adviser with the insurance firm.
He recalls a young woman who nearly died after she broke her kneecap traveling through Mexico. Her husband had to give local doctors $4,000 up front for her to be treated, he says.
"They brought her into an operating room with blood on the floor when they started," Dr. Zimring says.
Though the operation proved successful, she developed venal thrombosis during her economy-class flight back to the United States.
The condition, essentially blood clots that formed in her legs and lungs, was caused by her extended inactivity during the plane ride.
She survived the ordeal, he says. Others might not be as fortunate.
Plenty of her fellow countrymen are willing to take such risks to see the world.
Dr. Martin Wolfe, director of Travelers Medical Service of Washington, says the travel bug bites people across demographics.
"It's all ages. Younger people tend to either backpack or take a truck across Africa. Older people often go on tours that are organized," says Dr. Wolfe, whose service helps travelers with shots and medical advice. "It's not as strenuous."
Young or old must be wary of the danger abroad, often from benign sources.
Unpeeled fruit may have been washed in dirty water, Dr. Wolfe adds.
"The best thing is to eat food hot out of the oven or the pot," he says.
Mary Hendi, a travel nurse consultant with Foxhall Immunizations in Northwest, says Africa, India and China are the top destinations of late, with interest in Middle Eastern visits on dramatic decline due to safety concerns.
Mrs. Hendi says information comes into her office daily concerning medical concerns at various destination points.
Her patients often have no idea of the potential dangers awaiting them.
"I've had adults traveling with family abroad who are just dumbfounded when they hear all the disease risks they may encounter," says Mrs. Hendi, who has been giving shots in recent months to area economists traveling abroad to help build up the economies of devastated nations such as Afghanistan.
Danielle Nazelrod-Davis, a 30-year-old Baltimore resident who works at Mercy Medical Center with Dr. Zimring, needed several vaccinations to prepare for her recent honeymoon through Tanzania and Kenya.
Mrs. Nazelrod-Davis received shots for meningitis and hepatitis A, plus a booster shot for tuberculosis.
She also took mefloquine, a prescription pill to help prevent malaria. In addition to shots, travelers often need to take other medication before their trips and should check with their physicians about any side effects and whether the medication is right for them.
Some patients become ill from all the inoculations they must endure. Mrs. Nazelrod-Davis reported feeling a little lightheaded after her shots, but the side effects were short-lived.
The travel consultants agree that too many travelers don't plan ahead, despite the potential dangers.
Dr. Zimring says for every person who allows months of preparation time, there are dozens who call "at the last minute."
Travelers must have a yellow fever shot 10 days before entering some countries, he says.
"You don't want a shot at the border," Dr. Zimring says. "Those needles are not like our needles."
He recommends at least a four- to six-week window before the trip begins.
Dr. Zimring says travelers shouldn't be dissuaded by all the necessary precautions.
"If they go and come in advance and get the proper shots, they can enjoy their holiday and adventures without getting sick," he says.

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