Technical Information Bulletin 

U.S. Department of Labor

Occupational Safety and Health Administration

TIB02-04-12

The Occupational Safety and Health Administration’s

(OSHA’s) Directorate of Technical Support issues Technical

Information Bulletins (TIBs) to provide information about

occupational hazards and/or to provide information about

noteworthy, innovative, or specialized procedures, practices, and research that relate to occupational safety and

health. These bulletins are not standards or regulations and

create no independent legal obligations. They are advisory

in nature, informational in content, and are intended to

assist employers in providing a safe and healthful workplace.

 Further information about this bulletin may be obtained

by contacting OSHA’s Directorate of Technical Support at

202-693-2095.

Safety and Health During International Travel

Purpose

The purpose of this Technical Information

Bulletin is to:

1. Inform employees and employers of the availability of specific travel health information including

preventive measures and immunizations for

employees whose work requires international

travel;

2. Provide informational resources about travel health

with the goal of protecting the health of workers

who travel internationally;

3. Inform employees and employers of the availability of country-specific safety and health information.

Background

In recent years there has been a significant

increase in the number of U.S. residents traveling to

countries where they are at risk of contracting

infectious diseases.1 Depending on the country

visited, travelers are potentially exposed to hepatitis

A and B, typhoid fever, malaria, meningococcal

disease, yellow fever, cholera, poliomyelitis, encephalitis, rabies, and other diseases.

In 2000, 35% of international travel by U.S.

residents was work-related.1

 These travelers incur the

risk of exposure to infectious disease as an occupational hazard. Many of these workers may be

receiving inadequate disease prevention information

and medical prophylaxis. For example, 7 to 8

million U.S. residents travel annually to countries

where malaria is present. In 1998, according to the

Centers for Disease Control and Prevention (CDC),

there were 636 cases of malaria in returning U.S.

civilian travelers. CDC has data for 584 of these cases:

59% had not taken any preventive medication and

13% had been prescribed a drug not recommended

for the area to which they were traveling.2 Hepatitis

A is another disease where prevention is possible.

Travelers who visit developing countries are considered high-risk for hepatitis A, the most common

vaccine-preventable disease in travelers.3

The failure of travelers to receive preventive

medication results in unnecessary illness, medical

expense, and the potential spread of contagious

diseases within their local communities. For this

reason, the Office of Disease Prevention and Health

Promotion, U.S. Department of Health and Human

Services, includes in its prevention agenda Healthy

People 2010, the developmental objective to:

Increase the proportion of international travelers who receive recommended preventive services

when traveling in areas of risk for select infectious

diseases: hepatitis A, malaria, and typhoid.4
Resources for Disease Prevention

The Centers for Disease Control and Prevention

(CDC) has developed detailed and specific travel

health information including recommendations for

preventive measures and immunizations for U.S.

residents traveling abroad. Many diseases could be

avoided by implementing these recommendations

which appear in CDC’s publication Health Information for International Travel and on their website

www.cdc.gov/travel. The information is organized

by geographic regions. Each entry contains these

topics specific to the region:

· food and waterborne diseases

· infectious diseases, with reference to specific

 countries

· recommended vaccines

· tips on staying healthy

· tips on avoiding illness

· suggestions on helpful items to pack

· what to do after returning home

· referrals for further information

Depending on destinations, travelers may need

an International Certificate of Vaccination to prove

immunization for yellow fever. In the United States,

vaccine is obtained from Yellow Fever Vaccine

Centers designated by state health departments. The

CDC website www.cdc.gov/travel/yfever.htm

provides information about yellow fever vaccination

requirements.5

The U.S. Department of State prepares a Consular Information Sheet for every country, Public

Announcements, Travel Warnings, and Medical

Information for Americans Traveling Abroad. This

information is available at http://travel.state.gov. The

State Department also offers the pamphlets “Your Trip

Abroad”, “A Safe Trip Abroad,” and “Tips for

Americans Residing Abroad.”

All Travelers Should Take the Following

Precautions No Matter the Destination

· Wash hands often with soap and water.

· Because motor vehicle crashes are a leading

cause of injury among travelers, walk and drive

defensively. Avoid travel at night if possible and

always use seat belts.

· Don’t eat or drink dairy products unless you

know they have been pasteurized.

· To avoid acquiring sexually transmitted diseases

(AIDS, hepatitis B and C, syphilis) don’t have

sexual contact with people whose health status is

unknown or uncertain.

· Eat only thoroughly cooked food or fruits and

vegetables you have peeled yourself. Remember:

boil it, cook it, peel it, or forget it.

· Never eat undercooked ground beef and poultry,

raw eggs, and unpasteurized dairy products. Raw

shellfish is particularly dangerous to persons who

have liver disease or compromised immune

systems.

Travelers Visiting Developing Areas Should Take

the Following Precautions

· Drink only bottled or boiled water, or carbonated

(bubbly) drinks in cans or bottles. Avoid tap water,

fountain drinks, beverages with ice, ice cubes, and

beverages cooled by submerging their containers

in water.

· If this is not possible, make water safer by BOTH

filtering through an “absolute 1-micron or less” filter AND adding iodine tablets to the filtered water.

“Absolute 1-micron filters” are found in camping/

outdoor supply stores.

· If you visit an area where there is risk for malaria,

take your malaria prevention medication before,

during, and after travel, as directed. See your doctor for a prescription. Protect yourself from insects

by remaining in well-screened areas, using repellents applied sparingly at 4-hour intervals, wearing

long-sleeved shirts and long pants from dusk

through dawn, and using permethrin impregnated

netting around beds if not in screened or airconditioned housing.

· To prevent fungal and parasitic infections, keep feet

clean and dry, and do not go barefoot.

· Don’t eat food purchased from street vendors.

· Don’t handle animals, especially monkeys, dogs,

and cats, to avoid bites and serious diseases,

including rabies and plague.

· Don’t swim in fresh water except for well-chlorinated swimming pools. Salt water is usually safer

except for areas where it may be contaminated by

sewage.
Recommendations

· Employers are encouraged to identify employees

who may travel internationally and to refer employees to qualified health care professionals for the

purpose of providing travel health information and

recommended vaccinations.

· Employers and employees should implement these

preventive measures with appropriate lead-time

before travel so as to maximize effectiveness and

to minimize health risks.

· U.S. workers who travel abroad should be familiar

with the infectious diseases to which they may be

exposed. With this knowledge, they may modify

their behavior to avoid contracting infection,

obtain necessary medication and vaccinations

before travel, and recognize symptoms of disease.

1

 U.S. Department of Commerce, International Trade

Administration, Tourism Industries, http://tinet.ita.doc.gov/

cat/f-2000-101-001.html

2

 Centers for Disease Control and Prevention, Morbidity and

Mortality Weekly Report, December 7, 2001, http://

www.cdc.gov/mmwr/preview/mmwrhtml/ss5005a1.htm. 3 Centers for Disease Control and Prevention, www.cdc.gov/

travel/diseases/hav.htm. 4 Public Health Service, Healthy People 2010

www.health.gov/healthypeople/document/html/objectives/

14-15.htm

5

 Centers for Disease Control and Prevention, www.cdc.gov/

travel/yfever.htm

*