The following sections are designed to help you prepare for your trip as well as provide some advice for staying healthy while you’re away.
You should visit your doctor or travel clinic at least four to six weeks prior to travel, as they’ll have access to the most up-to-date requirements for your destination. They’ll also be able to advise on what is appropriate for you personally, taking into account your medical history and any pre-existing conditions. This is important as some immunisations aren’t recommended for everyone.
Vaccination against hepatitis A and typhoid is generally recommended for tropical and subtropical countries. You should also check that your primary vaccinations, such as tetanus, polio and TB, are up to date. Other vaccinations to consider, if you’re going for an extended travel period or to remote areas, are cholera, diphtheria, rabies and Japanese encephalitis.
A yellow fever vaccination is required by many countries, even though the disease is only found in parts of Central and South America, and Sub-Saharan Africa.
Yellow fever is a viral infection spread by the bite of an infected Aedes aegypti mosquito, which mainly bites during daylight hours. Vaccination serves two purposes: to protect the individual, and to prevent the international spread of the disease into countries where the right conditions exist for it to occur.
Some countries, therefore, require proof of vaccination, either for all entrants or for all entrants arriving from certain destinations. This may include passengers in transit. Requirements are complex and subject to change on a regular basis, so you should seek the most up-to-date advice from your medical practitioner.
Malaria is widespread in many tropical and subtropical countries. The illness is caused by a parasite spread by the Anopheles mosquito, which generally bites after sunset.
You can’t be vaccinated against malaria. Mosquito bite avoidance is essential as no antimalarial is considered totally effective. It’s important to discuss your requirements with your doctor, as some antimalarials have side effects or may be incompatible with certain medical conditions.
Make your doctor aware of all the destinations you’ll be visiting, so the correct antimalarial can be prescribed. It’s extremely important to take the tablets as directed, including after you have returned home, to cover the incubation period of the disease.
Other mosquito-borne diseases
In addition to malaria and yellow fever, there are a number of other diseases and viral infections carried by mosquitoes. Some of these have mild symptoms but can have very serious consequences:
Zika virus: this is spread by the Aedes mosquito, which predominantly bites during the day. Most people infected have very mild or no symptoms. Of particular concern, however, is the link between Zika infection and birth defects, notably microcephaly. As there’s no treatment for the infection and currently no vaccine against it, it’s generally recommended that anyone who is pregnant or planning on getting pregnant should avoid travel to countries with a high or moderate risk of Zika virus transmission. It’s essential that up-to-date advice is sought, as the situation is evolving. Strict mosquito bite avoidance measures are recommended for all travel.
Dengue and Chikungunya fevers: also spread by the daytime biting Aedes mosquito, there’s no treatment for these infections, or any vaccine against them. Symptoms can range from very mild fever to severe complications in rare cases. Dengue is one of the most common identified causes of fever in people returning from tropical and subtropical countries.
Mosquito bite avoidance
Measures to avoid bites should be taken both during the day and at night. Wear clothing that covers as much of the body as possible, including long sleeves and long trousers. As dawn and dusk are often peak times for mosquitoes, ensure you are well covered when eating out in restaurants.
Mosquitoes may bite through thin clothing, so using an insect repellent is also recommended. Use repellent on exposed skin. The most effective form of repellent is considered to be one containing DEET. Take plenty of supplies with you, as there can be shortages overseas, particularly in countries with Zika transmission.
If sleeping in an unscreened room or outdoors, ensure you use a mosquito net. This should be impregnated with an insecticide. Burning pyrethroid coils can also help control mosquitoes.
If you do fall ill after your travels, it’s important to mention your recent travel history to your doctor.
Food and water hygiene
Poor hygiene and sanitation are, unfortunately, prevalent in some parts of the world. Following a few simple rules will help to reduce the risk of travellers’ diarrhoea, as the key to prevention lies in taking effective food and water precautions and maintaining good personal hygiene.
Do not drink tap water, or use it for brushing teeth, unless it has been boiled, filtered or chemically disinfected. Use bottled water and avoid ice cubes unless you’re sure they’ve been made with clean water. The same applies to salads and raw vegetables, as these are easily contaminated by soil and may not have been washed in clean water. Eat fruit that can be peeled.
All hot food should be served piping hot and not left exposed to the air for any length of time. Avoid leftovers or anything that appears to have been reheated.
