This update is being sent to members of the Wisconsin Travel Health Network.
Traveling with Chronic Conditions
The winter months can be busy with travel for Wisconsinites who are looking to escape the cold. This is a good time to remind travelers with chronic conditions about the extra steps they may need to take to stay healthy while traveling.
Traveling with medication
Individuals with chronic conditions should be advised to schedule an appointment with their established health care provider at least one month prior to travel to discuss health concerns, planned travel activities, and any medication concerns. If traveling abroad with medication, travelers should check with the US embassy at their destination to make sure their medications are allowed. Most countries will require a written prescription or medical certificate for the medications. Anyone traveling for longer than 30 days may also need to check with their insurance company to make sure they can get enough of their medication to last the full duration of travel.
Getting care while abroad
Travelers with chronic conditions should also plan for how they will get health care while they are traveling should a medical need arise. Carrying a card with information about health conditions and a list of current medications is important. If care is needed, the US embassy or consulate should be able to help travelers locate medical services at their destination. Travelers should find out if their insurance covers medical care abroad. If not, they should be advised to consider buying additional insurance that covers health care and medical evacuation expenses outside the U.S.
Resources for travelers with specific chronic conditions
In addition to the general recommendations above, there may be special considerations for different chronic conditions. A full list of all special considerations can be found in the 2024 CDC Yellow Book. A list of resources for travelers can also be found in the 2024 CDC Yellow Book.
Holiday Travel
Now is the time of year that many people are embarking on holiday travel to visit family and friends or to simply take a vacation. There are steps that all travelers can take before, during, and after holiday travel to stay safe and healthy on their trip. These steps are outlined on the Travel Health Network Safe Travel Checklist. The checklist is available to save or print and can be shared with patients and future travelers to help keep them safe and healthy!
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CDC Travel Health Notices for international travelers
Level 4 – Avoid All Travel
None at this time.
Level 3 – Reconsider Non-Essential Travel
None at this time.
Level 2 – Practice Enhanced Precautions
Chikungunya
The CDC has issued a level 2 travel notice for chikungunya in several districts in Burkina Faso. Chikungunya disease is caused by the chikungunya virus and is spread to humans by mosquitoes. Travelers to this area should take care to protect themselves from mosquito bites by using insect repellent, wearing long sleeves shirts and pants, and staying in places with air conditioning or that use window and door screens. The CDC recommends that pregnant travelers reconsider travel to Burkina Faso. Mothers who are infected with chikungunya near the time of delivery can pass the virus to their baby before or during delivery. Infected newborns are at risk for severe illness and poor long-term health outcomes.
Travelers should seek medical attention if they develop fever, joint pain, headache, muscle pain, joint swelling, or rash, during or after travel.
Mpox in the Democratic Republic of the Congo (DRC)
The CDC issued a level 2 travel notice on December 6, 2023, for the DRC where 22 of 26 provinces have had reported cases. Mpox is caused by the monkeypox virus and can be transmitted person-to-person, animal-to-person and by contact with contaminated materials. There is some evidence that Clade I, which can have more severe clinical presentation and has a case fatality rate around 10%, is causing mpox in DRC. This is in contrast to the 2022–2023 mpox outbreak that was driven by the less virulent Clade IIb monkeypox virus. Travelers in the DRC should:
- Avoid close contact with sick people, including those with skin lesions or genital lesions.
- Avoid contact with contaminated materials used by sick people (such as clothing, bedding, or materials used in health care settings) or materials that came into contact with infected animals.
- Avoid contact with dead or live wild animals, such as small mammals including rodents (rats, squirrels) and non-human primates (monkeys, apes).
- Avoid eating or preparing meat from wild game (bushmeat) or using products derived from wild animals from endemic countries throughout Central and West Africa (creams, lotions, powders).
Level 1 – Practice Usual Precautions
Dengue in the Americas – updated 11/27/23.
Global Measles– updated 11/20/23.
You can review all new and ongoing international travel notices on the CDC Travel Health website.
