Travel preparation more than just vaccinations
Before setting off on your overseas trip it is important to get advice on how to remain healthy for the duration of your trip. While most people travel without any health problems, there is the potential for everything from jet lag to tropical diseases.
Travel Medicine Clinics can help with planning and sound advice
Make an appointment to see a doctor well before you leave. Many GPs and their practice nurses have an interest in travel medicine. These days, there are a number of specialist travel medicine clinics. These clinics advise on travel medicine alone and are designed to offer a one-stop shop for all travel needs.
Make an appointment at least six weeks (preferably earlier) before you plan to travel so that your travel health needs can be sorted out well in advance and you avoid any last-minute hassles and anxiety. The last thing you want is to be worrying about vaccine and antimalarial medication side effects in the days leading up to your departure. Remember, getting your travel health needs sorted involves a whole lot more than just getting a few vaccinations.
Fitness to travel
Some people might be at increased risk of health problems while travelling. For some, the first hurdle might be your fitness to travel in a commercial aircraft. If you have any concerns, it is essential you discuss them with a doctor who can liaise with the medical officer of the airline. Commercial airlines are generally very accommodating, provided they are given plenty of notice of your medical concerns.
If you have an ongoing medical condition you also need to think about how travel might affect you. This might mean the effect of a humid environment on your eczema or - more complex - the management of insulin-dependent diabetes while travelling to tropical destinations.
Regular medications
Ensure that regular personal medication is always on hand, split some between items of luggage and make sure the sole supply is never in your checked-in luggage. Think about how you are going to get repeats of medication while travelling. Always carry a letter from your doctor outlining the medication you are on, including the dose and the non-brand (generic) name.
Travel-related deep vein thrombosis/venous thromboembolism
It appears that a small number of travellers get their first deep vein thrombosis (DVT) during travel. Discuss this with your doctor. Are you at greater risk of getting this kind of blood clot? During any lengthy, seated travel, make sure you get up and move around and drink plenty of fluids (avoid excessive caffeine and alcohol). For some, it might be advisable to be fitted with compression socks to help circulation. A few people are recommended to have injections of blood-thinning agents before they travel.
Travel insurance, safety and security issues
You need to take out travel insurance that is adequate for your needs. It needs to cover all pre-existing medical conditions and all proposed and possible activities. You do not want to find out on the slopes of Mt Kilamanjaro that your insurance will not cover your pre-existing heart condition.
It is always worthwhile checking the New Zealand Ministry of Foreign Affairs and Trade website for current advisories on travel - www.safetravel.govt.nz
Reading about the customs and societal norms in the destination country goes a long way to reducing the likelihood of unpleasant incidents.
Regular communication with home, if broken, helps alert friends and relatives to the possibility of something having gone wrong. It is useful for you to have a plan, eg, a specific person to phone or email, perhaps with a secret code/message in the event of an emergency. Groups travelling together need to have a plan of where to meet or who to contact if they become separated.
Food and water-borne illnesses
Access to safe drinking water and to food free of contamination by various micro-organisms, chemicals and toxins cannot be guaranteed in most less developed countries.
Travellers' diarrhoea
This is one of the most common illnesses for travellers - with between 10% and 50% of individuals becoming infected. It is generally considered a mild illness, but it can be a real nuisance and there can be serious complications. While not a guarantee, adhering to the following advice should offer some degree of protection:
- "Cook it, boil it, peel it or forget it"
- Avoid all water unless bottled, boiled or purified.
- Avoid all ice.
- Take care not to ingest water in shower, pools or while brushing teeth.
- Alcohol is generally safe (if ice free).
- Carbonated drinks are generally safe.
- Eat cooked food, freshly prepared and served piping hot.
- Eat in busy restaurants with a high turn-over of food.
- Eat raw, peelable fruit and raw vegetables but ONLY if you have peeled them yourself. Avoid all other raw fruit and vegetables, especially salads.
- Avoid reheated food.
- Avoid food left exposed to flies.
- Be cautious with dairy products, have they been pasteurised?
- Baked goods are generally safe.
- Ensure frequent hand-washing and drying, especially before meals.
Insect-borne diseases
In the tropics, many diseases are transmitted by the bite of insects. Those most likely to affect New Zealand travellers are dengue fever and malaria. Both are transmitted by mosquito bites.
Advice on avoiding insect bites
- Cover as much of the skin with clothing as is possible/practical.
- Light-coloured clothing appears to be less attractive to mosquitoes than dark colours.
- Use insect repellent containing DEET (N,N-diethyl-m-toluamide) at tropical strength (minimum 30% for adults; up to 30% for children over 2 months of age).
- Reapply the repellent as recommended by the manufacturer and after swimming, showering or excessive sweating.
- Avoid outdoor activity at peak biting times (two hours either side of dawn and dusk, but note that dengue-carrying mosquitoes also bite during the day).
- Sleep in screened or air-conditioned accommodation, frequently check screens for rips and holes.
- Sleep under a mosquito net, preferably one pre-treated with permethrin.
- Check the room and spray with an insecticidal spray before settling down for the night.
- Consider pre-soaking clothing and bed nets in permethrin.
The distribution of dengue fever is increasing rapidly throughout the tropics and subtropics, especially in Asia and the Pacific. It is now well established in Northern Queensland (Australia). The mosquito responsible for the transmission of the virus is well adapted to the urban environment and is a predominantly day-biting mosquito. Infection with the dengue fever virus can cause anything from mild flu-like illness through to life-threatening illness. There is no vaccine available. Preventing illness is dependent on total avoidance of mosquito bites (including in large cities and well-touristed areas).
