Health perils in paradise?

Some of the world's most spectacular destinations are also home to some of the world's nastiest infections. Yellow fever, malaria and even polio can strike international travellers. Protect yourself by learning which vaccines or health precautions are advised for your destination. To give vaccines time to take effect, see your doctor or travel clinic at least 4-6 weeks before your trip.

Polio booster

If you're planning an African safari, you may need a polio booster. This debilitating disease is still active in some parts of Africa and Asia. The infection can be spread through food, water and contact with an infected person. Even if you received a polio vaccine as a child, if you've not had a polio booster in the last 10 years you may need to get vaccinated again.

Yellow fever vaccine

Yellow fever is mainly found in sub-Saharan Africa (south of the Sahara desert), South America and in parts of the Caribbean. It can be life-threatening. Vaccination is required to visit certain countries, with a booster jab needed after 10 years. Avoiding mosquito bites is important, too.

Typhoid fever vaccine

Typhoid fever is a life-threatening infection common in the developing world. It's caused by bacteria found in contaminated food or drink. Around 500 people from the UK get typhoid each year, most of them contract it abroad, especially in India, Pakistan and Bangladesh. Vaccines give protection for one to three years.

Tetanus booster

Before planning any adventure travel, make sure you’re up to date on your tetanus jab. Tetanus infections often result from skin injuries, including frostbite, burns or punctures. The culprit is a bacterium that occurs in all parts of the world. All UK children are offered the tetanus jab as part of the NHS childhood vaccination programme. Tetanus can be fatal. Boosters are recommended every 10 years.

Hepatitis A vaccine

One of the great pleasures of international travel is trying a variety of exotic cuisines. Unfortunately, contaminated food or water can spread infections, including hepatitis A. This viral infection, which causes inflammation of the liver, is common throughout the developing world. Your GP can arrange vaccination for hepatitis A on the NHS or you can pay for it at a travel health clinic.

A blood test will show whether you are already immune to hepatitis A virus from a previous infection. Otherwise, you should have one injection 4 to 6 weeks before you travel and a booster dose 6 to 12 months later.

Hepatitis B vaccine

The hepatitis B virus also causes liver inflammation, but is spread through blood or other body fluids infected with the virus rather than food. Many chronically infected people carry the virus in Africa, South-east Asia, sub-Saharan Africa and the Pacific islands, such as Hawaii, the Solomon Islands and Fiji. The NHS recommends the hepatitis B vaccine for all travellers to these areas. Your GP can arrange vaccination.

Rabies vaccine

Rabies is found on all continents, except Antarctica, and is spread through the bite of an infected animal. Street dogs in Africa, Asia and South America pose the greatest risk to travellers, followed by monkeys living among the temples of Asia. Without treatment, rabies is fatal. A three-dose vaccine is available, though it doesn't eliminate the need for treatment after a bite. Booster injections every two years are needed for continued protection.

Flu vaccine

If you get an annual flu jab, factor your travel plans into the timing of your vaccine. In the Southern Hemisphere, flu epidemics are most common from April to September. So families planning a summer holiday in Australia, for example, should make sure they are vaccinated before setting off. 

Malaria precautions

Malaria is a life-threatening disease carried by mosquitoes. It is most common in sub-Saharan Africa, but also occurs in parts of South Asia and South America. There's been a steady rise in malaria cases among UK travellers, many of whom did not take precautions such as anti-malarial tablets before they left. Other precautions include using mosquito repellents, wearing long sleeves and trousers outdoors and sleeping under insecticide-treated mosquito nets.

Dengue fever precautions

Dengue has been found in travellers returning from the Caribbean, South Central Asia, Central America and even Florida in the US. While most cases are mild, some people develop dengue haemorrhagic fever, which can be fatal. There is no vaccine, but travellers can reduce their risk by protecting against mosquito bites.

Tuberculosis (TB) precautions

Tuberculosis (TB) is more common in Asia and sub-Saharan Africa, although it is found throughout the world. The infection is spread when a contagious person coughs. The Bacillus Calmette-Guérin vaccine, also known as the BCG vaccine, can protect against TB. It provides effective protection against TB in up to eight out of ten people who are given it. If you feel you may have been exposed, it’s important to get a skin test. Prompt treatment is the key to avoiding complications.

Leishmaniasis precautions

Sleeping on the beach may sound romantic, until you consider the infected sand flies. Their bites can spread a disease called leishmaniasis. The most common type, found in parts of the Middle East, Asia, Africa and South America, causes skin sores and ulcers. A less common form affects internal systems and causes life-threatening disease. To avoid bites, stay indoors from dusk to dawn. Wear long-sleeved shirts, trousers and socks. Insect repellent and bed nets can also help.

