How to avoid holiday health hazards

Even minor problems can ruin your precious weeks in the sun. Simon Usborne gets some expert advice on how to stay fit and well this summer

Like filleting pufferfish, wrestling bears and jumping out of aeroplanes, travelling can seriously affect your health. A generous dose of common sense will prevent most holiday ills, but whether you're backpacking through Bhutan or sunning yourself in St Tropez, there are certain things you should know (or at least be reminded of) before you go. Doctor Jane Wilson-Howarth is a zoologist, GP and the author of, among other tomes on travel health, Shitting Pretty: How To Stay Clean And Healthy While Travelling (described by the Washington Post as "an evacuation manual of sorts"). Her new book, The Essential Guide to Travel Health, out this month, is a comprehensive guide to avoiding sickness and mishaps abroad. Here, she offers her top tips for a healthier holiday.



Insurance

Travel safety starts long before you get to the airport. A decent insurance policy could be the most important thing you pack. And it's not enough just to plump for the cheapest you can direct your computer mouse to the night before you fly. And if you don't always travel with insurance (like 41 per cent of students, according to a recent Foreign Office survey) you're just asking for trouble.

"Too many people don't look at the fine print," Wilson-Howarth says. "If, for example, you want to be covered for getting evacuated from the States, you'll need cover up to at least two to three million pounds. And never cover up any health problems. If you're asthmatic and get a chest infection, you won't be covered if you haven't declared it.

"You also need to make sure your insurance company has a link with a reputable medical assistance company with an emergency line. And when you're travelling in Europe, always carry your European Health Insurance Card, or EHIC. It will give you access to state healthcare in European Economic Area countries and Switzerland. But an EHIC isn't a replacement for travel insurance. You need both. If you have insurance but no EHIC, your insurer could say, well, this would have been covered by EHIC, so we'll only pay so much."



First aid

The second-most important thing you'll pack, after travel insurance? Perhaps a first aid kit, which for minor injuries could be the difference between a complicated claim and getting on with your holiday. Here, Wilson-Howarth prescribes a standard first aid kit for starters. Lifesystems make a range of doctor-approved kits to suit the needs of most travellers, with basics including bandages, painkillers and a thermometer.

There are certain essentials Wilson-Howarth packs in addition to her standard kid: "Savlon Dry spray is a brilliant antiseptic that dries up oozy mosquito bites or other breaks in the skin that can so readily become infected, especially in humid environments," she says. "I'll also take soluble paracetamol, which can be great for sore throats when gargled and swallowed, as well as pain and fever. Meanwhile, steri-strips will pull together the edges of wounds, which might avoid the need to queue at an A&E. And if you're travelling with children, novelty plasters seem to have miraculous pain- relieving properties."

Jabs

It doesn't matter how tough you think you are, even Bruce Parry is no match for the worst diseases the tropics can throw at us. The crucial thing here is not to leave it too late. "The earlier you get your jabs, the better the immune response," Wilson-Howarth explains. "Yellow fever, for example, only becomes valid ten days after the jab. Countries that require a certificate won't let you in unless those ten days have passed. Ideally, you need to be thinking about jabs at least six weeks before you travel."

But what jabs do you need? The easiest way to find out is to go to Fit for Travel (fitfortravel.nhs.uk), an NHS site that includes a world map. Just click on your destination and get the lowdown. "You also need to make sure you're up to date with the immunisations recommended for life in Britain," adds Wilson-Howarth. When you've got a list of what you need, you can choose between your GP, who may or may not offer a full range of immunisations, and a private clinic. "It pays to do your homework," says Wilson-Howarth. "GPs vary and some will charge more than a clinic."



