August 2012

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. Some of the most common hazards include accidents and injuries, travellers’ diarrhoea, sexually transmitted infections, insect bites and sunburn.

With forward planning and appropriate advice, travellers can minimise these risks. 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 and if vaccines or malaria prevention tablets are recommended using the NaTHNaC Country Information Pages, preferably before booking the holiday.
• An appointment for travel health advice should be made 6-8 weeks before departure, but it is never too late to seek or provide advice. Travellers with pre-existing medical conditions should ideally seek advice before booking a holiday to ensure the destination is appropriate.
• Travellers should be advised to put together a travel health kit which should include first aid items such as antiseptic and painkillers, insect repellent, sun protection lotion, rehydration sachets and condoms.
• Travellers should take out 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).
• The Foreign and Commonwealth Office website should be consulted for safety and security advice.
• A comprehensive risk assessment should be made by the health practitioner taking into consideration seasonal vaccine-preventable risks such as tick-borne encephalitis. All travellers should receive health advice and recommendations that are tailored to their individual needs.

Whilst away

• Accidents and injuries are the greatest life threatening risks amongst travellers [1]. Particular attention should be paid to road safety, whether as a driver or a pedestrian. Traffic may be driving on the right and road signs may be unfamiliar. Children should be supervised at all times especially near water and roads. Incidents involving balconies, including falls, are a common cause of hospitalization, particularly in young tourists [2; 3]. The number of incidents reported in 2012 has already matched the number reported in 2011 [4].  Alcohol is often a factor and because of the heights involved injuries are usually very serious or fatal. Travellers should be reminded to drink responsibly, avoid risky behaviour at heights and remember that alcohol can affect judgement. Diving into a swimming pool from a balcony is highly dangerous and invariably results in death or permanent disability [4].
• Personal safety. Travellers should maintain a heightened awareness of personal safety whilst in unfamiliar environments.
• Food, water & personal hygiene. All travellers should receive advice on the prevention of food- and water-borne illnesses. Hands should be washed before eating or drinking and after using the toilet. Tap water should not be drunk and ice in drinks should be avoided unless it is certain the water is safe.
• Sun protection. Apply a high protection sun lotion and regularly reapply especially after swimming. Take particular care that infants and children are protected; babies should not be placed in direct sunshine.
• Insect bite avoidance. Many insect-borne infections are not preventable by vaccination including dengue, chikungunya and leishmaniasis and no malaria chemoproyhlaxis is totally effective. It is therefore important that all travellers receive advice on avoiding insect bites.  Insect repellents, preferably DEET based, should be applied regularly after sun lotion to exposed areas of skin. Particular care should be taken when applying repellents to children to ensure it does not come into contact with eyes or lips. Travellers, especially those to malaria risk areas, should consider taking an insecticide-treated bed net.
• Sexually transmitted infections (STIs). Even if travellers are not planning a sexual encounter, they should receive advice on the avoidance of STIs. A condom should always be used. Travellers should be aware that excessive alcohol consumption can lower inhibitions and make risky behaviour more likely.
• Travellers’ diarrhoea. Up to 60% of travellers to higher risk destinations suffer from travellers’ diarrhoea [5] making it the most common syndrome affecting travellers. Sensible food, water and personal hygiene precautions will reduce the risk. If travellers are affected they should be advised to increase fluids and use rehydration sachets as directed to prevent dehydration. This is particularly important for infants. Cryptosporidiosis infections have been associated with swimming pools [6]. Travellers should therefore practice swimming pool hygiene including showering before entering the pool and not swimming whilst suffering from diarrhoea. Infants should wear swim nappies before using swimming pools to avoid faecal accidents.

On return

• Travellers should be advised of the importance of continuing any malaria prevention tablets for the recommended period of time on their return.
• If unwell, especially with a high fever, persistent diarrhoea, or ‘flu-like symptoms travellers should be advised to seek medical assistance urgently. Health professionals should consider malaria 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 at any time up to a year later [7]. Returned travellers with a fever should be considered as having malaria until proven otherwise Returned travellers with a fever should be considered as having malaria until proven otherwise and referred urgently to a specialist centre for diagnosis and treatment. Malaria treatment guidelines have been published by 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, 2011. [Accessed 20 March 2012]. Available at: http://www.who.int/ith/chapters/ith2011chap4.pdf

2. Foreign and Commonwealth Office. British Behaviour Abroad Report 2012 [Accessed 16 August 2012], Available at: http://www.fco.gov.uk/resources/en/pdf/travel-living-abroad/21151574/british-behaviour-abroad-2012

3. Foreign and Commonwealth Office. Travel and living abroad. Balcony safety. 15 August 2012. [Accessed 16 August 2012]. Available at:  http://www.fco.gov.uk/en/travel-and-living-abroad/staying-safe/balconysafety

4. Association of British Travel Agents. Taking Action to Help Prevent Balcony Incidents in Popular Overseas Resorts. 15 August 2012. [Accessed 16 August 2012]. Available at:  http://www.abta.com/about/news/view/512

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

6. Health Protection Agency. Cryptosporidiosis and swimming pools. 15 August 2011. [Accessed 16 August 2012]. Available at: http://www.hpa.org.uk/web/HPAweb&HPAwebStandard/

HPAweb_C/1313154715900

7. Chiodini P, Hill D, Lalloo D et al. Guidelines for malaria prevention in travellers from the United Kingdom. London, Health Protection Agency, January 2007.