The Biggest Travel Health Risk Isn't What You Think

When people think about staying healthy while traveling, they often worry about catching a tropical disease, such as Ebola, yellow fever, Japanese encephalitis or hantavirus or even coming home with a mysterious flesh-eating bacterium. According to WakeMed infectious disease physician Christopher Ingram, MD, those concerns aren't what send most travelers to the doctor.

"The number one thing that goes wrong medically when people travel is the exacerbation of their underlying disease," explains Dr. Ingram.

In other words, your biggest travel health risk may be the medication you left behind in your bathroom cabinet.

Don't Forget Your Chronic Condition When You're Leaving for Vacation

Whether you have diabetes, heart disease, high blood pressure, asthma or another chronic illness, traveling can make it harder to stay on top of your health.

Here's what normally happens on vacation:

• Eating foods you wouldn't normally eat
• Walking far more than usual
• Drinking more alcohol
• Sleeping less
• Spending time in extreme heat or humidity
• Forgetting to take medications

For someone with diabetes, indulging in desserts and unfamiliar meals can send blood sugar soaring. For someone with heart disease, long days of sightseeing or excessive heat can put additional stress on the body.

"The vacation mindset makes people think normal rules don't apply," Dr. Ingram notes. "But your chronic illness doesn't take a vacation."

He offers practical advice: pack enough medication, take it consistently and continue managing your condition just as you would at home.

In fact, he shares this startling finding: "One of the busiest days in the hospital is the day after Thanksgiving, when people have overindulged and forgotten medications on Thanksgiving and experienced flare-ups of chronic illnesses the next day."

Watch Out for the Second Biggest Travel Danger

Surprisingly, after chronic medical conditions, motor vehicle collisions are among the most common travel-related risks. Travelers often rent unfamiliar cars, ride scooters or mopeds, bike in busy cities or become distracted or disoriented in new surroundings.

Dr. Ingram remembers nearly getting hit while visiting England because he instinctively looked the wrong direction before crossing the street.

"When you're on vacation," says Dr. Ingram, "you feel like nothing bad can happen, but traveler collisions happen every day."

Being extra cautious on unfamiliar roads may do more to protect your health than worrying about rare tropical diseases.

Before You Travel Abroad, Visit the CDC Website

One of Dr. Ingram's top recommendations is surprisingly straightforward — before international travel, check the CDC's travel guidance for your destination.

Many people assume the site only lists infectious diseases, but it also provides a lot of other helpful information:

• Required vaccines
• Disease outbreaks
• Malaria risk
• Political unrest
• Safety advisories
• Entry requirements

Dr. Ingram notes, "It's one of the best resources available."

If vaccines or preventive medications are recommended, don't wait until the week before your flight.

Travel Vaccines Require Planning

Many travelers don't realize that specialized travel vaccines aren't typically available through a primary care office.

Your primary care physician can often update routine vaccines, which are critical to check before travel within the United States and abroad:

• Tetanus
• Measles
• Influenza
• COVID-19

Specialized vaccines — such as yellow fever — or medications to prevent malaria often require a travel clinic or health department visit. These appointments may need to be scheduled months in advance, especially because clinics book quickly.

Traveler's Diarrhea Is Usually Less Exotic Than You Realize

Traveler's diarrhea has earned a dramatic reputation, but Dr. Ingram says the explanation for it is much less complex.

"Every region has different bacteria in its water and food. Your digestive system is accustomed to the microbes where you live, but not necessarily those somewhere else."

That doesn't mean the water is "dirty." It means your body is encountering unfamiliar organisms — whether that means traveling across the United States to the West Coast or across the globe to another continent.

You can lower your risk:

• Drink safe water.
• Wash your hands frequently.
• Choose thoroughly cooked foods.
• Be cautious with raw fruits and vegetables if you're in higher-risk areas.

Dr. Ingram emphasizes, "People who take acid-reducing medications may also have a higher risk because stomach acid normally helps destroy many germs before they reach the intestines."