Bites and stings

Most bites, those delivered by rattlesnake notwithstanding, are uncomfortable rather than potentially fatal. But they're enough to cause pain or put a dampener on your holiday. The simplest way to protect yourself is to cover up, but not everyone wants to wear trousers and long-sleeves when it's 35 degrees outside. "Any Deet-based repellent will provide enough protection," says Wilson-Howarth. "There are people who get worried about toxic ingredients but often it's companies who promote natural repellents who say it must be terrible because it's not natural. Of course you're not going to plaster a small baby head-to-toe but used sensibly, it's good stuff. If repellents that are applied to the skin puts you off, a lesser-known alternative is permethrin, which can be applied to clothes. Of course, that relies on you covering up. A good treatment for stings is a one per cent hydrocortisone cream. They work a lot better than antihistamines to reduce inflammation in, for example, bites and jellyfish stings."



The sun

It is, quite literally, not cool to get sunburnt. Apart from being uncomfortable and potentially causing skin cancer, the lobster look does nothing for the reputation of Brits abroad. "The experts advise avoiding the sun between 10am and 4pm and not exposing yourself for more than 10 or 15 minutes the first time you get into the sun," says Wilson-Howarth. "That's a big window but there's no doubt the incidence of skin cancer is rocketing as a generation who have had the money to travel start to show the effects of too much time spent soaking up the sun.

"Be aware that you must stay well hydrated after severe sunburn – you lose fluid through burnt skin. Good sun-block is important but don't be fooled into a false sense of security by high-factor creams. It stops burning but there are question marks over its ability to protect against skin cancer-producing radiation. It's also very expensive and at least low-factor creams will leave you feeling frazzled sooner and make you realise you ought to go in. Just make sure you do.

"If you get heat rash, antihistamines won't work. The only treatment is to get into a cool place and dab the area with tepid water on a face flannel, preferably under a fan."



Food and drink

Whether it's "Delhi belly" in India or "Montezuma's revenge" in Mexico (named after the disgruntled Aztec ruler defeated by the Spanish), diarrhoea is one of the least pleasant experiences travellers and tourists can face. With a bit of caution and care, it can be avoided. "People often worry about water, but badly prepared food is the most common cause of diarrhoea," says Wilson-Howarth. "As the mantra goes, 'peel it, boil it, cook it or forget it'. That rules out things like lettuce or fruit you can't peel such as strawberries. Ice cream is a bad idea in a country where there are power cuts.

"I prefer to avoid bottled water because of the litter it creates. Take your own decent bottle and fill it with boiled water. Some people like expensive filtration units, but I prefer adding a couple of drops of iodine, which is much more portable and will clobber most bugs. If you do get diarrhoea, you need to re-hydrate. You can take Imodium but I think it makes you feel sicker for longer. Drink anything with salt or sugar. Even water with a spoon of sugar or honey stirred in is good. Coke works, but not Diet Coke. Add a pinch of salt to improve the transport of fluid into the body. Once the body has got rid of the toxic stuff, you should start feeling better after about 12 hours. If you have blood in your stool, or persistent pain that last more than two hours, or a fever of over 38 degrees, you need to see a doctor."



Safe sex

"Travelling," says Wilson-Howarth, "is a very good way to get HIV. Most people here who get it do so abroad or from a partner who has been abroad." Amorous tourists all too easily drop their guard, opening themselves to the risks of dozens of other sexually-transmitted infections. "It's the same old safe sex message people all too easily forget when they travel. Condoms are essential and it's worth taking your own – sizes and quality can vary. Insect repellents and sunscreens can damage condoms, so keep them separate. And if you do get infected, get it sorted promptly."

Malaria

There's no way to immunise against malaria, but it's easy to minimise the risk of contracting the mosquito-borne killer. Crucially, seek advice before getting dosed up. Fitfortravel.nhs.uk will tell you what you need to know. Don't skimp. "Lots of people get over-the-counter pills but these aren't good enough for many African countries," Wilson-Howarth explains. "There are also people who take anti-malarials when they don't need to. You need to be vigilant – in bad cases patients can die within the first 24 hours of showing symptoms. Pregnant women and children are particularly at risk."

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