Filariasis precautions

Lymphatic filariasis is caused by a tiny, parasitic worm that spreads through bites. It affects millions in Asia, Africa and the Western Pacific, and a fraction go on to develop elephantiasis. In the Americas, the disease occurs in Haiti, the Dominican Republic, Guyana and Brazil. Short-term travellers are at low risk, but it's prudent to avoid mosquito bites: use repellent, wear long sleeves and trousers, and sleep under a mosquito net.

Bedbug detection

Bedbugs are not choosy about their accommodation – they check into cheap hostels and five-star resorts across the globe. They cause itchy red bites on the face, neck, arms, hands or other body parts – but these marks can take up to 14 days to appear. To detect an infestation more quickly, look for tiny bugs in the folds of mattresses or sheets, rust-coloured spots on the mattress, and a sweet musty odour.

Preventing travellers' diarrhoea

Travellers' diarrhoea is the top travel-related illness, affecting up to half of international travellers. People visiting Latin America, the Middle East, Africa, and Asia, are the most at risk. It's rarely dangerous and almost always goes away on its own. Still, you can take steps to prevent it that also help prevent more serious illnesses such as cholera. The NHS recommends avoiding tap water, ice in drinks, food sold by street vendors, raw or undercooked meats and seafood, and unpeeled fruits and vegetables.

What about fruit and veg?

With a few precautions, you can enjoy fruit and vegetables while abroad. In higher risk countries, avoid raw fruit and veg, unless you can peel them yourself. A good rule of thumb: boil it, cook it, peel it or leave it. Also be wary of salads that may have been washed in tap water or smoothies made with non-purified ice.

Water purification

"Don't drink the water" may be a mantra of international travellers, but there are actually several ways to make local water safe. The most reliable method is to boil it for several minutes. When this isn't possible, you can disinfect water with iodine tablets or chlorine, but this may not kill all types of parasites. You can also use a special portable water filter, not one designed for UK tap water. If you choose to buy bottled water, make sure the bottles come from a trusted source and the lids are sealed.

Antibiotics for diarrhoea

Despite all your precautions, there’s still a chance you may get travellers' diarrhoea. If you’re heading to an area where this is likely, you could ask your doctor about taking antibiotics with you as a precaution. Cases of moderate to severe traveller's diarrhoea can be treated with a course of antibiotics. If diarrhoea persists after taking antibiotics, it's important to get tested for possible parasitic infections.

Dehydration precautions

Adventures in extremely hot and humid climates can put travellers at risk of dehydration. The risk is even greater if you develop traveller's diarrhoea. Signs of dehydration include sunken eyes, dry mucous membranes and urinating less. Sport drinks can help you stay hydrated if you're well, but they are not suitable when you have diarrhoea. In that case, you should sip a special oral rehydration solution.

Sunburn precautions

Few things take the fun out of a beach holiday like red, peeling skin. Besides being painful, UV rays and sunburn can lead to premature ageing of the skin and an increased risk of skin cancer. Protect yourself with a broad spectrum sunscreen that blocks UVA and UVB rays. Doctors also recommend staying inside or in the shade between 10 am and 4 pm, even on cloudy days.

Precautions during pregnancy

Being pregnant doesn't put travel off limits, but you should take some precautions. The NHS says the best time is between 14 and 28 weeks, but check with your GP or midwife first. Avoid any country where malaria is present. Following food and water safety guidelines is even more important, because the consequences of a food-borne illness could be more severe. And if you're in your third trimester, make sure you will be near a medical centre than can cope with premature labour and/or birth.

Precautions for young children

The best way to protect infants against food and waterborne illnesses is to breastfeed while travelling. If this isn't possible, make formula with water that has been boiled sufficiently or bottled. When babies or young children develop diarrhoea, they can become dehydrated quickly and may need medical attention. Children are also more vulnerable to complications if they become infected with malaria and other infections.

First aid kit for travellers

You can buy a travel first aid kit or make your own. For minor injuries, the NHS recommends antiseptic with gauze squares, non-adherent dressings, bandages, fabric plasters, adhesive tape, scissors, tweezers, safety pins, bottles or sprays of standard antiseptic or ready-prepared antiseptic wipes. You should also include any medications you take regularly in their original containers, along with copies of your prescriptions.

Travel and insurance

Before your trip, check with your health insurance provider to find out which services are covered abroad and any exclusions for various countries or activities. In Europe, remember your EHIC card to get free or reduced-cost medical treatment in European Economic Area countries and Switzerland. This does not replace travel insurance, as it doesn't cover things like mountain rescue for skiing accidents.

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