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| Making Travel Safe Injuries Injuries, especially those from motor vehicle crashes, pose the greatest risk of serious disability or loss of life to international travelers. The risk of motor vehicle-related death is generally many times higher in developing countries than in the United States. Motor vehicle crashes result from a variety of factors, including inadequate roadway design, hazardous conditions, lack of appropriate vehicles and vehicle maintenance, unskilled or inexperienced drivers, inattention to pedestrians and cyclists, or impairment due to alcohol or drug use; all these factors are preventable or can be abated. Defensive driving is an important preventive measure. When driving or riding, request a vehicle equipped with safety belts, and, where available, use them. Cars and trucks should be carefully inspected to assure that tires, windshield wipers, and brakes are in good condition and that all lights are in good working order. Where available, also request a vehicle equipped with air bags. As a high proportion of crashes occur at night when drivers are returning from "social events," avoid nonessential night driving, alcohol, and riding with persons who are under the influence of alcohol or drugs. This risk of death in a motor vehicle crash is greater for persons sitting in the front seat than for those in the rear seat. Where possible, travelers should ride in the rear seats of motor vehicles. Pedestrian, bicycle, and motorcycle travel are often dangerous, and helmet use is imperative for bicycle and motorcycle travel. In developing countries, helmets will likely not be available, so bring your own with you if you plan to ride bicycles or motorcycles. For travel with young children, you should bring your own child safety seat. Fire injuries are also a significant cause of injuries and death. Do not smoke in bed, and inquire about whether hotels have smoke detectors and sprinkler systems. Travelers may wish to bring their own smoke detectors with them. Always look for a primary and alternate escape route from rooms in which you are meeting or staying. Look for improperly vented heating devices which may cause carbon monoxide poisoning. Remember to escape a fire by crawling low under smoke. Other major causes of injury trauma include drowning (see the Swimming Precautions below) and injuries to water skiers and divers due to boat propellers. Boats equipped with propeller guards should be used whenever possible. Wear a personal flotation device (PFD) whenever you ride on a boat. Travelers should also be aware of the potential for violence-related injuries. Risk for assault or terrorist attack varies from country to country; heed advice from residents and tour guides about areas to be avoided, going out at night, and going out alone. Do not fight attackers. If confronted, give up your valuables. For more information, contact the U.S. Department of State, Overseas Citizens Emergency Center at (202) 647-5225, or visit the U.S. Department of State web site for specific country Travel Warnings and Consular Information Sheets. Animal-Associated Hazards Animals in general tend to avoid human beings, but they can attack, particularly if they are protecting their young. In areas of endemic rabies, domestic dogs, cats, or other animals should not be petted. Wild animals should be avoided; most injuries from wild animals are the direct result of attempting to handle or feed the animals. The bites, stings, and contact with some insects cause unpleasant reactions. Medical attention should be sought if an insect bite or sting causes redness, swelling, bruising, or persistent pain. Many insects also transmit communicable diseases. Some insects can bite and transmit disease without the person being aware of the bite, particularly when camping or staying in rustic or primitive accommodations. Insect repellents, protective clothing, and mosquito netting are advisable in many parts of the world. (See the Insect Protection section for more information.) Poisonous snakes are hazards in many parts of the world, although deaths from snake bites are relatively rare. The Australian brown snake, Russell's viper and cobras in southern Asia, carpet vipers in the Middle East, and coral and rattlesnakes in the Americas are particularly dangerous. Most snakebites are the direct result of handling or harassing snakes, which bite as a defensive reaction. Attempts to kill snakes are dangerous, often leading to bites on the fingers. The venom of a small or immature snake may be even more concentrated than that of larger ones; therefore, all snakes should be left alone. Fewer than half of all snake bite wounds actually contain venom, but medical attention should be sought any time a bite wound breaks the skin. A pressure bandage, ice (if available), and immobilization of the affected limb are recommended first aid measures while the victim is moved as quickly as possible to a medical facility. Specific therapy for snakebite is controversial, and should be left to the judgment of local emergency medical personnel. Snakes tend to be active at night and in warm weather. As a precaution, boots and long pants may be worn when walking outdoors at night in snake-infested regions. Bites from scorpions may be painful but seldom are dangerous, except possibly in infants. In general, exposure to bites can be avoided by sleeping under mosquito nets and by shaking clothing and shoes before putting them on, particularly in the morning. Snakes and scorpions tend to rest in shoes and clothing. Anthrax-Contaminated Goatskin Handicrafts Anthrax is a disease caused by a bacterial organism that produces spores that are highly resistant to disinfection. These infectious spores may persist on a contaminated item for many years. Anthrax spores have been found on goatskin handicrafts from Haiti. Travelers to Caribbean countries are advised not to purchase Haitian goatskin handicrafts. Because of the risk, importation of goatskin handicrafts from Haiti is not permitted at U.S. ports of entry; such items will be confiscated and destroyed. Swimming Precautions Swimming in contaminated water may result in skin, eye, ear, and certain intestinal infections, particularly if the swimmer's head is submerged. Generally for infectious disease prevention, only pools that contain chlorinated water can be considered safe places to swim. In certain areas, fatal primary amebic meningoencephalitis has occurred following swimming in warm dirty water. Swimmers should avoid beaches that might be contaminated with human sewage or with dog feces. Wading or swimming should be avoided in freshwater streams, canals, and lakes liable to be infested with the snail hosts of schistosomiasis (bilharziasis) or contaminated with urine from animals infected with Leptospira. Biting and stinging fish and corals and jelly fish may be hazardous to the swimmer. Never swim alone or when under the influence of alcohol or drugs, and never dive head first into an unfamiliar body of water. See the sections on Safe Food and Water and on Diseases for more information about waterborne diseases such as schistosomiasis, E. coli, leptospirosis, and cryptosporidiosis. Emerging Infectious Diseases Emerging infectious diseases are diseases of infectious origin whose incidence in humans has increased within the past two decades or threatens to increase in the near future. Many factors, or combinations of factors, can contribute to disease emergence. New infectious diseases may emerge from genetic changes in existing organisms; known diseases may spread to new geographic areas and populations; and previously unknown infections may appear in humans living or working in changing ecologic conditions that increase their exposure to insect vectors, animal reservoirs, or environmental sources of novel pathogens. Reemergence may occur because of the development of antimicrobial resistance (see the CDC Antimicrobial Resistance Home Page for more information) in existing infections (e.g., gonorrhea, malaria, pneumococcal disease) or breakdowns in public health measures for previously controlled infections (e.g., cholera, tuberculosis, pertussis |
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