Table 2.

Preventive counseling required for international travelers

TOPIC	PREVENTIVE COUNSELING
Food and water consumption	Avoid consumption of tap water, ice made from tap water, and raw foods rinsed with tap water
	Avoid unpasteurized dairy products and undercooked meat and fish, as well as open buffets
	Consume only boiled, treated, or bottled water
	Consume only piping hot, thoroughly cooked food
	Seek only restaurants and other locations of food consumption that have excellent reputations for safety
Personal protective measures against vector-borne illnesses	Avoid outdoor exposure during vector feeding times (eg, for malaria this is between dusk and dawn)
	Avoid areas where vectors are known to be active
	Wear full-length, loose-fitting garments to reduce the amount of exposed skin; this includes taping the cuffs of pants or placing them inside footwear
	Use insecticide-treated bed nets and clothing
	Use insect repellents that contain DEET or picaridin
	Inspect for ticks during and after high-risk activities, and follow appropriate procedures for tick removal
High-risk activities	Avoid the following: freshwater exposure in areas where schistosomiasis or other parasitic infections are prevalent recreational water activities following floods or heavy rainfalls approaching animals, including domestic animals (particularly in countries where rabies is prevalent) walking barefoot on soil and beaches
	Obtain a comprehensive medical examination before scuba diving Recognize signs or symptoms of potential injury and seek qualified dive medicine advice if symptoms occur
	Take proper precautions when at high altitudes Acclimatize: spend 2–3 nights at 2500–3000 m Ascend gradually: spend an extra night for every 600–900 m if continuing ascent Avoid alcohol and sedatives Consider a high-carbohydrate diet Avoid overexertion
	Take proper precautions against road-related or motor vehicle–related injuries or accidents Always use seat belts and child safety seats; rent vehicles with seat belts; when possible, ride in taxis with seat belts and sit in the back seat Always wear helmets when driving or riding motorcycles, motorbikes, or bicycles Ride only in marked taxis; hire drivers familiar with the area
	Avoid STIs by using safer sex practices and avoiding higher-risk partners
	Avoid percutaneous blood exposure (eg, IV drug use, tattoos, piercings, acupuncture)

DEET—diethyltoluamide, IV—intravenous, STI—sexually transmitted infection.
Data from Hill et al,⁹ Centers for Disease Control and Prevention,¹⁰ Committee to Advise on Tropical Medicine and Travel,^11–14 and World Health Organization.¹⁵