Health
Information for Travelers to the
Indian:
The
health of any traveller abroad may not
be protected by services and
legislation well-established at home.
Changes in food and water may bring
unexpected problems, as may insects
and insect-borne diseases, especially
in hot countries. Few have at their
fingertips the current detailed
knowledge needed to advise the
traveller going to a particular
country and personal reminiscences may
not always reflect current or common
problems. A danger of generalising is
that it may be forgotten, for example,
that malaria is a risk in Turkey,
poliomyelitis occurs in Europe, and
hepatitis A virus occurs worldwide and
is not destroyed by many methods of
purifying drinking water. Specific
advice on which diseases are present
in countries to be visited is likely
to be complicated. A practical
starting point for the traveller
seeking advice is to consider which
diseases can be prevented by
immunisation, prophylactic tablets, or
other measures, and decide whether it
is appropriate to do so for each
individual.
An unpredictable environment is
especially a problem for the overland
traveller who plans his own journey,
and he needs greater knowledge of
disease prevention and management than
the traveller in an airplane or on a
sea cruise, whose environment, food
and drink are largely in the hands of
the operator. Unforeseen changes in
timetables may lead to stays in
accommodation not of the expected
standard. Delays at airports can take
place in overcrowded and unhygienic
conditions where the facilities have
not kept pace with increased demand,
and also insect-borne diseases may be
contracted. Jet-lag and exhaustion may
prompt a traveller to take risks with
food and drink. More experienced
travellers tend to have fewer health
problems. Better planning,
immunisations and experience in
prevention may all play a part, as
well as salutary lessons learnt on
previous occasions.
A questionnaire survey of returning
travellers (most of whom had been to
Europe, especially the Mediterranean
countries) showed that half had had
diarrhoea or respiratory symptoms
while abroad. Excessive alcohol, sun
and late nights can add to the
problems. About one in 100 package
holidaymakers who take out a health
insurance policy make a claim.
Diarrhoea and sunburn are principal
reasons, but accidents are also
common. Injuries occur especially in
and around swimming pools, to
pedestrians forgetting that traffic
drives on the right, and from
unfamiliar equipment such as gates on
lifts. Sexually transmitted diseases
may be contracted and may require
urgent treatment.
Long-stay travellers may adapt to
these initial problems, but then find
themselves suffering from diseases
endemic in their chosen country, such
as malaria, hepatitis, diarrhoea and
skin problems. Two per cent of British
Voluntary Service overseas personnel
contract hepatitis A within eight
months if they are not protected. Car
accidents occur while driving on
unmetalled roads, and some emotional
problems may be resolved only by an
early return home.
The traveller should be insured
against medical expenses and most
policies include the cost of emergency
repatriation when appropriate. Such
insurance, however, rarely covers a
service overseas similar to that
available at home. Language and
administrative differences are likely
to present problems. Leaflet T6 issued
yearly by the Department of Health
describes the free or reduced-cost
medical treatments available in other
countries and the documents (passport,
NHS medical card, form E111) which the
traveller has to have with him or her.
Reciprocal arrangements between
countries differ and money may have to
be paid and then reclaimed in the
visited country itself, which can be
time consuming. Extra provision should
be made for such emergencies. Any
reciprocal arrangement between the UK
and a country is mentioned in each
country's entry.
Form E111, counterstamped in post
offices, is needed in some countries
of the European Union. Only a 'small'
supply of medicines for personal use
may be taken out of Britain, unless
Home Office permission is obtained.
Immunisation
Yellow Fever:
This disease is caused by a virus that
circulates in animals indigenous to
certain tropical forested areas. It
mainly infects monkeys, but if man
enters these areas the virus may be
transmitted to him by mosquitoes whose
normal hosts are monkeys. This is
jungle yellow fever. It occurs
haphazardly and is clearly related to
man's habits. If, from an animal
source, the virus begins to circulate
between man and his own mosquitoes,
primarily Aedes aegypti, epidemics of
urban yellow fever result.
