All students and employees traveling abroad are expected to review this material before making any Travel Health appointments or receiving any required immunizations. This information may also be useful to anyone traveling abroad. Learn more about: Traveler's Health Kit Air Travel Safety Illnesses While Traveling Aquatic Hazards Sexual Health and Wellbeing Mental Health Personal Safety and Injury Prevention After Travel Other Resources Traveler's Health Kit All international travelers should prepare and bring a travel health kit tailored to their individual health needs. There are commercially available health kits that you can purchase, or you can assemble one on your own. Be sure to pack your Travel Health Kit and any prescription medicines in a carry-on bag rather than packed in luggage to avoid loss or theft. Review this checklist of what include in a Traveler’s Health Kit. Additional lists of more specific items to pack can be found by searching your destination on the CDC Traveler’s Health website. Medication Restrictions: Customs authorities strictly regulate the importation of medications. Certain medications, including inhalers and some cough, cold, allergy, or sinus medications, may be prohibited and can result in detention for up to several weeks. In addition to narcotics and other controlled substances, banned ingredients include those deemed to be stimulants, such as pseudoephedrine, levomethamphetamine, and the common cough suppressant dextromethorphan. Review more information and a list of prohibited items. Be careful of purchasing medications while abroad. Learn more about counterfeit medications. Travelers with chronic illness or disabilities should carry along a medical summary of their condition(s). Since travelers may visit areas that are far from English-speaking medical providers, travelers should discuss needed prescription medications and emergency plans with their medical provider(s), and/or during a UHS Travel Health appointment. COVID-19 We recommend all students complete a primary series of COVID vaccine. International travelers are recommended to be up to date with their COVID vaccine boosters. All student travelers should be familiar with the COVID-19 public health policies they may be required to follow traveling to and within their destination. Air Travel Safety Jet Lag Jet lag is caused by a mismatch between a person’s normal daily rhythms and a new time zone. It is a temporary sleep problem that usually occurs when you travel across more than three time zones but can affect anyone who travels across multiple time zones. Jet lag can affect mood, ability to concentrate, and physical and mental performance. Fortunately, travelers can take steps to minimize the effects of jet lag. A word on Melatonin: The use of this nutritional supplement is controversial in the prevention of jet lag. While taking low doses of this supplement may be effective, as a nutritional supplement the production of melatonin is not regulated by the FDA (Food and Drug Administration). Therefore, there is no assurance that commercially available products contain the dose listed on the bottle, contain any melatonin at all or are free of contaminants. Low Oxygen Environments Low flying aircraft may not have a pressurized cabin and the air pressure is still lower on jets with pressurized cabins than on the ground. Individuals with certain medical conditions such as heart conditions or chronic obstructive pulmonary (lung) disease may need supplemental oxygen during flights. Blood Clots Sitting for prolonged periods during air travel increases the risk of forming blood clots in the legs, especially in those with clotting disorders, are on an estrogen containing oral contraceptive pill. Read more about preventing blood clots while traveling. Ear and sinus symptoms Changes in air pressure during flights can cause difficulty hearing and discomfort in the ears and sinuses, especially in those with upper respiratory illnesses. Taking over the counter decongestants or antihistamines may help with these symptoms. Remember to check medication restrictions for your destination. Illnesses While Traveling Proper hand washing is the most important precaution you can take to prevent illness during travel. Some common illnesses experienced by travelers are: Foodborne and Waterborne Illness Traveler’s Diarrhea Airborne Infections Heat Illness High-Altitude Sickness Illnesses Transmitted by Vectors (mosquitoes, ticks, and other pests) Foodborne and Waterborne Illness It’s important to understand how to treat water and prepare foods to avoid illness. Many illnesses can be acquired from contaminated food and water such as E. Coli and Salmonella infections (including typhoid fever), hepatitis A, cholera, and many illnesses associated with parasites. In any area