Travel health advice

The advice included on this page is intended as guidance only, and is not a substitute for medical advice provided by a healthcare professional.

This page provides travel information and advice on the following topics:

• Your vaccinations
• On the move – useful information
• Accidents – precautions to prevent emergencies
• Staying safe in the sun
• Malaria – what you should know
• Beware biting bugs – avoiding insect bites
• Taking care with food and water
• Treating travellers' diarrhoea
• Travel during pregnancy
• Travel with children
• Animal bites – information about rabies
• Sexually transmitted infections (STIs)

Your vaccinations

Added reassurance while travelling
It is recommended that you visit your healthcare professional or travel clinic at least 8 weeks before you travel to confirm the vaccinations or preventative treatment (prophylaxis) required for your trip.

Vaccination helps to protect you from contracting certain diseases while travelling. Specific vaccinations may be required for entry into certain countries – check before travel.

Possible side effects
You may experience mild side effects for up to 48 hours following vaccination, including:

• temporary soreness
• redness or swelling at the injection site.

More general symptoms may include:

• mild fever
• headache
• general aches
• tiredness.

Your healthcare professional can give you more information on likely side effects of the actual vaccinations you are given, and any advice for treating them. Symptoms such as breathlessness, high temperature, swelling or rash may be a result of an allergic reaction to the vaccine. Prompt medical attention should be sought.

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On the move - useful information

Motion sickness
The following may help relieve symptoms:

• try to move to a position where motion is minimised
• lie horizontally if possible
• avoid reading
• close your eyes or look forward to a point on the horizon
• avoid heavy or rich meals before travelling and the smell of food while travelling
• avoid smoky atmospheres.

Deep vein thrombosis (DVT)
Sitting still during long-distance travel may increase the risk of developing DVT. Although the risk is small, all travellers should consider the following:

• move around rather than sitting for long periods of time
• avoid sleeping tablets
• avoid dehydration, drink plenty of water
• consider compression stockings.

Jet lag
Symptoms may include fatigue, difficulty sleeping or concentrating and loss of appetite. Adjust your daily activities to the local time at your destination – it may help to change the time on your watch as soon as you start travelling.

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Accidents – precautions to prevent emergencies

Accidents are one of the leading causes of serious injury and death in travellers abroad. Taking general precautions while travelling can help to prevent accidents and avoid the need for emergency medical care.

Before you leave

• Ensure that your travel insurance is adequate for your trip and will cover your transportation to better medical facilities if required.
• If travelling in Europe, ensure you have a valid European Health Insurance Card (EHIC). See www.ehic.org.uk for further information.
• If travelling to countries where medical facilities are less advanced, it may be worth taking a sterile pack containing sterile medical equipment to avoid issues with the reuse of needles and syringes.
• Ensure your health records are up to date and visit the dentist.
• Have a sufficient supply of any personal medications for the duration of your trip, as they may be difficult to obtain abroad.

While abroad

• Avoid unfamiliar animals that could be venomous or aggressive.
• Avoid swimming alone and swim in lifeguard-patrolled areas where possible. Certain dangers such as shallow water, strong currents, or very cold water may not be apparent from the surface.
• Excess alcohol can lead to accidents – avoid drinking before undertaking any activities and be aware that you may be more vulnerable after drinking.
• Ensure any rented equipment is fit for purpose.

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Staying safe in the sun

Sun exposure
Ultraviolet radiation (both UVA and UVB) can prematurely age skin and increase long-term risk of cancer. Tanning and burning means that the skin is damaged. You can decrease your risk with the following precautions:

• Avoid direct sunlight during the hottest part of the day, between 11am and 3pm.
• Invest in a high-quality sunscreen that protects against both UVA and UVB. A sunscreen with an SPF of at least 15 is recommended. Reapply sunscreen regularly and after swimming.
• An SPF of at least 30 is recommended for children.
• Wear long-sleeved tops and a wide-brimmed hat to protect skin.
• While swimming, the cool temperature of water may mask the heat of the sun – therefore, it is advisable to cover exposed skin while in the water.
• Wear sunglasses with lenses that filter UV radiation to protect eyes.

Heat exhaustion
This is the result of excessive dehydration made worse by high temperatures. Avoid strenuous exertion in hot climates and drink plenty of water. Extreme cases of heat exhaustion may lead to heat stroke. This can result in a medical emergency if left untreated and the individual needs to be cooled quickly.

