US SoccerUS Soccer

Travel Medicine

Daryl A. Rosenbaum, MD

Whether you are traveling halfway around the world for a match or just across town there are some important steps that should be taken in order to ensure a safe and productive trip. Remember these tips apply to everyone in the travel party, from athletes to coaches to chaperones.

Months before you leave
Regular check-ups with your health care provider are important for a variety of reasons. Medical problems or injury risk factors can be identified. Your doctor can then work with you to make sure your health issues (asthma, diabetes, blood pressure, tendinitis, etc) are under good control and therefore less likely to interfere with your trip. This is also the perfect time to see if regular immunizations like tetanus are up to date or if others are needed based on your travel plans. A flu shot makes sense during the late fall and winter months. For international travel, the hepatitis A immunization series can reduce your chance of catching this extremely unpleasant illness.

There are a variety of other diseases common to international destinations that may require specific immunizations (yellow fever or typhoid for example) or preventive medications (malaria). You and your doctor can visit the Center for Disease Control’s Traveler’s Health website to see what risks are associated with the regions you will be visiting.

Shortly before departure
All members of the traveling party should provide a summary of their health and insurance information and these documents should accompany the team. Emergency contact information and, for minors, a signed form by the parent/guardian giving permission to treat should also be required. Medical problems can occur any time. A relative may not always be present to provide consent or a medical history or a list of medications and allergies.

Each person should make sure they have an adequate supply of personal medication, both those taken regularly and important “as needed” medications like an epi-pen for allergic reactions or an inhaler for asthma, to last for the duration of the trip. Also check to make sure the meds you have are not out of date. This is the time to call your doctor or pharmacist for refills. Meds should be labeled and transported in original containers if possible, especially for international travel.

To prepare for the unexpected, pack a general team medical kit too. US Soccer national teams lug around a hard suitcase loaded with advanced medical equipment and over 40 different medications. Your group may not have the resources or a physician trained to use and dispense these items but a simpler kit can still be very useful. In studying the medical issues that came up while US Soccer teams traveled abroad, we found that simple pain relievers (acetaminophen, ibuprofen, naproxen), cough and cold remedies, gastrointestinal agents (acid blockers like ranitidine, anti-diarrheals), and possibly an oral antibiotic (like ciprofloxacin or azithromycin) will address the vast majority of problems. Round out the kit with bandages, gauze, a thermometer, gloves, hand sanitizer, and plastic bags to hold ice.

While away
Air travel across multiple time zones can lead to “jet lag”. Symptoms can include fatigue, headache, and GI upset and usually are worse the more time zones crossed and when flying from west to east. Some steps to reduce the impact of jet lag include gradually adjusting awakening/practice/bedtime toward the time of your destination in the week leading up to the trip, staying hydrated and avoiding caffeine and alcohol while on the plane, then getting some light exercise and avoiding exotic foods upon arrival. More sophisticated strategies using exposure to light, exercise, or melatonin are described here. Finally, while it is important to have the team buy in to a sensible plan that limits the potential negative effects of time zone travel, avoid dwelling on the idea of jet lag once you have arrived. Mind over matter can make a big difference.

Traveler’s diarrhea can affect 25-50% of people traveling from the US to developing countries and young people are most at risk because 1) inexperienced immune systems aren’t as well prepared to deal with the offending bacteria and 2) teens and young adults don’t necessarily follow preventive instructions well. To avoid being stuck on the sidelines (or in the bathroom) take these simple precautions:

  1. Avoid water that has not been adequately filtered or boiled. This includes ice as freezing does not kill the bacteria, nor does alcohol. The supposed filtration systems in hotels cannot always be trusted so to be safe stick with bottled water and drinks.
  2. Properly clean your hands before eating
  3. Avoid raw / undercooked foods except for those that can be peeled. Remember that even if fruits and veggies have been washed it was with local water.
  4. Avoid food from street or stadium vendors.
  5. Consider taking a probiotic like Lactobacillus.

If you are unlucky and still come down with a case of traveler’s diarrhea then the primary treatment focus should be on staying hydrated. Sports drinks or World Health Organization recommended oral rehydration solutions available at almost all pharmacies around the world are best. Diet should be limited to these clear liquids until the diarrhea starts to slow down. As for medication, antibiotics can shorten the duration of the illness from the usual 3-5 days so if your doctor provided you with one consult the criteria for use and dosing instructions. Anti-diarrheals like loperamide (Immodium) or diphenoxylate (Lomotil) can slow things down temporarily but don’t treat the underlying problem. Anyone with a high fever, bloody stools, abdominal pain, or signs of dehydration (lightheadedness, dark urine, infrequent urination, or fast heart rate) should seek medical attention.

Hopefully this information will help you get the most out of your experience away from home.