Staying Healthy on the Road Know Before You Go

All the world's ills can be found in the Centers for Disease Control and Prevention reference guide "Health Information for International Travel."

And it takes only 262 pages, divided into seven sections, to list them.

Published every two years and dubbed the "yellow book" --- for its bright cover, not for all the different ways to get jaundice --- its heft gives an indication of the bugs, viruses and diseases lying in wait in jungles, rivers, mountains and deserts. Illnesses such as African trypanosomiasis, Ebola and Rift Valley fever, to name a few.

But such exotic-sounding diseases are not what plague most Americans abroad. Instead, more mundane woes --- traveler's diarrhea, dehydration, altitude sickness and sunburn --- are of much greater concern.

"I see more people getting sick in Mexico than Africa," said Jessie Mullins, a nurse at Peachtree Travel Clinic at Piedmont Hospital. "They think just because they're still in North America, they don't have to be worried about the food and water. So they get off the plane and right away have a frozen margarita, and fresh salsa and chips. Well, right there, you have fresh ice, water and fresh vegetables."

Avoiding unbottled water and ice, fresh vegetables and unpeeled fruit is at the top of the list of precautions for international travelers. The reason? Microorganisms causing diarrhea can lurk in local water, and hepatitis A can be spread by restaurant food handlers.

Mullins' mantra: "Boil it, cook it, peel it or forget it."

At Atlanta's three main travel clinics --- at Crawford Long, Piedmont and St. Joseph's hospitals --- business is not exactly booming, but there remains some impact from the rash of recent political conflicts and emerging diseases, providers say.

"People are more nervous, I think, hearing about West Nile virus, SARS, news about monkeypox. But I don't think it's stopping them from traveling, overall," said Dr. Joel Rosenstock, infectious disease specialist at Piedmont's clinic.

Asking your primary care doctor for advice before traveling is an option, of course, but she may not be up-to-date on the latest bulletins of emerging diseases or travel advisories.

"You could go to a family physician and say, 'I'm off to Kenya. What do I need?' but they won't know," said Bill Fineran, who's preparing for an African shoot of the photographic kind. He and wife Mary Jo plan to join four others, including Tom LaRock of Zoo Atlanta, who will serve as tour guide through the many national parks and game preserves of Kenya, where "the big five" roam --- lions, elephants, giraffes, rhinos and hippos.

Residents of Eatonton, about 90 minutes east of downtown Atlanta, the Finerans plan to leave for their three-week adventure Sept. 1.

While the travel industry is still recovering from what really stopped travelers in their tracks --- the terrorist attacks of Sept. 11, 2001 --- there are many precautions against expected risks that those on holiday, business, missionary or medical missions should take, international disease experts advise. Such as: > A vaccination for hepatitis A, recommended for all travelers to developing countries. > Never leaving home without bottled water and some packaged food, like crackers, energy bars or other small items. > Not forgetting the sunblock, DEET insect repellent, Imodium, cough drops and other items usually close at hand in your medicine cabinet.

Carol Roberts of Dunwoody logged onto www.cdc.gov/travel and checked out warnings about Bolivia, where she and and her 14-year-old son, Davey, are headed with Dunwoody Baptist Church. A group of 10 teens will be helping build an orphanage in Santa Cruz.

Mother and son recently got poked at St. Joseph's Hospital for an inoculation against yellow fever, a mosquito-borne viral disease occurring in sub-Saharan Africa and tropical South America. Although rarely contracted by traveling Americans and Europeans, it can be fatal.

"Yellow fever has a low-risk rate, but even so, I wanted to get the vaccination so we wouldn't have to worry," Roberts said.

During consultations, travel doctors discuss specific risks in various countries on a client's itinerary, as well as how their personal health problems may be affected.

More people with advanced disease or physical limitations are showing up wanting to take an adventurous fling, said Dr. Phyllis Kozarsky, director of Emory's TravelWell clinic at Crawford Long Hospital.

"It used to be only healthy folks and businessmen traveled abroad. Not anymore," she says. "I've had a heart-transplant patient walk in with a long list of medications they take, saying, 'I want to go on a hunting safari in South Africa.' "

Kozarsky is also chief of Travelers' Health with the Atlanta-based CDC and the co-author of the agency's "yellow book." Fifteen years ago, she lobbied for opening one of the city's first travel clinics, back when the words "Atlanta" and "international" were not heard in the same breath.

Now, many immigrants and refugees from around the globe call Atlanta home and Atlantans' footprints are far and wide.

High-profile companies such as Coca-Cola and CNN consult the TravelWell clinic about diseases and conflicts before shipping off their employees. Kozarsky sees her task as arming them with the know-how to survive in an ever-changing world.

"This world is so different than it was even 10 years ago --- the diseases, the resistance to diseases. It's become so complicated," she said. "The American public is still fairly naive about the risks of international travel and that most of the world has risks of diseases that are never seen in the United States."

Bill and Mary Jo Fineran, the couple studying all things Kenyan --- maps, books, brochures and animal guides --- said they're not nervous or worried about their trip.

International travelers know, or quickly learn, that such ventures come with inherent risks --- contaminated food and water, illness, crime, conflict, terrorism and accidents.

Or, as Bill Fineran put it, "I think it's just part of life."

Copyright 2003 The Atlanta Journal-Constitution