Travel Advice

Holiday season is here, are you ready? Before travelling abroad, it is a good idea to look up the latest health advice for your country of choice from the Department of Health website and travel safety updates from the Foreign and Commonwealth Office.

Check to see if your immunisations are up to date and indeed if you need any for the country you are travelling to. Look up on the website www.fitfortravel.nhs.uk. Do not leave it late to book the appointment with the nurse, they are booked up well in advance you should seek health advice about six to eight weeks before travelling. You may also need to consider if malarial cover is required, it only takes one bite. Malaria is a potentially fatal disease but the good news is that it is preventable, so plan wisely and prepare for healthy and happy travels!

Take a first aid kit, include:

Antihistamines tablets and cream
Anti-diarrhoea pills
Rehydration sachets
Antiseptic wipes
Sun block
Analgesia and Bite prevention lotion.

The most common problems are sunburn, diarrhoea, mosquito bites, accidents and sexually transmitted infections (STIs) so maybe condoms should be taken too, since fake brands may not protect you.

Water

Diseases can be caught from drinking contaminated water, or swimming in it.

Boiled water
Bottled water with the seal intact or canned drinks
Water treated by a sterilising agent.

This includes ice cubes in drinks and water for cleaning your teeth.

Swimming

It is safer to swim in water that is well chlorinated. If you are travelling to Africa, South America or some parts of the Caribbean, avoid swimming in fresh water lakes and streams. You can catch a parasitic disease called schistosomiasis from such places. This disease is also known as Bilharzia. It is wise never to go barefoot, but to wear protective footwear when out, even on the beach. Other diseases can be caught from sand and soil, particularly wet soil.

Food

Contaminated food is the commonest source of many diseases abroad.

You can help prevent it by following these guidelines:

Only eat well cooked food
Avoid leftovers and reheated foods
Ensure meat is thoroughly cooked
Eat cooked vegetable, avoid salads
Only eat fruit you can peel
Never drink unpasteurised milk
Avoid ice-cream and shellfish
In general, avoid buying food from street vendor's stalls

Another source of calories is alcohol! If you drink to excess, alcohol could lead you to become carefree and ignore these precautions.

Two phrases to help you remember:

Cook it, peel it, or leave it!
When in doubt, leave it out!

Personal Hygiene

Many diseases are transmitted by what is known as the ‘faecal-oral’ route. To help prevent this, always wash your hands when going to the toilet also, consider that those who have not washed their hands may have touched the door handles.

Do not leave your toothbrushes out when you have finished there has been some reports that they are being used by the maid for cleaning around the sink.

Hepatitis B risk has risen in Spain and Portugal due to manicures and pedicures, so please bear this in mind.

Travellers' Diarrhoea

This is the most common illness that you will be exposed to abroad and there is no vaccine against it at present. Travellers’ diarrhoea is caused by eating and/or drinking food and water contaminated by bacteria, viruses or parasites. The risk of illness is higher in some countries than others.

High risk areas include North Africa, sub-Saharan Africa, the Indian Subcontinent, S.E. Asia, South America, Mexico and the Middle East.

Medium risk areas include the northern Mediterranean, Canary Islands and the Caribbean Islands.

Low risk areas include North America, Western Europe and Australia.

You can certainly help prevent travellers’ diarrhoea in the way you behave – make sure you follow the food, water and personal hygiene guidelines already given.

Travellers’ diarrhoea is said to occur when you pass 3 or more loose stools in a 24 hour period often accompanied by stomach pain, cramps and vomiting. It usually lasts 2-4 days and whilst it is not a life threatening illness, it can disrupt your trip for several days. The main danger is if dehydration occurs during the illness, and this, if very severe, can be life threatening if it is not treated. Treatment is therefore rehydration. In severe cases and particularly in young children and the elderly, commercially prepared rehydration solution is extremely useful. This can be bought in tablet or sachet form from a chemist shop e.g. Dioralyte or Electrolade. (Dioralyte Relief is a formula containing rice powder which also helps to relieve the diarrhoea, particularly useful in children). Prepare all products according to instructions, taking care regarding their use in very small children and seeking medical advice where necessary).

Anti diarrhoeal tablets can be used for adults but should never be used in children under 4 years of age, and only on prescription for children aged 4 to 12 years. Commonly used tablets are Imodium, Lomotil or Normaloe.

None of these tablets should ever be used if the person has a temperature or blood in the stool.

Do seek medical help if the affected person has:

A temperature
Blood in the diarrhoea
Diarrhoea for more than 48 hours (or 24 hours in children)
Becomes confused

Please note, a woman taking the oral contraceptive pill may not have full contraceptive protection if she has had diarrhoea and vomiting. Extra precautions must be used – refer to your ‘pill’ information leaflet. If using condoms, use products which are CE approved.

Hepatitis B and HIV Infection

These diseases can be transmitted by:

Blood transfusion
Medical procedures with non sterile equipment
Sharing of needles (e.g. tattooing, body piercing, acupuncture and drug abuse)
Unprotected sexual contact

The risk of contracting hepatitis B in Spain and Portugal has increased due to pedicures and manicures.

