Patient Travel Advice
This Page is designed to inform you of some of the information that is important when you are travelling – Please read it! The information will help you to stay healthy on your trip.
Diseases can be caught from drinking contaminated water, or swimming in it. Unless you KNOW the water supply is safe where you are staying.
This includes ICE CUBES and water for CLEANING YOUR TEETH.
ONLY USE (in order of preference)
- Boiled water.
- Bottled water or canned drinks; Bottled drinks - ensure the top is clean and sealed – never use a bottle of water without a protective seal and ensure a canned top is thoroughly cleaned, and pour in to a clean cup don’t drink directly from the can (not all bottled water is safe for babies)
- Water that is treated by a sterilising agent.
It is safer to swim in water that is well chlorinated. If you are travelling to Africa, South America or some parts of the Caribbean, AVOID SWIMMING in fresh water LAKES and STREAMS. You can catch a parasitic disease called SCHISTOSOMIASIS from such places. This disease is also known as BILHARZIA. It is wise NEVER TO GO BAREFOOT, but to wear protective footwear when out, even on the beach. Other diseases can be caught from sand and soil, particularly wet soil.
Contaminated food is the commonest source of many diseases abroad. You can help prevent it from following these simple guidelines:
- - Only eat well cooked fresh food
- - Avoid leftovers and reheated foods
- - Ensure meat is thoroughly cooked
- - Eat cooked vegetables and avoid salads
- - Only eat fruit you can peel
- - Never drink unpasteurised milk
- - Avoid ice-cream and shellfish
- - Avoid buying food from street vendor’s stalls.
If you drink to excess, alcohol could lead you to become carefree and make you forget these precautions.
Two phrases to remember
- Cook it, Peel it, or leave it!
- When in doubt, leave it out!
For specific information about travelling with babies/children – please visit http://www.fitfortravel.nhs.uk/advice/general-travel-health-advice/child-travellers.aspx under section Food and Water Hygiene.
Many diseases are transmitted by what is known as the ‘faecal-oral’ route. To help prevent this, always wash your hands with soap and clean water after going to the toilet and before eating or handling food.
This is the most common illness that you will be exposed to abroad and there’s no vaccine against it!
Traveller’s diarrhoea is caused by eating and / or drinking food and water contaminated by bacteria, viruses or parasites. Risk of illness is higher in some countries than others.
High Risk areas include North Africa, Sub-Saharan Africa, the Indian Subcontinent, SE Asia, South America, Mexico and the Middle East.
Medium risk areas include the northern Mediterranean, Canary Islands and the Caribbean Islands.
Low Risk areas include North America, Western Europe and Australia.
You can certainly help prevent traveller’s diarrhoea by making sure you follow the food, water and personal hygiene guidelines already given above.
Traveller’s diarrhoea is 4 or more loose stools in a 24 hour period often accompanied by stomach pain, cramps and vomiting. It usually last 2-4 days whilst it is not a life threatening illness, it can disrupt your trip for several days.
The main danger of the illness is DEHYDRATION, and this, if very severe, can kill if it is not treated. Treatment is therefore REHYDRATION. In severe cases and particularly in young children and the elderly, commercially prepared rehydration solution is extremely useful. This can be bought in tablet or sachet form at a chemist shop e.g. DIORALYTE™ or ELECTROLADE®. (Dioralyte Relief™ is a formula containing rice powder which also helps to relieve the diarrhoea, particularly useful in children). Prepare according to instructions.
DID YOU KNOW! A teaspoon of sugar, and a pinch of salt in a glass of water will also help to rehydrate.
ANTI-DIARRHOEAL TABLETS can be used for adults but should NEVER be USED in children under the age of 4 years, and only on prescription for children aged 4 – 12 years. Commonly used tablets are IMODIUM® and LOMOTIL® (Loperamide)
None of these should ever be used if the person has a temperature or blood in their stools.
