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10 rules to help you stay healthy abroad

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There's no way to guarantee you won't get sick on your next vacation trip, except maybe not to go.

That's the message Dr. Jay S. Keystone has for travelers as they plan summer vacations.Keystone, past president of the International Society of Travel Medicine, made his remarks here at a gathering of the nation's top travel editors.

This year, Keystone said, travelers may be more at risk because of El Nino. The abnormal weather phenomenon, he said, has increased by 2 1/2 times the risk of contracting malaria in some South American locales because of its heavy rains. Malaria-carrying mosquitoes multiply in wet conditions.

Hepatitis also is a rising health risk for travelers. "Twenty-four million Americans are going to areas with a risk of hepatitis A," Keystone said.

Keystone devised what he calls his "Ten Commandments for Tropical Travel."

1. Thou shalt consult with thy physician.

Travelers should visit their doctor well ahead of their departure. Preparing for healthy travel includes getting advice, immunizations, dental care, a letter regarding any current medical problems and Medic Alert tag (if needed). It includes packing ongoing and prophylactic medications, extra eyeglasses and information about your health and health insurance. All travelers, Keystone said, should be current with routine immunizations - tetanus, diphtheria, polio, MMR, measles. And, of course, they should obtain vaccines required for international travels.

Keystone recommends hepatitis A vaccine for all travelers to risk areas. Elderly and high-risk travelers should have influenza and pneumococcal shots.

2. Thou shalt acclimatize thyself.

Take adequate fluids and get adequate rest. Combat jet lag with altered sleep and light-exposure routines and/or medications. Use sunscreen (SPF 15 or higher) as indicated. Malignant melanoma is caused mostly by excessive exposure to the sun. If going to high altitude, be prepared for altitude sickness.

3. Thou shalt protect thyself from insects.

Dengue fever is a problem in the Caribbean, Keystone said, and malaria is a problem in much of the world. Malaria-carrying mosquitoes bite between dusk and dawn, he says. Use insect repellents ("DEET is the best") and mosquito nets ("most important").

4. Thou shalt purify the water that thou drinkest, including thy cubes of ice.

5. Thou shalt cook well thy food and peel thine own fruit and vegetables.

6. Thou shalt carry self-treatment for travelers' diarrhea.

If you are afflicted with this most common of all traveler ailments, Keystone suggests three courses of action. One, replace your fluids - discontinue milk products, drink carbonated beverages and electrolyte/glucose mixtures (do-it-yourself formula: 8 ounces of fruit juice, 1/2 teaspoon of honey, sugar or corn syrup, a pinch of salt; alternate with 8 ounces of water with 1/4 teaspoon of baking soda). Two, you can use anti-motility agents such as diphenoxlate HCL (Lomotil) or loperamide (Imodium), but do not use these in case of severe illness. Three, antibiotic treatments; the quinolones (floxacins) are the drugs of choice. A nonantibiotic that is effective is bismuth subsalicylate (Pepto-Bismol). New anti-malarial drugs include primaquine, azithromycin, atovaquone and etaquine. Insect precautions also must be used, as no anti-malarial drug guarantees protection.

8. Thou shalt not swim in fresh water nor walk in thy bare feet.

9. Thou shalt be concerned about thy security.

For personal safety, Keystone says to dress inconspicuously, leave expensive jewelry and watches at home, avoid night or solo travel, don't flash rolls of bills and use alcohol in moderation.

10. Thou shalt be wary of thy conveyance.

The leading cause of death of long-term travelers in the Third World - 27 percent - is motor-vehicle accidents, according to Keystone. Motorcycles are particularly dangerous, he said.