When travelling, we often forget that the ticket to a good holiday or a successful working trip is good health.
WHEN we look at the confirmed flight reservations for our upcoming destinations, chances are, health concerns are the last thing on our minds. Because all we can think of are the pristine beaches, exotic resorts or the vibrant cities we are going to visit, and the interesting sights to behold.
Otherwise, if we are bound for an overseas working trip, we might be busy preparing for it right up to the day before we leave. Health precautions often take a back seat – we’ve already got our visa application, flight reservations, and travel insurance coverage to worry about.
So, Dr Bret A. Nicks and co-author Dr Debra Slapper’s comment in their article Travel Medicine and Vaccinations shouldn’t come as a surprise: “whether associated with tourism, humanitarian efforts, globalisation of industry, or migrant workers, studies suggest only a small number seek pre-travel health advice.”
It may be a case of misplaced priorities, because as much as a passport is important for us to cross international borders, good health is vital for us to enjoy our holidays and excel in what we do.
That said, the task of keeping ourselves protected from infectious diseases and making sure our existing health problems are not exacerbated while we travel is far from easy, as Nicks and Slapper went on to describe.
“The composition of those travelling continues to become more diverse and medically complex, creating a vastly different perspective on travel-associated medical concerns, preparations, and required medical knowledge.
“So, whether you are a humanitarian aid worker in Tanzania, an educator in Latin America, a tourist, or a businessperson for a multinational corporation, understanding the dynamics of travel and the interplay of healthcare will minimise the adverse effect of travel-related illnesses and concerns while maximising enjoyment and success for the trip.”
But perhaps, the lack of knowledge about travel medicine isn’t the main hurdle to having more of us take precautions against illnesses. Many people show a lackadaisical attitude towards travel-related illnesses.
“Many travellers do not know the consequences of overlooking health precautions when they travel,” says Malaysian Society of Infectious Diseases and Chemotherapy (MSIDC) president Prof Dr Yasmin Abdul Malik at the launch of the Fit-to-Fly educational campaign (organised by GlaxoSmithKline Pharmaceuticals Malaysia in association with the MSIDC).
“That is why we need to educate and increase the awareness of the availability and importance of travel vaccinations as preventative measures; and encourage travellers to talk to their doctors about their travel plans,” she adds.
Germs without borders
While the level of awareness on travel health worldwide is less than ideal, we have the Influenza A(H1N1) pandemic to thank for the increasing acknowledgement by travellers and health authorities that travel medicine is indeed an important component of public health.
As the virus continues to spread worldwide, health scans at points-of-entry are more diligently administered and monitored in many countries, and more airport staff are equipped with masks and hand sanitisers to protect them from getting infected. On top of that, aggressive educational campaigns have been launched to disseminate information about the virus and the ways to stop its spread.
As a result, many of us have become very “familiar” with the Influenza A(H1N1) virus. And many of us (I hope) would have taken precautions to prevent ourselves from getting the flu, regardless of whether we are travelling abroad or just going to a nearby supermarket.
But influenza is only one of many infectious diseases closely related to international and domestic travel. Other diseases such as hepatitis, malaria, dengue, yellow fever, typhoid, and traveller’s diarrhoea are also infectious diseases that pose health risks to tourists.
In fact, Dr Yasmin says, among the most widespread vaccine-preventable diseases worldwide, including hepatitis A (1.4 million new cases per year), hepatitis B (over 1 million deaths per year) and typhoid (16 million new cases per year), at least 50% of the cases in industrialised countries are associated with recent travel. “The risk of infection increases with duration of travel and low levels of hygiene,” she adds.
And like natural disasters, infectious diseases also do not recognise borders, she says. “That is why we have to protect ourselves in every possible manner.”
Keeping bugs at bay
One of the best ways to prevent infectious diseases is through vaccination, says Dr Yasmin. But, with vaccines available for more than 20 diseases, how do we choose?
