29 April 2010

Advice for summer travel

Country specific information can be found on the NaTHNaC Country Information Pages and the Outbreak Surveillance Database.

With the start of the holiday season arriving, many people are planning their spring and summer holidays and preparing to travel abroad. Travellers are advised to discuss their plans with their GP, Practice Nurse or a travel clinic, well in advance of travel.

Travellers should prepare to reduce potential health risks, especially if travelling to visit friends and relatives (VFR). Some VFR travellers mistakenly believe that they have immunity to diseases such as malaria. Being aware of risk is crucial in preventing illness.

Travel insurance

All travellers should have comprehensive travel insurance. In addition, travellers to Europe should apply for a European Health Insurance Card (EHIC) which entitles UK residents to free or reduced cost medical treatment in the European Union (EU) and some non-EU countries including Switzerland.

The Foreign and Commonwealth Office (FCO) website should be consulted for safety and security advice. The FCO is encouraging all British nationals to register with their new LOCATE service so that the FCO can provide travellers with assistance in the event of an emergency.

Safety and Security

Accidents, particularly road traffic accidents, are an important cause of injury and death amongst travellers. Standards of driving and road conditions vary worldwide.

Travellers undertaking unfamiliar sports or activities should receive adequate training and supervision. They should be aware that their travel insurance may not provide cover for any injuries sustained.

It is strongly advised that travellers should not swim or dive into water in unfamiliar areas, particularly at night, after drinking alcohol or ingesting illegal drugs

Personal behaviour

For some travellers a summer holiday is associated with increased alcohol consumption or drug use that can result in risk taking behaviour. Women may be more vulnerable to risks to their personal safety including sexual assault.

Alcohol is banned in some countries, with severe penalties for consumption. Punishments for drug offences can include lengthy prison sentences, or in some countries, the death penalty. Travellers are advised:

  •  Don’t take illegal drugs.

  •  Avoid excessive alcohol intake, and always be aware of your personal safety and that of your friends.

  •  Ensure that drinks are not left unattended, to avoid drink spiking, and don’t accept drinks from strangers or casual acquaintances.

  •  Do not drive after drinking alcohol or using illegal substances.

Travel insurance policies will not provide cover for accidents or illnesses related to alcohol or drug use.

Further information on personal behaviour, local customs and important issues for women travellers is available from the FCO: Know Before you Go Campaign

Sexual health

Lowered inhibitions whilst on holiday may result in a sexual encounter with a new partner and the risk of sexually transmitted infections such as chlamydia, gonorrhoea, human papillomavirus and HIV.

Condoms can be difficult to obtain in some countries. Travellers should carry a personal supply of British Kite marked condoms.

An information leaflet, Sexually transmitted infections – reducing your risk, is available on the NaTHNaC website.

Tattooing and body piercing

Tattoos and body piercing should be avoided due to the risk of transmission of blood-borne virus infections such as hepatitis B, hepatitis C and HIV. Travellers should be reminded that many low income countries have a higher incidence of these infections than the UK.

Travel-Related Deep Vein Thrombosis (DVT)

Long periods of immobility, including bus and train journeys and long haul flights of eight hours or longer, increase the risk of travel-related DVT.   Some underlying medical conditions or treatments can also increase the risk of DVT during travel.  Further information can be found in the NaTHNaC Health Information Sheet on Travel Related Deep Vein Thrombosis.

A number of measures can reduce the risks of DVT:

  •  Avoid dehydration and excessive alcohol.

  •  Avoid stowing luggage under seats, as this restricts movement.

  •  Regular extension and flexion of ankles to encourage blood flow to the lower limbs.

  •  Take regular deep breaths.

  • Walk around as much as possible during the journey.

Those at increased risk of travel-related DVT should wear compression stockings or flight socks that have been properly fitted. Those at very high risk should seek medical advice regarding the use of anti-coagulant medication.

