The Complete Guide To: Travel health

Should you drink the water? What about brushing teeth in it? How many diseases do mosquitoes carry? And where are the worst roads? Simon Calder has the answers
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The Independent Travel

ABROAD: UNFIT FOR HUMAN HABITATION?

No, but as soon as you leave the green and pleasant lands of the British Isles, the range and degree of potential health hazards rises. The world is at your feet, but sometimes it kicks back. "Almost every tropical disease, almost every travel-related health issue is on the increase," warns Dr Richard Dawood of the Fleet Street Travel Clinic (020-7353 5678; www.fleetstreetclinic.com).

Of the 450 or so British people who die abroad of non-natural causes each year, the chart-toppers are depressingly predictable. They have nothing to do with terrorism, nor with diseases that devour your vital organs. The most significant (and most frequently overlooked) danger is the risk of being injured or killed on the roads, which claim between 150 and 200 lives of British travellers each year.

Bad drivers begin at Calais, and this weekend - when most of the population of Paris decamps to the south - is going to be risky for anyone heading through France, despite the French government's attempts to reduce the atrocious road toll.

Places whose road safety records are so poor that you should seriously consider travelling by rail or air as much as possible include Portugal, Greece, Turkey, Cuba, New Zealand and much of Africa. The risks are highest in developing countries with poor infrastructure and ineffective traffic laws; the death toll in Egypt is 50 times the rate in the UK, and you are more likely to fall victim to a crash on the roads of Kenya or South Africa than you are to contract a deadly disease.

Even so, the well-prepared traveller will take the necessary precautions to reduce all the significant health risks - not least because there are plenty of non-life-threatening holiday illnesses that can ruin your travels.

Anything from painful sunburn to a gastric upset of Montezuma proportions, via more specialised threats such as altitude sickness, could spoil your trip. The choice is yours: prepare for the worst, or head for Frinton.

SO WHERE DO I START?

To reach Frinton? Catch a nice, safe train from Colchester or London Liverpool Street. But before you dip a toe in the water, make sure you understand the risks posed by the sea. Be aware, in particular, of how to cope with a riptide - where localised currents close to the shore have the effect of sweeping bathers out to sea. The natural response is to try to swim back against the tide, but that could prove ineffective and simply exhaust you. The correct action is to swim parallel to the shore for some way until the riptide subsides, and then swim back to the beach.

Drownings and other accidents in water account for around 100 deaths of British people abroad. Victims may become caught in a submerged obstacle, fall asleep on an inflatable mattress and drift out to sea or simply slip on the side of a swimming pool. Many of these tragedies are alcohol-related, and every year travellers are flown back by air ambulance with a broken back or neck after diving into a shallow pool. For many tourists, "don't try this at home" becomes "try anything while away"; but heavy drinking and a midnight swim do not mix.

When we transform from rational human beings to holidaymakers, there is a tendency to cancel common sense and caution along with the milk and newspaper. A plane ticket and a guidebook do not guarantee touristic immunity.

I PROMISE TO DRIVE AND SWIM CAREFULLY. WILL I BE SAFE?

That depends - largely on you, and the seriousness with which you take your holiday-health regime. Plan in advance: most vaccinations must be administered a fortnight or so before exposure.

All travellers should ensure their childhood vaccines (polio, tetanus and diphtheria) are up to date; it may be useful to record these and any other vaccinations on an International Health Certificate available from your doctor or travel-medicine specialist. Protection against hepatitis A and B is also advisable, wherever you are heading; A is easier to contract, through food or water; B is usually caught through sex or a blood transfusion, and is nastier. Once you go beyond Europe, North America and Australasia, dangers proliferate and it is well worth seeking specialist travel health advice.

A good first point of contact is Medical Advisory Services for Travellers Abroad (0113 238 7575; www.mastatravelhealth.com). This long-established commercial company can provide an individual travel brief, outline the risks at your destination - and provide solutions to deal with them.

Another specialist is Nomad (020-8889 7014; www.nomadtravel.co.uk), which has on-site pharmacists and nurses in various UK locations, plus shelf after shelf of equipment from water-purifiers to industrial-strength insect repellent. And Trailfinders has a vaccination centre at its main base at 194 Kensington High Street in west London (direct line: 020-7938 3999; www.trailfinders.com).

WHAT IS THE BIGGEST MEDICAL THREAT?

The mosquito: a small, vicious insect that wreaks havoc with travellers' - and residents' - health because of its unsavoury habit of dining on human blood. This practice, preceded by the injection of an anticoagulant which causes the maddening itch, would be merely infuriating were it not for the fact that it serves as a very effective vector (means of transmission) for a wide range of diseases.

The biggest single killer is malaria. Annually, 2,000 British travellers return home having contracted this parasite abroad; of those, around 20 tourists die from malaria. High-risk areas include most of sub-Saharan Africa, parts of Asia and a swathe of South and Central America.

Anopheles mosquitoes are the culprits. Following a bite from one that is infected with malaria, symptoms will usually develop in one to three weeks (though if you become ill up to three months after visiting the tropics, you should take medical advice and mention your trip). The indications are similar to flu: fever, chills, muscle aches, headache and, sometimes, vomiting and diarrhoea, and coughing. In malaria's more severe stages, liver and kidney failure, convulsions and coma are possible. And even when you think you are better, you may not be: parasites may remain dormant in the liver for many months, causing a reappearance of symptoms months or years later.

