Preparing and planning a trip has been transformed into a DIY activity, with ever fewer opportunities for personal, face-to-face advice, or even interacting with another human until you step aboard your flight. Meanwhile, remote, exotic destinations have become easier to reach, while the risks remain the same.
Health problems are common in travellers, but are largely preventable or under a high degree of individual control. To get the most from your trip, and to avoid losing precious days through avoidable illness, do your homework and find out all you can about risks at your destination and how to avoid them. Go to your doctor or a specialist travel clinic well in advance and make sure enough time is allowed for receiving vaccines and discussing other health concerns.
1. Be insured
For travel to Europe, make sure every family member has their own valid EHIC card, providing proof of entitlement to free or reduced-cost healthcare, otherwise you will have to pay. The card is free from the official website (ehic.org.uk), but beware of scam websites that will trick you into paying £20 or more for “helping” with your application.
Check your travel/medical insurance policy, and disclose any pre-existing medical conditions that might later become an excuse for your insurer to avoid paying out. Check what’s covered if one of your group falls ill and you need to change flights or travel plans; and see if activities such as water-skiing, diving, climbing or bungee jumping are excluded.
2. Know what’s happening at your destination
Check the latest news about outbreaks, health news and safety warnings on the NaTHNaC (nathnac.org/travel/news), FCO (gov.uk/knowbeforeyougo), WHO (who.int/csr/don/en) and CDC (cdc.gov/travel) websites. For example, the Seychelles, Kenya, Angola and Tanzania have all reported outbreaks of dengue fever this year (see Insect Bites, below).
3. Don’t just rely on the internet
The internet can be great for news, facts and general advice; but it is not always good at putting things into context and tailoring advice for you, your family and your exact medical needs. Get advice from a specialist travel clinic, ideally one that sees lots of travellers taking the same type of trip as you have in mind.
4. Get vaccinated
Get your vaccines in early for best protection and to avoid problems with supply. Several travel vaccines have been scarce this year. For example, there’s a current shortage of typhoid vaccine (particularly necessary if you are heading for the Indian subcontinent). Vaccines are important, but so is the health information and advice that a good clinic will also provide when you attend. Save time and avoid unnecessary jabs by bringing a record of all your past vaccines. Mention future trips (eg, gap-year plans) – it may make sense to have protection from now.
5. Minimise the chances of food- and water-borne infection
Diarrhoea affects up to two thirds of all international travellers and is more likely in hot countries and wherever hygiene is poor. It is not always trivial: 13 per cent of sufferers are typically confined to bed, with a further 40 per cent having to change their travel plans. Basic prevention includes sticking to bottled water for drinking and brushing teeth, eating food cooked freshly to order rather than from buffets, and using cleansing wipes or hand sanitisers immediately before handling food.
Treat diarrhoea promptly, with oral rehydration solution to prevent or correct dehydration; loperamide to stop diarrhoea symptoms; and consider having antibiotics available in case of more severe symptoms. (Loperamide is not advised for children under 12, but there is now a new prescription alternative, Hidrasec, that’s safe enough to treat watery diarrhoea in children over three months of age.)
6. Make safety a priority
Many people worry about infective risks, but accidents and safety are the real dangers, made worse by our natural inclination to let our guard down on holiday and by inadequate medical care at our destination. Be your own safety police. The biggest hazards are on the roads: not using seat belts, car seats for kids, helmets or protective clothing when on bikes or mopeds, are recurring themes. So too are alcohol issues, driving too fast on unfamiliar roads, unsafe hotel balconies, diving into shallow water and unregulated dive centres, helicopter or ballooning excursions. Britons are 5.5 times more likely to drown abroad than in the UK, most deaths occur in swimming pools and under-sevens are at highest risk. Join the Bloodcare Foundation, which ensures access to safe blood for transfusion at low cost (bloodcare.org.uk). Young people planning gap years should beef up safety skills (objectivegapyear.com).
7. Avoid sunburn
Sunburn is the visible tip of a sinister iceberg and the UK death rate from melanoma, the deadliest skin cancer, has doubled over the past 30 years, in tandem with our appetite for holidays in sunnier climes; the number of new cases has multiplied five-fold. Other (disfiguring but more treatable) skin cancers have risen to 100,000 cases every year. Protect kids, use hats, sunscreens and keep out of the sun at the hottest times of the day. (The exact time of “solar noon” varies across Europe and can be as late as 2.40pm on the Atlantic coast of Spain.)
8. Protect against malaria and bites
For travel to tropical Africa, Asia or Central/South America, get up-to-date malaria advice. Wherever you go, keep in mind that many other diseases are also spread by insects or ticks. Dengue fever is now the world’s fastest growing tropical disease: this unpleasant viral infection is spread by mosquito bites throughout the tropics, with even a few cases in Madeira and southern Europe. To prevent bites, cover up, use plenty of Deet-based insect repellent on skin and clothes. At night, use room sprays, plug-in insect killers or mosquito nets.
9. Pack a medical kit
Include medication you take regularly (plus a list of their names or a photo of the prescription on your mobile phone) and any others you sometimes need, for example for pain, allergies, hay fever or indigestion. Consider remedies for diarrhoea (above), insect bites, motion sickness, altitude sickness, children’s medicines and other factors specific to your trip. Discuss the need for “standby” prescription medicines (such as antibiotics) with your doctor or travel clinic. Don’t run out, make sure they are clearly labelled and seek advice on travelling with medicines such as codeine-containing pain- killers that may be banned in some countries.
10. Practise safe sex
People have more sex when they travel. Casual sex, either with fellow travellers or local people, is often unexpected so be prepared, protect against unwanted pregnancy and the considerable risk of sexually transmitted infection. This is not just a risk for younger travellers: one of the biggest increases in rates of STI has occurred in men and women over the age of 50.
Dr Richard Dawood is a specialist in travel medicine at the Fleet Street Clinic (020-7353 5678). The new edition of his book, Travellers’ Health: How to Stay Healthy Abroad (OUP), is out now.