Introduction
The increasing affordability of air travel has enabled more people to travel to worldwide destinations, whether it is to visit family and friends, for religious reasons, for business trips or for holidays.
In the last 12 months especially, more people are choosing destinations outside the Eurozone, because of the weakness of the £ against the €.
The world has effectively opened up and travel to exotic destinations such as Asia, India, Africa and South America is commonplace. Not only that, many people are now heading ‘off the beaten track’ to see wonderful sights in more remote areas, and teenagers often undertake ‘gap year’ travel, backpacking through many developing countries.
However because of the ‘normality’ now associated with travelling to developing countries, many have become blasé about the associated health risks.
Travel Health Ignorance
A year long cross-sectional multi-centre study conducted between 2002 and 2003 by the European Travel Health Advisory Board delivered some alarming statistics. Although the majority of travellers (73.3%) had sought general information about their destination prior to departure, only just over half (52.1%) had sought travel health advice. Of those who had sought travel health advice, 34.7% had done so less than 2 weeks before departure.
The most common sources for travel advice were their GP (57.4%), a Travel Clinic (35.3%), a Travel Agent (30.0%) or family and friend (27.8%).
The study showed general ignorance amongst travellers regarding the risks of vaccine-preventable diseases for their destination. Hepatitis A was perceived as having the highest risk, followed by HIV and Hepatitis B. In spite of a generally positive attitude towards vaccines, 58.4% and 68.7% of travellers could not confirm protection against Hepatitis A or Hepatitis B respectively.
In addition, only one in three travellers to a destination country with endemic malaria were carrying anti-malarial drugs. Almost one in four travellers visiting a high risk area had an inaccurate risk perception about malaria.
The study demonstrated an important educational need among those travelling to risk destinations, both to ensure travellers stay healthy while abroad, and also to minimise the risk of importation of infectious diseases.
The Most Common Vaccine Preventable Travel Health Risks
Typhoid
Typhoid fever is a serious and potentially fatal bacterial infection. It can cause symptoms of fever, abdominal pain and constipation followed by diarrhoea. If they are not treated, symptoms can rapidly get worse and lead to serious complications, such as internal bleeding.
Hepatitis A
Hepatitis A is an infection of the liver caused by the hepatitis A virus. It leads to inflammation (swelling) of the liver. Some people with hepatitis A do not have any symptoms. Others have flu-like symptoms, loss of appetite, abdominal pains or jaundice.
Hepatitis B
Hepatitis B is an infection of the liver caused by the hepatitis B virus. It can cause inflammation (swelling) of the liver, and sometimes significant liver damage. Many people do not even realise they have been infected with the virus, because the typical flu-like symptoms may not develop immediately, or even at all.
Japanese Encephalitis
Japanese encephalitis (JE) is a viral disease caused by a flavivirus. In most cases, the illness is mild, with symptoms including headaches and a high temperature. JE can cause more serious symptoms, such as vomiting or seizures. Encephalitis (inflammation of the brain) can develop in around 1 in 300 cases. Among those who develop more serious symptoms, there is around a 30% chance that JE will be fatal.
Meningitis ACWY
Meningococcal meningitis is caused by the bacterium Neisseria meningitidis. There are 13 serotypes although only five serotypes, A, B, C, W135 and Y, are clinically important. Serotypes A, B and C are the most common causes of illness worldwide. W135 has emerged in recent years in Africa and the Middle East. Meningococcal meningitis usually has a sudden onset with symptoms of fever, intense headache, nausea and vomiting. These symptoms can develop within minutes or hours. The patient is often irritable, has a stiff neck and prefers to lie still. A non-blanching rash often occurs with septicaemia, and delirium, coma and shock can ensue.
Rabies
Rabies is an infection of the central nervous system that can affect all warm-blooded creatures, including humans. Rabies is passed to humans from animals. The rabies virus causes inflammation (swelling) of the brain.
Cholera
Cholera is a bacterial infection. Many people who are infected with cholera bacteria do not develop any symptoms. However, cholera can cause severe, watery diarrhoea, nausea, vomiting and muscle cramps.
Tick-borne Encephalitis
Tick-borne encephalitis (TBE) is a viral infection of the central nervous system that is spread by tiny blood-sucking parasites called ticks. TBE can cause encephalitis (inflammation of the brain), meningitis (inflammation of the membranes that surround the brain and spinal cord) and other serious problems with the nervous system.
Yellow Fever
Yellow fever is a serious viral disease that is usually transmitted by a type of day time biting mosquito known as the Aedes aegypti mosquito. Typical symptoms of yellow fever include headache, high temperature, nausea and vomiting, jaundice, and bleeding (haemorrhage).
What About Malaria?