Ways to protect yourself:

Only accept a blood transfusion when essential
If travelling to a developing country, take a sterile medical kit
Avoid procedures e.g. ear or body piercing, tattooing and acupuncture
Avoid casual sex, especially without using condoms

Remember – excessive alcohol can make you carefree and lead you to take risks you otherwise would not consider.

Insect Bites

Mosquitoes, certain types of flies, ticks and bugs can cause different diseases. e.g. malaria, dengue fever, yellow fever. Some bite at night, but some during daytime, so protection is needed at all times.

Avoid being bitten by:

Covering up skin as much as possible if going out at night, (mosquitoes that transmit malaria bite from dusk until dawn). Wear loose fitting clothes, long sleeves, trousers or long skirts and socks.
Use insect repellents on exposed skin. (DEET containing products are the most effective. A content of up to 50% DEET is recommended for tropical destinations.) Clothes can be sprayed with repellents too or clothing specific sprays. Check suitability for children on the individual products. If using sunscreen always apply first followed by an insect repellent spray on top
If room is not air conditioned, but screened, close shutters early evening and spray room with knockdown insecticide spray. In malarious regions, if camping, or sleeping in unprotected accommodation, always sleep under a mosquito net (impregnated with permethrin). Avoid camping near areas of stagnant water, these are common breeding areas for mosquitoes etc.
Electric insecticide vaporisers are very effective as long as there are no power failures!
There is no scientific evidence that electric buzzers, savoury yeast extract, tea tree oil, bath oils, garlic and vitamin B are effective.

Malaria

If you are travelling to a malarious country, the travel health adviser will have given you a separate leaflet with more details, please read it. remember, malaria is a serious and sometimes fatal disease. If you develop flu like symptoms, including fever, sweats and chills, feeling unwell, headaches, muscle pains, cough, diarrhoea, then seek medical advice immediately for advice and also mention where you’ve been abroad, this is vital, don’t delay.

Animal Bites

Rabies is present in many parts of the world. If a person develops rabies, death is 100% certain.

There are 3 rules regarding rabies:

Do not touch any animal, even dogs and cats
If you are licked on broken skin, scratched or bitten in a country which has rabies, wash the wound or area thoroughly with soap and running water for a minimum of 5 minutes then apply an antiseptic solution if possible e.g. iodine or alcohol. Such precautions also apply if you are licked by an animal with their saliva coming into contact with your eyes or inside of your mouth (essentially any mucous membranes)
Seek medical advice IMMEDIATELY, even if you have been previously immunised, this is essential

Accidents

Major leading causes of death in travellers are due to swimming and traffic accidents. You can help prevent them by taking notice of the following.

Precautionary guidelines:

Avoid alcohol and food before swimming
Never dive into water where the depth is uncertain
Only swim in safe water, check currents, sharks, jellyfish etc.
Avoid alcohol when driving, especially at night
Avoid hiring motorcycles and mopeds
If hiring a car, rent a large one if possible, ensure the tyres, brakes and seat belts are in good condition
Use reliable taxi firms, know where emergency facilities are.

Insurance Cover

Take out adequate insurance cover for your trip. This should possibly include medical repatriation as without it, this service if needed is extremely expensive.
If you have any pre existing medical conditions, make sure you inform the insurance company of these details and check the small print of the policy thoroughly.
If you travel to a European Union country, make sure you have obtained an EHIC card before you travel which takes some time to obtain. Further information about the EHIC is found at

Air Travel

It is sensible on any long haul flight to:

Be comfortable in your seat
Exercise your legs, feet and toes while sitting every half an hour or so and take short walks whenever feasible. Upper body and breathing exercises can further improve circulation
Drink plenty of water and be sensible about alcohol intake which in excess leads to dehydration

Further information can be obtained from the websites detailed at the end of this leaflet with more specific advice and information on travel-related deep vein thrombosis.

Sun and Heat

Sunburn and heat-stroke cause serious problems in travellers, but in the long term can be a serious cause of skin cancer. Long term damage to the skin due to sun exposure can lead to skin cancer. There is no such thing as a safe suntan but the following advice should be taken.

Precautionary Guidelines

Increase sun exposure gradually, 20 minutes limit initially.
Use sun blocks which contains both UVA and UVB protection and sufficient sun protection factor (SPF) and a minimum of SPF 15. Children under 3 years should have a minimum SPF 25 and babies under 6 months should be kept out of the sun at all times. Reapply often and always after swimming and washing. Read manufacturer instructions
Always apply sunscreen first followed by an insect repellent spray on top
Wear protective clothing – sunhats, T shirts and sunglasses etc.
Avoid going out between 11.00am and 3.00pm, when the sun’s rays are strongest.
Take special care of children and those with pale skin/red hair.
Drink extra fluids in a hot climate.
Be aware that alcohol can make you dehydrated

Interesting web site addresses and further information:

Scottish NHS public travel health site –

National Travel Health Network and Centre – www.nathnac.org

NHS UK www.nhs.uk – go the ‘Live Well’ menu and select ‘travel health’

Foreign and Commonwealth Office – www.fco.gov.uk/travel

Malaria for the general public –

International Websites for Travel Health

World Health Organisation www.who.int

Centers for Disease Control and Prevention www.cdc.gov

International Society of Travel Medicine ‘global travel clinic locator’ www.istm.org

Original work by Jane Chiodini