Travel health

The following information provides useful hints & tips to help you remain fit & healthy before during and after your break!

Introduction

Each year about 40 million journeys are made from the UK to other countries and increasingly people are travelling to more exotic destinations including South America and Asia. What people often do not consider is that they are going from a safe familiar environment to a more hazardous and certainly an unfamiliar situation.
A bit of forward planning before a holiday can go a long way towards preventing health problems and preparing for any that do occur, so that the time abroad can be enjoyed without being interrupted or ruined by ill health.
The following is a guide not only to minimising the damage when illness hits, but also to maximising the fun when it doesn't.

Before travel

Forward planning: As soon as the destination and route are known, make sure that your know the health requirements for your journey. This means knowing the immunisations required for the destination and any countries visited en route, and any special health hazards that might be present. You can start collecting this information through your travel agent or from a specialist travel clinic. Useful information can also be obtained from those organisations listed at the end of this fact sheet.
Medical Advice: Immunisation can protect the body against many of the more serious illnesses that can be contracted abroad but they can take several weeks to take effect and provide the boy with maximum immunity. It is advisable to contact your surgery at least two months before departure for immunisation advice. Some countries require yellow fever vaccination in order to cross their border, the practice nurse or travel clinic professional will inform you if this is the case (sometimes you will be asked to go to a special centre to obtain the yellow fever vaccine as not all centres are approved to give this). There may be a charge for some immunisations.
If you have children, don't forget to check their immunisations too.

Malaria prevention

Over 2000 UK people contracted malaria abroad in 1997 of whom 12 died, and with ever increasing travel this is likely to increase in the future. Most cases of malaria occur in people who do not take adequate preventative measures. It is therefore important to do as much as possible to avoid contracting the disease.
The chief means of preventing malaria is to avoid being bitten by a mosquito in he first place because anti-malarial tablets do not provide 100% protection against the illness. Measures such a insect repellant, clothes which cover most of the body and mosquito nets at night are very important in areas prone to malaria.
You will need advice (eg through a travel clinic or GP) about what kind of malaria tablets are required for the part of the world being visited since in some countries the malaria parasite is resistant to the usual malaria prevention medication. Many kinds of malaria prevention medication can be bought over the counter at the pharmacy, but it is important to know which ones to obtain. Follow the instructions given to you about the medication because malaria prophylaxis (prevention) needs to be started before travel and continued for several weeks after returning home.
If someone develops an illness with a fever after travelling to a country where malaria exists medical advice should be sought, even if malaria prophylaxis tablets have been taken. It is still possible that malaria has developed,whichif diagnosed and treated early enoughis almost always treatable.
Current medical conditions and treatment: It is a good idea to discuss any significant health problems with the doctor or nurse giving the travel vaccines in case you need particular advice regarding your condition. It is also sensible to take an adequate supply of essential medication with you, although for travellers going abroad for a long time it is wise to check how much you are able to take. NHS doctors are restricted in the amount of medication they are allowed to prescribe for people going abroad for many months.
A clear record of any current medical condition, drug treatment and allergies is useful to take with you and it is best to record the generic or actual drug name, not just the brand name. Keep prescribed medication in its original labelled container at all times. If necessary, take a printout or surgery-stamped record of the prescription medication and keep it with the drugs. This will present no problems at the customs gate.
Dental check up: Dental work can be expensive and difficult to obtain abroad, so make sure your teeth are healthy with a dental check up at least a month before departure.

Travel kits

Two sorts of kits should be carried, a first aid and an emergency kit.
First Aid Kit: This needs to be small and portable and should contain the following.
§: If you have any medical conditions requiring urgent self-administered treatment (such as inhalers for asthma, or serious allergy needing adrenaline injections or spray), then a supply of your emergency medication should be in this kit.
§: A packet of adhesive dressings for minor cuts.
§: Insect repellant. This is absolutely essential in hot countries not only to lessen the misery of insect bites but also to reduce the risk of malaria, yellow fever and dengue haemorrhagic fever , all carried by infected mosquitos, and tick-borne encephalitis. The best types contain a chemical called DEET (diethyloluamide). This comes in various strengths. Higher strength is for adults, applied on clothing and exposed skin, the lower strength for children, to be applied mainly to clothing.
Emergency kit: This is a more comprehensive and larger kit to cover the most frequent health problems. A survey of travellers over a 12 year period has highlighted that 63% come home with no medical problems The other 37% could have minimised their problems with a good emergency kit. This kit should be tailored to your own personal medical needs, for example, if you suffer from severe reactions to insect bites, pack hydrocortisone cream; if you suffer from motion sickness, pack travel sickness medication etc. §: So as not to be caught if your luggage ends up on the other side of the world, split the contents between two bags. It is easy to end up packing a huge amount of stuff, most of which will not be needed. It is sensible to pack items aimed at the health problems you are most likely to encounter.

