Travel health guide

Don't let an avoidable illness ruin your long-planned holiday
 
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01 .Introduction

Travel health

Australians love to travel — we take more than five million trips to overseas destinations every year. And being prepared for common health problems before you head off on holidays will help ensure you’ll see more than just the hotel bathroom. 

Travel checklist

  • Visit a travel health specialist and get the appropriate vaccinations for the area you’re travelling to.
  • Take out travel insurance to cover hospital treatment, medical evacuation, and any activities.
  • Always carry your insurance company’s emergency assistance card with you and contact the company as soon as you need help – most insurance companies provide 24-hour advice to travellers.
  • Carry a traveller’s medical kit containing items such as headache tablets, antiseptic lotion, cotton wool, Band-Aids or similar, latex gloves, safety pins, insect repellent and hand sanitiser. Specialised kits for diarrhoea are also available from a travel doctor.
  • Exercising a little care with food and drinks and good personal hygiene can help you avoid gastro symptoms.
  • To avoid being bitten by disease-carrying mosquitoes, pack some good repellent and a long-sleeved shirt and long pants.
  • Avoid animals such as dogs and monkeys as they could be carrying rabies.
  • Have a check-up on return if you’ve been ill.


Do your research

While your travel agent may be knowledgeable, it’s a good idea to seek independent advice on the country you wish to travel to. The Department of Foreign Affairs and Trade travel website, smartraveller.gov.au, has comprehensive information on up to 150 countries, including the latest health alerts and advice and other potential risks (personal crime, terrorism and so on), tips on travelling with children and contact details for Australian embassies and consulates around the world. You can also register your details on the site beforehand so you can be traced in an emergency.


Useful websites

Smartraveller - Australian government travel advice - smartraveller.gov.au

The travel doctor tmvc.com.au

The United States Centres for Disease Control and Prevention Yellow Book - probably the most comprehensive medicinal resource for travellers. If you're travelling a bit further off the beaten track, this is a great resource to help you prepare.

Travel Health Advisory Group welltogo.com.au

World Health Organization who.int/en


 
 

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02.Visit your travel doctor

 

Visit a doctor for advice on vaccinations, travel medicines and other travel health issues. Specialist travel doctors are ideal, and some GPs have a special interest in travel medicine. Visit the doctor six to 12 weeks before you depart, to allow time for the appropriate vaccinations — some require a series of jabs. The vaccines you need to get depend on the country and region you’re visiting, and this is where the expert knowledge of a travel doctor comes in handy.

Even if you’re from that country originally, you may have lost immunity to some diseases and be at risk, particularly if you’re spending a long time there, living in the same conditions as locals (as opposed to travelling on tourist buses and staying in sanitised, air-conditioned hotels) or travelling to remote areas.

No matter where you’re going, make sure your childhood vaccinations are up to date. This includes tetanus, whooping cough, measles, mumps and rubella. Hepatitis B is part of the standard vaccination schedule for children, but many adults may not have been vaccinated for it. Consider getting the series of shots (there are three) for lifetime protection.

If you’re over 65, a travel doctor may advise you to get a pneumonia vaccine before travelling overseas. All travellers should consider the influenza vaccine (flu jab) to reduce their chances of getting struck down in a place where medical care is hard to come by.

Diseases to avoid

The following list will give you a general idea of what disease you’re up against in certain regions:

  • Rabies Rabies(Africa, Asia, South America) A fatal virus transmitted in the saliva of animals (usually dogs but also bats and monkeys) through a bite or licking broken skin or mucus membranes (eg lips). Whether you need this series of jabs depends on the type of trip you’re taking and how quickly you’ll be able to get treatment – you’re not so likely to need it on a package tour stopping at tourist spots.
  • Malaria (Africa, Asia, Central and South America) Malaria is a parasite carried by mosquitoes and kills about 600,000 people a year. Anti-malarial drugs are available but can have serious side effects. For holidaying in areas with some risk – but not high risk – of malaria, experts in travel medicine are increasingly recommending the use of standby emergency treatment rather than preventative medicine. The main advantage is that travellers won’t need to suffer the side effects of taking preventative medicines when they’re unlikely to contract the disease – and when used in conjunction with repellents and physical barriers, may be the most appropriate anti-malarial strategy.
  • Yellow fever (Africa, South America) A virus carried by mosquitoes. Some countries require a yellow-fever vaccination certificate as a condition of entry into the country.
  • Hepatitis A (Africa, Asia, South America) This viral disease of the liver is transmitted through contaminated food and water. In addition to a straight hep A vaccine, there is a combined hep A and B vaccine or a combined hep A and typhoid vaccine.
  • Typhoid fever (Asia, Africa) This bacterium is usually transmitted by handling food with dirty fingers. Vaccination is highly recommended if travelling to areas where sanitation is poor.
  • Japanese encephalitis (Asia, PNG) Viral brain infection transmitted by mosquitoes.
  • Tick-borne encephalitis (Europe, Asia) A vaccine is usually only recommended for people spending a long time hiking, camping, etc.
  • Meningitis (Africa) Potentially fatal inflammation of the membrane covering the brain, passed person to person through droplets, and can be caused by bacteria, viruses or fungi – bacterial meningitis is the most serious.
  • Cholera (Asia, PNG) A bacterial disease causing severe diarrhoea.

Smartraveller has flagged the following health issues for these popular destinations. Some diseases mentioned here are only a risk at certain times of the year, in certain areas (rural, mountainous, forested, etc) or only occur during occasional outbreaks. Your travel doctor can give you the most up-to-date advice. The information was up-to-date in November 2013 – check the smartraveller website for the most recent advice.

CHINA – Japanese encephalitis; malaria; rabies; hand, foot and mouth disease; poliomyelitis.

FIJI – Water-borne, food-borne and other infectious diseases (including typhoid, hepatitis, leptospirosis, tuberculosis, measles and mumps); dengue fever; filiariasis; ciguatera poisoning from eating reef fish.

GERMANY – tick-borne encephalitis in forested areas, particularly in the south.

HONG KONG – Dengue fever; water-borne, food-borne and other infectious diseases (including tuberculosis, hepatitis, scarlet fever and hand, foot and mouth disease).

INDIA – high incidence of food-borne, water-borne and other infectious diseases (including meningitis, cholera, typhoid, Mozzieshepatitis, tuberculosis, diphtheria and rabies); mosquito-borne diseases (such as dengue fever, malaria, Japanese encephalitis, chikungunya and filariasis); black henna tattoos.

INDONESIA/BALI – Mosquito-borne diseases (including dengue fever, malaria, Japanese encephalitis, chikungunya and filariasis); water-borne, food-borne, parasitic and other infectious diseases (such as cholera, hepatitis, measles, typhoid and tuberculosis); rabies; black henna tattoos; methanol-contaminated alcoholic drinks; magic mushrooms.

JAPAN – Japanese encephalitis; measles; drug restrictions, including codeine and pseudoephedrine.

MALAYSIA – Mosquito-borne diseases (including dengue fever, malaria, Japanese encephalitis, chikungunya and filariasis); marine stings; water-borne, food-borne and other infectious diseases (such as hepatitis, tuberculosis, cholera, and hand, foot and mouth disease).

NEPAL – Mosquito-borne diseases (including dengue fever, malaria, Japanese encephalitis); food- and water-borne bugs (such as typhoid, cholera, leptospirosis, hepatitis and rabies); conjunctivitis after monsoon season; altitude sickness. Ensure your travel insurance covers helicopter evacuation if you’re trekking in the mountains.

NEW ZEALAND – injury risk from adventure sports activities. Make sure your insurance covers these activities.

PAPUA NEW GUINEA – Cholera is endemic; mosquito-borne diseases (including dengue fever, malaria, Japanese encephalitis, chikungunya and filariasis); tuberculosis; typhoid; hepatitis; marine stings.

PHILIPPINES – Mosquito-borne diseases (including dengue fever, malaria, Japanese encephalitis and filariasis), water-borne, food-borne, parasitic and other infectious diseases (such as cholera, typhoid, hepatitis, tuberculosis, measles, meningitis and rabies); freshwater diseases contracted while swimming (including bilharzia/schistosomiasis and leptospirosis); ciguatera poisoning from eating reef fish.

SINGAPORE – Mosquito-borne illnesses (including dengue fever, chikungunya fever and Japanese encephalitis); hand, foot and mouth disease.

SOUTH AFRICA – Cholera; malaria; filiariasis; water-borne, food-borne and other infectious diseases (including typhoid, hepatitis, rabies, measles, Rift Valley fever and drug-resistant tuberculosis).

