If you think planning an exotic trip means making reservations, finding your passport, and buying a guidebook, you're missing a vital step. Unless your destination is in North America, Europe, Australia, or New Zealand, a visit to a travel clinic should be on your predeparture list. There are serious, potentially fatal, infectious diseases that travelers can pick up, "even in destinations as close and well traveled as the Caribbean or Mexico," warns Susan Early, R.N. at George Washington University Travel Clinic in Washington, D.C.


Take your best shot.

"The most important travel vaccine is the Hepatitis A vaccine," says Jane Johnson, R.N., with Smart Travel in Alexandria, Virginia. Hepatitis A is a virus present in contaminated food and water. "The virus is extremely stable and sustains very high and low temperatures, even chemical disinfection—which means you can get it even in what you might call a 'safe' eating establishment," says Johnson. The vaccine is safe, it's a single dose that lasts for one full year, and a second booster dose given six to 12 months later extends the vaccine for 10 to 15 years.

Typhoid is also transmitted through contaminated food, water, and food handling. "This vaccine is recommended if you are going abroad outside of North America, Europe, Australia, or New Zealand for three or more weeks—it gets increasingly difficult to be vigilant the longer you are there—or if you plan to buy food from vendors, or if you stray far from the usual tourist itinerary," says Johnson.

If you're traveling to Africa, Asia, or South America, you may also need to take medication to protect you against malaria. (There's no malaria vaccine, but you can take prophylactic malaria medication before, during, and after exposure.) Your travel clinic doctor or nurse can assess your needs. Updated information about epidemics and areas of concern can also be found on the Centers for Disease Control Web site, www.cdc.gov.

You probably got your shots for measles, mumps, rubella, and polio when you were a child, but if there's any doubt, you should discuss it with the travel clinic professional. Also, have you had your diphtheria and tetanus boosters in the past 10 years? "You should have these immunizations regardless of whether you travel, but it becomes more important when you do, because your chances of exposure can increase greatly," says Johnson.


Pack it in.

Johnson recommends putting some over-the-counter diarrhea medicines like Imodium in your bag for trips abroad. "A change of diet and time zone can upset your stomach," says Johnson. Other suitcase essentials: antibiotic ointment, anti-inflammatory medicine, insect repellent, sun screen, water purification tablets, and a small first aid kit with Band-Aids, says Early.


Bug off.

Insect repellent is crucial, say travel medicine experts. Mosquito-borne diseases are very serious and include malaria, yellow fever, Japanese encephalitis, and dengue fever (for which there is no vaccine.) Recommended repellent: For your skin, any brand with a chemical called DEET, but not a greater concentration of DEET than 35 percent says Johnson. "And it should preferably be used in conjunction with an insect repellent/insecticide called premethrin, which is applied to clothing. It comes from the chrysanthemum plant and is nontoxic." And, both of our experts agree, wear long sleeves and pants whenever possible.


Avoid it like the plague.

The most important thing, says Early, is to stay away from the water. "Use bottled water when you can, otherwise, boil water and use iodine-based chemicals, water purification tablets, and filters." She also recommends that you void any raw food, milk products, and food sold from street vendors. As for fruits and vegetables, "The motto is boil it, peel it, and cook it—or forget it," says Early.


Parting Words.

"Be careful about what you hear from well-meaning people who may have heard of a folk remedy somewhere," warns Early. "Being young and healthy, exercising, and eating well isn't enough to protect you."

For more information, check out the International Society of Travel Medicine Web site at www.istm.org; the state-by-state directory will give you the names of society-approved doctors and clinics.