Food and water hygiene

Travellers’ diarrhoea is one of the most common travel-related illnesses. The risk of food and water-borne infections can be minimised by taking common sense food and water hygiene measures and by ensuring that appropriate vaccinations are administered.

Usually travellers’ diarrhoea is self-limiting but can disrupt travel plans. Travellers can carry self-treatment medication with them for use if symptoms occur. Hydration is essential. Children, the elderly and those with pre-existing illnesses are more at risk of complications and dehydration. Travellers should seek medical advice if they have a fever, blood in the stool or if symptoms do not resolve within a couple of days.


Dehydration can occur rapidly in hot conditions and adequate fluid intake should be maintained.

Sun protection

A suntan is the goal of a summer holiday for many travellers; however, a tan is the visible effect of damage to the skin from the ultraviolet rays of the sun. This damage can lead to skin ageing and cancer.

It is still possible to enjoy the benefits of the sun, but extra precautions should be taken:

  •  Always use a sunscreen with a high sun protection factor (SPF) (usually at least SPF15).
  •  Choose a broad-spectrum sunscreen with a star rating of four stars or more.
  •  Sunscreen should be applied at least 30 minutes before exposure to the sun. It should be reapplied about every two hours, and also after swimming and vigorous exercise.
  •  Always apply enough; most people apply too little which reduces the effectiveness of the sunscreen. About two tablespoons of sunscreen will be needed to protect an average adult.
  •  Wear a wide-brimmed hat to protect the head and face.
  •  Children are particularly vulnerable to the damaging effects of sunlight. Babies under six months of age should never be exposed to direct sunlight and young children should always have a high SPF applied.

Insect bite avoidance

Many tropical diseases such as malaria, Japanese encephalitis, yellow fever and dengue, are transmitted by insects. Tick-borne encephalitis occurs throughout parts of Central and Eastern Europe during the spring, summer and autumn and could be a risk for campers and walkers in forested areas. 

In tropical areas of Australia the risk of mosquito-borne diseases, including dengue, increases during the UK summer months (their wetter season) [1, 2]. 

Insect bite avoidance measures include:

  •  Apply an insect repellent to exposed skin.
  •  Wear protective clothing and treat it with insecticides designed for clothing.
  •  Sleep in air conditioned, screened accommodation or under intact mosquito nets if this is not available.
  •  Ticks can be avoided by wearing long trousers tucked into socks and enclosed footwear. Skin should be checked for ticks regularly and removed promptly with tweezers or tick removers.
  •  Take appropriate malaria prevention tablets in risk areas, as advised by a healthcare professional.

Information on recommended vaccinations and malaria prevention tablets can be found on the NaTHNaC Country Information Pages.


The influenza season in the Southern Hemisphere usually occurs during the months of April to September.  Pandemic H1N1 (2009) influenza (swine ‘flu) vaccine should be offered to all travellers to countries in the Southern Hemisphere during their influenza season (April to September) [3, 4].  This includes travel to countries such as Australia, New Zealand and South Africa (particularly if travelling to the Football World Cup tournament, South Africa, 2010). Vaccination should ideally be completed two weeks before travel to enable an adequate immune response.

Summer events

Advice for travellers attending summer events such as indoor and outdoor festivals and sporting tournaments including the Football World Cup tournament, South Africa, 2010 can be found on the NaTHNaC website.


1. Government of Western Australia. Health Department. Media release 8 April 2010. Mosquito-borne disease risk in the north of WA. [Accessed 28 April 2010]. Available at:

2. Department of Health and Families, Northern Territory Government: Health Alerts. [Accessed 28 April 2010]. Available at:

3. Department of Health. Swine ‘Flu vaccine available for the protection of travellers. Press release. [Accessed 28 April 2010]. Available at: DH_114270


4. NaTHNaC. Clinical Update 22 March 2010. Pandemic H1N1 (2009) influenza vaccination for travellers to the Southern Hemisphere. Available at: