Travelers
As of Thursday, April 21, 2022, DHS will extend COVID-19-related land border entry requirements. Non-U.S. travelers seeking to enter the United States via land ports of entry and ferry terminals at the U.S.-Mexico and U.S.-Canada borders are required to be fully vaccinated against COVID-19 and provide proof of vaccination upon request.
Travelers
As travel returns to pre-pandemic levels, wait times are expected to increase. The resources below are intended to prepare travelers to improve the cross-border travel experience. Travelers should plan for longer than normal wait times and longer lines at U.S. land border crossings when planning their trip and are reminded to exercise patience.
To help reduce wait times and long lines, travelers arriving or departing from air, sea or land ports of entry are encouraged to opt in to using Simplified Arrival or Mobile Passport Control, which can make the inspection process touchless and more expedient with the use of facial comparison technology. Documented non-citizens may also apply for and manage their I-94s through the CBP OneTM mobile application, which serves as a single portal for individuals to access CBP mobile applications and services.
Since January 22, 2022, DHS has allowed inbound non-U.S. travelers (non-U.S. citizens who are neither U.S. nationals nor lawful permanent residents) to seek to enter the United States via a land port of entry (POE) or ferry terminal if they are fully vaccinated and have appropriate documentation.
The most important thing you can do to help protect yourself from severe illness from COVID-19 is to stay up to date with your vaccines. This is especially important if you or someone you are visiting is at higher risk for severe illness if infected with COVID-19. The CDC recommends that you should avoid travel until you are up to date with your vaccinations. All travelers should consider the risks of getting or spreading COVID-19 and follow recommendations and requirements at their destination. Find a COVID-19 vaccine or booster: Text your ZIP code to 438829 or call 1-800-232-0233 to find location near you or visit COVID-19 Vaccine.
Traveler's diarrhea is a common ailment in individuals traveling to resource-limited destinations overseas. It is estimated to affect nearly 40 to 60 percent of travelers and is the most common travel-associated condition. Bacterial, viral, and parasitic infections can cause symptoms, though bacterial sources represent the most frequent etiology. Although traveler's diarrhea is typically a benign, self-resolving condition, it can lead to dehydration and, in severe cases, significant complications. This activity reviews the evaluation and management of traveler's diarrhea and highlights the role of interprofessional team members in collaborating to provide well-coordinated care and enhance outcomes for affected patients.
Traveler's diarrhea can occur in both short and long term travelers; in general, there is no immunity against future attacks. Traveler's diarrhea appears to be most common in warmer climates, in areas of poor sanitation and lack of refrigeration. In addition, the lack of safe water and taking short cuts to preparing foods are also major risk factors. In areas where food handling education is provided, rates of traveler's diarrhea are low.
The foundation of diarrhea management is fluid repletion. In mild cases, travelers should focus on increasing water intake. Water is usually sufficient though sports drinks and other electrolyte fluids can be used. Pedialyte can be used for pediatric patients. Milk and juices should be avoided as this can worsen diarrhea. In more severe cases, oral rehydration salt can be used to ensure rehydration with adequate electrolyte repletion. In cases of severe dehydration, IV fluids may ultimately be required.
Also, travelers can be given antibiotics to take as needed at the onset of symptoms. Ciprofloxacin is commonly used for treatment, though there are concerns with resistance with Campylobacter species. For this reason, fluoroquinolones are not often prescribed for travelers to Asia and azithromycin preferable. Also, azithromycin is often prescribed for pregnant travelers and children. A common regimen is 500 mg daily for three days, though evidence suggests that a single dose of 1000 mg may be slightly more effective. Parents can be given azithromycin powder with instructions to mix with water when needed. Rifaximin is a minimally absorbed antibiotic that is also available and is safe for older children and pregnant travelers.
The key to traveler's diarrhea is preventing it. Today, nurses, the primary care provider and the pharmacists are in the prime position to educate the patient on the importance of hydration and good hygiene. The traveler should be educated on drinking bottled water and washing all fresh fruit and vegetables prior to consumption. Plus, travelers should be warned not to drink from lakes and streams. Carrying small packets of alcohol desansitizer to wash hands can be very helpful when hand washing is not possible.
Antibiotics provide no protection against viruses and parasites, but they can give travelers a false sense of security about the risks of consuming local foods and beverages. They can also cause unpleasant side effects, such as skin rashes, skin reactions to the sun and vaginal yeast infections.
Governmental entities, as well as park districts and authorities, may be eligible to operate a Travelers' Information Station (TIS, also called Highway Advisory Radio) for the purpose of disseminating information by broadcast radio to travelers. A license is required before construction of, or operation of, a Travelers' Information Station. This service, which was created in 1977 by the Report and Order in Docket 20509, is covered under rule 47 CFR 90.242. Travelers' Information Stations operate in the AM Broadcast Band (530 kHz - 1700 kHz) and are limited to a 10 watt transmitter output power, an antenna height no greater than 15 meters (49.2 feet), and a coverage radius of 3 km. These stations may not transmit commercial information. (Some revisions to the service's rules were adopted in PS Docket 09-19.) This service is not available to individuals or groups, but only to governmental entities and park districts. See 47 CFR 90.242 and 47 CFR 90.20(a).
Vaccines protect travelers from serious diseases. Depending on where you travel, you may come into contact with diseases that are rare in the United States, like yellow fever. Some vaccines may also be required for you to travel to certain places.
Background: : Travelers' diarrhea causes significant morbidity including some sequelae, lost travel time and opportunity cost to both travelers and countries receiving travelers. Effective prevention and treatment are needed to reduce these negative impacts.
Methods: : This critical appraisal of the literature and expert consensus guideline development effort asked several key questions related to antibiotic and non-antibiotic prophylaxis and treatment, utility of available diagnostics, impact of multi-drug resistant (MDR) colonization associated with travel and travelers' diarrhea, and how our understanding of the gastrointestinal microbiome should influence current practice and future research. Studies related to these key clinical areas were assessed for relevance and quality. Based on this critical appraisal, guidelines were developed and voted on using current standards for clinical guideline development methodology.
Results: : New definitions for severity of travelers' diarrhea were developed. A total of 20 graded recommendations on the topics of prophylaxis, diagnosis, therapy and follow-up were developed. In addition, three non-graded consensus-based statements were adopted.
Conclusions: : Prevention and treatment of travelers' diarrhea requires action at the provider, traveler and research community levels. Strong evidence supports the effectiveness of antimicrobial therapy in most cases of moderate to severe travelers' diarrhea, while either increasing intake of fluids only or loperamide or bismuth subsalicylate may suffice for most cases of mild diarrhea. Further studies are needed to address knowledge gaps regarding optimal therapies, the individual, community and global health risks of MDR acquisition, manipulation of the microbiome in prevention and treatment and the utility of laboratory testing in returning travelers with persistent diarrhea. 041b061a72