Common mishaps and perils when traveling abroad might include a bad case of sunburn, lost traveler's checks or, heaven forbid, forgetting to pack those extra pairs of underwear.

At the time, these incidents might seem unbearable, but imagine the agony of spending the few remaining days of a trip bedridden with a high fever, nausea and severe muscle aches. Suddenly, that camera you forgot to bring isn't such a big deal anymore, is it?

Now picture yourself on a research project in Cambodia, and you have to be medically evacuated to Bangkok for diagnosis and treatment of falciparum malaria, a potentially life-threatening disease that can lay you up for several months.

Shone Sterner, R. Bradley Sack and Judy Baker in the Travel Medicine waiting room.

Although all travel presents some form of risk, the health perils associated with visits to many parts of the world, especially underdeveloped and tropical regions, can be particularly significant.

The Johns Hopkins Travel Medicine consultation and immunization service, located on the eighth floor of the Outpatient Center, deals almost exclusively with the health issues related to global travel. Since 1986, the goal of this service has been to reduce the risks associated with international travel by offering to the public preventive health services, such as consultations, immunizations and prescriptions. The clinic annually serves about 3,500 clients, 10 percent of whom are associated with Hopkins.

"We provide travelers with current information, practical advice, immunizations and necessary prescriptions to lessen their risk of illness and injury abroad," says Judy Baker, assistant director. "While most people remain healthy, it pays to be an informed and immunized traveler."

The Travel Medicine staff will advise travelers, depending on their destination and length of stay, about all they need to know in regard to potential hazards. Some of the health issues include recommending and discussing immunizations for vaccine-preventable diseases, updating routine immunizations, preventing malaria and other insect-borne diseases, food and water safety, prevention and treatment of traveler's diarrhea, personal safety, HIV prevention, jet lag, motion and altitude sickness and medical care and insurance abroad.

The pretravel consultations, which should be scheduled for two or more weeks prior to departure, are focused primarily on prevention.

These consultations are not just for extended stays to places like Africa or India. For even a weeklong trip to Costa Rica, for example, Baker says people should know that in coastal areas there is a risk of not only traveler's diarrhea but hepatitis A, dengue fever and malaria.

R. Bradley Sack, a professor of international health in the School of Public Health and director of the clinic since its inception, has both lived and worked abroad extensively, as has Baker. Baker says this allows staff to give clients the best possible service by combining both professional expertise and personal experience.

Having lived seven years in West Africa, for instance, Baker says people can ask her about anything there--from road conditions to the types of snakes they can expect to run into.

Baker, a nurse who received her master's degree in public health at Johns Hopkins, says clients range from weeklong vacationers to Hopkins researchers who have multi-year commitments to work overseas. Baker says each office visit is tailored to the degree of travel experience the person has.

"We don't waste their time with what they already know but rather fill in the gaps and provide information about things that are new and different--such as new vaccines or different medications used to prevent malaria," Baker says. "These are important things they need to know."

Baker says that travelers who spend a good deal of time overseas may think they are sufficiently immunized, but their vaccines may have expired and they need to get booster shots. Or they might not be aware of new vaccines licensed over the past few years. They might also be relying on older or incorrect drugs for malaria and traveler's diarrhea prevention.

Also, it is not just tropical diseases that people should worry about.

"Many adults are not current on their tetanus-diphtheria boosters or MMR immunization, and many individuals at risk have not received hepatitis B, influenza or pneumonia immunizations," Baker says. "We review all vaccines, tell you which ones are recommended and then we let you decide which ones you want to get."

Physicians also offer post-travel consultations for the diagnosis, treatment and follow-up of illness associated with travel.

Routine non-travel immunizations are also available.

The fee for a pre-travel consultation is $40, and immunizations range from $20 to $150. Although the price of vaccines has increased over the years, Baker says the cost is still well worth it.

"One case of traveler's diarrhea accompanied by dehydration could cost several hundred dollars for a doctor's visit, laboratory tests, prescription medication and follow-up," Baker says. "Not to mention three to five days of misery that ruin your trip and lost days of vacation or work."

Consultations can be arranged by calling Shone Sterner at 410-955-8931.