Advice for travellers
DOH booklet Health advice for travellers
The Department of Health’s booklet Health advice for
travellers has been revised and is now available free of charge
by phone from the Health Literature Line on 0800 555777 any time.
The information is also available, and regularly updated, on the internet http://www.dh.gov.uk/PolicyAndGuidance/HealthAdviceForTravellers/fs/en.
It contains information on
health risks around the world and how to avoid them, and on how
to get treatment abroad in an emergency. It also incorporates a
copy of form E111, the certificate which entitles people to
emergency treatment in the European Economic Area. An application
form, and form E111 itself, have to be completed and handed in at
a post office. The stamped and signed E111 is then handed back.
Travel clinics at The Devonshire Lodge Practice
Travellers can consult our practice nurse for advice. Please
make an appointment well in advance of the
departure date to allow time for any necessary immunisations.
This consultation is an opportunity to discuss the health risks
of travel and their prevention.
Travelling and the risk to your health
Injuries
Injuries are one of the commonest risks, especially due to
road traffic and water-related accidents. Accidents are the most
common cause of holiday disasters. Many of the safety laws
protecting you at home simply don’t exist abroad. Examples
include drink driving, crash helmet and seatbelt regulations.
Common sense will prevent many accidents if you just take time to
think. Accidents are not confined to vehicles.
Alcohol is the direct cause of many accidents and complicates
others, like falling asleep in the sun. Try to assess the
potential risks of some of the more adventurous holiday
activities before trying them, and remember that some activities
will not be covered by your insurance. As many accidents are
minor, take a first aid kit which is relevant to the type of
holiday, and make sure that one of your party can use it properly.
Diarrhoea and Vomiting, Food, Drink and Hygiene ("boil
it, cook it, peel it or forget it")
Many diseases are caught by eating contaminated food or drink.
These include travellers’ diarrhoea, Hepatitis A, Salmonella
and Typhoid. You can help avoid catching them by paying strict
attention to food, drink and general hygiene. If in doubt about
the drinking water, boil or sterilise it before use. Follow these
simple rules:
 | wash hands after going to the toilet, before handling
food and before eating. |
| eat freshly cooked food that is thoroughly cooked and
still hot cooked food that has been held at room
temperature for several hours is particularly hazardous. |
| avoid food which has been exposed to flies. |
| avoid shellfish-these are particularly hazardous, even
when cooked. |
| avoid uncooked food unless you can peel or shell it
yourself. |
| remember that salads will be washed with untreated water
which will be unclean. |
| avoid ice cream from unreliable sources such as kiosks or
itinerant traders. |
| avoid ice unless sure it is made from safe water. |
| avoid, or boil unpasteurised milk. |
| if treated mains water is not available, sterilise water
for drinking, washing food and cleaning teeth, or use
bottled water preferably carbonated, from sealed
containers. |
| and remember that recreational water is often
contaminated. |
Dehydration following fluid losses from sweating and diarrhoea
and fever, if left untreated, can kill. Travellers’
diarrhoea can affect 1 in 2 tourists. Any bowel disturbance must
be treated with liberal quantities of rehydration fluid made up
in the cleanest water available. Sachets of rehydration salts are
available from the chemist without prescription and should always
be carried, especially when travelling with children. Seek
medical advice if you have a temperature, persistent symptoms or
blood is passed.
Sunburn
Over-exposure to sunlight causes sunburn, premature skin
ageing and an increased risk of skin cancer. Even in the UK,
ultraviolet (UV) radiation can damage skin (weather forecasts
from the Meteorological Office may now contain predicted mid-day
solar UV levels). UV is much more powerful at holiday
destinations nearer the equator. A separate risk of over-exposure
to strong sun is sunstroke or heatstroke, caused by overheating.
Travellers are advised to avoid strenuous activity during the
hottest hours, and to drink plenty of safe, non-alcoholic liquids
to replace body fluid lost through perspiration. Use an effective
sunscreen and apply it often. Do not sunbathe during the hottest
part of the day and wear a wide brimmed hat. Free telephone
advice is available on: 0800 556655.
