The pandemic taught us that, in the age of jet travel, germs can hitch a ride and be anywhere in the world in a matter of hours. But the irony of fretting about getting sick in other countries is you’re most at risk of the same infections you can get at home – for example, pneumonia, influenza and COVID-19, which has been downgraded to a low-level threat.
“We call them cosmopolitan illnesses,” says Dr. Philippe Lagacé-Wiens, a medical microbiologist at Winnipeg’s St. Boniface Hospital and a member of the federal Committee to Advise on Tropical Medicine and Travel. “Make sure your vaccinations are up to date for those routine things.”
A lot of us don’t think about getting injured in a traffic accident either, which is far more common than infectious diseases like malaria. Lagacé-Wiens is surprised how often travellers don’t take simple precautions such as wearing a seatbelt or a helmet.
Of course, gastrointestinal illnesses are rightly top of mind, and contaminated water (that includes ice cubes!) and food is the most common cause of nausea, vomiting and diarrhea. “Peel it, cook it, boil it or forget it,” he says. “It does work, but most don’t do it.” The Dukoral vaccine protects against one bacterium that causes travellers’ diarrhea, but Lagacé-Wiens doesn’t recommend it because myriad bugs can ruin a holiday. He suggests packing anti-diarrhea pills like Imodium, which are effective in mild to moderate cases.
Another real risk are viruses and parasites delivered via mosquito, tick and other insects – like West Nile, dengue fever, leishmaniasis, chikungunya and zika. There are no approved vaccines in Canada for them, and the main strategy is to avoid bites by using repellants, wearing long-sleeved, light-coloured clothing and sleeping under nets.
There is a yellow fever vaccine that offers lifelong protection, and Health Canada recently OK’d one for chikungunya, but it’s not widely available yet. Medications to treat malaria are the same ones you take to prevent it – malarone and doxycycline, for example – but the parasite has developed resistance to some drugs in certain parts of the world. That’s why, even if you took malaria drugs, you should go to the emergency department if you develop a fever within three months of a trip to a high-risk country. “Malaria is a medical emergency,” says Lagacé-Wiens. “You can go from a little bit sick to the ICU within a couple hours.”
Check travel health notices on the Public Health Agency of Canada and American Centers for Disease Control websites before you go, but note headline-grabbing cases of avian flu (H5N1) in Canada and the U.S. and HMPV (human metapneumovirus) in China and the U.S. don’t warrant a red flag, because bird flu’s risk of transmission is low and HMPV is considered akin to the common cold.
Meanwhile, other scary-sounding diseases like Marburg, Ebola and river blindness are uncommon in travellers, with most North American cases found in medical workers who spend extended time in high-risk areas such as sub-Saharan Africa, and even then, they’re rare.
Also, getting attacked by piranhas is rarely fatal and less common than stepping on a stingray. “Legendary stories of walking into the Amazon basin and being skeletonized in three seconds, it’s mostly fable,” says Lagacé-Wiens. “People would generally have the opportunity to get out quickly enough.” —Sharon Oosthoek