Dr Yasmin says the idea is not to vaccinate everyone with every single vaccine available – prioritisation is necessary to determine which vaccine we need to travel (see Vaccines for travellers).
A rule of thumb is to take into consideration the incidence (the frequency of the disease) and impact (the degree of harm a disease can have on your health) of a disease when you plan to travel.
For instance, if we are travelling to a country where yellow fever and Typhoid is endemic, we might want to consider getting vaccinated against those diseases. However, for a disease like hepatitis B, which is widespread and has a high case fatality rate, we might want to make sure we are well protected before travelling anywhere.
Besides, our itinerary will also determine our risk of being infected by certain diseases – a study in 1994 found that the prevalence of hepatitis is much higher among hikers compared to hotel tourists.
“Imminent departure is often seen as a deterrent to immunisation,” says Dr Yasmin. “But although late vaccination may not offer immediate protection, for long duration trips, it would be better to be vaccinated late as opposed to not at all,” she adds.
Most vaccines need to be given at least two weeks before departure, but current monovalent (single) and combined vaccines can offer flexible vaccination schedules to accommodate even last-minute travellers.
However, as much as we want to think that vaccines are the ultimate protection against infectious diseases, they do not always fully protect all its recipients. Also, there are many diseases for which there are no vaccines.
That is why we should also take additional precautions against infections, says Dr Yasmin. Simple steps, such as making sure our drinking water and food are safe, using insect repellents, and opting for pre-exposure treatment (there are certain medications that are used as prophylaxis for select diseases) could protect us from many food, water and vector borne diseases.
The travel health checklist
So, if you are preparing for an upcoming trip, these are some practical suggestions:
Know your destination – To ensure your well being during your stay, details about your destination that are useful are things like the climate, altitude, potential hazards (including socio-political ones), level of hygiene and sanitation, the availability of medical care, and water quality. This way you would know what to pack for your trip and what to avoid during your trip.
Talk to your doctor – Your general practitioner or family doctor can advise you on the kind of vaccinations or medicines you could bring with you when you travel.
If you have any pre-existing medical condition, a chat with your doctor is especially important because you may need to carry a doctor’s letter and a copy of your prescriptions. It will also be good if you could find out how the trip may affect you and the steps you could take if it does.
Vaccinate! – It is best if you could get your vaccines four to eight weeks before departure. So, if you are a frequent traveller travelling often on short notice, it might be a good idea to make sure all your important vaccinations are up to date.
Get insured – A travel or medical insurance, which provides adequate healthcare coverage at your destination, is a good idea as healthcare costs can be expensive in foreign countries.
Prepare, prepare, prepare – It is also important to know where you could get medical help quickly at your destination.
At the very least, try to keep a list of local emergency services numbers (e.g. 9-1-1 in the United States), and the contact numbers of a few local hospitals.
Stay safe, and keep your hands clean! – Although you’re on a holiday, common health advice applies: drink plenty of water in hot climates, apply sunscreen if you are going to be under the sun for longer periods of time, and practise safe sex. Also, always make sure you wash your hands regularly. This way you can keep food borne diseases away, and of course, stay away from the flu!
All things said, making the effort to ensure a sickness-free trip may seem like an extra hassle (I mean, look at this list!). But staying healthy is important for us to fully enjoy our trip.
Better still, if good health eludes us during our time away, at least we know we will be prepared for it!
1. Foreign and FCO Office (2009, September 23). Travel Health. Retrieved September 23, 2009 from http://www.fco.gov.uk/en/travelling-and-living-overseas/staying-safe/health/
2. World Health Organisation (2008). International Travel and Health 2009 Edition. Retrieved September 23, 2009 from http://www.who.int/ith/chapters/en/index.html
3.GlaxoSmithKline (2009). Fit-to-fly booklet.
4.Professor Dr Yasmin Abdul Malik. “Are you fit-to-fly?” presentation.
Related Stories: When you are home...
Did you find this article insightful?