Is your inner travel bug abuzz with excitement about an excursion abroad? Have not even fears of tsunamis or terrorism dampened your wanderlust for locations foreign and exotic?

If so, you're among the estimated 20 million Americans who will visit a place where the risk of contacting a serious disease can be significant, according to the American Society of Travel Agents.

"There has been a huge movement to unique and unusual destinations," said Kathryn W. Sudeikis (search), president of the ASTA and vice president of corporate relations for "All About Travel" in Mission, Kansas. Right now, the hottest spots on the globe are the farthest flung. "It's all about experiential travel," she said.

Unfortunately, while a survey by ASTA found that Americans are very savvy when it comes to booking bargain flights and confirming creature comforts, it also revealed that very few take the necessary precautions to protect themselves from the threat of disease abroad. According to the survey, of the 58 million Americans who will venture beyond U.S. borders this year, only 19 percent seek travel health advice from a health-care professional before embarking on an overseas trip

"American travelers put so much less time into health preparation than into hotel or air preparation," said Don George, travel editor for LonelyPlanet.com, a travel Web site that publishes guide books, including medical guides. And this can be a problem, experts say, when Americans are increasingly visiting the far corners of Asia, Africa and Latin America.

Dr. Karl Neumann (search), a travel medicine specialist and pediatrician from Forest Hills, N.Y., said the first entry on any travel itinerary should be a pre-departure visit with your doctor to discuss your travel plans, educate yourself on possible health risks in the region you plan to visit, and make sure immunizations and vaccinations are up-to-date.

"These are not shots you would have had as childhood immunizations," Neumann explained. "The injections are very specific for a destination."

While Neumann emphasized that the overall health risks to travelers visiting exotic locations and developing nations remains small — and that immunizations are not necessary in most situations — he also stressed that a person's specific travel plans can boost that risk dramatically. For example, backpackers are eight times more likely to contract a serious illness than those who stay in hotels, he said.

"There is a spectrum of destinations," said George. "As you get farther a field, you probably want to see a specialist," he said.

Heading to Thailand or Mexico? The precautions you need to take depend almost entirely on the particular region of the country you plan to visit and what you plan to do there.

"To say that someone is going to get malaria in Mexico can be misleading," Neumann said. "If you go only by country, you're over-treating."

But if your idea of a great souvenir is a new tattoo or body piercing, or if you engage in sexual activity on your vacation, keep in mind that such choices can come with devastating health consequences, he said.

Danger Abroad: Myth vs. Reality

From bird flu and SARS in Asia to an eruption of polio in Indonesia, from the AIDS epidemic in South Africa to an outbreak of Marburg virus — a hemorrhagic fever similar to Ebola — in parts of Africa this year, the public health crises occurring around the globe are not to be taken lightly. For example, over the past year, the World Health Organization has issued increasingly alarming warnings that a global influenza pandemic is nearly inevitable.

However, experts say tourists are at very little risk of contracting these illnesses. According to the Centers for Disease Control and Prevention, the No. 1 health threat to tourists is food- and water-borne disease, whether it be a case of "traveler's diarrhea," food poisoning, or a more serious condition like malaria.

Just ask Carin Zissis, a New York-based freelance reporter whose passport has been stamped in such places as Morocco, Egypt, Turkey, North Africa, Brazil, Bolivia, Guatemala, Mexico and Cuba. Zissis has been vaccinated in preparation for many of her adventures, and visited a special immunization clinic in the United States before a five-month stay in Bolivia five years ago.

But those precautions didn't protect her from first contracting a mild case of salmonella and then an intestinal parasite when she moved from a city to a rural village with no running water. She was sick for a week with a fever and stomach problems — along with three of her travel companions — and felt the effects of the illness for months.

"We boiled the water and cleaned the produce with boiled water, but sometimes, there are things that are unavoidable," says Zissis. "I've gotten sick adjusting to being back in the states."

The WHO has named malaria — which occurs in more than 100 countries including the Caribbean — one of the most serious threats to international travelers. More than 7 million U.S. residents travel each year to areas where malaria is present, and about 1,200 travelers return home every year with the disease.

However, only 8.4 percent of the ASTA survey respondents who had traveled to malaria-endemic countries reported taking an anti-malarial medication to protect themselves.

Some of the resistance may be a conscious decision. Zissis, for example, said she was concerned about the side effects of the anti-malarial medication provided in the U.S. and prefers to take the over-the-counter remedies available in the countries she visits.

"The doctors there know how to treat tourist illness, they know how to take care of you," she said. "What I've found when I travel is that the medical staff and the pharmacies are able to advise you pretty well," she said, adding that she believes U.S. doctors may provide medications stronger than necessary.

In addition to malaria, Hepatitis A, which is contracted mostly from fruits and vegetables, is another major travel health threat. However, taking a few simple precautions with what, where and how you eat and drink, and protecting yourself from insect bites, can insulate most travelers from most health risks.

It is also extremely important, experts say, to take very seriously any signs of illness that may occur after returning from a trip and to inform doctors of foreign travel, even if it is months after the fact. Malaria, for example, can be very slow to present symptoms and is often misdiagnosed unless doctors are aware that the patient may have been exposed. Treatable if caught early, malaria can be very serious, even deadly, when diagnosis is delayed.

"This is something we can protect people from," Neumann said.

Government Action

Meanwhile, fears that modern travel will import diseases like bird flu and SARS (search) into the United States has swung the U.S. government into defensive action.

In April, President Bush signed an executive order adding influenza to the list of diseases for which the government is empowered to detain people in quarantines. The CDC has announced that it is doubling the number of quarantine stations used to evaluate and detain travelers who enter the country ill with potentially dangerous, contagious illnesses.

Plus, federal health officials are seeking electronic access to the passenger lists for flights arriving from places with an outbreak of an infectious disease. The move has touched off concerns among privacy advocates, but the government says the lists will help them head off epidemics the way the Customs Bureau uses the passenger lists to check for terrorists.

Sudeikis says she doesn't expect fear of disease to dampen Americans' wandering spirit.

"It's not something that would have an impact on travel," she said, noting that baby boomers are leading a globe-trotting pack that has pushed travel numbers past pre-9/11 levels. "If our clients can't go somewhere, we'll send them somewhere else," she said.

Certainly, travelers like Zissis aren't changing their plans.

"There might be things I wouldn't do in a country because of health risks, but there are not places I would not go," she said, recalling her decision not to swim in the Nile River during a visit to Egypt. "I would be so bored going to the typical places," she said.

In fact, in an age where travel consumers are increasingly taking a do-it-yourself approach to booking cheap flights and hotels online, their appetite for the exotic has helped travel agents redefine their role as expert advisers. When Asia was dealing with the SARS outbreak, Sudeikis directed clients to Australia and New Zealand. Political strife in Africa? How about Latin America or India?

"None of these things have to be issues," she said, if tourists seek out the necessary expert advice. "For example, we may recommend against taking very young kids to some places."

Lonely Planet's George — whose products cater to the do-it-yourself travel market — concurs. "If you're spending $5,000 on a trip, $50 for an agent can be a wise investment," he said. "But it is important to find an agent who is a specialist in a specific region," he said.

For travelers who want to do the research themselves, the CDC Web site offers extensive, country-by-country, region-by-region information and advice on travel health risks and disease prevention. The travel medicine Web site MD Travel Health.com also offers a wealth of information.

Neumann, the travel medicine specialist, said travelers should stay away from getting health information from the sites of tourism agencies, governments or embassies of the countries being visited. With an interest in promoting tourism, it's unlikely that the government or travel industries of a given nation would offer an objective or accurate assessment of health threats.