Travel Advice

General Information

Every year, residents of the United Kingdom go on more than 56 million overseas journeys. Travel across the world is now so common that it is easy to forget the health risks which can be involved and the fact that very few countries offer such easy access to medical facilities as Britain.

Travelling round the world always brings some risk to health. However, by taking certain and often simple steps, you can minimise your exposure to almost every major health hazard. The following information is taken from Department of Health Travel Advice Brochures.

Eating and Drinking Safely

It is important, wherever you are in the world, that you are careful with what you eat and drink. Food and water may be contaminated in a variety of ways, this also includes the water in swimming pools, lakes, rivers and the sea so try not to swallow water when you are bathing.

Travellers’ diarrhoea is very common, especially in hot countries.
Travellers’ diarrhoea, as well as diseases such as cholera, typhoid and hepatitis A, can be caught from contaminated food and water. BUT THEY CAN LARGELY AVOIDED BY TAKING SIMPLE PRECAUTIONS:

• Always wash your hands after going to the lavatory, before handling and eating food.
  
• If you have any doubts about the water available for drinking, washing food or cleaning teeth, boil it, sterilise it with disinfectant tablets or use bottled water – preferably carbonated with gas – in sealed containers.
  
• Avoid ice unless you are sure it is made from treated and chlorinated water. This includes ice used to keep food cool as well as ice in drinks. It is usually safe to drink hot tea or coffee, wine, beer, carbonated water and soft drinks, and packaged or bottled fruit juices.
  
• Eat freshly cooked food which is thoroughly cooked and still piping hot.
  
• Avoid food which has been kept warm.
  
• Avoid uncooked food, unless you can peel or shell it yourself.
  
• Avoid food likely to have been exposed to flies.
  
• Avoid ice-cream from unreliable sources, such as kiosks or itinerant traders.
  
• Avoid – or boil – unpasteurised milk.
  
• Fish and shell fish can be suspect in some countries. Uncooked shellfish, such as oysters, are a particular hazard.

Be Safe Out of Doors

Take care in the sun

Many people travel from this country in search of the sun. The sun should be enjoyed, but with care as too much exposure can cause sunburn, leading to premature skin ageing and an increased risk of skin cancer. It is the ultraviolet rays which cause this; even in the UK they can damage your skin, and UV is much more powerful the nearer to the equator you go.

If you want to avoid trouble, take care not to burn. It is particularly important to take care of your babies and children. Babies should never be placed in direct sunlight. Stay out of the sun for at least two hours during midday and use what shade there is at other times, and cover up with a wide – brimmed hat and tightly woven but loose clothing. Protective creams suitable for your skin type can help protect unavoidable exposed parts of the body. Wear sunglasses which filter UV rays to protect your eyes.

A separate risk of too much exposure to the sun is a sunstroke or heatstroke, caused simply by overheating. Avoid strenuous activity during the hottest hour, and make sure you drink plenty of non – alcoholic liquids to balance the loss of body fluid through perspiration. What you drink must be safe – either soft drinks from sealed cans or bottles, or water which has been boiled or is bottled.

Avoid insect and animal bites

Cover up arms and legs and also use insect repellent preparations, when advised, to avoid insect and animal bites. Tick-borne diseases such as tick-borne encephalitis and borreliosis (Lymes disease) are prevalent in temperate climates. It is therefore not only in tropical areas that one needs to take precautions.

Take Care In Water

Do not go swimming alone. Bathing will cool you but remember that fatal accidents can happen very easily and in the most unexpected conditions. Adults should watch each other for signs of trouble when in the water. Children should always be supervised by an adult who can swim well. Young children should never be left unattended near a stretch of water, even a paddling pool.

Take Care on the Roads

Traffic accidents are the major cause of death among travellers.

Whether you are a driver or a pedestrian, always check on local traffic regulations. If you are in a car always wear a seat belt. If you are on a motor – or pedal-bike, always wear a helmet and put children in a restraint. If you hire a car or bike, check its condition and insurance cover. Never drink and drive.

Hazardous Sports and Diving

If you are going to take part in potentially hazardous sports, such as skiing, canoeing or mountaineering, follow all the relevant safety guidance; ensure that there are adequate emergency medical facilities on hand; and check that you have a medical insurance that covers you fully in the event of an accident. Diver should allow 24 hours between their last dive and a flight.

‘No Go’ Areas

In many countries, there are areas which are unsafe for travellers to visit because of the risk of violence. For guidance and information, use the Foreign and Commonwealth Office Advice to Traveller telephone line: 0870 6060290

Day Trips

Even if you are only going on a day trip to another country, accidents can happen. So please make sure you have adequate travel insurance and a completed Form E11 if you are visiting a country in the European Economic Area.

Major Diseases and the Precautions to Take

Malaria - Please see Malaria Advice section.

Rabies

Rabies is an acute viral infection of the nervous system. Its symptoms include delirium and painful muscle spasms in the throat. Once a person develops symptoms, the disease is usually fatal.

Rabies occurs in animals in Europe and North America as well as in the less developed countries. So be careful not to touch any animals, whether wild, stray or appear to be tame. If you are bitten, post exposure treatment – if given enough early enough usually prevents the disease developing.

If you are bitten by an animal while away from then UK:

• Wash the wound immediately using soap or detergent or flush clean with water. Apply alcohol if available.
  
• Get medical attention – fast. Go to the doctors or the hospital as you may need a rabies vaccine and the course of injections must be started immediately. Ask for human diploid cell vaccine if possible. In case of any difficulty, contact the nearest British Consular official.
  
• Note the date and where the incident happened with the animal’s description.
  
• If the animal was not a stray or was not wild try to identify its owner and assertain whether the animal is sick or has become ill. If the animal can be kept under observation for two weeks following the incident exchange names address and telephone numbers with the owner and arrange to keep in contact to find out whether the animal becomes sick or dies. If the animal has already had the vaccine asks to see the certificate, but even if a certificate is produced do not assume there is no risk.
  
• Inform the local police.
  
• Whether or not you receive treatment outside the UK, consult your doctor as soon as you arrive home.

Rabies vaccine before travel is only recommended if you will be exposed to unusual risk of infection or are undertaking a long journey in remote areas where medical treatment may not be immediately available. This vaccine is not normally free under the NHS.
Even of you are immunised this does not mean there is no need for urgent treatment if bitten by an infected animal.

Remember that the UK is free from animal rabies. Keep it that way. Do not bring in any animals into the country without a licence. This is not only illegal and involves severe penalties, it could endanger lives.

HIV/AIDS

AIDS (Acquired Immune Deficiency Syndrome) has now spread across the world. There is no vaccination or a cure for aids. AIDS is caused by a virus known as HIV (human Immuno deficiency virus). Infection with HIV is more common than AIDS itself. People infected with HIV remain infected and infectious all their lives.

HIV/AIDS can be passed on in four main ways:

• Through unprotected sex with an infected person.
  
• Trough the use of infected syringes, medical and dental instruments and anything else which can puncture the skin such as tattooing. Equipment.
  
• By transfusions of HIV-infected blood.
  
• From an infected mother to her baby, before or during child birth or through breast feeding.

HIV/AIDS cannot be passed on through everyday social contact, or through insect bites, dirty food or crockery, nor activities such as kissing, coughing or sneezing.

To protect yourself against HIV/AIDS:

• Do not have sex except with your usual partner. Casual sexual intercourse can be very risky. People can be infectious even though they may not be aware of it, and even if they look and feel well.
  
• If you do have sex with a new partner, always use a condom. They are the most effective protection against HIV/AIDS and other sexually transmitted diseases. Pack an adequate supply of condoms if you think you may need them when travelling, as they might not be easily available or of good quality in some countries. Those bought in the UK should carry the British Standards Kite Mark, or the European Standard mark. If you drink, remember that alcohol can make it easier to forget about safe sex.
  
• Do not inject non-prescribed drugs. If you do, never share equipment.
  
• Do not have a tattoo, acupuncture, or your ears pierced, unless you can be sure that the equipment is sterile.
  
• Since some countries do not have the same standards of medical and dental hygiene as the UK, needles and other equipment may not be adequately sterilised, nor blood screened for the presence of HIV or hepatitis B or C, so:
  
  • try and ensure that any medical treatment, particularly a blood transfusion, is absolutely necessary;
  • make sure that any medical equipment used is freshly sterilised or is taken from a sealed pack;
  • If you need a transfusion, ask for screened blood. If you are going to an area where the availability of sterile needles is in doubt, consider taking an emergency medical travel kit with you.

Some countries have introduced HIV antibody testing for visitors, or require an HIV antibody test certificate. If in doubt, check with the Embassy or the High Commission of the country concerned.

Bilharziasis

This is a parasitic disease caused by a worm which is most common in waterways in Africa. The worm penetrates the skin and can cause damage to the intestines, the liver and the urinary tract. The disease can be treated, but no vaccine is available. Visitors to the areas where bilharziasis is present should avoid wading or bathing in streams, rivers and lakes.

Cholera

Cholera is an intestinal infection that can cause severe diarrhoea, which may lead to dehydration and ultimately death. It is caught from the consumption of contaminated food and water. An increasing problem in areas of poor sanitation in South America, the Middle East, Africa and Asia, it is relatively uncommon among travellers. It can be avoided by scrupulous attention to food and personal hygiene.

No vaccine against cholera is currently available (the old one was not effective) and no country now requires cholera immunisation as an official condition of entry.

Dengue

Dengue – and its more severe form, dengue haemorrhagic fever – occur throughout the tropics where they are increasing in many countries. They are transmitted by the bite of an infected mosquito. There are no vaccines against the diseases.
Prevention is by avoiding mosquito bites by day as well as after dusk.

Diphtheria

Diphtheria remains a serious disease throughout much of the world, especially in tropical countries where there is overcrowding and poor hygiene. It is caught through having close contact with an infected person. Until the 1930s, it was one of the most important causes of childhood death worldwide, but the mass immunisation of children since the 1940s has effectively eradicated the disease in developed countries. However, immunisation programmes have to be continued if the disease is to be kept at bay. For unimmunised adults, a special low-dose vaccine is available.

Hepatitis

Viral hepatitis is an infection of the liver which can cause jaundice. There are several forms of the disease; including hepatitis A, sometimes called infectious hepatitis; hepatitis B and hepatitis C.

Hepatitis A

Usually caught by consuming contaminated food or water, this can also be spread from person to person, since the virus is present in faeces. Travellers to places where sanitation is primitive need to be especially aware of the risk of infection. The main precautions are care over what you eat and drink, and washing your hands after going to the lavatory and before handling food.

There is a vaccine against hepatitis A.

Hepatitis B

This occurs worldwide and is spread in the same ways as HIV/AIDS, that is through;

• Intimate person-to-person contact;
  
• Sharing contaminated needles or syringes;
  
• Transfusions of contaminated blood or the use of inadequately sterilised equipment in medical treatment, tattooing and ear-piercing.

There is a vaccine, which gives good protection against the disease. However, it can take six months to become effective. The best way to prevent infection is to avoid the high-risk activities listed above and also to take a travel kit for use in medical emergencies.

Hepatitis C

This is being increasingly recognised worldwide and is spread in the same way as HIV/AIDS and hepatitis B. There is no vaccine. The best way to avoid infection is to take the precautions recommended against HIV/AIDS and hepatitis B.

Japanese Encephalitis

A viral inflammation of the brain which, in some cases, can be life threatening, this occurs throughout Southeast Asia, mainly in rural areas and during the monsoon season. A vaccine is available and is recommended for travellers who are staying in risk areas for a month or more. However, the vaccine is not normally supplied under the NHS and you will have to pay a fee.

Legionnaires Disease

Legionnaires disease is an uncommon form of pneumonia which occasionally occurs in holiday-makers. It is spread through aerosols of water contaning the legionella germ, usually through poorly maintained cooling towers or air-conditioning systems. It is treatable with antibiotics. There is no vaccine.

Meningitis

Meningitis is an inflammation of the membranes covering the brain and spinal cord. It particularly affects children and young adults and can result in death. Meningococcal meningitis is more prevalent in some areas of Africa and Asia than in the UK, and a vaccine is available. This vaccine, however, does not cover the strain most common in the UK. Saudi Arabia requires the immunisation of all those going on Hajj, the great annual Muslim pilgrimage.

Poliomyelitis

Polio is a viral infection which can cause paralysis of the muscles. Everyone travelling outside North and Western Europe, North America, Australia and New Zealand should have up-to-date polio immunisations. Previously unimmunised people should receive a full course of three doses of vaccine. Those immunised more than ten years ago require a booster dose.

Tetanus

Tetanus is a dangerous disease, which causes severe and painful muscle spasms, and is caught by the introduction of bacterial spores into the body through even a slight wound. The spores are found worldwide, mainly in soil and manure. Tetanus is particularly dangerous where medical facilities are not available for immediate treatment. Everyone should be protected by immunisation, especially those who travel to remote areas. If you were immunised as a child, ask your doctor about a booster. If you were not, you will need a course of three injections.

Tick-Borne Encephalitis

An inflammation of the brain contracted from the bite of an infected tick, tick-borne encephalitis occurs in forested parts of Austria, Northern Europe and Scandinavia, especially where there is heavy undergrowth. It is more common in late spring and summer. When walking or camping in areas where the disease is prevalent, you should wear clothing that covers most of the skin and use insect repellents as well. A vaccine is available but not free of charge under the NHS.

Tuberculosis

Tuberculosis is increasing worldwide. If you or your family have not been immunised against the disease, and you are going to stay for more than a month in Eastern Europe, Asia, Africa, Central or South Africa, you should discuss the need for BCG immunisation with your doctor – preferably at least two months before departure. You will need a skin test first.

Immunisation is particularly advisable for those who will be travelling, living or working closely alongside the indigenous population, and for members of ethnic groups visiting their country of origin. It is not necessary for short visits if you are staying in international-style hotels. Once immunised, reimmunisation is unnecessary.

Typhoid

Typhoid fever is caught through the consumption of contaminated food or water. Immunisation against the disease should be considered by those travelling to places where sanitation is primitive. It is also essential to take scrupulous care over food and water.

Yellow Fever

Yellow fever is caught from the bite of an infected mosquito and occurs in parts of Africa and South America. Some countries require a vaccination certificate for entry. The vaccine can only be given at a designated Yellow Fever Vaccination Centre – your doctor will be able to advise you. It is not available free of charge on the NHS. The certificate itself is valid from ten days after vaccination for a period of ten years.