Health advice for travellers

• MASTA •

• Travellers are exposed to many hazards while abroad; only a small percentage of these can be prevented by vaccines
• Advice should be given on how to minimise the risk by taking preventative measures
• A risk assessment should be performed to obtain details of the planned trip and traveller's medical history. Pre-travel advice can then be tailored to each journey

Avoiding contaminated food and water

• Vaccination against hepatitis A, typhoid, polio and/or cholera may be recommended
• Advice on treating/managing travellers' diarrhoea is appropriate
• Travellers should:
  • always wash hands before preparing and eating food
  • peel/wash all fruit and vegetables to be eaten raw; avoid in restaurants
  • avoid food left out for long periods of time; food served piping hot is much safer
  • not eat undercooked or raw meat, fish or shellfish
  • ensure milk is pasteurised (if in doubt bring almost to the boil first) and avoid dairy products e.g. cheese, butter, ice-cream from an uncertain source
  • avoid ice in drinks unless it is known to be made with safe water
  • drink bottled water (ensure seal is intact), hot drinks such as tea and coffee (ensure milk is pasteurised) and bottled sodas/beers or boil/purify water
  • only clean teeth in water considered safe to drink
  • avoid swimming in fresh water lakes and rivers

Insect bites

• Specific advice on malaria prevention is often required
  • this should include
    • awareness of the problem
    • bite prevention
    • chemoprophylaxis
    • diagnosis
  • see Guidelines for malaria prevention in travellers from the United Kingdom (summary in this book)
• Other insect-borne disease risks should be highlighted, e.g. dengue fever, Japanese encephalitis, tick borne encephalitis
  • vaccination may be appropriate in some cases
  • yellow fever vaccination is mandatory for some countries
• Give the following advice:
  • insect repellent should be applied to exposed areas of skin at day and night in risk areas
    • use repellents containing DEET or a lemon eucalyptus-based product
    • it may be necessary to re-apply more than 3-4 hourly when hot and humid
  • cotton clothing can be impregnated with DEET or DEET-impregnated wrist and ankle bands may be used
  • mosquito nets for each bed are especially important when the room to be slept in is not air-conditioned or screened
    • nets should be treated with residual insecticide such as permethrin and re-impregnated every 6 months during a long stay. Long-acting insecticides are also now available
    • travellers should ensure that nets are not torn and they tuck under the mattress
  • 'knockdown' sprays can be used under nets before bedtime and in a room at dusk to destroy mosquitoes that entered during the day
  • insecticide coils or plug-in vaporisers can be used to deter mosquitoes
  • cover up when outdoors after sunset, with long trousers, a long-sleeved shirt and socks