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Malaria - what you should know

Malaria is caused by a parasite that is transmitted by the bite of an infected female mosquito. Malaria occurs in many tropical regions, including sub-Saharan Africa, Asia, Latin America, the Middle East and parts of Europe. Travellers from malaria-free regions (such as the UK), who have little or no immunity, and who go to areas with high rates of malaria, are more vulnerable.

Precautions and advice

• Planning: Check whether your trip includes any locations in which you would be at risk of contracting malaria. This information is available from your healthcare professional or see the resources and useful links page.
• Medication: If travelling to areas with high malaria rates, you will be advised to take anti-malarial medication (chemoprophylaxis), which may require you to take the medication before, during and after your trip – you must follow these instructions to ensure that you are protected.
• Insect bite prevention: Reduce the risk of being exposed to malaria by taking steps to prevent insect bites (see below).
• Be aware of symptoms: In particular, if you develop a fever after travelling to a malaria risk area, seek medical help and inform the medical professional of your travel itinerary and any malarial medications that you have been taking.
• Diagnosis: Malaria is diagnosed by a blood test, and prompt treatment can prevent serious illness and reoccurrence.

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Beware bitings bugs – avoiding insect bites

Many insects are capable of transmitting disease when they bite, including mosquitoes, sandflies, ticks and tsetse flies. For some insect-transmitted diseases there is no vaccine or cure, so avoiding insect bites is the only way to avoid contracting the disease.

Take these precautions to avoid bites

• Cover exposed skin after dusk, and when walking through long grass or in forested areas during the day (eg. tuck trousers into socks to prevent ticks gaining access to skin).
• Insects can bite through tight-fitting clothes, so wear long, loose-fitting clothing.
• Use safe and effective chemical repellents on exposed skin. Always check manufacturer instructions regarding the use of repellents, especially for children.
• Reapply insect repellent regularly, following the advice from the manufacturer. Clothes and nets can also be impregnated with suitable insect repellents.
• Use mosquito nets to prevent insects getting into sleeping areas; slow-burning coils may also be effective for outdoor areas.
• When indoors, ensure windows and screens are shut, use air conditioning if available, and consider the use of knock-down insecticides or plug-in vapourisers to clear the room.

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Taking care with food and water

A number of serious diseases, including hepatitis A, typhoid and cholera, as well as travellers’ diarrhoea, are transmitted by eating or drinking contaminated food and water, or can be the result of ingesting raw or cooked food that has been prepared in areas with poor hygiene.

Water safety

• Drink bottled water with intact seals or treat the water with boiling, chemicals (iodine or chlorine) or filtration to make it safe to drink.
• Other sealed, packaged drinks are usually safe to drink.
• Avoid ice in drinks – ice cubes may be made using unclean water.
• Use safe water to brush teeth and wash food.
• Avoid swimming in freshwater rivers or lakes that may carry contamination.

Food safety

• Wash hands thoroughly before eating and after using the toilet.
• Avoid eating fruit and vegetables (including salad items) unless these have been peeled or boiled.
• Ensure food is freshly cooked and served hot – avoid food that has been left to stand at room temperature or exposed to flies.
• Avoid leftovers.
• Avoid food from street traders unless the food is freshly cooked in front of you, and served with clean plates and cutlery.
• Avoid raw or undercooked seafood and meat.
• Avoid milk and dairy products such as ice cream.

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Treating travellers' diarrhoea

Travellers’ diarrhoea affects 20–60% of overseas travellers. Symptoms usually last 3–4 days but can mean that you are confined indoors and have to change travel plans. Severe cases require medical assistance.

Advice on treatment

• Drink plenty of safe fluids, such as bottled water. Packaged fruit juice will help to restore sugar levels in adults.
• Oral rehydration sachets are effective in restoring electrolyte balance, but must be mixed with clean water.
• In the case of vomiting, fever, prolonged diarrhoea (more than 3 days) or the presence of blood/mucous in the stools, prompt medical attention should be sought.
• Antibiotics may be used in cases of moderate-to-severe travellers’ diarrhoea, but are usually not recommended for prevention.
• Agents that relieve the symptoms of diarrhoea (such as loperamide or diphenoxylate plus atropine) can be used in the short-term, but overuse can have side effects, including rebound constipation. These agents should not be used in young children or people with existing gastrointestinal conditions, or if fever or bloody diarrhoea is present.
• As the diarrhoea resolves, bland foods can be reintroduced to the diet, but avoid spicy or rich food until completely recovered.
• Avoid eating dairy products for several days after recovery.

