Other precautions

• Protective footwear, this is particularly important due to the potential for tetanus. Injuries should be evaluated on site by a health-care professional. Of particular importance is room cleansing with soap and water.

• Food and water, major concerns are enteric pathogens, including hepatitis A and hepatitis E. The general recommendation is to consume food that is thoroughly cooked, and to avoid salads and ice cubes. If bottled water or a trusted source of water is not available, water should be boiled or disinfected (www.cdc.gov/travel/foodwater.htm). The traveler is recommended to carry loperamide and an antibiotic for self-treatment of acute diarrhea; this could be ciprofloxacin or azithromycin. These should be taken until the symptoms resolve, which is usually within three days. Diarrhea associated with blood or high fever indicates the need for consultation with a health-care professional.

• Mosquito bites, the risks include Japanese encephalitis, dengue, and malaria. Prevention will include use of insect repellent containing deet, wearing long-sleeved shirts and long pants when out of doors, and, as noted above, sleeping under a bed-net, preferably one treated with permethrin.

• Health kit, the health kit for travel should include medicines that are routinely taken, an antidiarrheal (usually loperamaide), an antibiotic for self-treatment for acute bacterial illness (such as a fluoroquinolone or azithromycin as recommended for diarrhea), insect repellent, sunscreen, and antimalarial drugs. It should be emphasized that professional health care in areas of natural disasters may be sharply limited. Also important is consideration of a food supply (preferably canned or processed) and a method of water purification.

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