Common problems and essential items
First aid: Take a pack of assorted plasters; a crepe bandage for supporting minor sprains; a small pack for padding bleeding wounds; a roll of surgical tape for fixing the bandage and gauze; a dry antiseptic spray for sealing wounds (which is very important in the tropics where wounds fester easily); sharp scissors and tweezers (useful for removing splinters, sea urchin spines and other foreign objects); a few safety pins and some painkillers.
Diarrhoea: Travellers tummy is very common. Take something to calm the bowel down. Loperamide is a good example, and though it doesn't treat the cause, it reduces the inconvenience and misery of diarrhoea, making travel possible. The main risk of diarrhoea is dehydration, especially so in hot countries. The simplest and easiest way to replace the lost salt and water is to use rehydrating solutions. These are widely available as sachets of powder or effervescent tablets. Alternatively prepare your own solution, by mixing one litre of boiled, filtered water, with eight teaspoons of sugar and one further teaspoon of salt.
Insect itch: Hydrocortisone 1% cream and antihistamine tablets are available over the counter in pharmacies, and provide effective relief for insect bites and stings. Seriously consider a mosquito net and mosquito killer to prevent contact. Mosquito repellant (containing DEET) is essential. Anti-malarial medication as advised.
Sun safety: Take a sunscreen cream or lotion to prevent sunburn and reduce the risk of skin cancers in later life. Pack an anti UVA and UVB (referring to the two types of ultraviolet ray) sunscreen with a sun protection factor (SPF) of at least 15. The most effective ones contain the highly reflective substance Titanium Dioxide. Sunscreens are the second line of defence; the first is to cover up well with clothing, and wear a hat of closely-woven material (ie not straw).
Fungal infections: Athletes foot, Dhobi itch, and related fungal skin complaints are very common in humid climates. Take an effective antifungal cream (eg clotrimazole) and a zinc oxide talc for dusting on the skin and in shoes.
Tooth trouble: Unless you have special expertise, avoid dental DIY repair kits. A simple measure is to fill any cavity with sugar-free chewing gum until you return home.
HIV and Hepatitis: The virus causing these diseases are transmitted in body fluids through immediate contact in unsafe sex or medical procedures, such as unclean instruments in surgery. Take a supply of condoms if casual sex is likely. If traveling to areas with poor healthcare facilities you may wish to take a prepacked sterile kit of needles, syringes and sutures, which can be used by medical personnel on you. These are available at your local pharmacy.

Deep vein thrombosis (DVT)
There has been a lot of publicity about the risks of blood clots in the legs as a result of long-haul flights, so-called 'economy class syndrome. A deep vein thrombosis (DVT) is a clot which forms in the veins of the legs which run deep inside the leg ie not superficial veins which are visible under the skin. The danger of a DVT is that part of the clot can occasionally break off and become lodged in the lung (something called a pulmonary embolus or PE). This can be dangerous depending on how large the clot is and where it lodges itself.
There are several things that can make a DVT more likely to happen, one of which is reduced blood flow such as occurs in the legs when someone sits in one position for any length of time. As a result, some people have developed DVTs after long air flights. However, thromboses can occur after any long journey in a car, coach or train and so far there is no evidence to suggest that flying is in itself a specific risk factor.
Studies have shown that most DVTs occur in people who have at least one other risk factor for thrombosis. These include:
§: Previous personal or close family history of thrombosis.
§: An abnormality of the blood clotting factors.
§: Certain forms of heart disease such as abnormalities of the heart rhythm or the valves of the heart.
§: Current malignant disease.
§: Hormone treatment including the oral contraceptive pill or oestrogen-containing hormone replacement therapy (HRT).
§: Pregnancy.
§: Recent major surgery.
§: Recent immobility in the previous day(s).
Dehydration, smoking or obesity may also play a part in increasing the risks.
The symptoms and signs of a DVT are pain and swelling in one (or rarely both) calves. The leg may also have a different colour to usual due to the congestion of the veins as a result of the back pressure produced by the blockage. If in doubt, seek urgent medical advice.
There are some measures that can reduce the chance of developing a thrombosis including:
§: Performing regular leg exercises such a moving the feet and stretching the arms and legs or occasionally walking up and down the aisle (but not so often as to annoy the other passengers or cabin staff!).
§: Trying to avoid crossing your legs since this exacerbates the 'pooling' of blood in the legs.
§: Maintaining a good fluid intake (preferably not alcoholic since this can actually lead to a degree of dehydration).
§: Avoiding smoking .
In otherwise healthy people there is a degree of controversy as to whether or not taking aspirin before the flight is truly preventative and it does carry a small risk of bleeding from the stomach. However, those people with particular risks of developing thrombosis should discuss with their doctor whether or not they should take aspirin or use other preventative measures such as wearing special socks or taking additional anti-clotting medication.

