Travel Destination Advice

Drinking Water – Essential Tips

Important for reducing risk of traveller’s diarrhoea, as well as other water-borne infections-hepatitis A, typhoid, polio, cholera.

• We advise against drinking or brushing with tap water
• Avoid using ice cubes
• Please drink only boiled water or carbonated beverages.
• Be wary of bottled water as safety and bottling conditions may not be adequate
• Boiling water for 3 minutes followed by cooling, kills infection carrying organisms.
• Filtration devices or chemical disinfection such as chlorine tablets (may not kill all parasitic infections) are also worth considering as alternative
• For people who are unvaccinated against rabies, Human Rabies Immunoglobulin (HRIG) could be life-saving. However, HRIG is often unavailable or unreliable in many countries, and without it, the results of a rabies infection is often fatal. Receiving a rabies vaccination before you travel is the best way to protect yourself, as although post-exposure care may be needed, it will eradicate the need for HRIG. Read more about Rabies here.

Food Safety

Please adhere to the following advice:

• Avoid eating unpeeled fruit
• Please refrain from eating raw vegetables
• Avoid drinking unpasteurised dairy products
• Do not eat raw or rare meat, shellfish
• Ensure that your food is always piping hot

Traveller’s Diarrhoea

Very common: 20-60% incidence depending on destination (high risk regions include: Africa, Asia, Middle East and South America).

Bacterial – Bacterial pathogens occur in 80-90% of cases. Common agents include E.coli, Campylobacter jejuni, Shigella spp and Salmonella spp.

Viruses – Norovirus, rotavirus are common causes.

Parasites – Giardia most common, others include Entamoeba.

Symptoms

Usually includes the sudden onset of diarrhoea (can be bloody), abdominal pain/cramps, fever, vomiting. Duration typically 3-5 days in bacterial cases, 2-3 days in viral and can be weeks in untreated parasitic infections.

Treatment

Hydration – oral rehydration sachets/solutions

Antibiotics – in moderate/severe cases have proven beneficial.

Antimotility drugs – provide symptomatic relief

Travellers’ Diarrhoea Kits can be purchased from us for £35. These include all three treatments listed above; oral rehydration solution, Azithromycin (an antibiotic) and Loperamide (anti-motility).

Oral rehydration solution packs can also be purchased separately for £5.85 (box of 6 sachets). These are suitable for both children and adults.

Prompt medical advice must be sought if you should develop a fever, vomiting, confusion, blood in your stools or if the diarrhoea has not improved within three to four days. We advise to seek medical advice if not improving after 1-2 days, especially in the elderly/children or if symptoms of dysentery (bloody loose motions) are present.

Prevention

The cholera vaccine gives cross-protection against E. coli enterotoxin. Can be effective for traveller’s diarrhea.

• Avoid contact with animals especially dogs, monkeys and cats.
• If bitten wash wound thoroughly with soapy water for 10 minutes
• Do not suture or close wound
• Seek urgent medical advice
• Open water, soil and sand can harbour infection therefore
  • avoid swimming in fresh water (risk schistosomiasis)
  • avoid walking barefoot on sand/soil, which may be contaminated with faeces (hookworm infection)

Insect Bite Avoidance

• Mandatory even if vaccinated or taking antimalarials
• Plan activities, so you can avoid insect/tick/mite infested areas and maximise preventive measures during peak hours to reduce exposure where possible
• Day biting mosquitoes-spread infections also including dengue and yellow fever
• Night biting mosquitoes- spread diseases including malaria and Japanese Encephalitis
• Sandflies-cause leishmaniasis and are active from dusk until dawn
• Tsetse fly-cause sleeping sickness and are found within vegetation and grasslands of Sub Saharan Africa, and exhibit day biting
• Ticks/mites-cause lyme’s disease and tick borne encephalitis, and are found meadows / woodlands / grasslands / forests
• Protective clothing-long sleeved shirts and pants, tucking in shirts / pants, closed shoes, can add permethrin to clothes for added protection
• Check skin regularly for ticks/mites during and following outdoor activities
• Apply insect repellants regularly to exposed areas

• Always wear sun protection, using a minimum of SPF 15+.
• Avoid sun bathing between 12-2pm
• Wear Sun glasses

• Photocopy passport and any certificates
• Email details of bank, help numbers etc to yourself
• Email photocopies of certificates etc
• Know where to get help
• Obtain Comprehensive insurance including
  • Covers for all activities
  • Ensure Insurance company aware of any medical problems (may not cover if decline recommended vaccines).