Year-round, UAB medical faculty and staff journey to the four corners of the world to heal, teach, research, and explore. This holiday season is no exception, as you set out for the Ukraine, Africa, India, China, Europe, South America, and points in between. With offices in The Kirklin Clinic®, UAB Travelers' Health Clinic Director and geographic medicine expert David Freedman, MD, and partner Michael Kimerling, MD, advise domestic and international travelers on everything from pretrip immunizations to appropriate preventive behaviors to ward off travel-related diseases.

During a typical session, they assess inoculation and other requirements according to an individual's medical history, itinerary, and destination. "Vaccines, malaria drugs, and self-treatment for travelers' diarrhea are the pillars of what we do," says Dr. Freedman. "Secondly, we educate on preventive strategies, as most common travel illnesses can be avoided by being careful about food and water, not getting bitten by insects or animals, for that matter, and being careful to stay out of accidents." Depending on the destination and duration, Dr. Freedman might recommend vaccinations against hepatitis A and B, tetanus/diphtheria, typhoid, polio, yellow fever, measles, bacterial meningitis, and rabies. The most common vaccines can be administered at a single session.

He emphasizes that travelers to certain parts of Southeast Asia and other areas where the H5N1 influenza strain has been detected be inoculated against seasonal influenza. (See CDC Travelers' Health Web site, www.cdc.gov/travel/seasia.htm, for updates.) "If you're unlucky enough to come down with flu symptoms in an area where there's an outbreak of human avian flu, you could be quarantined with infected individuals and contract the H5 strain," he says. "So you don't want to appear remotely symptomatic."

Dr. Freedman for many years has packed the prescription antiviral oseltamivir (Tamiflu) to ease seasonal flu symptoms and as a prophylactic against the H5N1 strain, although it may not ward off a mutated human-to-human avian strain. The risk at present is in the droppings and respiratory excretions of domesticated poultry and some migratory birds, so he says to avoid live fowl, including those in farms and open markets. Eat no eggs and only well-cooked chicken. For any fever or influenza-like symptoms during or after travel to H5N1 areas, seek early medical consultation.

The user-friendly UAB Travelers Health Web site (https://start.tripprep.com/uabtraveldoc) provides destination country profiles with links to endemic illnesses, including malaria, Hepatitis A & B, rabies and influenza, among other afflictions, and covers immunizations, emergency planning, and food and beverage precautions. Headed to Cambodia? Dengue fever-carrying Aedes aegypti mosquitoes are daytime feeders with peaks of biting activity during the day, so use repellents and take other preventive measures at all times, being especially vigilant in the early morning and late afternoon. Peru? Prepare for abrupt altitude change when flying from Lima to Cuzco, the village at 11,500 feet near the ruins at Machu Pichu. Medical mission to Panama? Be vigilant about boiling water and avoiding raw vegetables and fruit to fend off Chagas disease and giardia. Falkland Islands? Reportedly well mapped and fenced off, there still are an estimated 14,000 land mines remaining from the war with Argentina in 1982.

Stay on the beaten path....

UAB Travelers’ Health Clinic is on call 24-7 to advise existing patients while traveling abroad, and upon their return regarding post-travel-associated disease. Contact the clinic at 205.934.1630 during the day. For urgent problems after hours, dial 205.934.3411 and page the Travelers’ Clinic physician on call.