Sexually transmitted diseases
Hepatitis B and HIV infection may be acquired through
unprotected sex with an infected person; in many countries,
heterosexual intercourse is the major transmission route for HIV.
These infections exist worldwide. Travellers are advised to avoid
sexual intercourse except with their usual partner, but if they
do have sex with another partner, to use a condom (better to pack
an adequate supply of good quality condoms-they may not be easily
available or of good quality abroad).
Hepatitis B and HIV may also be acquired through sharing
equipment for non-prescribed drugs, or through tattoos, ear-piercing
or acupuncture. all of which should be avoided, or from infected
medical equipment or blood transfusions. Travellers on
expeditions should consider taking medical kit containing sterile
needles and syringes for use in an emergency. The surgery can
supply you with a travel pack for use in medical emergencies. It
contains sterile needles and other useful equipment.
Malaria
Malaria is a blood disease caused by a parasite which is
caught from the bite of an infected mosquito. About 2000 cases of
imported malaria are reported in England and Wales each year, an
increasing proportion being due to the more severe falciparum
malaria. Most have not taken, or have been poorly compliant with,
prophylaxis (preventative tablets and anti-mosquito measures).
Recommendations for prophylaxis are available from the practice
nurse and are updated on a monthly basis. Up-to-date information
is available from the Malaria Reference Laboratory on a recorded
message (Tel 01891 600 350). No regimen of drugs is 100%
effective and any fever while in, or within six months after
leaving, an endemic area could be malaria.
Whilst anti-malarial tablets can reduce the risk of catching
malaria, because they are not 100% effective it is essential that
you also take steps to avoid being bitten. These simple
guidelines will help you to avoid catching malaria and other
insect borne diseases.
- Use an insect repellent containing DEET.
(Diethyl-Toluamide)
They are safe and are very effective.
- Malaria mosquitoes are most active at dusk and night, so
cover arms and legs between dusk and dawn.
- If your accommodation does not have insect screens or
windows which close, sleep under a mosquito net. Mosquito
nets are more effective if impregnated with insecticide
such as permethrin. Do not sleep touching the net-the
mosquito can bite through it if your skin is adjacent.
- Remember that during the day mosquitoes hide in the
darker parts of the room, such as ceilings, rafters and
under furniture, so just closing windows may not be
sufficient.
- If necessary, use ‘knock-down’ insecticide
sprays. Try to clear the room of mosquitoes.
It must be emphasised that taking prophylaxis (malaria tablets
taken to prevent infection) does not lead to dangerous delays in
the diagnosis of malaria. Studies have showed clearly that
malaria is much less likely to be severe at the time of diagnosis
in patients who have taken prophylaxis than in those who have not.
As far as adverse reactions are concerned, the three major
antimalarials currently used as prophylactics (chloroquine,
mefloquine and proguanil) are all much less hazardous than would
be their avoidance in the countries for which they are
recommended. Patients who have conscientiously taken malaria
prophylaxis are unlikely to die even if they catch malaria. It is
those patients who do not take, or stop taking the drugs too
early on return to the UK, that are at risk of developing the
rapidly fatal form of malaria. Malaria can kill within hours in
the unprotected. After the mosquito has bitten and transmitted
the malaria parasite into the bloodstream, the parasite has a
dormant stage when it hides in the liver. For this reason it is
essential to continue taking malaria prophylaxis on return to the
UK. If you take whilst abroad and stop on returning to the UK you
are unprotected.
Malaria prophylaxis should be started 1 or 2 weeks before
travelling. The reason for this is to determine whether or not
side effects will occur, so that an alternative drug can be
prescribed before you leave. Adverse effects from chloroquine and
proguanil are generally mild. Chloroquine may lower the seizure
threshold in epileptics and occasionally causes rash. It
frequently causes itching in black skinned people. Proguanil may
cause aphthous-like mouth ulcers. Mefloquine’s adverse
effects include rashes, nausea, diarrhoea and dizziness. Rarely,
it may cause anxiety, sleep disturbance and depression, and in
these circumstances should be discontinued.
Malaria prophylaxis must be purchased by patients, it is no
longer available for travel as an NHS prescription.
Remember:
