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Traveller's health for exotic locations

This factsheet is for people who are travelling abroad to "exotic" longhaul destinations and offers a checklist of advice on how to avoid health problems.

Around 64 million UK residents make trips abroad each year.¹ Travel to exotic destinations is becoming increasingly popular. While abroad, travellers can be exposed to a variety of health risks that they would not encounter at home, including diseases that are not common in the UK, as well as different standards of hygiene.

What counts as "exotic"?

Broadly speaking, exotic destinations include Central and South America, the Caribbean islands, Sub-Saharan Africa, the Indian subcontinent, South East Asia, the Far East (except Japan) and the Pacific islands.

Health risks

The risk of health problems is not simply due to the tropical climate in these regions (although this is important), but also the level of local development. Areas in temperate countries can be affected, too.

There are a number of factors that can affect your health risk. These include:

• the country you are travelling to - and what region^2,3
• the time of year²
• your type of accommodation - in general, you are less likely to get ill staying in a first-class hotel than a cramped, back-street hostel, where facilities may be basic^2,3
• your activities - eg if you do outdoor pursuits such as safari^3,4
• how long you go for³

Most health risks can be minimised if you:

• make the necessary preparations before travelling
• take sensible measures while you are away
• watch out for any problems after you return

Before you go

There are a number of considerations you should make when you are planning your trip. Some of these are outlined below.

Vaccinations

It is important to seek up-to-date advice about vaccinations before you travel to exotic destinations. The requirements for immunisations change frequently and vary from country to country, and between regions in large countries. Always seek advice from your GP or a travel clinic. The links in "Further information" (below) also give recommendations on which vaccinations you will need.

You should get advice four to six weeks in advance of your planned departure as it can take some time for some vaccination courses to be completed and effective.³ However, if you have left this until the last minute it is still worth getting some medical advice before you leave.

You cannot get travel vaccines free on the NHS; you usually have to pay for these.²

Anti-malarial drugs

You should get advice about malaria at least four to six weeks before your trip as preventive medicines may need to be started up to three to four weeks prior to departure.³ Over 2000 people a year in the UK get infected with malaria whilst abroad.^4,5

Malaria is caused by infection with a parasite that is transmitted by the female of the Anopheles species of mosquito. For more information, please see the separate BUPA factsheet, Malaria - the disease.

The first step in preventing malaria is to avoid being bitten. However, there are also a number of anti-malarial drugs, known as malaria prophylaxis, which can significantly reduce the risk of you getting malaria.

These drugs need to be started one to three weeks before travelling (depending on the type of drug) and continued for one month afterwards. For more information, please see the separate BUPA factsheet, Malaria - prevention.

Taking medicines abroad

If you are taking prescription medicines, ask your doctor for advice on whether you will be able to get them while you are away, or if you need to take a supply with you. For more information, please see the separate BUPA factsheet, Travelling with medicines.

It may also be useful to take some basic medical supplies with you, particularly if you are travelling to a remote region.³ For more information, please see the separate BUPA factsheet, Travel first aid kit.

Insurance

It is important to get travel insurance and to ensure this covers your activities and includes adequate medical cover, including emergency assistance. If appropriate care isn't available locally, you may need to be evacuated or repatriated. Your insurance policy needs to cover this very high-cost service.

While you are away

There are a number of simple precautions you should take while on holiday to help avoid many health problems.

Hygiene and sanitation

Poor hygiene standards can expose you to food or drink contaminated with a range of bacteria, viruses or parasites. These can cause a range of illnesses such as traveller's diarrhoea (see below) and cholera - for more information, please see the separate BUPA factsheet, Cholera.

There are a number of precautions that you should take including:

• wash your hands after going to the toilet and before handling food⁶
• if you are in doubt about the local tap water, boil it or sterilise it (preferably with an iodine-based preparation) - alternatively, drink only bottled water (and break the seal yourself)3,6
• don't have ice in drinks^3,6
• don't buy ice cream from unreliable vendors (such as street vendors)^3,6
• take care with uncooked foods, including salads and fruit and vegetables (unless they are peeled by you, as the water they are washed in may be contaminated)^3,6
• only eat freshly cooked food that is served piping hot^3,6

Traveller's diarrhoea

This is the most common health problem in travellers to exotic destinations.³

The most common causes of traveller's diarrhoea are bacteria and viruses in contaminated food and water. For more information on the causes, symptoms and treatment of diarrhoea, please see the separate BUPA factsheets, Gastroenteritis in adults and Gastroenteritis in children.

Insects

Insects, especially mosquitoes, can carry a variety of tropical illnesses. Therefore, it is important to avoid being bitten. Mosquitoes bite most commonly after dusk, so this is when you need to be most careful.

For advice on how to avoid getting bitten by insects, please see the separate BUPA factsheet, Malaria - prevention.

Animals

A range of diseases is carried by animals including:

• rabies, which is spread through bites or saliva of infected animals
• lyme disease, which is caused by bacteria transmitted through the bite of a tick
• bilharzia, which is caused by a parasitic worm that lives in a snail host - you can get infected if you come in contact with fresh water (lakes, rivers and streams) where the snail lives

You should therefore have no contact with animals and don't swim in fresh water in tropical regions. Seek medical advice if you are bitten or scratched.

Sexual health

HIV and other sexually transmitted infections are extremely common in certain areas. At the end of 2004, an estimated 6.2 million people were living with HIV/AIDS in South-East Asia - this is the second highest number of cases in the world after Sub-Saharan Africa.⁷

Using condoms with any new sexual partner is essential. For more information, please see the separate BUPA factsheet, HIV and AIDS.

Outdoor protection

The risks of sunburn and sunstroke are much higher in the tropics than in the UK. You should use sunscreens, clothing and shade to protect your skin, and drink more fluids. For more information about protecting yourself in the sun, please see the separate BUPA factsheet, Sun care.

Accidents

A significant number of medical problems that occur abroad are as a result of accidents.³

In particular, take extreme care on the road, as both a pedestrian and a motorist, since road and vehicle safety standards can vary greatly. Traffic laws may also vary between countries.

Outdoor activities

You should be aware of the risks associated with activities that are new to you, such as riding a scooter or watersports.

Remember that if you're scuba diving, you must allow 24 hours between your last dive and a flight.⁶

When you get home

Some diseases picked up overseas become apparent only after you get back to the UK. Often, diarrhoea illnesses can be evident on returning to the UK and you should see a doctor if they don't clear up within a week or so, or if the diarrhoea is severe or contains blood.

You should say which countries you have recently visited as it will help your doctor to diagnose your illness. You may have an uncommon illness in the UK and need to be referred to a doctor specialising in tropical medicine.

It is particularly important to seek medical advice for any feverish illness that develops for up to three months after you have travelled to an area where malaria is present. You should tell the doctor where you have travelled in the last three months.³

Remember that most preventive drugs for malaria need to be continued for one month after leaving the malarial region - even if you have no symptoms.

Further information

• Health Advice for Travellers
  www.dh.gov.uk
• Foreign and Commonwealth Office
  0845 850 2829
  www.fco.gov.uk

References

1. Visits and spending by UK residents abroad and overseas residents in the UK - monthly series derived from the International Passenger Survey (IPS). 1980 - 2005. National Statistics.
   www.statistics.gov.uk
2. Before you go. Department of Health.
   www.dh.gov.uk
   accessed 9 November 2005.
3. International Health and Travel Publication. World Health Organisation. 2005.
   www.who.int
4. PRODIGY Guidance - Malaria prophylaxis. UK Department of Health. PRODIGY.
   www.prodigy.nhs.uk
   accessed 1 August 2005.
5. Simon C, Everitt H, Birtwistle J, Stevenson B. Oxford Handbook of General Practice. Oxford: Oxford University Press, 2002:416-419.
6. While you're away. Department of Health.
   www.dh.gov.uk
   accessed 9 November 2005.
7. Facts about HIV/AIDS in the South-East Asia Region. World Health Organisation.
   www.who.int
   accessed 10 November 2005.

Reviewed by Dr James Quekett, Bsc.MB Ch.B MRCGP DRCOG DFFP. partner/principal general practitioner at Rowcroft Medical Centre.

Published by BUPA's health information team, healthinfo@bupa.com, February 2006.

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