Am I fit to fly?
As air travel is so commonplace, most people do not even consider whether or not they are fit to fly. Generally, flying is safe for most people but all aeroplanes suffer some loss of cabin pressure at cruising height, which in turn can reduce the amount of oxygen in the atmosphere of the cabin. For the majority of traveller s this is of no concern and will not affect their health, but airlines may refuse to allow passengers to fly with the following conditions:
§: Significant lung conditions causing breathlessness at rest.
§: Significant heart failure.
§: Recent major surgery such as abdominal, chest or head operations.
§: Newborn babies only a few days old.
§: Pregnant women from 36 weeks of pregnancy onwards.
§: Uncontrolled epilepsy.
§: Severe sinus or ear infections.
§: Recent pneumothorax (collapsed lung).
§: Recent heart attack.
§: The possibility of a transmissible disease.
§: Significant uncontrolled psychiatric disease.
If you are in doubt about your fitness to fly, consult the airline or your GP.
Return from holiday If you were treated abroad, declare your medication in customs on return to the UK; it may not be legal to bring it in to the country.
Remember to continue and finish your course of anti-malarials on return.
If you have diarrhoea on return and your job involves food handling, tell your employer as soon as possible.
If you were ill abroad, submit a note of the illness, with as much medical information as possible to your GP on your return.
If you fall ill after returning, remember to tell your doctor where you have travelled.

Paperwork
§: Passport.
§: Form/card E111, where appropriate (for EEC countries). Available on application through a post office.
§: Proof of UK residence such as a drivers licence or NHS card.
§: Vaccination certificates.
§: Travel insurance documents. It is very important to obtain suitable travel insurance before you travel, since in many countries of the world, medical treatment has to be paid for and can add up to thousands of pounds depending on the treatment required.
§: Record of the serial number of travel tickets.
§: Record of passport number and date issued.
§: Record of credit card numbers.
§: Record of driving licence number.
§: Serial number of travel insurance policy and a note of the emergency contact number.

Cost of treatment abroad
§: Check eligibility for free treatment or costs of treatment (travel agent.).

Travel kits
§: Assemble and pack within a month of departure.

Things to remember abroad
§: Take a list of medical problems, allergies and treatments (generic drug names). Make a list of any treatments received abroad.

Receipts
§: Keep all receipts for treatments or drugs if you wish to make a claim on your travel insurance.

British Consulate
§: Keep names and addresses of friends and relatives with your passport so that the British Consulate can contact them if necessary. They may be able to help you return to the UK quickly but remember you will have to bear the costs.
§: Remember that the British Consulate is not able to pay any bills, including hotel or hospital bills, act as a travel agent, pay for travel, or give any legal advice or interfere with the legal proceedings of the country concerned. It is your own responsibility to organise these things for yourself.

Where can I get further information?

Foreign and Commonwealth Office:
King Charles Street London SW1A 2AH Travel Advice: 020 7008 0232/0233 Main switchboard / General enquiries: 020 7270 1500 Consular Enquiries: 020 7008 0218 Visa enquiries: 020 7238 3838

Hospital for Tropical Diseases:
Mortimer Market Capper Street London WC1E 6AU Travel Clinic Healthline: 0839 337733
Malaria Healthline: 0891 600350

BBC2 Ceefax Service:
Page 564 onwards

MASTA (Medical Advisory Service for Travellers Abroad):
London School of Hygiene & Tropical Medicine London WC1E 7H 24 hour Travellers Healthline: 0891 224100 Administration: 020 7837 5540 Website:www.masta.org

Vaccination Information (Health Action Network):
Patrick Holdsworth PO Box 43 Hull HU1 1AA Telephone: 01482 562079 Email: yvonne@vaccinfo.karoo.co.uk Website:www.vaccinfo.karoo.net

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