The 2016
Summer Olympics begin in Rio de Janeiro on August 5. Travelers to the Olympics
face unique health risks. Martin Cetron, MD, director of the Division of Global
Migration and Quarantine at the Centers for Disease Control and Prevention
(CDC), answers questions about counseling patients who are traveling to the
2016 Summer Olympics.
PREPARING TO TRAVEL TO THE OLYMPICS
Medscape: What vaccines do travelers to Brazil
need?
Martin Cetron,
MD: All travelers should be current on routine immunizations, including an
annual influenza vaccine. Most travelers should also be vaccinated against
hepatitis A and typhoid. Some travelers should consider hepatitis B
vaccination, particularly if they may be at high risk (engage in risky sex, get
tattoos, or use injection drugs). Those who are likely to have contact with
animals should consider the rabies vaccine. Most of the Olympic Games will be
held in and around Rio, where there is no risk for yellow fever or malaria, but
some of the soccer venues are in cities where these diseases can be acquired.
Depending on their itineraries, some travelers may need yellow fever vaccine or
malaria prophylaxis (Figure 2).
Figure 2. Areas of
Brazil associated with mosquito-borne diseases.
Medscape: What other health risks do travelers
face in Brazil?
Dr
Cetron: Broadly, the three most common categories of health risks are (1)
foodborne and waterborne diseases, primarily travelers' diarrhea; (2)
vector-borne diseases such as Zika; and (3) threats to safety and security.
FOODBORNE AND WATERBORNE DISEASES
Medscape: Do you recommend prescribing
antibiotics so that travelers can self-treat diarrhea?
Dr
Cetron: Travelers' diarrhea is among the most predictable travel-related
illnesses. Travelers can avoid it by choosing only bottled drinks and eating
only food that is cooked and served hot. Adults and older children may wish to
treat mild to moderate diarrhea symptoms with antimotility agents such as
loperamide or bismuth subsalicylate. Antibiotics can be reserved for more
severe symptoms, but travelers may appreciate having them available so that
they don't miss a crucial event. A single dose of 500 mg ciprofloxacin is
standard treatment.
Medscape: What about swimming? A recent news
report said that the beaches are contaminated with raw sewage.
Dr
Cetron: Some recreational water around Rio has been found to be contaminated
with sewage. Travelers should look for recreational water areas that the
government has classified as suitable (própria in Portuguese), cover cuts with
waterproof bandages, and try to avoid swallowing water. Note that
schistosomiasis is also a risk in Brazil, so travelers should not swim in fresh
water (lakes and rivers). A chlorinated pool is probably safest.
Medscape: Does CDC have any resources that I
can offer my patients to help them avoid foodborne and waterborne disease?
Dr
Cetron: I thought you'd never ask! Yes, CDC has two useful mobile apps for
iPhone and Android. The first is called Can I Eat This? and it guides travelers
through a series of questions to help them make safe food and beverage choices.
CDC's app TravWell is a healthy-travel planning app that offers vaccine
recommendations and a travel-health packing list. CDC also has printable infographics
that show examples of safer and riskier choices (Figure 3).
Figure 3. Safe food and
drink choices.
ZIKA AND OTHER VECTOR-BORNE DISEASES
Medscape: What should I tell patients about
Zika?
Dr
Cetron: Most Zika virus infections are asymptomatic; when symptoms develop,
they are usually mild and last only a few days. Many people might not realize
that they have been infected. However, Zika virus infection during pregnancy
can cause microcephaly and other neurologic abnormalities. There may also be a
link between Zika and Guillain-Barré syndrome.
Medscape: What can travelers do to prevent
vector-borne diseases?
Dr
Cetron: Travelers can reduce their risk by preventing mosquito bites. They can
wear long-sleeved shirts and long pants and stay in accommodations that are air
conditioned. People going to the Olympics should also use an EPA-registered
insect repellent that includes DEET, picaridin, IR3535, oil of lemon
eucalyptus, or para-menthane-diol. Because Zika can also be transmitted
sexually, travelers should use condoms or abstain from sex while in an area
with ongoing Zika virus transmission. Travelers with a pregnant partner should
use condoms or not have sex during pregnancy, even after returning from Rio
(Figure 4).
Figure 4. Protection
from Zika during and after the summer Olympics.
Medscape: My patients who are traveling are
healthy, young, and not pregnant or planning to become pregnant. They don't
perceive any risk from Zika. How can I convey the need to take precautions?
Dr
Cetron: Tell your patients that even if they don't become sick, they can infect
local mosquito populations after returning home. Infected people are viremic
for about a week, and if they are bitten by mosquitos back at home, they can
transmit the Zika virus to those mosquitos, which can then infect other people.
Even if they do not feel sick, travelers returning to the United States from
Brazil should take steps to prevent mosquito bites for 3 weeks (a 2-week
incubation period plus 1 week of active viremia). This will prevent them from
infecting mosquitoes in the United States with Zika. To prevent sexual
transmission, men should use condoms or abstain from sex for 8 weeks after
leaving (6 months if they become symptomatic). Women should wait at least 8
weeks after travel before trying to conceive.
THREATS TO SAFETY AND SECURITY
Medscape: My patients are worried about their
safety, even in such tourist destinations as Copacabana and Ipanema. What
should I recommend?
Dr
Cetron: As with any international mass gathering, US travelers may be targets
for criminals. Advise travelers not to travel at night, to avoid questionable
areas, and to travel with a companion. If your patients drink alcohol, advise
them to do so in moderation. Drunk people are more likely to hurt themselves or
other people, engage in risky sex, or get arrested. More information on safe
travel to mass gatherings is available at Travel to Mass Gatherings.
Medscape: This question comes up very often:
What should travelers do with their passports while in Brazil? Should they
carry their passports with them at all times?
Dr
Cetron: No. Travelers should carry a photocopy of their passport and entry
stamp but leave the actual passport securely in the hotel. Travelers should
also carry contact information for the nearest US embassy or consulate in
Brazil.
Medscape: What other safety tips do you have
for people going to Rio for the Olympics?
Dr
Cetron: Like in any other big city, travelers should not wear expensive
clothing or jewelry. Keep hotel doors locked, and store valuables in secure
areas. If possible, travelers should choose hotel rooms on the second through
the sixth floors. A room on the first floor of a hotel may provide easier
access for criminals. Rooms on the seventh floor or above may be difficult to
escape in the event of a fire.
Dr Martin Cetron is the director of the
Division of Global Migration and Quarantine at the US Centers for Disease Control
and Prevention. Dr Cetron holds faculty appointments in the Division of
Infectious Disease at the Emory University School of Medicine and the
Department of Epidemiology at Rollins School of Public Health. His primary
research interests are global health and migration, with a focus on health
disparities, emerging infections, tropical diseases, and vaccine-preventable
diseases, particularly in mobile populations.
Susan
Yox, RN, EdD; Martin Cetron, MD
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