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| Technical Information Bulletin |
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U.S. Department of Labor
Occupational Safety and Health Administration |
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Safety and Health During International Travel
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| TIB 02-04-12 |
The Occupational Safety and Health Administration’s
(OSHA’s) Directorate of Science, Technology and Medicine issues Technical
Information Bulletins (TIBs) to provide information about
occupational hazards and/or to provide information about
noteworthy, innovative, or specialized procedures, practices,
and research that relate to occupational safety and
health. These bulletins are not standards or regulations and
create no independent legal obligations. They are advisory
in nature, informational in content, and are intended to
assist employers in providing a safe and healthful workplace.
Further information about this bulletin may be obtained
by contacting OSHA’s Directorate of Science, Technology and Medicine at
202-693-2095. |
Purpose
The purpose of this Safety and Health Information Bulletin is to:
- Inform employees and employers of the availability
of specific travel health information including
preventive measures and immunizations for
employees whose work requires international
travel;
- Provide informational resources about travel health
with the goal of protecting the health of workers
who travel internationally; and
- Inform employees and employers of the availability
of country-specific safety and health information.
Background
In recent years there has been a significant
increase in the number of U.S. residents traveling to
countries where they are at risk of contracting
infectious diseases.1 Depending on the country
visited, travelers are potentially exposed to hepatitis
A and B, typhoid fever, malaria, meningococcal
disease, yellow fever, cholera, poliomyelitis, encephalitis,
rabies, and other diseases.
In 2000, 35% of international travel by U.S.
residents was work-related.1 These travelers incur the
risk of exposure to infectious disease as an occupational
hazard. Many of these workers may be
receiving inadequate disease prevention information
and medical prophylaxis. For example, 7 to 8
million U.S. residents travel annually to countries
where malaria is present. In 1998, according to the
Centers for Disease Control and Prevention (CDC),
there were 636 cases of malaria in returning U.S.
civilian travelers. CDC has data for 584 of these cases:
59% had not taken any preventive medication and
13% had been prescribed a drug not recommended
for the area to which they were traveling.2 Hepatitis
A is another disease where prevention is possible.
Travelers who visit developing countries are considered
high-risk for hepatitis A, the most common
vaccine-preventable disease in travelers.3
The failure of travelers to receive preventive
medication results in unnecessary illness, medical
expense, and the potential spread of contagious
diseases within their local communities. For this
reason, the Office of Disease Prevention and Health
Promotion, U.S. Department of Health and Human
Services, includes in its prevention agenda Healthy
People 2010, the developmental objective to:
Increase the proportion of international travelers
who receive recommended preventive services
when traveling in areas of risk for select infectious
diseases: hepatitis A, malaria, and typhoid.4
Resources for Disease Prevention
The Centers for Disease Control and Prevention
(CDC) has developed detailed and specific travel
health information including recommendations for
preventive measures and immunizations for U.S.
residents traveling abroad. Many diseases could be
avoided by implementing these recommendations
which appear in CDC’s publication Health Information
for International Travel and on their website www.cdc.gov/travel. The information is organized
by geographic regions. Each entry contains these
topics specific to the region:
- food and waterborne diseases
- infectious diseases, with reference to specific countries
- recommended vaccines
- tips on staying healthy
- tips on avoiding illness
- suggestions on helpful items to pack
- what to do after returning home
- referrals for further information
Depending on destinations, travelers may need
an International Certificate of Vaccination to prove
immunization for yellow fever. In the United States,
vaccine is obtained from Yellow Fever Vaccine
Centers designated by state health departments. The
CDC website www.cdc.gov/travel/yfever.htm
provides information about yellow fever vaccination
requirements.5
The U.S. Department of State prepares a Consular
Information Sheet for every country, Public
Announcements, Travel Warnings, and Medical
Information for Americans Traveling Abroad. This
information is available at http://travel.state.gov. The
State Department also offers the pamphlets "Your Trip
Abroad", "A Safe Trip Abroad," and "Tips for
Americans Residing Abroad."
All Travelers Should Take the Following
Precautions No Matter the Destination
- Wash hands often with soap and water.
- Because motor vehicle crashes are a leading
cause of injury among travelers, walk and drive
defensively. Avoid travel at night if possible and
always use seat belts.
- Don’t eat or drink dairy products unless you
know they have been pasteurized.
- To avoid acquiring sexually transmitted diseases
(AIDS, hepatitis B and C, syphilis) don’t have
sexual contact with people whose health status is
unknown or uncertain.
- Eat only thoroughly cooked food or fruits and
vegetables you have peeled yourself. Remember:
boil it, cook it, peel it, or forget it.
- Never eat undercooked ground beef and poultry,
raw eggs, and unpasteurized dairy products. Raw
shellfish is particularly dangerous to persons who
have liver disease or compromised immune
systems.
Travelers Visiting Developing Areas Should Take
the Following Precautions
- Drink only bottled or boiled water, or carbonated
(bubbly) drinks in cans or bottles. Avoid tap water,
fountain drinks, beverages with ice, ice cubes, and
beverages cooled by submerging their containers
in water.
- If this is not possible, make water safer by BOTH
filtering through an "absolute 1-micron or less" filter
AND adding iodine tablets to the filtered water.
"Absolute 1-micron filters" are found in camping/
outdoor supply stores.
- If you visit an area where there is risk for malaria,
take your malaria prevention medication before,
during, and after travel, as directed. See your doctor
for a prescription. Protect yourself from insects
by remaining in well-screened areas, using repellents
applied sparingly at 4-hour intervals, wearing
long-sleeved shirts and long pants from dusk
through dawn, and using permethrin impregnated
netting around beds if not in screened or air-conditioned housing.
- To prevent fungal and parasitic infections, keep feet
clean and dry, and do not go barefoot.
- Don’t eat food purchased from street vendors.
- Don’t handle animals, especially monkeys, dogs,
and cats, to avoid bites and serious diseases,
including rabies and plague.
- Don’t swim in fresh water except for well-chlorinated
swimming pools. Salt water is usually safer
except for areas where it may be contaminated by
sewage.
Recommendations
- Employers are encouraged to identify employees
who may travel internationally and to refer employees
to qualified health care professionals for the
purpose of providing travel health information and
recommended vaccinations.
- Employers and employees should implement these
preventive measures with appropriate lead-time
before travel so as to maximize effectiveness and
to minimize health risks.
- U.S. workers who travel abroad should be familiar
with the infectious diseases to which they may be
exposed. With this knowledge, they may modify
their behavior to avoid contracting infection,
obtain necessary medication and vaccinations
before travel, and recognize symptoms of disease.
1. U.S. Department of Commerce, International Trade
Administration, Tourism Industries, http://tinet.ita.doc.gov/
cat/f-2000-101-001.html
2. Centers for Disease Control and Prevention, Morbidity and
Mortality Weekly Report, December 7, 2001, http://
www.cdc.gov/mmwr/preview/mmwrhtml/ss5005a1.htm.
3. Centers for Disease Control and Prevention, www.cdc.gov/
travel/diseases/hav.htm.
4. Public Health Service, Healthy People 2010
www.health.gov/healthypeople/document/html/objectives/14-15.htm
5. Centers for Disease Control and Prevention, www.cdc.gov/
travel/yfever.htm
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