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With spring break upon us, many Canadians are taking respite from the winter cold and heading to warmer climates. But with reports of Norwalk virus on cruise ships, malaria outbreaks in Jamaica and the Dominican Republic, dengue fever in Mexico and concerns about traveller's diarrhea, a lot of my patients have come in asking what precautions to take.

Let's start with some general advice. If you are planning to travel you should ask your physician or travel clinic at least a month before you depart whether any immunizations or special measures are recommended. It can take several weeks for some vaccines to take effect. That's why you can't leave your medical appointment to the last minute.

For both adults and children, it is essential to make sure that all routine vaccinations are up to date. Adults often forget that a tetanus and diphtheria booster shot is recommended every 10 years. Many adults cannot remember when or even if they have had an updated shot. In addition, if travelling this time of the year, during flu season, an influenza vaccination is a good idea.

Another vaccine to consider is the Hepatitis A vaccine. Hepatitis A is one of the most common diseases picked up by travellers. Typically, the virus is transmitted through contaminated food or water and causes inflammation of the liver. A single dose of the vaccine will offer short-term immunity within three weeks of it being given. A second vaccine, given six months to one year after the initial vaccine, will typically give lifetime protection to most individuals.

Hepatitis B also causes an inflammation of the liver but is not spread through contaminated food or water. Instead, it is spread through contact with the body fluids of an infected individual during sex, by sharing injected drug needles, or through a contaminated blood transfusion. Immunization is available for hepatitis B.

Recently, there has been concern about malaria in many popular destinations. Malaria is caused by a parasite that is essentially injected into the blood stream by the bite of an infected mosquito. It is important to know if malaria is present so that precautions can be taken. These would include using insect repellents on exposed skin, particularly between dusk and dawn, and wearing protective clothing. In addition, anti-malarial medication exists.

The specific anti-malarial drug required will depend upon the particular strain of the disease that is present in the travel region. Some strains have developed a resistance to certain drugs. The medication must be started before departure, and continued for the entire time you are away as well as for several weeks after leaving the area. Side effects should be reviewed with the prescribing physician.

Dengue fever outbreaks were reported early in the new year in Puerto Vallarta, Mexico. It causes a severe flu-like illness, although it rarely leads to death. Common symptoms include muscle aches, headaches, joint pain and rash. The fever typically lasts from three to five days.

Dengue virus is spread by the bite of an infected mosquito. There is no vaccine for dengue fever, so following recommendations to prevent being bitten is critical. A total of 215 cases of the fever were reported in the Pacific resort last month.

Another common vacation illness is so-called traveller's diarrhea. It is characterized by frequent loose or watery bowel movements. It often occurs as a result of consuming contaminated food and liquids. One of the most common bacterial sources is enterotoxigenic E. coli or ETEC.

A relatively new vaccine called Dukoral is now available to prevent ETEC diarrhea. Two doses of the vaccine are taken by mouth one week apart. About 60 per cent of the protection offered by the vaccine occurs within one week of completing the final dose. A booster dose given three months later is suggested if you are still away and at risk. Dukoral will also protect against cholera. This vaccine can be given to those aged two and older.

Depending on where you are going, there are other available vaccines ranging from polio to yellow fever to meningococcal vaccines and Japanese encephalitis vaccine. It is always important to review what particular risks you face based on the area of travel.

Dr. Marla Shapiro can be seen Tuesdays on CTV's Canada AM.