Health care Provider Continuing Education Opportunities
The Centers for Disease Control and Prevention (CDC) has continuing education opportunities available for health care providers who are caring for travelers before or after travel. These trainings are intended for physicians, nurses, pharmacists, veterinarians, physician assistants, health educators, and other clinicians. Topics include:
- Yellow Fever
- Hantavirus
- Lassa Fever
- Malaria
- Typhi
- Rickettsioses
Trainings include information regarding the epidemiology, diagnosis, and treatment for the above diseases. There is no cost to complete the trainings. They can be accessed on the CDC Travel Health Website on the “Clinician Resources” page.
Disease Spotlight: Cholera
Cholera is a diarrheal disease caused by certain types of Vibrio cholerae bacteria. Only strains of Vibrio cholerae-O1 and Vibrio cholerae-O139 that can produce the cholera toxin can cause the disease called cholera. Other strains of V. cholerae cause a disease called vibriosis. Cholera is rare in the developed world. There are zero to five cases reported in the United States each year and they are usually acquired during international travel. Cholera is a major cause of morbidity and mortality in developing countries where V. cholerae is endemic, population density is high, sanitation is poor and access to safe drinking water is scarce. An estimated 1.3 to 5 million infections occur worldwide annually with most infections occurring in children under 5 years old.
Who is at risk?
Anyone who travels to areas where cholera is endemic can become infected with the bacteria. There has been an ongoing global pandemic in Asia, Africa and Latin America for the last 60 years. Although still rare, cholera appears to be more common in travelers who are visiting friends and relatives and those performing humanitarian aid work in outbreak settings. These groups may have longer stays and limited access to safe food and water. Some examples of travelers at higher risk include:
- Health care personnel treating cholera patients.
- Cholera outbreak response workers.
- Travelers in an area of active cholera transmission who cannot or do not always follow safe food and water precautions and personal hygiene measures to prevent fecal-oral transmission.
What are the symptoms?
Most people with cholera are asymptomatic or have mild gastrointestinal symptoms. However, about one in 10 people with cholera will experience severe symptoms, which, in the early stages, include:
- Mild to profuse, voluminous, watery diarrhea (“rice-water” appearance).
- Severe dehydration and electrolyte imbalances.
- Muscle cramps.
- Low blood sugar.
- Vomiting.
- Restlessness or irritability.
Usually, no fever or abdominal cramps are present. If dehydration is untreated, it can lead to kidney failure, shock, coma, and death within hours. Symptoms typically begin two to three days after a person is exposed to the bacteria. However, they can begin as soon as two hours and up to five days after exposure.
How is it spread?
Most people get cholera by drinking water or eating food contaminated with cholera bacteria. People who are sick with cholera can shed large amounts of cholera bacteria in their stool (poop) for seven to 14 days after their symptoms stop. The bacteria can then spread easily to others if it enters food or water or contaminates the environment. The disease can spread rapidly in areas with inadequate treatment of sewage and drinking water. Although less likely, people can also become infected through close contact with person with cholera or contact with their poop. V. cholerae can also live in saltwater and brackish water (a mix of fresh and salt water) environments, and in shellfish that grow in these areas.
The most common ways people get cholera include:
- Ingestion of contaminated water (main mode of transmission) or food contaminated by infected humans (street vendors, unpeeled fruits, and vegetables).
- Ingestion of salt water and brackish water in the environment, such as from an ocean.
- Ingestion of undercooked/raw shellfish or seafood.
- Through close contact with an infected person.
- Through meals prepared by infected people.
How is it treated?
People with severe illness can recover with antibiotics, rehydration therapy (fluids), and correction of any electrolyte imbalances. Zinc treatment improves symptoms in children. People with mild illness usually recover within three to six days.
How can it be prevented?
Although a cholera vaccine exists, it is not routinely recommended for most travelers because most travelers do not visit areas of active transmission. However, those going to endemic areas to perform humanitarian work or visit friends/family should discuss vaccination with their doctor. CDC maintains a website listing countries with endemic transmission. You can also visit CDC’s Travel Health Notices website.
The key to cholera prevention is practicing food and water precautions and hand hygiene in areas with cholera outbreaks. CDC has very detailed information and handouts on these steps.
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