Travelling outside the country can be exhilarating and enlightening. Before you go, boost the health quotient of your trip by getting the right vaccines and medications. Dr. Jay Keystone, a leading expert in travel medicine and former head of the tropical disease unit at Toronto General Hospital, gives this advice.

1. Get immunized against hepatitis A and B if you're travelling somewhere other than Canada, the United States, Australia, New Zealand, Japan and most of western Europe.
Hepatitis A is transmitted through food and water and hepatitis B through blood and unprotected sex. Even if sex isn't part of your agenda, you need protection against hepatitis B. Why? Because you could contract it from a haircut, a manicure or an injection. Between 25 and 75 per cent of all injections given in developing countries are given with unsterilized equipment, which puts you at risk for hepatitis B.

You can get lifelong protection against both hepatitis A and B with three doses of a single vaccine given over three weeks.

2. Keep routine shots updated.
Get vaccinated every 10 years against tetanus and diphtheria and be sure to get an annual flu shot.

3. Find out about the fevers -- yellow and typhoid.
If your travel plans include sub-Sahara Africa or South America (the Amazon in particular), you may need immunization against yellow fever as well. Get your shot 10 days before you go on your trip. You only need a second dose if, 10 years later, you plan to go to a place where there is yellow fever; otherwise you'll just need a single dose.

If you're planning a lengthy trip to any part of the developing world, especially to South Asia, or are going off the main tourist routes, you may need protection against typhoid fever. More than 75 per cent of typhoid cases in North Americans occur in travellers who stay with friends or family in their mother country.

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4. Malaria is the insect-borne disease you need to worry about most.
It is found everywhere in the developing world, including Central and South America, southern Mexico, Haiti and some areas in the Dominican Republic. Use insect repellents that contain Deet, to help prevent malaria. Canadians can buy products containing a maximum of 30 per cent Deet (which means they last four to six hours); these can be used on babies as young as two months of age.

Mosquitoes that transmit malaria are almost all resistant to chloroquine, an older antimalarial drug, so other drugs, such as atovaquone-proguanil (malarone), mefloquine (Lariam) or doxycycline, are prescribed instead.

Another mosquito-borne virus, dengue fever, is common in southeast Asia and Latin America. Unlike malaria, which is found mainly in rural areas, the virus that causes dengue fever is largely urban and is transmitted by mosquitoes, which bite in early morning and late afternoon. Use insect repellent at these times -- but put the sunblock on first.

5. Carry the antidiarrheal drug Imodium and an antibiotic for self-treatment of diarrhea.
The most common problem that travellers face is traveller's diarrhea because we all need to eat and drink. Still, try to stick to some basics: don't drink the water; skip the ice cubes; keep salads and consumption of food from street vendors to a minimum; and don't consume unpasteurized dairy products. "You should also brush your teeth either with the hottest tap water or bottled water," adds Keystone.

Even if you do everything right, you still may not be out of the woods. Thus, Keystone's No. 1 rule when travelling: Don't leave home without Imodium and an antibiotic for self-treatment of diarrhea. Anything from the quinolone class of antibiotics (ciprofloxacin and levofloxacin are two examples) will be effective against any bug that will give you traveller's diarrhea -- except in Thailand, where the bacteria are resistant to these antibiotics but azithromycin is effective. At the first sign of trouble (any diarrhea that interferes with your daily activities qualifies), take one dose of antibiotic with a dose of Imodium. "If you are better after your first dose," says Keystone, "you don't even need the next two doses."

Where to go for vaccines
• Visit a travel health clinic or family doctor six to eight weeks before your trip, so that any vaccines or immunizing agents you need will have time to take effect.
• To find a clinic near you, see the Travel Medicine Program section of Health Canada's website at www.travelhealth.gc.ca.
• If you're not near a clinic, ask your health-care provider about vaccines, where to get them and costs.
- Carlye Malchuk

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