Immunisation protects the individual
and is effective in preventing the
spread of the virus to countries where
Aedes aegypti is prevalent. It is
therefore reasonable for such
countries to request a certificate of
vaccination of all travellers from
areas where human cases are occurring.
Many national administrations,
however, require immunisation of all
travellers over one year of age from
all countries, or else all travellers
over one year from countries where
enzootic foci occur. A map of zones
where yellow fever is endemic (enzootic)
can be found on page 1091.
Immunisation is clearly not indicated
when travelling outside the enzootic
zones. Within the zones, if it is not
compulsory, it is not always
necessary. For instance, in the
absence of an epidemic of yellow
fever, a business trip within the
confines of Nairobi would be perfectly
safe. Nevertheless, local and current
knowledge of cases is required for
such decisions to be made, so in
practice immunisation is recommended
to all travellers within enzootic
zones. Immunisation in Great Britain
is undertaken only at recognised
yellow fever vaccination centres.
Once immunised (a single vaccination
is used), the vaccination certificate
is valid after ten days for ten years.
It is not recommended for pregnant
women and children under nine months.
Cholera:
In 1973 the WHO, recognising that
immunisation cannot stop the spread of
cholera among countries, deleted from
the International Health Regulations
the requirement of cholera
immunisation as a condition of
admission to any country. In 1990 the
WHO stated that immunisation against
cholera was not effective and they do
not recommend it. In 1991 the WHO
confirmed that certification was no
longer required by any country or
territory.
Typhoid
Fever:
Typhoid fever is endemic worldwide and
is usually spread faecal-orally. The
risk of infection is increased in
areas of high carriage rates and poor
hygiene. The risk is not significantly
increased for the traveller to areas
with public health standards similar
to those of Britain - namely, northern
Europe, USA, Canada, Australia, New
Zealand and Japan - and immunisation
for these areas is not necessary.
Outside these areas the risks reflect
not only local hygiene and carriage
rates but also lifestyle. Travelling
or living rough, living in rural
areas, or 'eating out' make
transmission more likely. The risks
are therefore small for the air
traveller with full board at a
reputable hotel, and immunisation is
unnecessary. On the other hand,
overland travel to Australia would be
a clear indication for immunisation.
Between these extremes there are many
circumstances for which risks cannot
be precisely defined. Typhoid vaccine
is now no longer routinely recommended
for the millions of tourists to
southern Europe each year, although it
may still be advisable not only for
those whose lifestyle or occupation
increase the risk of such exposure,
but also during local outbreaks.
Hepatitis
A:
The hepatitis A virus is endemic
worldwide and spread by the faecal-oral
route; protection from symptomatic
infection can be provided by active
immunisation or passively acquired
immunoglobulin. The virus circulates
freely in our own population however,
and many travellers will be immune
already. Protection should be offered
to the same groups as are offered
typhoid immunisation, as exposure to
one infection would imply the risk of
exposure to the other. The recurrent
tropical traveller may have his
antibodies against hepatitis A
checked. If antibodies are present,
that person is immune. If antibodies
are absent, inactivated hepatitis A
vaccine should be given. Hepatitis A
in children is usually mild and more
often asymptomatic, so immunisation is
not essential. Immunoglobulin can,
however, be given in reduced doses.
Hepatitis A vaccine is available for
use in children over the age of 12
months. Preparations combined with
either Hepatitis B ot typhoid Vi
vaccines are available.
Poliomyelitis:
A survey undertaken in Scotland in
1989 showed that 20% of the tested
population did not have antibodies to
all three serotypes of poliovirus.
Hence a consultation about travel
abroad is a vital opportunity to
complete primary courses or boost
immunisations which are nationally
recommended. Oral poliomyelitis
vaccine is given, but supplies of
inactivated polio vaccine are
available if oral vaccine is
contra-indicated.
Tetanus:As
with poliomyelitis, all individuals
should gain or maintain immunity to
tetanus. It is as firmly recommended
for life in Britain as for travel
abroad. A preparation combined with
low dose diphtheria toxoid is
recommended for travellers when
immunity requires boosting.
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