4 July 2008

Advice for summer travel

With the start of the summer holiday season, many UK residents will be preparing to travel abroad. Travel health advice should be sought from a GP, Practice Nurse or a Travel Health clinic well in advance of travel.

Travellers returning to their country of origin to visit friends and relatives (VFR travellers) are at particular risk of travel related illness. This is due to several factors, including the likelihood that they will spend long periods in high risk areas. Some VFR travellers also mistakenly believe that they and their children have immunity to diseases such as malaria. These travellers should be actively encouraged to attend a travel health consultation. Raising awareness of risk is crucial in protecting this group of travellers.

Environmental risks

Food and water hygiene

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

Usually travellers’ diarrhoea is self-limiting. However, travellers may wish to carry self-treatment medication with them for use if symptoms occur. Hydration is crucial. 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.

Insect bite avoidance

The risk of insect transmitted illnesses can be minimised by following insect bite avoidance measures:

• Use personal insect repellents.
• Wear protective clothing and treat them with insecticides designed for clothing.
• Sleep in air conditioned, screened accommodation.
• Sleep under intact mosquito nets, if properly screened accommodation is not available.
• Take anti-malarial tablets in risk areas, as advised by a healthcare professional.

Deep vein thrombosis (DVT)

Certain factors have been associated with an increased DVT risk. These include:

• Long periods of immobility, including bus, plane and train travel. Trips of eights hours or longer are considered to increase risk.
• Congestive cardiac failure or recent myocardial infarction.
• Dehydration.
• Certain haematological disorders.
• History of DVT or pulmonary embolism.
• Malignancy.
• Oestrogen therapy such as the oral contraceptive pill.
• Pregnancy and puerperium.
• Recent surgery.

A number of measures can be taken to reduce the risks of travel related DVT. These include:

• 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 at regular intervals during the journey.

Sun protection

Suntan is a visible sign of skin damage. Skin cancer, malignant melanoma, certain eye conditions and photo-ageing have all been associated with exposure to sunlight.

The World Health Organization advises common sense measures to reduce the harmful effects of the sun:

• Protect children.
• Limit midday sun exposure.
• Use shade.
• Wear protective clothing.
• Use a sunscreen.

Sunscreens are classed by sun protection factor (SPF), a guide to the level of protection against ultraviolet B (UVB) light provided by the product. UVB rays are responsible for skin burning. A sun screen of at least SPF 15 should be regularly applied, even on cloudy days.

Sunscreens are less effective against filtering ultraviolet A (UVA) rays, which are associated with long term skin damage. Sunscreens may also provide a false sense of security, encouraging longer sun exposure and increasing risk of sun damage.

Infectious diseases

Avian influenza

Over the last six months bird cases of avian influenza A (H5N1) have been reported in several countries in Asia, Europe, the Middle East and Africa. There have been rare human cases of avian influenza and none have occurred in travellers. Current information about avian influenza in birds and humans can be found on the NaTHNaC Outbreak Surveillance Database.

Individuals visiting regions reporting cases should ensure they:

• Avoid live animal markets and poultry farms.
• Avoid contact with animal/bird faeces and contaminated surfaces.
• Do not eat or handle raw or undercooked poultry (including ducks) or eggs.
• Do not pick up or touch dead or dying birds.
• Practice good personal hygiene, with frequent hand washing.
• Do not attempt to bring live poultry or products back to the UK.

Measles

There is increased measles activity in many countries of the world, including Europe and North America. Previously unvaccinated and/or non-immune travellers are at risk. A travel health consultation is an opportunity to ensure that individuals have received two doses of the MMR vaccine given at least one month apart.

Rabies

Rabies virus is found in the saliva of infected animals. It can be transmitted to humans via a bite, lick or scratch or whenever saliva from an infected animal comes into contact with broken skin, the eyes, nose or mouth.

Rabies attacks the central nervous system. Once symptoms occur, it is fatal. Therefore, medical treatment must be sought as soon as possible after a bite, even if the animal is believed not to have rabies and/or the rabies pre-exposure vaccine has been given.

Pre-exposure rabies vaccination should be recommended for travellers at risk. Country specific rabies advice can be found on the NaTHNaC Country Information Pages and vaccination information can be found in the NaTHNaC Rabies Health Information sheet.

Schistosomiasis

Travellers planning to visit regions with a schistosomiasis risk (e.g. Lake Malawi in Africa) must avoid fresh water swimming. Country specific risks for schistosomiasis can be found on the NaTHNaC Country Information Pages.

