A SHOT IN THE ARM FOR TRAVEL

IT WASN'T THAT MANY YEARS AGO THAT MOST FOREIGN TRAVEL ENTAILED ENDURING A SERIES OF PAINFUL VACCINATIONS, ALONG WITH BEING RESPONSIBLE FOR CARRYING THE PAPERWORK TO PROVE IT.
The situation has changed dramatically.
Now, if they're traveling directly from the United States, Americans are no longer required to get any shots at all either to enter most other countries or to return home. (The primary exception is a short list of nations that require incoming travelers to prove they have been vaccinated for yellow fever.)
But official requirements notwithstanding, if you'll be away for a long time or if your itinerary is complex or includes visits to areas of special risk, it is always wise to find out about health conditions where you're going and what precautions you should take, both before you go and once you arrive.
Traditionally, people traveling on business have been particularly vaccination-conscious, but with the ex plosion in adventures in offbeat places, leisure travelers are increasingly at risk.
If the major cities of Western Europe are your destination, you probably won't need to take any special precautions. But if you're heading to Eastern Europe, Africa, Asia, India, Central or South America, or the Pacific islands, you may need to be immunized against a variety of infectious diseases. This is especially true if you plan to travel outside major cities. Travelers to certain areas of Alaska are being cautioned about outbreaks of influenza A.
Some vaccines are themselves risky, however, so it's prudent to get only those prophylactic shots necessary to where you'll actually visit. Also, vaccinations are often expensive, and probably not covered by health insurance (such as Blue Cross).
Investigate vaccination requirements early in your trip plans. Some vaccines require multiple injections over several weeks or even months. Some can produce side effects such as soreness and fevers, which a health professional should monitor. Also, since most vaccines take a while to establish themselves in your body, they may not even give protection for a few weeks.
Physicians recommend that most travelers should allow at least two months to get a travel evaluation and take a full battery of shots, but since most provide protection for many years, it's never too early to start the process.
Yellow fever and malaria are the two diseases that most commonly require advance medication.
Yellow fever vaccine is safe and effective. Get a shot if there's any risk of exposure.
Travelers heading someplace where malaria is endemic should start taking oral malarial medication one week before they leave and continue for six weeks after they return. The usual prescription is chloroquine tablets, but be aware that travel to some parts of the planet, specifically India and southeast Asia, requires a different medicine, most commonly sold under the name of Larium or Fansidar. Unfortunately, both have also been associated with a variety of nasty side effects, ranging from disorientation and depression to outright hallucinations. We'll take a closer look at malaria issues in a future column.
Cholera vaccine is another questionable call. It is only about 50 percent effective and can even make you ill. Even if your destination is rural South America, where this water-borne disease is a serious problem, get a cholera shot only if necessary to satisfy local entry requirements.
It's always wise to get a diphtheria/tetanus booster shot if you haven't had one within the last ten years. Same for the MMR vaccine (measles mumps and rubella). And make sure your polio immunizations are up to date. If you can't remember when you had your last shots, better to get them again.
Beware of the ABCs of hepatitis, which also are present worldwide, both in water and uncooked food. Gamma globulin can prevent an attack or lessen its severity, but to be effective, shots must be given six months or a year apart.
Vaccines for typhoid and T.B. are safe, effective, and wise for travel where either disease is endemic.
In general, your travel agent should be able to provide information about which shots you need. The Centers for Disease Control in Atlanta maintains excellent travel resource files on its Web site at www.cdc.gov/travel.
Area travelers are fortunate to have a variety of health resources available locally.
Many of the more common vaccines can be administered by your regular health care provider. The Allegheny County Department of Health operates the Infectious Travel Clinic (3441 Forbes Ave., 412-578-8062) where travelers can get many vaccinations (but not anti-malarial medicines) without an appointment.
Travelers who would like more comprehensive evaluations of the risks they'll face on their journey can turn to health centers at both Mercy Hospital (412-0232-0509) and UPMC's Downtown Medical Center (339 6th Ave., 412-560-8807). Another option is the International Travel Health Center (5750 Centre Ave., 412-661-1633), where Dr. Nalini Rao, most experienced of Pittsburgh's travel-medicine doctors, maintains her private practice.
All can provide more personalized and in-depth evaluations, as well as more exotic medicines. Travelers have another last-minute option, if they're making connections at a primary international gateway, such as New York, Miami, and Los Angeles. The airport medical office may be able to dispense shots for a small fee.
But never ignore your medical needs. Some countries still maintain quarantine stations for those who can't prove they're free of infectious diseases. For that reason, experienced travelers often carry an international yellow card issued by the World Health Organization.
Next time, we'll look at other important medical precautions travelers should heed once they arrive.
Finally, for Civil War buffs who'd like a bit more comfort in their experience, Delta Queen Steamships offers themed cruises on the Ohio and Mississippi throughout the summer and fall, with battlefield tours and lectures by noted Civil War authorities. For information, call 800-543-1949 or www. deltaqueen.com.  Have a happy, safe and thoughtful Fourth. And spend a moment to remember all those who have given their lives so that this government of the people, by the people and for the people shall not perish from the earth.


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