The simplest and most effective way to avoid malaria is to avoid being bitten. Anopheles mosquitoes usually bite only between dusk and dawn. Make sure your ankles and wrists are covered and douse yourself with a good insect repellent, such as high-strength Deet - a chemical compound that is even more unattractive to the mosquito than it is to you. If your room is not air-conditioned or effectively screened, use a mosquito net over your bed; consider taking along one of your own rather than relying on those in hotels, which are often damaged. GlaxoSmithKline's website www.malariahotspots.co.uk gives more advice.

CAN I GET A JAB AGAINST MALARIA?

Not yet. While research to find a vaccine against malaria continues, you will need to decide which anti-malarial tablets - if any - are most appropriate for you. The main anti-malarials are Lariam, doxycycline, Malarone, chloroquine and Paludrine, each with attendant risk and benefits. The optimum* *for you will depend on where you are going, because in some places the malaria parasite has developed resistance to particular drugs.

The best policy may be to take no prophylaxis: while the UK health authorities still recommend chloroquine and Paludrine for most travellers to the Indian subcontinent, the latest travel advice from a group of tropical-medicine specialists suggests that there may be more risks from the side-effects of anti-malarials than from the disease itself. If this makes you focus more on avoiding bites, so much the better. The damnable mosquito spreads many other serious mosquito-borne illnesses, including yellow fever, Japanese encephalitis and dengue fever - which is unlikely to kill you, but may well make you feel like death warmed up.

Many other serious illnesses are spread by small creatures such as ticks and worms. These include lymphatic filariasis, loiasis (African eye worm) and leishmaniasis, which is sometimes fatal.

OH, CHEER UP. WE'RE GOING WHERE THE SUN SHINES BRIGHTLY

To disaster... or at least it could be if you fail to protect yourself against ultra-violet rays. The fact that you will look ridiculous with bright pink sunburn is only the start of the downside; strong sun ages your skin and increases the likelihood of skin cancer.

The Department of Health says you should stay out of the sun for two hours around midday; use shade and a wide-brimmed hat; wear tightly woven but loose-fitting clothes; smother uncovered skin with high-factor sun screen; and protect your eyes with UV filter sunglasses. Precautions are particularly necessary for babies and young children. And even when you've covered up, it is possible to suffer from heatstroke. To avoid the effects of overheating, don't do strenuous activity during the hottest hours of the day and drink plenty of water.

I'M HUNGRY AND THIRSTY

Before you let anything pass your lips, consider the implications. In many parts of the world, food and water can pose threats: whether you are on the Trans-Siberian or the Silk Road, beware of the faecal-oral route. A good mantra for deciding whether to eat something is "cook it, boil it, peel it or forget it". Street food, where you can see the meal prepared in front of you, can be safer than a fancy restaurant. You should also seek out places with a high turnover of local customers (in the friendliest sense), because this indicates both that the food is reliable and that the dishes have not been sitting around for ages, as can be the case with a hotel buffet. Shellfish can harbour a wide range of menaces to devastate your digestion, while meat and fish should always be treated with circumspection.

In countries such as India it is safest (and tastiest) to become a vegetarian for the duration of your stay, even if you normally eat meat. But be wary of anything raw and green: salads may have been washed in untreated water, or not washed at all; try to stick to vegetables that have been cooked.

Water presents a problem: you need to drink plenty of it, but it can carry a range of threats, from giardia to amoebic dysentery. You will not relish either of these, and neither will your travelling companion. Bottled water is available almost universally; where it is not, tincture of iodine or branded chlorine-based treatments such as Sterotabs and Puritabs can render the local supply safe. For regular travellers to wilderness areas, an iodine resin water purifier is a good investment. And do not relax your guard for a moment: use bottled or purified water when cleaning your teeth, and reject offers of (potentially dangerous) ice-cubes in your drink.

I NEED TO FIND OUT MORE

You certainly do; fortunately, you can buy some excellent books on the subject. Twenty years ago, Dr Richard Dawood - who now runs the Fleet Street Travel Clinic - wrote the seminal book on travel medicine. How to Stay Healthy Abroad (Oxford University Press, £14.99) set the agenda for travel medicine. The book, now in its fourth edition, describes the causes, symptoms and treatment of a multitude of complaints from roundworm - which affects one in five of the world's population - to bubonic plague ("the risk to travellers is very small indeed"). Dr Dawood's catalogue of catastrophes is laced with essential information such as the fact that a severed snake head can still deliver a venomous bite, and how to remove a tumbu fly maggot from the skin ("rather an unpleasant spectacle to watch", he warns).

Rough Guides and Lonely Planet publish books on travel health, but perhaps the most approachable guide is Bugs, Bites and Bowels by Dr Jane Wilson-Howarth (Cadogan, £9.99), who writes on travel medicine for The Independent.

Should you find yourself obliged to give medical treatment in a remote area, the Ship Captain's Medical Guide (HMSO, £36, or free online from www.mcga.gov.uk) advises on splinting a broken bone and giving subcutaneous injections, as well as the basics of delivering a baby and burial at sea.

Advice online is not always reliable; dependable sources include the Hospital for Tropical Diseases ( www.thehtd.org) and the very useful site run by the Scottish Centre for Infection and Environmental Health ( www.fitfortravel.scot.nhs.uk).

Additional research by Jo Cox and Emily Edmondstone

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