Eating local street food can be a highlight of travel in some countries. We suggest you follow the advice of your guide, who’ll be able to recommend the best vendors. Choose food that’s freshly cooked to a high temperature and served immediately while still hot.
Always wash your hands before handling or eating food, and after using the toilet. If handwashing facilities are inadequate, it’s prudent to carry sanitising gel or hand wipes.
If you’re unlucky and do suffer from diarrhoea, rehydrate yourself with clean fluids and oral rehydration solution. Seek medical attention if symptoms are severe or don’t resolve after a few days.
Many popular travel areas, particularly in South America and the Himalaya, are located at high altitude, where the air pressure is lower than at sea level. Although the amount of oxygen in the air remains constant, the amount of oxygen in the lungs and bloodstream is reduced.
The human body can generally adjust to high altitude, and the majority of visitors have a trouble-free time, but this process can take several days and will vary between individuals. Altitude sickness is more likely to occur in those who haven’t allowed sufficient time to adjust or who arrive directly into an area of high altitude (for example Cuzco in Peru, at 3,300 m [10,825 ft]).
Anyone can suffer, regardless of age or fitness. Most people will notice some symptoms of hypoxia (lack of oxygen), including breathlessness and an increased heart rate. Other symptoms include headaches, difficulty sleeping, vivid dreams and lack of appetite. In a minority of cases, some people may go on to develop more acute symptoms such as severe headaches, nausea and dizziness.
To reduce your chances of developing altitude sickness, you should take things slowly on arrival, get plenty of fresh air, keep well hydrated and avoid alcohol, smoking or rich food.
Painkillers, such as paracetamol and ibuprofen, can be taken to relieve headaches. There are medicines that can be used to prevent symptoms of altitude sickness, but these shouldn’t be used without proper medical advice.
In South America, you’re often offered coca tea as a local remedy. This is a popular drink, but you should be aware that the leaves are often not produced under hygienic conditions. Also, due to the altitude, the water may not have reached boiling point for a sufficient period of time so may not be fully purified. Do not be tempted to take coca tea bags or coca leaves out of the country, as it’s illegal to import these into the UK, the US and many other countries. Coca tea is also a stimulant, so don’t drink it at night.
The safest way to enjoy the sun and protect your skin is through a combination of clothing, sunscreen use and seeking shade at the hottest times of day. Pack plenty of high-factor sunscreen, a wide-brimmed hat, long-sleeved tops and sunglasses.
Be aware that the risk of sunburn is greater at high altitudes. Also, UV light is reflected from water, white sand and snow. If you’re snorkeling or swimming for long periods, it’s a good idea to wear a T-shirt and shorts.
Pre-existing medical conditions
Before embarking on travel you should ensure that you have planned carefully so that your health can be maintained throughout the trip and your travel insurance covers you for the destinations you will travel to, the activities you plan to undertake and for any pre-existing medical conditions. If necessary, arrange a pre-trip medical with your doctor or nurse. This can be helpful if you have to take medication at certain times of day, as travel and time differences can cause disruption.
If you take medication, you should ensure that you take enough to see you through the trip and allow for possible delays. If you require a fridge in your room to keep medication cold, please request this in advance. Always keep medicines in your hand luggage.
You should be aware that, while medicines may be legal for use in their own country, regulations may be different overseas. It’s strongly recommended that you travel with a copy of your prescription and the original packaging. Do bear in mind airline restrictions on taking liquids as hand luggage. These are usually waived for medicines, but you’ll have to provide the relevant supporting documentation. For further information about carrying medicine abroad, we recommend NHS choices — can I take my medicine abroad?
If you require a wheelchair and/or additional assistance at airports and on the aircraft, please request this well in advance.
Appreciate that travel can be stressful as well as enjoyable. Consideration of your mental wellbeing is as important as your physical health. Research your destination so you know what to expect. Be aware of factors such as time-zone changes, jet lag, sleep disruption, culture shock, anxiety due to travel and flying, and ensure you have strategies to deal with these. Find out how to access medical facilities at your destination and don’t be afraid to ask for help if you need it.
Deep vein thrombosis (DVT)
Prolonged periods of immobility, for example during long flights, can lead to slow blood flow in the veins and the risk of blood clots. General advice is to stretch and exercise the legs whenever possible, keep well hydrated, and limit alcohol and caffeine consumption. The risk to most is generally very low, but if you have a history of DVT, have had recent surgery, are pregnant, or have heart or lung disease, you should speak to your doctor.