Medical advice for international travelers

Each year, approximately 30 to 40 million Americans travel outside the Unit ed States. Although the most popular destinations are Europe, Central Ameri ca, and the Caribbean, travel to Africa and Asia is increasing substantiall y. International travel, particularly to developing countries, can be assoc iated with the risk of infectious and noninfectious diseases. These risks c an be decreased, eliminated, or modified with vaccinations, prophylactic me dications, and education. Optimally, pretravel advice must be individualize d to a person's medical history, itinerary, and risk behavior. In addition to risk assessment-based immunizations, issues such as traveler's diarrhea, malaria prophylaxis, sexually transmitted diseases, and management of unde rlying medical problems must form a part of pretravel management. Adventure or prolonged travel or persons with underlying medical diseases such as in sulin-dependent diabetes mellitus, transplantation, immunodeficiencies, and dialysis warrant additional preventive measures. This review primarily upd ates pretravel management of adults.