Travel and Health

Travel and Health

More and more people are going abroad every year. It is our desire that our patients go and have a great time, returning with wonderful memories and nothing infectious! Unfortunately, particularly with the increased availability of short-notice holidays to exotic locations, some patients do return with more than they bargained for. To this end our nurses offer travel advice, including precise information on vaccinations and malaria prevention for all holiday destinations. The information on this site is general, but please do not hesitate to contact our practice nurses or your GP for further information.

Traveller’s Diarrhoea
Half of Europeans succumb to traveller’s diarrhoea if they spend 3 or more weeks in Africa, the Middle East, Latin America or Asia. It is usually a mild disease but sometimes can be severe. Treatment is aimed at restoring lost fluids (and if severe, lost salts as well). There are many different causes. The vast majority comes from water that is infected.

Water
• Always wash your hands after going to the lavatory, before handling food, and before eating.
• If you have any doubts about the water quality, boil it, use sterilising tablets, or stick to carbonated bottled water from a sealed container.
• Avoid ice unless you are sure it is made from treated or chlorinated water.
• Hot tea, coffee, wine, beer, carbonated water and soft drinks tend to be safe.

Food.
Beware of :
• Salads
• Uncooked fruit and vegetables unless you can peel them yourself.
• Food which has been kept warm.
• Food likely to have been exposed to flies.
• Dishes containing uncooked egg.
• Ice cream from unreliable sources such as kiosks and itinerant traders.
• Shellfish, especially if uncooked.
• Unpasteurised dairy produce.
• Food from street traders unless you are sure it is freshly prepared and hot.

Management of Traveller’s Diarrhoea
Traveller’s diarrhoea is usually mild although sometimes it can be severe. The sufferer should continue to eat as food shortens the illness and lessens fluid loss.

Anti-diarrhoeal drugs should be avoided if at all possible. They can prolong the duration of symptoms, make the diarrhoea more severe, and can also extend the time in which you can pass the infection on to others.

Commercially available sachets containing sugar and salts can ease symptoms and reduce dehydration. Similarly you can add a teaspoon of sugar and a pinch of salt to a glass of boiled or bottled water and flavour to taste with fresh orange juice.

Medical attention should be sought if any of the following occur:

• There is blood in the faeces.
• The illness is accompanied by fever.
• The affected person becomes confused.
• The diarrhoea does not settle within 72 hours (24 hours in children and the elderly).

Travel Immunisation
Immunisation requirements for international travel are often a concern for patients planning a trip abroad. Please discuss these with the practice nurse as there are specific requirements for many overseas destinations. Make sure vaccinations are sorted out well in advance of travel, as some vaccines require a course of injections over a few weeks or even months.

Yellow Fever: This is a special case, it is the only vaccine for which an International Certificate of Vaccination is needed.The Department of Health will no longer be responsible for the designation of yellow fever centres. For all enquiries please use the attached link to the National Travel Health Network and Centre (NaTHnac) website for Designated Yellow Fever Vaccination Centres: Click here.

Malaria
Malaria is a mosquito-borne disease that is widely spread throughout the world. We see about 2000 cases every year in the UK, and worryingly, the more severe form is being seen more often. All of these cases are contracted by people either working or on holiday while abroad. The majority of these cases are in people who have failed to take their anti-malarial tablets correctly. In 2001 seven people died of malaria in Britain.

The amount and severity of malaria varies from region to region, even from month to month. For this reason the surgery receives updates every month for the correct malaria prevention for every country. The practice nurse has this information.

Protection from mosquito bites
The best way to avoid malaria is to avoid being bitten by mosquitoes! Mosquitoes are most active in the hour before and after sunset, but feed throughout the night. Simple measures can help:

• Wear long-sleeved shirts and long trousers in the evenings
• Protect exposed limbs and the face with an effective insect-repellent (DEET or “diethyltoluamide” is the most effective) but remember to reapply it every 2-4 hours.
• There are now additional sprays (usually containing Permethrin) for spraying onto clothing. These can be useful as I have seen a mosquito bite through fabric to get a meal!
• Sleep in fully air-conditioned or screened accommodation.
• Spray your room an hour before sleep with a “knockdown” insecticide or use a mosquito coil.
• When the room cannot be protected from insects, use a permethrin-impregnated bed net, this is far more effective than a simple “mosquito-net.”

Anti-Malarials Medication
Always seek advice from the practice nurse or your GP on the correct anti-malarial tablets for the region you are visiting. There are some important rules:

• Weekly anti-malarials need to be started at least one week before departure (2 or 3 weeks for Mefloquine).
• Most anti-malarials need to be taken regularly for four weeks after return. (Malarone is the main exception, this can be stopped a week after return).
• No anti-malarial medications are 100% effective, avoiding bites remains important even though on medication.

Symptoms of Malaria
Malaria can present any time for up to a year after visiting an infected area. The symptoms can be come serious in as little as 24 hours. For this reason, if you suffer any of the following in the 12 months after visiting a malaria zone, you must seek urgent medical advice:

• Fever (the most common symptom)
• Flu-like illness
• Backache
• Diarrhoea
• Joint pains
• Sore throat
• Severe headache