DO CONTACT MEDICAL HELP IF THE AFFECTED PERSON HAS:
- - A temperature
- - Blood in their diarrhoea
- - Diarrhoea for more than 48 hours (or 24 hours in children)
- - Becomes confused
In very special circumstances, antibiotics are used for diarrhoea, but this decision should only be made by a doctor.
(A woman taking the oral contraceptive pill may not have full contraceptive protection if she has had diarrhoea and vomiting. Extra precautions must be used – refer to your “pill” information leaflet. If using condoms, use products with the British Kite Mark and ensure they are in date and the packaging is not damaged).
HEPATITIS B and HIV INFECTION
These diseases can be transmitted by
- Blood transfusion
- Medical procedures with non-sterile equipment
- Sharing of needles (e.g. tattooing, body piercing, acupuncture and drug abuse)
- Sexual contact (other Sexually Transmitted Diseases can also be transmitted this way)
WAYS TO PROTECT YOURSELF
- - Only accept a blood transfusion when essential
- - If travelling to a developing country, take a sterile medical kit with you (available from a Pharmacy)
- - Avoid ear, body piercing, tattooing, acupuncture and IV use.
- - Avoid casual sex, especially without using condoms
REMEMBER – Excessive alcohol can make you carefree and lead you to take risks you otherwise would not consider.
Mosquitos, certain types of flies, ticks and bugs can cause many different diseases e.g. malaria, dengue fever, yellow fever. Some bite at night, but some during the day time.
If you are travelling to country that has Malaria.
REMEMBER, Malaria is a serious and often a fatal disease.
Malaria is a serious illness that is common in many tropical countries. Symptoms can develop rapidly and it can kill you, but if you take the correct precautions you can greatly reduce your risk of catching it. The disease is spread by mosquitoes that bite at night (dusk to dawn).
You can protect yourself against malaria, and you must do so every time you visit a country with malaria. This is very important, even if you grew up or lived there and are now returning to visit your friends or family. No one has full immunity to malaria. Any partial protection you may have from being brought up in a malarious country is quickly lost when you live in countries with no malaria, so everyone needs to take precautions to avoid getting malaria.
Your family are at risk as well. Babies and children, especially those born outside the tropics, can get very sick with malaria very quickly. It is also particularly dangerous for pregnant women, who should avoid visits to malarious areas. Use the ABCD approach to protect yourself.
A – be Aware of the risks Malaria is common in many parts of Africa, Asia, the Indian subcontinent, South America and some areas in the Far and Middle East. The risk is particularly high in sub-Saharan Africa.
Seek advice from your travel health services or go to a travel clinic to check if there is malaria in the country you are visiting. They can give you malaria prevention advice. Seek their advice 6-8 weeks before your trip, if possible, but remember it is never too late to seek advice. Even last-minute travellers can get useful protection.
B – use Bite prevention • use an insect repellent containing DEET. Other effective repellents are picaridin (icaridin) and lemon eucalyptus. These are readily available in pharmacies or camping and travel shops. Remember to reapply insect repellent frequently and to follow the manufacturer’s recommendations, particularly when applying repellents to young children •cover up with trousers and long-sleeved clothes after sunset. •treat clothing with insecticides •use knockdown sprays or coils to kill any mosquitoes before you go to bed. These products are readily available in pharmacies or travel and camping shops •sleep in a properly screened, air conditioned room or under a mosquito net that has been treated with insecticide
Homoeopathic or herbal remedies, electronic buzzers, garlic and vitamins do not protect against mosquito bites.
C – take Chemoprophylaxis (malaria tablets) Tablets to prevent malaria play a very important role in protecting you. There are a number of different types. Ask your travel health services which type of tablets you and your family need.
Make sure you understand how and when to take your tablets. You need to start taking them before you go, continue all the time you are away and also for a period of time when you return. Remember – it is vital that you finish the course of tablets when you get back to make sure you are properly protected.
Homoeopathic or herbal remedies do not protect against malaria and must not be used in place of antimalarial tablets.
D – seek early Diagnosis if you become unwell Although modern prevention methods are highly effective and can greatly reduce your risk of dying from this dangerous disease, they do not give 100% protection.
If you or any of your family has a fever or flu-like illness after being in a country with malaria you must see your doctor urgently. Tell them where you have been and mention malaria. Remember you could still have malaria, even a year after a trip to a malaria-risk region.
*Malaria information above taken from PHE publications gateway number: 2013-064 June 2013 - Information for people travelling overseas leaflet.
Rabies is present in many parts of the world. If a person develops rabies, death is 100% certain. There are 3 RULES REGARDING RABIES
- DO NOT TOUCH any animal, even dogs and cats
- If you are licked on broken skin or bitten in a country which has rabies, wash the wound thoroughly with soap and running water for 5 minutes.
- Seek medical advice IMMEDIATELY, even if you have been previously immunised.
Major leading deaths in travellers are due to swimming and traffic accidents. You can help prevent them by taking the following
- - Avoid alcohol and food before swimming
- - Never dive into water where the depth is uncertain
- - Only swim in safe water, checking currents and for sharks, jellyfish etc.
- - Avoid alcohol when driving and also avoid driving at night time
- - Avoid hiring motorcycles and mopeds
- - If hiring a car, rent a large one if possible, ensure the tyres, brakes and seatbelts are in good condition.
- - Use reliable taxi firms; know where the emergency facilities are.
- - Know the countries emergency contact number(s).
- - Take out adequate insurance cover for your trip. This should possibly include medical repatriation as without it this service, if needed, is extremely expensive.
- - If you have any pre-existing medical conditions, make sure you inform the insurance company of these details and check the small print of the policy thoroughly.
- - If you are travelling to a European Union country, make sure you have obtained an EHIC card which is free of charge before you travel. You can apply by ringing the automated telephone line on 0300 330 1350 or applying online at www.ehic.org.uk. This takes time to obtain so needs to be applied for in advance. Additional travel insurance is still advised. Each member needs an individual EHIC card and you will need to have readily available your full name, date of birth and your national insurance number or NHS number (CHI number in Scotland, or Health and Care Number in Northern Ireland) prior to applying.
It is sensible on any long haul flights to
- - Be comfortable in your seat
- - Exercise your legs, feet and toes while sitting every half an hour or so and take short walks whenever feasible. Upper body and breathing exercises can further improve circulation.
- - Drink plenty of water and be sensible about alcohol intake which in excess leads to dehydration.
Further information can be obtained from the Department of Health website detailed below with more specific advice and information on travel-related deep vein thrombosis.
SUN and HEAT
Sun and heat-stroke cause serious problems in travellers, but in the long term can be a serious cause of skin cancer. Long term damage to the skin due to sun exposure can lead to skin cancer. There is no such thing as safe suntan but the following advice should be taken
- - Increase sun exposure gradually, 20 minutes limit initially
- - Use sun blocks of appropriate adequate “SPF” strength but a minimum of SPF 15. Children under 3 years should have a minimum SPF 25 and babies under 6 months should be kept out of the sun at all times. Reapply often and always after swimming and washing. Read manufacturer instructions.
- - Wear protective clothing – sunhats, T-shirts and sunglasses etc.
- - Avoid going out between 11am – 3pm, when the sun’s rays are strongest.
- - TAKE SPECIAL CARE of CHILDREN and those with pale skin/red hair.
- - Drink extra fluids in a hot climate.
- - Be aware that alcohol can make you dehydrated.
Further information about Sun safe: https://www.nhs.uk/livewell/skin/pages/sunsafe.aspx
Useful websites and further information/advice can be found:
We recommend www.fitfortravel.nhs.uk
National Travel Health Network and Centre - www.nathnac.net
Travel Health Pro - www.travelhealthpro.org.uk
Department of Health - www.dh.gov.uk
Foreign and Commonwealth Office - www.fco.gov.uk/knowbeforeyougo
Immunisation Issues - www.nhs.uk/Conditions/Travel-immunisation/Pages/Introduction.aspx
Malaria for the General Public - https://www.dred.com/uk/malaria-map.html