Handle the onset of diarrhea with care:

• If diarrhea develops, hydration is the priority.

"Vodka doesn't count as a rehydration fluid," Dr. Ingram jokes.

Water and electrolyte drinks are much better choices.

• If diarrhea is mild and there's no fever, an over-the-counter medication such as loperamide may help. 
• Medical evaluation is advised for fever or severe illness.

Crowded Spaces Can Spread More Than Casual Conversations

Crowded airplanes, buses, cruise ships and hotels make respiratory viruses easy to spread. COVID-19 highlighted this reality, but influenza and other respiratory viruses continue circulating every year.

If respiratory viruses are widespread where you're traveling — or if you're at higher risk for severe illness — consider taking extra precautions, including masking in crowded indoor settings. If you have asthma or a food allergy that affects your breathing, keep an inhaler on you at all times.

Why Doctor's Offices Always Ask If You've Traveled

Have you ever noticed that nearly every health care visit begins with this question — "Have you traveled recently?" It's not because doctors expect every traveler to return with an exotic disease.

Health care systems, including WakeMed, routinely screen for travel history because rare illnesses occasionally enter the country through international travel. Diseases such as measles, mpox or Ebola require rapid identification to protect patients and health care teams.

For most travelers, these illnesses are extremely uncommon — but asking everyone is part of a larger public health safety system.

Watch Out for Less Obvious Dangers

Travel health isn't only about viruses. Depending on your destination, Dr. Ingram recommends thinking about several other risks from bugs, animals, sexually transmitted infections (STIs) and contaminated water.

Mosquitoes and Ticks

Mosquitoes and ticks transmit illnesses around the world. Use insect repellent containing DEET, wear protective clothing when appropriate and check for ticks after hiking or camping. Rocky mountain spotted fever and Lyme's disease are real concerns from tick bites in the North Carolina area.

Animal Bites and Scratches

That friendly, stray dog — or seemingly harmless cat — can carry rabies in some countries. Avoid petting unfamiliar animals and note signs that housing could be infested by rodents. If you're bitten or scratched, visit a medical facility promptly to find out if rabies treatment is necessary.

Dr. Ingram recalls a medical mission trip where the team slept in large quarters infested with bats. Upon returning home, he learned of the unsanitary conditions and was informed he would need to visit his doctor for a potential rabies vaccination.

STIs

If you've ever heard the saying, "What happens on vacation, stays on vacation," you'll know travelers are speaking of nights out with no restraint — where memories get a "free pass." For travelers who engage in intimate behaviors, protection is warranted. The same protective measures used at home should be continued abroad to help reduce the risk of contracting STIs.

Water Exposure

Cuts exposed to warm coastal or brackish water can occasionally become infected with serious bacteria. If a wound becomes red, swollen or worsens rapidly after water exposure, immediately go to a nearby urgent or emergency care facility. Do not wait until you return home from your vacation.

Remember these Key Takeaways to Keep Your Vacation Memorable for All the Right Reasons

Most vacations end with wonderful memories — not medical emergencies. The key is remembering that good travel health starts before you board the plane.

• Pack your medications. 
• Stay hydrated. 
• Drive carefully.
• Protect yourself from insects. 
• Wash your hands. 
• Plan ahead if vaccines are needed.

Most importantly, remember Dr. Ingram's biggest takeaway:

"The vacation mindset makes people think they're immune to bad things happening, but your health still needs attention — even when you're away."

Preparation before your trip can help ensure you only bring home great memories.

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About Dr. Christopher Ingram

Dr. Christopher Ingram is a board-certified, fellowship-trained infectious disease specialist, working at WakeMed Raleigh Campus. He attended medical school at Bowman Gray School of Medicine. He completed his residency at Fairfax Hospital and also completed an internship at Georgetown University Medical Center. Duke University Medical Center is where he finished his fellowship. He is a diplomate of the American Board of Internal Medicine with a subspecialty in Infectious Disease.