Health Professionals

Travel Health Information Sheets

Health Advice for Summer Travel

Introduction

Many people will be planning to travel abroad during the summer months. Overseas travel can pose various health risks depending on the destination and type of travel being undertaken.  Potential hazards include accidents and injuries, travellers’ diarrhoea, sexually transmitted infections, insect bites and sunburn; with accidents and injuries being the greatest threat to life for healthy travellers [1].  

The information below is a summary of advice for summer holiday travel.

 

Before travel

  • Travellers should be encouraged to check the potential health hazards at their destination, preferably before booking the holiday, using the NaTHNaC Country Information Pages. Guidance will include whether vaccines or malaria prevention tablets are recommended.
  • Ideally, an appointment for travel health advice should be made 6-8 weeks before departure, but travellers should be reminded that it’s never too late to get advice. Travellers with pre-existing medical conditions should be encouraged to obtain advice before booking a holiday to ensure their destination is appropriate.
  • Travellers should be advised to put together a travel health kit, which should include items like antiseptic, painkillers, insect repellent, sun protection lotion, rehydration sachets and condoms. Travellers should also be reminded of the importance of carrying a good supply of any prescription medicines, along with copies of their prescriptions, in their hand luggage
  • Travellers should be reminded they need to obtain comprehensive travel insurance, ensuring that any medical conditions are declared and covered. Travellers to the European Economic Area should also carry a European Health Insurance Card (EHIC). Payment for health services overseas may be required at the point of care; access to funds during travel should be ensured.
  • Health professionals advising travellers should undertake a comprehensive risk assessment for every traveller and each journey. Health advice should be tailored to individual needs.

 

During travel 

 

Accidents and injuries:

  • Particular attention should be paid to road safety by both drivers and pedestrians. Traffic may be driving on the right and road signs may be unfamiliar. Children must be supervised at all times, but especially near water and roads.
  • Dozens of British holiday makers die or are seriously injured every year as a result of inappropriate behaviour on balconies, often after drinking alcohol or taking drugs [2]. Travellers should be reminded to drink responsibly and avoid risky behaviour at heights. Diving into a swimming pool from a balcony is highly dangerous and usually results in death or permanent disability [3].
  • Travellers should maintain a heightened awareness of personal safety in unfamiliar environments.

 

Food, water & personal hygiene:

  • All travellers should receive advice on the prevention of food and water borne illnesses.
  • The importance of hand-washing, especially before eating or drinking and after using the toilet, should be emphasised. 
  • Unless water is safe, tap water should not be drunk and ice should be avoided.

 

Sun protection:

  • Travellers should be advised to: cover up, seek shade, use high protection sun lotion and regularly reapply it, especially after swimming.
  • Particular care should be taken that infants and children are protected and babies should never be placed in direct sunshine.

 

Insect bite avoidance:

Many insect-borne infections are not vaccine preventable including chikungunya, dengue fever and leishmaniasis. Also, as no malaria chemoprophylaxis is totally effective, all travellers to areas where malaria is a risk should receive advice on avoiding insect bites.

  • Insect repellents, preferably DEET based repellents, should be applied regularly after sun lotion to exposed skin.
  • Care should be taken with children to ensure repellent does not come into contact with their eyes or mouths.
  • Travellers, to any tropical regions, but especially those to malaria risk areas, should consider travelling with an insecticide-treated bed net.

 

Sexually transmitted infections:

Even travellers not planning sexual encounters should be offered advice on avoiding sexually transmitted infections including practising safer sex by using condoms. Travellers should be aware that excessive alcohol consumption can lower inhibitions, which may make risky behaviour more likely.

 

Travellers’ diarrhoea:

Up to 60% of travellers to higher risk destinations suffer from diarrhoea during their trip [4], making it the most common illness affecting travellers.

  • Sensible food, water and personal hygiene precautions reduce the risk. If travellers are affected, they should drink plenty of fluids; oral rehydration solutions should be used if appropriate and according to manufacturer’s instructions. This is particularly important for infants.
  • Cryptosporidiosis infections have been linked to swimming pools [5]. Travellers should therefore practise swimming pool hygiene, including showering before swimming and not entering the pool if suffering from diarrhoea. Babies should wear swimming nappies to avoid faecal accidents.

 

Animal bites and scratches:

Rabies, a fatal virus carried in animal saliva, is a risk in many countries.

  • Travellers should be advised to avoid contact with wild or domestic animals and to seek urgent emergency medical treatment if any animal bites or scratches them, licks a broken area of skin, or spits in their face in a rabies endemic area.
  • Rabies vaccine prior to travel does not eliminate the need for post-exposure medical evaluation and additional doses of rabies vaccine.  Travellers should be advised to seek urgent medical advice following any animal bite or potential exposure.

 

After travel

  • Travellers should be advised of the importance of continuing any malaria prevention tablets for the recommended period of time on their return home.
  • Any unwell travellers, especially those with a high fever, persistent diarrhoea, or ‘flu-like symptoms, should be advised to seek urgent medical assistance.
  • Malaria should be considered in every ill patient who has returned from the tropics; malaria usually presents in the first three months after return from a risk area, but can occur up to a year later [6]. Returned travellers with a fever should be considered as having malaria until proven otherwise and referred urgently to a specialist centre for immediate diagnosis and treatment. Malaria treatment guidelines are available from the Advisory Committee on Malaria Prevention and an algorithm for the initial management of malaria has been published by the British Infection Society. 

 

References

1. World Health Organization. International travel and health. Chapter 4: Injuries and violence. Geneva, 1 January 2012. [Accessed 21 July, 2013]. Available at: http://www.who.int/ith/en/

2. Foreign and Commonwealth Office/Association of British Travel Agents. Booze and Balconies Don’t Mix. 10 April 2013. [Accessed  21 July 2013]. Available at: https://www.gov.uk/government/publications/booze-and-balconies-don-t-mix

3. Association of British Travel Agents. Taking Action to Help Prevent Balcony Incidents in Popular Overseas Resorts. 15 August 2012. [Accessed 21 July 2013]. Available at:

http://abta.com/news-and-views/press-zone/taking-action-to-help-prevent-balcony-incidents-in-popular-overseas-resorts

4. Steffen R. Epidemiology of traveller’s diarrhoea. Clin Infect Dis. 41(Suppl 8):S536-40, 2005.

5. Public Health England. Cryptosporidiosis and swimming pools. 15 August 2011. [Accessed 21 July 2013]. Available at:  http://www.hpa.org.uk/web/HPAweb&HPAwebStandard/

HPAweb_C/1313154715900

 

6. Chiodini PL, Field VK, Whitty CJM and Lalloo DG. Guidelines for malaria prevention in travellers from the United Kingdom. London, Public Health England, July 2014. [Accessed 31 July 2014]. Available at: https://www.gov.uk/government/uploads/system/uploads/atta

chment_data/file/337761/Guidelines_for_malaria_prevention

_in_travellers_UK_PC.pdf

 

July 2014