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New England

Health & safety

Before you go

Internet resources

There is a large amount of travel health advice on the internet. The World Health Organization (WHO) publishes a superb book called International Travel and Health, which is revised annually and is available online at no cost from its website at www.who.int/ith/. Another website of general interest is MD Travel Health at www.mdtravelhealth.com, which provides complete travel health recommendations for every country; it’s updated daily, also at no cost.

It’s usually a good idea to consult your government’s travel health website before departure, if one is available:

Australia (www.dfat.gov.au/travel/)

Canada (www.hc-sc.gc.ca/english/index.html)

UK (www.doh.gov.uk/traveladvice/index.htm)

US (www.cdc.gov/travel/)

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Recommended vaccinations

No special vaccines are required or recommended for travel to New England. All travelers should be up to date on routine immunizations.

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Dangers & annoyances

New England’s cities are relatively safe, but you should observe the following standard urban safety guidelines:

- Lock valuables in your hotel room or put them in the hotel safe.

- Lock your car doors and don’t leave any valuables visible.

- Avoid walking alone on empty streets or in parks at night.

- Try to use ATMs only in well-trafficked areas.

- Street people and panhandlers may approach you; nearly all of them are harmless.

In rural areas, be aware of hunters during the November hunting season. ‘No Hunting’ signs are widely ignored and are not a guarantee of safety.

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While you're there

Bites & stings

Commonsense approaches to these concerns are the most effective: wear boots when hiking to protect from snakes, and wear long sleeves and pants to protect from ticks and mosquitoes. If you’re bitten, don’t overreact. Stay calm and follow the recommended treatment.

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Mosquito bites

When traveling in areas where West Nile or other mosquito-borne illnesses have been reported, keep yourself covered (wear long sleeves, long pants, hats, and shoes rather than sandals) and apply a good insect repellent, preferably one containing DEET, to exposed skin and clothing. In general, adults and children over 12 should use preparations containing 25% to 35% DEET, which usually lasts about six hours. Children between two and 12 years of age should use preparations containing no more than 10% DEET, applied sparingly, which will usually last about three hours. Neurologic toxicity from DEET has been reported, especially in children, but appears to be extremely uncommon and generally related to overuse. DEET-containing compounds should not be used on children under the age of two.

Insect repellents containing certain botanical products, including eucalyptus oil and soybean oil, are effective but last only 1½ to two hours. Products based on citronella are not effective.

Visit the website of the Center for Disease Control (CDC; www.cdc.gov/ncidod/dvbid/westnile/prevention_info.htm) for information about preventing mosquito bites.

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Tick bites

Ticks are parasitic arachnids that may be present in brush, forest and grasslands, where hikers often get them on their legs or in their boots. Adult ticks suck blood from hosts by burrowing into the skin and can carry infections such as Lyme disease.

Always check your body for ticks after walking through high grass or thickly forested areas. If ticks are found unattached, they can simply be brushed off. If a tick is found attached, press down around the tick’s head with tweezers, grab the head and gently pull upwards – do not twist it. (If no tweezers are available, use your fingers, but protect them from contamination with a piece of tissue or paper.) Do not rub oil, alcohol or petroleum jelly on it. If you get sick in the following couple of weeks, consult a doctor.

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Animal bites

Do not attempt to pat, handle, or feed any animal, with the exception of domestic animals known to be free of any infectious disease. Most animal injuries are directly related to a person’s attempt to touch or feed the animal.

Any bite or scratch by a mammal, including bats, should be promptly and thoroughly cleansed with large amounts of soap and water, followed by application of an antiseptic such as iodine or alcohol. The local health authorities should be contacted immediately for possible postexposure rabies treatment, whether or not you’ve been immunized against rabies. It may also be advisable to start an antibiotic, since wounds caused by animal bites and scratches frequently become infected.

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Snake bites

There are several varieties of venomous snakes in the US, but unlike those in other countries they do not cause instantaneous death, and antivenins are available. First aid is to place a light constricting bandage over the bite, keep the wounded part below the level of the heart and move it as little as possible. Stay calm and get to a medical facility as soon as possible. Bring the dead snake for identification if you can, but don’t risk being bitten again. Do not use the mythic ‘cut an X and suck out the venom’ trick; this causes more damage to snakebite victims than the bites themselves.

