Travelers should also purchase a flying insect-killing spray to use in living and sleeping areas during the evening and night. If applied according to the directions, permethrin will repel insects from clothing for several weeks. Portable mosquito bednets, DEET containing repellents, and permethrin can be purchased in hardware, back-packing, or military surplus stores. Traveler's diarrhea is the most frequent health problem for travelers. It can be caused by viruses, bacteria, or parasites which are found universally throughout the region.
Transmission is most often through contaminated food or water.
Symptoms include fatigue, fever, loss of appetite, nausea, dark urine, jaundice, vomiting, aches and pains, and light stools. No specific therapy, only supportive care, is available. However, increased risk does exist in Southern Europe where there is intermediate risk of hepatitis A. Risk is even greater if travel plans include visiting rural areas and extensive travel in the countryside, frequent close contact with local persons, or eating in settings of poor sanitation. The virus is inactivated by boiling or cooking to 85 degrees centigrade for one minute, therefore eating thoroughly cooked foods and drinking only treated water serve as general precautions. Hepatitis A vaccine is preferred for persons who plan to travel repeatedly or reside for long periods of time in intermediate or high risk areas.