THAILAND – Mosquito-borne diseases (including dengue fever, malaria, Japanese encephalitis, chikungunya and filariasis); water-borne, food-borne, parasitic and other infectious diseases (including cholera, hepatitis, measles, typhoid and tuberculosis); rabies; marine stingers; black henna tattoos.

UAE / DUBAI – Middle East respiratory syndrome (MERS) coronavirus; various water-borne, food-borne, parasitic and other infectious diseases; medication restrictions.

UNITED STATES – extremely high medical costs. Make sure you’re insured with unlimited medical cover.

VIETNAM – mosquito-borne diseases (including dengue fever, Japanese encephalitis); water-borne, food-borne, parasitic and other infectious diseases (such as hepatitis, rabies, typhoid, tuberculosis, meningitis); cholera; hand, foot and mouth disease; conjunctivitis.

It is vital to take out comprehensive travel insurance, as it ensures you’re covered for general medical expenses, any existing medical conditions, hospitalisations and medical evacuation.

Always carry your insurance company’s emergency assistance card with you and contact the company as soon as you need help – most insurance companies provide 24-hour advice to travellers. Often your insurer will make arrangements for you to have treatment.

Read the Product Disclosure Statement (PDS) carefully

The Insurance Ombudsman Service recommends thoroughly reading the PDS and policy wording of your travel insurance policy to get a full understanding of any conditions, exclusions and limitations that may apply, what you need to do in order to make a claim and what’s expected of both you and your insurer. Some common traps include:

  • Claims relating to pre-existing conditions may not be covered. Check the PDS for those pre-existing conditions that are covered and under what circumstances, and also whether an extra premium can be paid for conditions not covered.
  • There may be certain procedures you must follow if you are going to claim medical expenses, such as contacting the insurer as soon as physically possible and obtaining their agreement to pay expenses; using a medical adviser specified by the insurer; having to follow the advice of the adviser (they might advise you get treatment locally, whereas if you’d prefer to go back to Australia your evacuation may not be covered). 
  • Exclusions or restrictions may relate to injuries caused by risky activities such as skiing, snowboarding or riding a motorbike. While you may be able to pay an additional premium to cover these activities, there may be some circumstances where you’re not covered – for example, taking part in racing, riding a motorbike without a helmet or off-piste skiing.

Travel insurance from your credit card company

If you’re planning to use the travel insurance you can get when you buy a ticket on your credit card, obtain a copy of the policy wording from your bank or credit card provider and make sure it meets your personal needs and situation. For example, it pays to check whether the policy covers existing medical conditions, and whether the travel has to take place within a certain time limit of buying the ticket.

Reciprocal Health Care Arrangements

The Australian Government has Reciprocal Health Care Agreements (RHCA) with New Zealand, the UK, Ireland, Finland, Sweden, the Netherlands, Italy, Malta and Norway, which cover the cost of any immediate treatment you may require. However, while this provides a safety net for Australians travelling to those countries, an RHCA won’t cover a medical evacuation back to Australia, which can cost, in extreme cases, up to $300,000.

The RHCA also won’t cover any health problems encountered while travelling to and from those countries.

Travelling with your own medicine ONLINE_HealthyHolidays_Pills

Many countries control or restrict imports of medication, even for personal use. Check the Smartraveller website for rules on carrying medication into the different countries you’re travelling to – you may need a certain type of documentation or there may be limits to how much you can take in.

General advice for travelling with medicine:

  • Take a list of current medications (use the generic rather than brand name, as brands vary from country to country) and drug allergies. It may be useful to carry a letter from your doctor explaining what medications you’re taking and the conditions they’re for, as well as an assurance they’re for personal use.
  • A prescription (including the generic drug name) can also provide evidence you have legitimate use for the drugs, and may be useful if you lose yours or it runs out.
  • Carry medication in its original packaging with your name and dosage instructions.
  • Check the expiry date to make sure they don’t expire while you’re away.
  • Take a few days’ supply in your hand luggage in case your checked baggage goes astray.
  • Be aware that counterfeit drugs are a big problem in Asia, Africa and South America, so it’s best to bring as much as you need from home. If you do need to buy medicine, buy from a reputable source, not a street market.
  • If medicines have special storage requirements (being kept refrigerated, for example), talk to your pharmacist about how to manage this.
  • Some conditions you’ve had previously, for example asthma, may flare up again when you’re overseas.
  • It’s been suggested that diabetics pack double the required insulin, putting half in your hand luggage and the rest in your hold luggage. Ask your doctor for advice on timing if you’re crossing time zones. Also take jelly beans or other quick-acting sugar-fix solutions. If you don’t have a medic-alert bracelet, consider getting one.