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Spider & scorpion bites

Although there are many species of spiders in New England, the only ones that cause significant human illness are the black widow, brown recluse and hobo spiders. The black widow is black or brown in color, measuring about 15mm in body length, with a shiny top, fat body and distinctive red or orange hourglass figure on its underside. It’s found throughout the US, usually in barns, woodpiles, sheds, harvested crops and bowls of outdoor toilets. The brown recluse spider is brown in color, usually 10mm in body length, with a dark violin-shaped mark on the top of the upper section of the body. It’s usually found in the south and southern Midwest, but has spread to other parts of the country in recent years. The brown recluse is active mostly at night, lives in dark sheltered areas such as under porches and in woodpiles, and typically bites when trapped. Hobo spiders are found chiefly in the northwestern United States and western Canada. The symptoms of a hobo spider bite are similar to those from the bite of a brown recluse, but milder.

If bitten by a black widow, you should apply ice or cold packs and go immediately to the nearest emergency room. Complications of a black widow bite may include muscle spasms, breathing difficulties and high blood pressure. The bite of a brown recluse or hobo spider typically causes a large, inflamed wound, sometimes associated with fever and chills. If bitten, apply ice and see a physician.

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Infectious diseases

In addition to more common ailments, there are several infectious diseases that are unknown or uncommon outside North America. Most are acquired by mosquito or tick bites.

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West nile virus

These infections were unknown in the United States until a few years ago, but have now been reported in almost all 50 states. The virus is transmitted by culex mosquitoes, which are active in late summer and early fall and generally bite after dusk. Most infections are mild or asymptomatic, but the virus may infect the central nervous system, leading to fever, headache, confusion, lethargy, coma and sometimes death. There is no treatment for West Nile virus. For the latest update on the areas affected by West Nile, go to the US Geological Survey website (westnilemaps.usgs.gov/).

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Lyme disease

This disease has been reported from many states, but most documented cases occur in the northeastern part of the country, especially in New York, New Jersey, Connecticut and Massachusetts. Lyme disease is transmitted by deer ticks, which are only 1mm to 2mm long. Most cases occur in the late spring and summer. The CDC has an informative, if slightly scary, web page on Lyme disease at www.cdc.gov/ncidod/dvbid/lyme/.

The first symptom is usually an expanding red rash that is often pale in the center, known as a bull’s eye rash. However, in many cases, no rash is observed. Flu-like symptoms are common, including fever, headache, joint pains, body aches and malaise. When the infection is treated promptly with an appropriate antibiotic, usually doxycycline or amoxicillin, the cure rate is high. Luckily, since the tick must be attached for 36 hours or more to transmit Lyme disease, most cases can be prevented by performing a thorough tick check after you’ve been outdoors.

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Rabies is a viral infection of the brain and spinal cord that is almost always fatal. The rabies virus is carried in the saliva of infected animals and is typically transmitted through an animal bite, though contamination of any break in the skin with infected saliva may result in rabies. In the US, most cases of human rabies are related to exposure to bats. Rabies may also be contracted from raccoons, skunks, foxes and unvaccinated cats and dogs.

If there is any possibility, however small, that you have been exposed to rabies, you should seek preventative treatment, which consists of rabies immune globulin and rabies vaccine and is quite safe. In particular, any contact with a bat should be discussed with health authorities, because bats have small teeth and may not leave obvious bite marks. If you wake up to find a bat in your room, or discover a bat in a room with small children, rabies prophylaxis may be necessary.

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This parasitic infection of the small intestine occurs throughout North America and the world. Symptoms may include nausea, bloating, cramps, and diarrhea, and may last for weeks. To protect yourself from giardia, you should avoid drinking directly from lakes, ponds, streams and rivers, which may be contaminated by animal or human feces. The infection can also be transmitted from person to person if proper hand washing is not performed. Giardiasis is easily diagnosed by a stool test and readily treated with antibiotics.

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As with most parts of the world, HIV infection occurs throughout the United States. You should never assume, on the basis of someone’s background or appearance, that they’re free of this or any other sexually transmitted disease. Be sure to use a condom for all sexual encounters.

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Availability & cost of health care

In general, if you have a medical emergency, the best bet is to find the nearest hospital and go to its emergency room. If the problem isn’t urgent, you can call a nearby hospital and ask for a referral to a local physician, which is usually cheaper than a trip to the emergency room. You should avoid stand-alone, for-profit urgent care centers, which tend to perform large numbers of expensive tests, even for minor illnesses.

Pharmacies are abundantly supplied throughout the USA, but you could find that some medications which are available over the counter in your home country require a prescription here, and, as always, if you don’t have insurance to cover the cost of these prescriptions, they can be shockingly expensive.

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