Malaria continues to cause significant illness and death in many parts of the world. Estimating the exact risk for any given traveller can be difficult. You need to discuss this with a doctor pre-travel. Preventing malaria in the first instance comes down to avoiding mosquito bites. The mosquito that transmits malaria is most active just after dusk and before dawn and through the night. So, basically, you need to avoid mosquito bites 24-hours a day.
Antimalarials
The risk of catching malaria can be significantly reduced by taking antimalarial medication. In New Zealand, the choice includes mefloquine, doxycycline, hydroxychloroquine and atorvaquone/proguanil combination. Which one is prescribed for you depends on many factors including pre-existing medical conditions, current medications, past side effects, resistance patterns at destination, what you can afford and your personal preference.
Insect repellents
The insect repellent most widely studied and shown to be most effective at protecting against mosquito bites is DEET. It has been shown to be very safe. Formulations of at least 30% DEET ("tropical strength") are advised for adults; and up to 30% for children over two months of age. It is best to buy repellent before you leave home as good repellents cannot be guaranteed overseas.
Permethrin
Permethin, a synthetic pyrethroid, is an effective insecticide. It can be used to impregnate items such as mosquito nets and clothing.
Vaccines... which ones and when?
Routine vaccinations
Your pre-travel consultation presents a good opportunity to revise your routine (non-travel) vaccines and bring you up to date. Are you (and your children) up to date with tetanus, flu vaccines and vaccination against measles, mumps and rubella (MMR)?
Recommended for all travellers to less developed countries
- Tetanus/diphtheria. For those travelling to less developed countries or in situations where rapid access to medical care cannot be guaranteed, it is recommended you have a booster if you have not had one within 10 years of travel.
- Polio. It is recommended travellers be up to date and have a single adult booster of polio vaccine if visiting an endemic country (ie, with recent disease activity). It is also recommended for long-term travellers to countries with poor sanitation.
- Hepatitis B. Hepatitis B is now considered a routine vaccine for virtually all travellers to less developed countries.
- Hepatitis A. All travellers to less developed countries should be protected against this food- and water-borne virus. A series of two injections six months apart protects against hepatitis A for over 25 years, possibly longer.
- Typhoid. Travellers spending more than two weeks in less developed countries are recommended this vaccine. Those on shorter trips to very high-risk countries (eg, India, Nepal, Peru or anywhere with increased disease activity) may also benefit. A single injection provides about 70% protection for two to three years.
- Flu vaccine. The influenza immunisation is recommended for all travellers who wish to have it.
Required vaccines
- Yellow fever. Visiting certain countries in South America and Africa can put you at risk of yellow fever; also, many countries require proof of yellow fever vaccination prior to entry (see the WHO website for these requirements). Yellow fever vaccine can only be given in specially approved yellow fever vaccination centres.
- Meningitis. This vaccine is required by the Saudi Arabian authorities for pilgrims attending the Hajj.
Special vaccines for longer journeys or specific activities
- Meningitis. Vaccination against meningitis is recommended for travellers to countries prone to outbreaks - mostly in sub-Saharan Africa. It is also recommended for long-term travellers without rapid access to medical care. A single injection will last three years.
- Rabies. Pre-travel vaccination against rabies is recommended for travellers spending significant time in rabies-endemic countries, especially if without ready access to good medical care. Prior vaccination with rabies vaccine makes the treatment simpler if you contract the disease.
- Japanese B encephalitis. This is recommended for travellers to Asia spending more than a month in at-risk areas (usually rural) during transmission season (usually monsoon). Also see: Diseases spread by mosquitoes
Medical kits
Having the means to treat simple conditions while travelling can be reassuring. Make sure you know when and how to use everything you take, however. Discuss this with your doctor and nurse before leaving and take clear written instructions. In general, the following are most commonly included in travel medical kits:
- Sunscreen (skin and lip formulations)
- Insect repellent (containing DEET, tropical strength)
- Water purification tablets/solutions
- For treatment of travellers' diarrhoea:
- oral rehydration salts (to help prevent dehydration)
- loperamide (to slow the gut)
- hycosine (eg, Buscopan) to help with stomach cramps
- norfloxacin (antibiotic)
- For treatment of chronic diarrhoea, giardia and amoebiasis: antibiotic, eg, metronidazole, ornidazole; broad-spectrum antibiotic: roxithromycin/erythromycin or amoxycillin + clavulanic acid
- Sleeping tablet: eg, zopiclone (Imovane) or alternative
- Laxative [short term use for constipation]: eg, docusate sodium (Coloxyl) or alternative
- Antihistamine [for allergic reactions/hayfever]: eg, promethazine (Phenergan), loratadine (Claratyne) or alternative
- Motion sickness medication: eg, promethazine (Phenergan) or hycosine (Scopoderm patch), or alternative
- Painkillers: paracetamol, non-steroidal anti-inflammatory
- First aid Items:
- Bandaids, crepe bandage, waterproof dressings, gauze, tape, safety pins
- gloves, sterile 3m syringe and needles, alcohol wipes, plastic zip-top bags
- normal saline 30ml
- iodine solution 15ml
- thermometer, scissors, tweezers.
Finally…
To ensure that you have the best experience possible while travelling, put the time and effort into getting informed, kitted out and prepared before you go. A little effort now could pay huge dividends while away. Travel safely and travel well. Bon voyage!
Useful websites
Original content provided by Dr Jenny Visser, The Travel Doctor, Wellington clinic, and edited by everybody, May 2006. Reviewed by everybody, December 2011.
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