Some countries, including Greece, Japan, Singapore and the (UAE, consider codeine to be a narcotic, so if you take painkillers containing codeine you may need to carry documentation or take alternative painkillers. Amphetamine drugs for ADHD and pseudoephedrine (a decongestant found in cold and sinus medicines) are other commonly used medications that are restricted or controlled in many countries.

The UAE, Qantas’s new stopover en route to Europe, has an extensive list of controlled and restricted drugs including painkillers; cough, cold and flu medicines; psychiatric medications; hormones (including contraceptives); and anti-acne and anti-diarrhoeal medications. Smartraveller has links to the embassy’s website, which has the list and describes the paperwork requirements and fees – this needs to be organised before you travel.

Travel medical kit ONLINE_HealthyHolidays_FirstAidKitkit

If you’re not going too far off the beaten track, take a small travel medical kit to deal with common problems. Potentially useful items in developing countries include:

  • painkillers (paracetamol, NSAIDs and/or aspirin)
  • diarrhoea medicine (such as loperamide)
  • oral rehydration salts (such as Gastrolyte or Hydrolyte)
  • antiseptic lotion and/or ointment
  • band-aids and other wound dressings (including gauze swabs and bandages, medical tape)
  • insect repellent
  • sunscreen
  • latex gloves
  • a thermometer
  • a pair of tweezers.

Your doctor may also suggest antibiotics for diarrhoea or severe respiratory infections. The more remote or primitive the conditions, or the more adventurous the travel, the more you should consider taking. Talk to your doctor or tour leader about extra requirements you may have.

Motion sickness

Hyoscine hydrobromide (Kwells) is an effective drug for reducing nausea associated with motion sickness, and can be bought over-the-counter from a pharmacy. Ginger tablets or chews may help some people in some situations, although study results are inconsistent. The evidence for acupressure bracelets is less convincing, but at least they do no harm.

Wonder soap

Although a little old-fashioned, consider taking a cake of soap with you. It can be used for:

  • Washing your hands – communal bar soap in public toilets may have other people’s germs on it, although these are usually washed off your hands. Having your own soap may help provide piece of mind.
  • Washing and shaving in the shower.
  • Hand-washing some clothes – to tide you over between laundromats.
  • Mozzie bites – rubbing dry soap on the itch is claimed to relieve it. Scented soap may attract mozzies, although citronella-scented soap may repel them.
  • After contact with animal saliva (including bites, or even licking broken skin) soap helps neutralise the rabies virus. Washing the wound with soap and water for 15 minutes should be done immediately after contact, even if you’ve been immunised.

05.Avoiding sickness

 

Gastro symptoms, such as diarrhoea, nausea and vomiting, are the most common health issues encountered by travellers, especially when travelling to developing countries. They're usually caused by bacteria such as E. coli, campylobacter or salmonella; parasites including cryptosporidium and giardia; or dysentery (bacterial or amoebic). Other causes are typhoid and cholera.

The bugs are spread in contaminated food and water, so the best way of preventing diarrhoea and other gastro symptoms is exercising good personal hygiene, and avoiding foods and drinks likely to cause problems.

  • Salad and other raw or unpeeled fruit and vegetables may be contaminated by unclean water or bugs in the soil (human sewage is sometimes used as fertiliser).
  • Any food can be affected by poor food storage and handling procedures. In particular, avoid uncooked, undercooked or reheated meat, poultry and fish, and be wary of crustaceans, shellfish and dairy foods.
  • Boiled or purified water, or bottled water with a properly sealed lid (bottles are sometimes refilled with unclean water) should be used for drinking and when brushing teeth.
  • Soft drinks, beer and wine are low risk.
  • Ice and drinks with ice in them should be avoided.