where sanitation may be poor, steps must be taken to reduce your risk of infection. Studies show it matters more where travelers eat and drink than what they eat and drink. People who eat in restaurants or from street vendors abroad are at significantly higher risk of foodborne and waterborne illnesses than those who eat meals prepared at home. Traveler’s Diarrhea Traveler’s diarrhea (TD) is the most common illness in travelers, occurring in about one third of all travelers to developing countries. Infectious bacteria, parasites, and viruses are the primary causes of TD. Normally, TD is a self-limited, (usually goes away on its own) illness that causes 3 to 4 days of watery diarrhea. Common symptoms associated with TD include abdominal cramps, nausea, headache, and a low-grade fever. Rarely is the condition life-threatening. Dehydration is a common problem that leads to symptoms after you develop TD. Following the food and water precautions listed above can decrease the likelihood of developing TD. However, even meticulous attention to food and water consumption does not guarantee that you will be symptom-free. Travel from industrial countries to developing countries may cause sudden changes in the types of microorganisms that inhabit one’s gastrointestinal tract. As a result, TD may occur to rid the digestive system of harmful agents. Learn more about TD, including how to treat your symptoms. Prescriptions for an antibiotic to that may help treat traveler's diarrhea can be prescribed by a travel health provider at UHS as part of a travel health appointment.. Airborne Infections Respiratory infections among travelers are quite common. The types of infections that affect travelers are like those in non-travelers, including viruses like Influenza, various cold viruses, and COVID, more rarely bacterial infections. Exotic causes are rare but possible. Check the CDC's website or use the CVD TravWell App for outbreak alerts specific to your destination. Respiratory illness outbreaks associated with travel usually occur with common exposure in hotels or tour groups. Travelers can reduce their risk of contracting a respiratory illness during travel by following these steps: Minimize contact with individuals who are coughing or sneezing. Wash hands frequently. Wearing a mask when there are any concerns about the environment. Heat Illness Chances of getting heat stroke, heat exhaustion, or other heat-related illness during travel depend on destination, activities, level of hydration, and age. Travelers who relax on a beach or by a pool are unlikely to get heat-related illness. Activities performed in elevated temperatures, can increase the likelihood of heat-related illness. Learn how to prevent, recognize, and treat heat-related illness. High-Altitude Sickness Rapid ascents to altitudes above 8000 feet (2400 meters) may cause acute mountain sickness (AMS). Symptoms range from mild headache and nausea to shortness of breath and extreme fatigue. Serious complications such as pulmonary edema (fluid in the lungs) and cerebral edema (brain swelling) may occur. Susceptibility to High-Altitude Sickness is multifactorial and genetic factors probably play a role. Travelers cannot predict whether they are prone to High-Altitude Sickness if they have not traveled to high altitude before. Read about how to prevent and treat High Altitude Sickness. Illnesses Transmitted by Vectors (Mosquitoes, Ticks, and other Pests) Insects such as mosquitoes, ticks, and other pests can transmit diseases such as yellow fever, malaria, dengue, chikungunya, Japanese Encephalitis, and others. Travelers can follow these steps to decrease their risk of bug bites when traveling. Learn more about how to protect against illnesses spread by Mosquitoes, Ticks, and Bed Bugs. Aquatic Hazards There are many water hazards travelers may be exposed to while abroad. Read more about safe swimming and diving. to prevent drowning, injury, and waterborne illnesses. Fresh Water Germs and Parasites Infections from swimming in fresh water such as lakes and rivers are common in in certain parts of the world, especially in Brazil, Egypt and most of sub-Saharan Africa, Southern China, the Philippines, and Southeast Asia. A flatworm (fluke) that uses specific freshwater snails as an intermediate host causes the infection. Infected snails release many larvae that can penetrate unbroken skin of human hosts. Even brief exposures to contaminated water can result in infection. Travelers are advised not to bathe, swim or wade in fresh water in areas known to have this problem. Salt-water swimming is safe from these infections. Learn more about preventing infections from exposure to fresh water. Sexual Health and Wellbeing Whether or not travelers plan to be sexually active during their trip, it is best to be