The most common things occur most commonly.

If there is one thing medical students learn on the first day of their third-year clinical rotations, this is it. The attending will introduce a young student to a patient in her clinic:

“This young man just returned from a mission trip to the jungles of the Philippines. No sooner did he step off the airplane than he developed nasal congestion, a low grade fever, a sore throat, and a wet cough. He also complains of  a mild frontal headache. He says he doesn’t feel like eating much and has passed two loose stools since his arrival. His exam is fairly unremarkable, except for a couple of hives on his left arm which look like mosquito bites. What is his diagnosis?”


Immediately the medical student’s mind swings into action, trying to remember all the exotic infectious diseases he learned in last year’s microbiology class and parasitology seminar. “Hmm. Could this be the beginning of a deadly virus transmitted by a mosquito? Early tuberculosis? How about amebiasis? Cerebral amebiasis! “Yes, that’s it!” the student silently exclaims. “Man, I am soooo smart!”

No, no. The young traveler has a simple upper respiratory infection. A cold! Oh, and he has a couple of mosquito bites on his left arm.

The most common things occur most commonly.

Our TravelReadyMD expert, Sarah Kohl, M.D., always reminds her colleagues that when traveling abroad, it’s the simple and most common things that will cause health problems. Before you roll up your sleeve to get any recommended travel vaccines specific to the area(s) you are visiting (typhoid, yellow fever, Japanese encephalitis are examples), it’s important to remember the other, more common threats that could ruin your trip in the long run. Consider:


— Are all your other vaccines, like tetanus, measles, polio, hepatitis A and B up-to-date?

— Are you protected against this year’s influenza strain? (In tropical areas, influenza does not follow seasonal patterns of infection the way it does in temperate climates.)

— Did you bring medications to treat your chronic medical conditions? (Did you bring enough?)

— Are you ready to protect yourself from biting mosquitos? Did you bring your anti-malaria pills and are you taking them properly?

— Will you remember to wear seat belts when you travel in cars abroad? Will you bring and use the appropriate child safety seat for your child?

— Will you observe the usual precautions abroad as you would use in any big American city, such as not traveling alone after dark, not “hooking up” with people you don’t know, practicing safe-sex, not drinking to the point of inebriation, and so forth?

— Do you have enough willpower to say “no” to foods and beverages that may not have been prepared in a healthy kitchen? (And did you wash your hands before sitting down to eat that delicious croissant?)


Here is another thing you really should be aware about anywhere you travel: the air you breathe. The PediaBlog spent most of the week before last (starting here) looking at air quality in this region and around the country. The air quality has improved over the years in some places and worsened in others. The Pittsburgh Metro region’s air quality has improved compared to the “Days of Steel,” though we still receive “F” grades because, let’s face it, the region’s polluted legacy sets the bar for a passing grade pretty high.

Last week, the World Health Organization announced study results on air quality around the rest of the planet and the conclusions shouldn’t be surprising:

  • In urban areas around the world, air pollution is getting worse.
  • Globally, 4 out of 5 urban dwellers breathe air that exceeds safety standards for particulate air pollution (PM2.5).
  • The poorest residents of cities are exposed to the most pollution.
  • The poorest and least developed countries suffer the most adverse public health outcomes.
  • Air pollution is shortening the lives of residents who have asthma, heart disease, and other chronic medical conditions

Chris Mooney and Brady Dennis find the report’s bottom line:

The WHO said 98 percent of urban areas in “low- and middle-income countries” with populations of more than 100,000 fall shy of the group’s air quality standards.

“Urban air pollution continues to rise at an alarming rate, wreaking havoc on human health,” Maria Neira, director of WHO’s department of public health, environment, and social determinants of health, said in a statement.


When it comes to fine particle pollution, American cities don’t crack the top 10. Zabol, Iran leads that list, followed by 4 cities in India, 2 in Saudi Arabia, 2 in China, and Bamenda, Cameroon. If you’ve watched the world news lately, you might think Beijing would be at the top of the list. Adam Taylor reviewed the data:

Delhi comes 11th in this ranking, while Beijing is far down the list at 57. For reference, WHO suggests that 10 micrograms per cubic meter of PM2.5 should be a guideline level for safe air.

WHO’s PM10 data paints a somewhat different picture. Nigeria’s Onitsha, a city of half-a-million people on the Niger River, is atop this list. The city has been known for its rapid growth and gridlock, though some locals were apparently still surprised that it appeared so high on the list. “We know pollution is very bad here. But this city must be much better than Lagos,” Solomon Okechukwa, a local official, told the Guardian.


Mr. Okechukwa is deluding himself. Two other Nigerian cities, but not Lagos, come in the top 10 for coarse particle (PM10) pollution.

Maybe we are all deluding ourselves. After 250 years of industrial development and the rise of modern civilization, the air we breathe has gotten very dirty and is getting dirtier. And the dirty air is making people sick. We would be wise and remember:


— What happens here stays here — and accumulates in the atmosphere. (Pollution doesn’t magically disappear into space.)

— What goes up comes down. Eventually airborne toxics come down and settle into our lakes, rivers, streams, and subsurface aquifers supplying our drinking water, and into the soil in which our food is grown.

— Air pollution travels. Wind does not observe signs indicating “City Limits.”


People travel, too. Travelers should consider air quality when choosing places to visit. If you have asthma, bring your inhaler and other medications. If you are pregnant (or hoping to become pregnant), remember the risks to reproductive health and pregnancy posed by air pollution. If you’ve had a heart attack, remember that a breath of air in a dirty city might be your last.

Travel safe. Travel smart. Be prepared. The most common things occur most commonly.