ONLINE_HealthyHolidays_WashingHandsApart from food, drinks and related utensils, you can pick up germs from all sorts of things, including money, shaking hands with people, door handles, hand rails, hotel room surfaces, tap handles, touching animals or even handling fresh produce in markets. So it’s a good idea to wash your hands frequently throughout the day, and definitely after using the toilet and before eating.

Extra measures you can take if you really want to reduce the risk of sickness are to use a disposable paper towel or tissue to turn off the tap, and don’t use a communal cloth towel to dry your hands. Watch how many people don’t wash their hands after using the toilet, and then consider using a disposable paper towel, a tissue or part of your clothing when opening the bathroom door!

It’s not always easy to find somewhere to wash your hands before eating, such as when tempted by street vendors’ fare, so alcohol or anti-bacterial hand wipes or liquid hand sanitiser are alternatives, and can be used regularly throughout the day.

Treating diarrhoea

Treating diarrhoea depends upon the cause – in simple cases that last a day, rest and rehydration with electrolyte drinks (see Travel medical kits) may be enough.

However, if it lasts longer, is accompanied by fever, or if there is blood in the stools, antibiotics or other treatment may be needed. Your GP or travel doctor can advise you on an action plan, and perhaps provide antibiotics to take with you, 'just in case'. Otherwise see a local doctor recommended by your travel insurance company or, depending on the type of accommodation you're staying in, the hotel concierge may be able to recommend a doctor.

Stoppers like loperamide (Imodium) can be useful if you have to get on a bus or plane, but this keeps the infection within you so you have it for longer.

Bothersome bugs

The world’s most deadly animal is depressingly common. The mosquito carries diseases including dengue fever, malaria, Japanese encephalitis, filiariasis, chikungunya fever and Ross River fever. Even if the disease doesn’t kill you, symptoms can be debilitating and it can take a long time to recover. The best prevention is to avoid contact with mozzies, and you can also:
• Use physical barriers (long pants and long-sleeves tops; bed nets)
• Avoid being out during biting times (usually dawn and dusk, but some species bite all day)
• Avoid attracting them (perfumes and dark clothing attract mozzies)
• Use chemical protection (such as repellent containing DEET or picaridin; permethrin-impregnated clothing, bedding and nets)

Ticks are another problem insect, and can cause serious diseases, including encephalitis and Lymes disease. Insect repellent and permethrin-impregnated clothing will help keep them at bay.

Bed bugs are small, non-flying biting insects that live in furniture, especially beds. They’re most active at night, and are increasingly reported to be in hotels, even upmarket ones, all around the world. While the effects aren’t serious, the itching is definitely a nuisance and you may end up taking them with you on your travels – and home. Look for small dark spots on sheets, and check crevices in the bed frame and walls near the bed for signs of the insects.

Extreme weather

Lazing around in hot weather is unlikely to cause problems for most people, but doing strenuous exercise or a long duration of exercise when you’re not accustomed to the heat can cause problems such as heat stroke, dehydration or hyponatraemia (caused by drinking too much water without replacing salts lost through sweating). In some cases (such as sports or hiking in the tropics or desert) an acclimatisation program may be beneficial.

Wearing lightweight, loose and light-coloured clothing with a broad-brimmed hat can provide ventilation for evaporation and reduce exposure to radiant heat from the sun, keeping you cool. If you’re sweating a lot, drink plenty of fluids and eat salty snacks (most sports drinks don’t contain enough salts to replace those lost). And don’t forget the SPF 50+ sunscreen!

Deep vein thrombosis (DVT)

DVT occurs when clots form in the blood vessels in the legs, which can lead to a heart attack and stroke. DVT is referred to as 'Economy Class Syndrome' because sitting in cramped conditions for long periods can increase your risk.

However, flying isn't the only risk. Research from New Zealand revealed that you’re more likely to get DVT from sitting at your desk for extended periods than sitting on a plane.

Risk factors include having a family history of DVT or pulmonary embolism, recent surgery, smoking, and being obese, pregnant and over the age of 40.

In order to reduce your risk during a long flight:

  • Stand up and walk around regularly and do exercises such as leg stretches every half an hour.
  • Drink at least one litre of water for every five hours you're flying. And avoid alcohol and caffeinated drinks before and during the flight.
  • Wear loose-fitting clothing.
  • Avoid sleeping tablets as they limit your mobility.
  • Avoid leg crossing and elevate your legs when possible. Talk to your doctor if you have any risk factors for DVT.