prepared and protect against Sexually Transmitted Diseases and/or pregnancy. In this case, Bring a supply of latex condoms from home as they may not be available during travel. Consider making an appointment with Sexual Health and Wellness (SHAW) to discuss sexual health issues and prescriptions as in PrEP (Pre-Exposure Prophylaxis) for HIV, STI (sexually transmitted infection) testing options, or to get a sexual health exam prior to departure. MPox: Mpox is a rare, potentially serious disease which can be spread by humans to anyone via close, intimate, often skin-to-skin contact. Information about Mpox can be found on the CDC MPox website. UHS Travel Health appointments can be scheduled to discuss concerns regarding MPox. Mental Health During travel, mental health well-being, is equally as important as physical well-being. Travel can be stressful and may cause mood changes and other mental health concerns. Read more about mental wellbeing during travel. Travelers with any mental health concerns, can make an appointment with a counselor at Counseling and Psychological Services (CPS) prior to their departure by calling UHS at 609-258-3141. Travelers currently in the care of a therapist or psychiatrist, should inform them of planned travel. Personal Safety and Injury Prevention Involvement in motor vehicle accidents is extremely common in travelers. Traffic abroad may be poorly managed, vehicles may not be equipped with seatbelts, road conditions may be hazardous, and emergency care may be slow to respond. In addition, injuries among travelers are also commonplace. Swimming in unfamiliar water may lead to drowning. Hotels may not have proper fire escapes. Be sure to read any safety alerts specific to your destination. Review essential information about road safety and injury prevention. Animal Safety Contact with animals during your trip could impact on your health. Some travelers, such as those traveling for an extended period of time in an area with a high rate of rabies, or spending time camping, or working with animals, should consider receiving the rabies vaccine series prior to departure. Travelers handling animals as part of research or other academic activities during their trip, should make a Travel Health appointment for further advice. Read more about animal safety while traveling abroad. Bloodborne risks Needles involved in tattoos, acupuncture treatments, and injections for medical or dental procedures are very risky because the equipment used may not be sterile. Travelers should avoid using intravenous drugs or sharing needles which can lead to HIV (Human Immunodeficiency Virus), and Hepatitis C transmission and more. Avoid the use of locally produced immune globulin and blood-clotting factors in countries where the blood supply is not routinely tested for communicable diseases such as hepatitis and HIV. If a blood transfusion is necessary, contact International SOS (ISOS) for guidance when on a Princeton University sponsored trip. For personal travel consider contacting the nearest American Consulate for advice. After Travel Medical Concerns Travelers with any medical concerns post travel, are encouraged to make an appointment for a general medical evaluation upon return from abroad. Travel health providers may be specifically requested or consulted if needed. Malaria: After returning from travel, malaria medication should be continued for seven days after leaving the malaria zone. Incubation times for malaria vary greatly and can last for up to one year after the initial infection. Malaria symptoms include fever, chills, headache, nausea, abdominal pain, diarrhea, and mimic a "flu-like" syndrome. If these symptoms occur, be sure to inform the medical providers regarding any travel to an area that was known to have malaria. Other Resources Websites CDC Traveler’s Health: The gold standard resource for general travel health and safety advice, immunization recommendations, and destination specific information. U.S. Department of State Travel: Register in the “STEP (Smart Traveler Enrollment Program)” program and you will receive timely travel alerts and warnings from the US Embassy in your destination country. Also helps the US Embassy and your family and friends to contact you in case of emergency. TripPrep: An excellent comprehensive guide to health and safety for most every destination including immunization recommendations, disease prevention, safety precautions, and local customs and laws that may impact your health. You will need to register to view this site. TRhIP: This tool lets you enter your age and where you plan to travel, then provides tips including a checklist of things to do before, during, and after your trip. The recommendations are based on CDC guidelines. Downloadable Apps International SOS' Assistance App