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USA

Health & safety

Before you go

Insurance

The USA offers possibly the finest health care in the world. The problem is that, unless you have good insurance, it can be prohibitively expensive. It’s essential to purchase travel health insurance if your regular policy doesn’t cover you when you’re abroad.

Bring any medications you may need in their original containers, clearly labeled. A signed, dated letter from your physician that describes all medical conditions and medications, including generic names, is also a good idea.

If your health insurance does not cover you for medical expenses abroad, consider supplemental insurance. Find out in advance if your insurance plan will make payments directly to providers or reimburse you later for overseas health expenditures.

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Recommended vaccinations

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

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Medical checklist

Recommended items for a medical kit:

acetaminophen (Tylenol) or aspirin

adhesive or paper tape

antibacterial ointment (eg Bactroban) for cuts and abrasions

antihistamines (for hay fever and allergic reactions)

anti-inflammatory drugs (eg ibuprofen)

bandages, gauze, gauze rolls

DEET-containing insect repellent for the skin

permethrin-containing insect spray for clothing, tents and bed nets

pocket knife

scissors, safety pins, tweezers

steroid cream or cortisone (for poison ivy and other allergic rashes)

sunblock

thermometer

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Internet resources

There is a wealth of travel health advice on the internet. The World Health Organization publishes a superb book, called International Travel and Health, which is revised annually and is available online at no cost at www.who.int/ith/en. Another website of general interest is MD Travel Health (www.mdtravelhealth.com), which provides complete travel health recommendations for every country, 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.smarttraveller.gov.au)

Canada (www.hc-sc.gc.ca; www.phac-aspc.gc.ca)

UK (www.dh.gov.uk/travellers)

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Dangers & annoyances

Despite its seemingly Babylon-like list of dangers – guns, violent crime, riots, earthquakes, tornadoes – the USA is actually a very safe country to visit. Perhaps the greatest danger for travelers is posed by car accidents (buckle up – it’s the law), and the two greatest annoyances will be city traffic and crowds at popular sites. Otherwise, there are a few dangers unique to the USA; pack your city smarts and you’ll be fine.

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Crime

For the traveler, petty theft is the biggest concern, not violent crime. When possible, withdraw money from ATMs during the day or at night in well-lit, busy areas. When driving, don’t pick up hitchhikers, and lock valuables in the trunk of your car (before arriving at your destination).

In hotels, locking valuables in room or hotel safes is prudent, and don’t open your hotel door to a stranger (if suspicious, call the front desk to verify who they are).

Guns, so prominent in the news, would seem to be everywhere, but unless it’s hunting season, you’ll rarely see them (except perhaps in Alaska and Texas). Then again, if it is hunting season, wear bright colors when hiking in the woods.

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Scams

You did pack your city smarts, right? You know that, in big cities, three-card-monte card games are always rigged, and that expensive electronics, watches and designer items sold on the cheap from sidewalk tables are either fakes or stolen? You realize there is no such thing as ‘bargain-priced authentic handicrafts?’ Good, good. Those truly fascinated by all the myriad ways small-time American hucksters make a living today (usually with credit card, real estate and investment frauds), visit ‘Consumer Guides’ on the government’s website, www.usa.gov.

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While you're there

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

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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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Giardiasis

This parasitic infection of the small intestine occurs throughout the world. Symptoms may include nausea, bloating, cramps and diarrhea, and may last for weeks. To protect yourself from Giardia, 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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HIV/AIDS

As with most parts of the world, HIV infection occurs throughout the USA. 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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Lyme disease

This disease has been reported from many states, but most documented cases occur in the northeastern part of the country, especially New York, New Jersey, Connecticut and Massachusetts. A smaller number of cases occur in the northern Midwest and in the northern Pacific coastal regions, including northern California. Lyme disease is transmitted by deer ticks, which are only 1mm to 2mm long. Most cases occur in the late spring and summer. The Center for Disease Control (CDC; www.cdc.gov/nci dod/dvbid/lyme) has an informative, if slightly scary, web page on Lyme disease.

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

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 USA, 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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West nile virus

These infections were unknown in the USA 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 (diseasemaps.usgs.gov).

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