If your strategy for not getting sick or hurt on your next trip involves staying away from any enclosed social environments, there’s definitely one you should add to your list.

It’s called civilization.

Of course, you can’t usually avoid that one. Even if you could, there are no guarantees that disease and injury won’t find you. According to the U.S. State Department, the leading cause of injury death among U.S. citizens traveling internationally is road traffic accidents. Homicide takes the number two spot, and drowning tops the list of leading injury causes among Americans visiting countries big on water sports.

Taking these and other statistics into account, one conclusion of the Center for Disease Control and Prevention (CDC) Yellow Book is that “injuries and violence are as much a public health problem to travelers overseas as are infectious and chronic diseases, and they are in many ways more deadly.”

This doesn’t mean that risks from disease aren’t real. They just may not be the biggest risks you face either where you’re going or how you’re getting there. “You aren't really any more likely to get a disease from being in an aircraft than you are from being on a train, bus, or shut up in a conference room all day with a group of people,” according to CDC travel health expert Dr. Phyllis Kozarsky, M.D.

Many of the reported injury-related deaths among American tourists would have been preventable if the travelers had used seat belts and child safety seats, avoided unsafe areas, or not consumed alcohol prior to swimming, according to the CDC. Likewise, despite any health risks posed by your destination or fellow travelers, the burden for having a healthy trip largely rests with you.

Prepare for the worst.

Of course, disease is a major issue in some parts of the world, and before heading off to an unfamiliar locale you should check out the CDC’s Traveler’ Health section, which includes a destination-specific section outlining health risks and precautions in top vacation spots, as does the State Department’s International Travel site.

If you’re traveling overseas with anyone who’s pregnant, elderly, under five, or has a pre-existing medical condition, consider seeing a travel medicine specialist as well as buying travel insurance that covers medical care, Kozarsky says. While you’re at it, “ask if your policy will pay to have you repatriated. You may prefer to be treated or recover from an illness here in the United States.”

Before you leave, make a list of medical contacts at your destination, suggests nutritionist Monika Woolsey, who also says to bring “a list of your meds and a short list of translated words that you can use to point to if you do have to see a doctor,” and ask your home physician if he or she will be available to take calls from foreign doctors while you’re away.

The CDC lists what should be in your vacation med kit, as does Woolsey, whose top supplies include medicine for treating and controlling diarrhea, an anti-inflammatory “good for fevers, sunburns, and aches and pains,” ointments for treating sunburn, scratches, and rashes, and an enzyme supplement that can help prevent gastrointestinal problems.

Does a mask belong on your packing list? “At this time, masks are not recommended,” Kozarsky says. “In situations where they are recommended, it is usually the sick person that wears the mask to keep from spreading germs,” she says, “and if you are sick, you shouldn't travel.”

Practice good hygiene

By now you know the rules to reduce the risk of spreading or catching germs: stay more than six feet away from sick people, avoid touching your face, and wash your hands. And carry hand sanitizer, especially in flight, observes Traveling Mamas blogger and former flight attendant Beth Blair, as “most airplane lavatories only provide cold water,” which is not efficient for killing germs.

Even if you wash or sanitize your hands after using an airplane lavatory, the simple truth is that “many of those who used it before you did not,” points out tour leader and Trip Chicks co-owner Ann Lombardi. “There are germs lurking on the door knobs and handles,” she notes, “and if you close the door from the outside with your freshly-washed hands, you can pick up some nasty germs again. Use hand sanitizer once you’ve returned to your seat” and clean your tray table with an anti-bacterial wipe, she adds.

Blair recalls that “as a flight attendant, I always made an effort to pass the beverage directly to each passenger. However, I've seen passengers coughing or sneezing all over their hands then ‘helping’ their fellow seatmate by passing their drink to them.”

Watch what you eat

Avoid eating raw vegetables overseas, especially in developing countries, Woolsey says, “due to the lack of knowing what was used to fertilize the vegetables.” Kozarsky also warns that “unpasteurized milk, certain cheeses, and food from street vendors can carry a risk of food borne illness.”

If you’re avoiding your destination’s iffy tap water, remember to avoid the ice as well as drinking from bottles that might have been chilling on it. Graze local snacks early in the day when displayed food is likely fresher, Woolsey advises, and pitch unrefrigerated leftovers or “you may be setting yourself up for food poisoning. Proteins can realistically only be at room temperature for about two hours before they start to spoil,” she says.

If all else fails

If you’re seriously ill or injured overseas, the local U.S. consular office will help you find appropriate care, Kozarsky says. Most resorts “have a physician they can call if your symptoms don't improve,” Woolsey notes. And Blair learned during a 14-hour wait in a New Orleans emergency room that it pays to “call various hospitals in the area for wait times if going to ER. Sometimes urgent care has shorter lines.”

If you become ill after you get home, ensure your doctor knows about any overseas trips you’ve made over the last six months. It’s routine for doctors to ask about this, Woolsey notes, “but I've seen it slip through the cracks. I did have a client once who had amoebic dysentery who had been diagnosed with an eating disorder. Her doctor was not used to asking about international travel.”

Also be sure you’re accurately reporting the details leading up to your sickness. “Gastrointestinal symptoms can take 48-72 hours to manifest,” Woolsey says, but “people tend to blame how they feel on the last thing they ate.” She recounts when her parents returned from Mexico with gastrointestinal problems.

“They blamed it on the last meal they'd eaten, which was at a high-end restaurant, but when we spoke a little longer it turned out they'd tried something from a street stand a day or two before.”

“I think we're more likely to be sick as a result of choices we make ourselves then we are from viruses,” says Woolsey. I certainly don't want to minimize the risk of viruses, but I think people need to be aware of what they inflict on themselves as well.”

Concurs Kozarsky, “you wouldn't get a tattoo at a sketchy parlor in the United States; don't do it on spring break overseas. Hepatitis isn't a good vacation souvenir.”

That said, Kozarsky adds, “we don't want people to worry. We want them to be prepared and to be able to enjoy their travels safely. And common sense is really the most important thing you can pack.”

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