Malaria is caused by the plasmodium parasite, spread by mosquito bites. When the parasite enters the blood it travels straight to the liver. It develops there and then re-enters the bloodstream and invades red blood cells, where the parasites grow and multiply. Eventually, the infected red blood cells burst and release even more parasites into the blood. Symptoms of malaria usually appear 10-15 days after being bitten, but can take up to a year to show. Symptoms are similar to flu symptoms and include a high temperature, sweats and chills, generally feeling unwell, muscle pains, headaches, cough and diarrhoea.
Getting the Right Advice
Just a decade ago most of us booked our holidays through a High Street Travel Agent, who would often give advice about travel health as part of the service. Many of these travel agents still do give advice, as evidenced by the study summarised above. However, many travellers these days make their own travel arrangements, either via ‘online’ travel agents, or totally independently, and therefore are not offered overt advice about travel health requirements.
As a result, many travellers realise the need for vaccinations and anti-malarials too late, and find it difficult to complete preventive vaccination schedules, and some don’t realise them at all, departing on their travels unprotected.
Firstly, it is important to budget for travel vaccinations right at the outset when you are booking your travel, as some are not cheap, and the cost can come as rather a surprise if unprepared. Researching what is needed for the destination at the beginning will enable you to estimate the costs for all involved in your travelling group.
It is then vital that you obtain travel health advice AT LEAST 6 weeks before you travel to a developing country. Many travellers contact their local NHS GP Surgery first to make an appointment with the Practice Nurse. However, given that there may be up to a two week wait, contact should be made at least 8 weeks before travel. During the consultation the Practice Nurse should offer advice on the vaccinations and anti-malarials recommended for your destination.
Not all travel vaccinations are available free on the NHS, even if they're recommended for travel to a certain area. As a general rule, the following travel jabs are usually free:
- tetanus, diphtheria and polio booster
- typhoid
- hepatitis A and some combined vaccines, such as combined hepatitis A and B
- cholera
Any additional vaccinations may be available privately from your GP, incurring a fee. NHS GP surgeries differ greatly in the range of private travel vaccinations they offer, and may refer you onto a local private travel clinic for any they are unable to offer. For example, if they are not a registered Yellow Fever Vaccination Centre they will point you towards your nearest one.
A number of people go to or are referred to their local Travel Clinic for advice, because they have left it too late to get timely appointments with their GP, because they are travelling to several countries and have complex health planning requirements, or because they know they can all get the advice, vaccinations and anti-malarials from one place.
There are many private travel clinics around the UK, many in the larger cities. MASTA has the largest network, with a total of 48 clinics spread across the UK. MASTA travel clinics offer flexible appointment times at short notice, the full range of vaccines, anti-malarials and other travel health products and give specialist advice from nurses with travel health expertise. The nurses have online access to up-to-the-minute travel health advice.
You can obtain online, or as part of your consultation, a personalised MASTA Travel Health Brief, which contains easy-to-understand vaccination advice, information on other travel health risks and how to safeguard against them, detailed maps showing the areas where there is a risk of malaria within a country and further information if you are pregnant or travelling with children.
So, if you are planning a trip to a developing country in the future, make a note in your diary 8 weeks before your departure and book an appointment with your local GP or Travel Health Clinic.
Aide Memoire
We have put together this handy guide to help you plan ahead for any travel vaccinations. Used in connection with a MASTA Travel Health Brief this table below will help to ensure you are well prepared. You buy a MASTA Health Brief, as well as find out where your nearest MASTA Clinic is, by visiting www.masta-travel-health.com
|
VACCINE |
AGE |
NO. OF DOSES IN PRIMARY COURSE |
IDEAL DOSE INTERVALS |
BOOSTER |
|
Cholera |
2yrs – 6yrs |
3 |
1 – 6 weeks |
6 months |
|
Diptheria, Tetanus & Polio Combined |
6yrs+ |
3 |
4 weeks |
10 years |
|
Hepatitis A & Typhoid Combined |
>15yrs |
1 |
|
Typhoid = 3yrs |
|
Hepatitis A |
>1yr |
2 |
6 – 12 months |
20 years |
|
Hepatitis B |
From birth |
3 |
0, 1 & 6 months* |
5 years |
|
Japanese Encephalitis |
>18yrs |
2 |
0, 28 days |
Unknown |
|
Meningitis ACWY |
>2yrs |
1 |
|
3 years |
|
Rabies |
From birth** |
3 |
0, 7, 21-28 days |
2 – 5 years |
|
Tick Borne Encephalitis |
>1yr |
3 |
0, 28 days, |
3 years |
|
Typhoid |
>2yrs |
1 |
|
3 years |
|
Typhoid Oral |
>6yrs |
3 |
48 hours |
1 year |
|
Yellow Fever |
>9mths |
1 |
|
10 years |
*Rapid courses are also available
** Pre exposure rabies vaccines usually given from 1 year of age, post exposure given at any age
