INTERNATIONAL TRAVELERS: DON'T FORGET YOUR SHOTS.

Byline: Susanne Hopkins Daily News Travel Editor

You have your tickets and travelers checks, your luggage is packed and you've found someone to take care of the cat. Looks like you're ready to jet away on that long-awaited trip to Italy.

Oops. What about your shots?

Shots, you ask. For Italy?

``Hepatitis A is occurring anywhere in the developing world, including Mexico, India and southern Europe - Greece, Spain and Italy,'' said Dr. Alan Spira, a physician specializing in tropical medicine at the Travel Medicine Center in Beverly Hills.

Transmitted via contaminated food or water, hepatitis A is a viral disease of the liver - not a souvenir you want to bring home. You can prevent it with an immunization - and many doctors are recommending it now.

Generally, health officials say, folks headed to destinations in North America (except Mexico), developed European countries and Australia and New Zealand needn't worry about immunizations. (Indeed, few countries require proof of immunization for entry; exceptions are nations in Africa and South America, which require yellow-fever immunizations). But step out of that arena into rural areas of even developed European countries, as well as Eastern Europe, South, Central and Latin America, Asia, Africa, the Middle East and Indonesia, for example, and the threat of disease grows.

Yellow fever, hepatitis A, Japanese encephalitis, malaria, meningococcal disease (which causes meningitis) and typhoid fever, among others, can be common in such places - and travelers can fall prey to them without proper immunizations or oral medication, said health experts.

``With proper behavior and common sense, you can avoid so many of these illnesses, and you can enjoy your trip so much more,'' added Spira.

But how is a person to know what they need?

You can get up-to-date, worldwide travel health information by calling the national Centers for Disease Control and Prevention in Atlanta (888- 232-3228 or 404-332-4559), or by tapping into the CDC's World Wide Web pages (http://www.cdc.gov/). And you can query your personal physician, who may refer you to a clinic specializing in travel medicine.

The physician administering the vaccinations will tell you what you need - and you may be surprised.

``It depends on where they (travelers) are going - are they going to urban areas or rural areas? - when they are going and what they are going to do. It makes a difference whether they are going on a cruise or a trek,'' said Spira, who relies on the CDC and the World Health Organization, as well as a private Web site available only to tropical physicians, for up-to-date information about health crises around the world.

At Kaiser Permanente, patients fill out a trip-planning questionnaire that includes a medical history and travel itinerary, said Dr. Barbara Scott, physician director of urgent care at the Woodland Hills facility.

``We also want to know how long they'll be gone, whether they're traveling independently or on a tour and whether they'll be staying in a hotel,'' she added.

Travelers going independently or venturing into rural areas might need immunizations not required if staying at a hotel in the city, doctors said.

Scott and other physicians advise patients to arrange a visit with them four to six weeks prior to leaving on trips. Generally, though, travelers treat immunizations as a last-minute thing.

``Usually, they do not give themselves enough time. It takes two weeks to develop the antibodies to get a reasonable defense,'' said Dr. Robert LeMaile-Williams of the L.A. Overseas Medical Center, which is affiliated with Good Samaritan Hospital in Los Angeles.

And some immunizations, such as those for hepatitis A, require a series of inoculations over a period of time, physicians said. Allowing more time to get immunizations also means travelers are likely to recover from any side effects - such as soreness at the inoculation site, headaches, nausea, cramps, vomiting, dizziness and muscle aches - from the shots or oral medications before embarking on their trip.

Travelers generally can get immunizations through personal physicians, clinics or medical facilities, but not all offer the service. The County of Los Angeles Department of Health Services, for example, does not offer the immunizations, said Dr. Shirley L. Fannin, director of disease control for the department. And many hospitals, including Northridge Medical Center and Tarzana Regional Medical Center, do not provide traveler's immunizations (see accompanying list for some of the local facilities offering them).

Even when immunizations are offered, physicians caution, do not assume you can just walk in and get the necessary shots. Some facilities don't stock every vaccine, and yellow-fever immunizations require that the person administering them be certified by the state; many physicians do not have that certification.

Getting all the pertinent immunizations, however, still doesn't guarantee you'll be immune to all the diseases in different parts of the world. You can only avoid things such as traveler's diarrhea by watching what you eat and drink and taking other precautions, health officials said. Knowledge about where you're going helps, too.

``Read before you go. Learn about the place,'' urged Spira. ``Don't Mr. Magoo your way around the world. The most important luggage you can take with you is common sense.''

Travel Tips

Immunizations aren't a traveler's only defense against disease. In the travel medicine field, there's a common saying:

``Boil it, cook it, peel it or forget it!''

Good advice for avoiding such things as dysentery and other diseases such as hepatitis A. Here are some more tips, culled from travel medicine experts, to help you travel safely in other countries, particularly in developing countries and rural areas:

Drink bottled water - and make sure it is sealed and purchased from a reputable merchant.

Brush your teeth with bottled water.

Avoid raw food, including salads and vegetables. Eat only fresh fruits that can be peeled.

Avoid unpasteurized dairy products - including ice cream.

To help avoid traveler's diarrhea, health experts recommend taking Pepto Bismol, two tablets four times a day starting the day before you leave and continuing daily until two days after returning home (side effects can include tinnitus, nausea and vomiting). As a precaution, take Immodium A-D along on the trip and take it only if you experience Montezuma's revenge.

Take along a water filter, which will filter out bacteria. If in doubt about water, boil it (you can just bring it to a boil - it does not have to boil for 10 minutes unless you are cleaning a wound, according to Dr. Alan Spira of the Travel Medicine Center in Beverly Hills).

Pack a good mosquito repellent - and use it liberally.

Take sunscreen with PABA - and use it.

Buy or put together a first-aid kit consisting of scissors, thermometer, tweezers, bandages (including Ace wraps, finger and knuckle strips), adhesive tape, gauze pads, insect netting, moleskin (for blisters), aspirin, antacid tablets, antifungal ointment (for tropical destinations) and any medications you normally take.

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Photo: Drawing (Colr) No caption (First-aid kit and syringe)

Box: Travel Tips (See text)