Vaccinations and malaria risk

Country specific vaccine and malaria advice can be found on the NaTHNaC Country Information Pages. The importance of following recommendations for immunisations, malaria tablets and other prevention strategies must be emphasised. 

Personal behaviour

Drugs and alcohol

Drug and alcohol intake may result in unpredictable behaviour and unpleasant, sometimes potentially life threatening consequences. Alcohol is banned completely in some countries, with severe penalties for consumption. Many countries administer harsh punishments for drug offences such as possession and supplying, including, in some regions, the death penalty.

Advice for travellers includes:

• Avoid illegal drug use and excessive alcohol intake.
• Drink sensibly.
• Ensure that drinks are not left unattended, to avoid drink spiking.
• Don’t accept drinks from strangers or casual acquaintances.
• Don’t drink or import alcohol in countries that prohibit alcohol.
• Some countries ban certain medicines that are legal in the UK. Further advice is provided by HM Customs and Revenue (see links section below).
• Do not drive after drinking alcohol or using illegal substances.
• Travel insurance policies are unlikely to provide cover for accidents or illnesses related to alcohol or drug use.

Sexual health

Unprotected sex should be avoided to reduce the risk of sexually transmitted infections such as HIV.

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

Tattooing and body piercing

Tattoos and body piercing should be avoided because of the risk of transmission of blood borne infections such as Hepatitis B, Hepatitis C and HIV. Travellers should be reminded that most low income countries have a higher incidence of blood borne infections than the UK.

Safety and security

Accidents and injuries

Travellers should:

• Be aware of personal safety whilst travelling.
• Check the Foreign and Commonwealth Office (FCO) website for country specific travel and security information (see links section below).
• Respect the cultural and dress codes at the destination.
• Avoid confrontational situations, large gatherings, marches or protests.

Accidents, particularly road traffic accidents, are an important cause of injury and death amongst travellers. Standards of driving and road conditions vary worldwide. Travellers should ensure that they familiarise themselves with local circumstances before undertaking journeys.

Seatbelts, child restraints and cycle helmets should always be used when available. Ideally, night travel should be avoided. Cyclists and pedestrians should be aware of their increased vulnerability in many countries and take extra care. Hitchhiking is not recommended.

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.

Swimming or diving after drinking or ingesting illegal substances, at night or in unfamiliar areas is not recommended.

Medical facilities and travel insurance

LOCATE

The FCO is encouraging all British nationals to register with their new LOCATE service to help them provide travellers with effective emergency assistance. The service is free and travellers can register online.

Medical care

The standard and availability of medical care varies greatly worldwide. Unlike the UK, many countries do not provide free at the point of delivery healthcare. Facilities, equipment and medication in many low income countries may not be of the same standard available in high income regions such as northern Europe.

Individuals with pre-existing medical conditions should seek advice from their specialists with regard to the advisability of travel. They should also request a letter providing details of their condition, treatment and any prescribed medication. Essential medicines should be carried in hand luggage.

All travellers should avoid buying medication over the counter in low income countries because of the risk of counterfeit drugs.

Travel insurance

Travellers must ensure that they have adequate travel insurance for their planned destination and activities. It is important that any pre-existing medical conditions are declared to the insurance company.

UK citizens travelling in Europe should be in possession of a European Health Insurance Card (EHIC). This is valid in the European Union (EU) and some non EU countries such as Switzerland.

Beijing Olympic and Paralympic Games

China is hosting the 2008 Summer Olympics and the 13th Paralympic Games. Over 1.1 million Chinese and 600,000 foreign nationals are expected to attend, with approximately 10,500 international athletes taking part.

Information on travel health issues for those planning to attend can be found in NaTHNaC’s Clinical Update of 17 June 2008 (updated 26 June 2008).

Specific safety, security and travel advice for the Beijing Olympics can be found on the Foreign and Commonwealth Office (FCO) website.

Links

The Department of Health. Travel safe: reducing the risk of getting a blood-borne infection when you're abroad.

Foreign and Commonwealth Office: travel related security advice, including country specific guidance, background information and political analysis.

HM Revenue and Customs Agency: advice related to customs issues, including the transportation of medicines.

NaTHNaC Health Information Sheet: General Information for Travellers.

NaTHNaC Country Information Pages

NaTHNaC Outbreak Surveillance Database