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Travel during pregnancy

Pregnancy and medical care

• Pregnancy may increase the likelihood of needing medical care, so the availability of appropriate medical facilities at your destination should be considered prior to travel.
• It is advisable to have a check up with your own doctor before you travel and take any relevant medical records.
• Illness can be more severe during pregnancy, so take extra care to avoid potentially unclean food and water.
• Ensure your travel insurance covers your travel while pregnant and any pregnancy-related complications when abroad.

Travel requirements

• Plan your travel after week 14 of gestation, when the risk of miscarriage decreases, and before week 28, after which the risk of going into early labour and other complications increases. Travel may be more uncomfortable in the later stages of pregnancy.
• Travel providers have their own restrictions on accepting pregnant passengers – check with your travel provider to confirm their limit and whether they require a medical certificate to travel.
• Travel to countries requiring vaccination or chemoprophylaxis is not recommended during pregnancy, as vaccines and anti-malarials may pose some risk. Check with your healthcare professional or travel clinic for the best options for your situation.

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Travel with children

Immunisation

• Children should have received their primary childhood immunisations before travel.
• If additional immunisation is required, the treatment may differ from that recommended for adults – discuss the specific requirements with your healthcare practitioner or travel clinic.

Precautions

• As for adult travellers, children should be protected from biting insects and avoid any unknown or unfamiliar animals.
• Cuts and insect bites may be more likely to become infected in hot, humid environments – any breaks in the skin should be kept clean and dry to avoid infection.
• Take a first aid kit including child-specific items such as liquid analgesics, dressings, antiseptic lotion and aftersun lotion.
• Children should always be closely supervised around water.

Sun exposure

• Protection from the sun is especially important for children. A sunscreen of at least SPF 30 should be used, and a hat and t-shirt are recommended.
• Infants under 9 months of age should not be exposed to direct sunlight.
• Care should be taken at the beach and around water, where the risk of sunburn is highest.

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Animal bites - information about rabies

Rabies is a viral infection that affects the central nervous system. The virus is transmitted to humans via the saliva of an infected animal, usually from a bite, scratch or lick.

Rabies is carried by many mammals, including domestic dogs and cats. Once symptoms develop, the disease is usually fatal, so any potential infection should be treated seriously. Although not present in the UK, rabies is endemic in many countries, and your healthcare practitioner will be able to tell you if rabies vaccination is recommended for your travel itinerary.

To avoid exposure to rabies while overseas, do not approach unknown animals and avoid attracting animals with leftover food. If bitten or licked by an animal while in an area where rabies is present, take the following precautions in this order:

1. Immediately wash the wound with soap and water, continue rinsing with running water for at least 5 minutes.
2. Apply an antiseptic to the wound – eg. iodine or alcohol.
3. Seek medical advice immediately, even if you received a rabies vaccination before you departed. Inform your healthcare professional which rabies vaccination you received (if any).
4. You may require a tetanus booster and antibiotics to prevent wound infection.
5. Inform your healthcare professional of your exposure and treatment when you return home.

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Sexually transmitted infections (STIs) - staying safe

Certain STIs may be more prevalent in developing countries than in the UK and may also be transmitted via unsterile medical equipment. Avoid any procedures that break the skin (eg. tattooing, acupuncture, piercing) unless the equipment is guaranteed sterile.

Safe sex

Sexual contact with a new partner while abroad may increase risk of STIs, take the following precautions:

• buy condoms that have a European Kite mark
• keep condoms somewhere cool and dry – condoms can be damaged by heat or contact with oil-based products (such as sunscreen)
• if you have any symptoms of an STI seek medical treatment
• if you have had sex with a new partner while abroad, consider having screening tests on your return home.

Blood transfusions

Blood donations in developing countries may not be screened for infection. Travellers who have a higher likelihood of requiring blood transfusions while travelling (such as pregnant travellers or those with certain medical conditions) should consider the availability of adequate medical facilities in their destination. Certain organisations, such as the Blood Care Foundation www.bloodcare.org.uk, will provide reliably screened blood products and sterile equipment in case of emergency.

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