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Many more people are travelling internationally and excursions to distant countries offer a wealth of new experiences. However, travelling can be problematic – especially when illness strikes. Nevertheless, careful planning will help minimise the potential risks that may arise either en route or while at the holiday destination.
Prior to travel
Here are some precautions patients should think about taking before they embark on their travels:
Vaccinations offer protection against a wide range of illnesses that might be encountered in different parts of the world and are normally administered a few weeks before travel. Though the specific vaccines required for different countries can be found online,1 it is advisable to vaccinate against hepatitis A, which can be acquired from eating and drinking, as well as hepatitis B, which can be transmitted from infected individuals.
Malaria is an endemic disease in the tropical and sub-tropical regions of the world that kills millions of people every year. It is caused by the parasite plasmodium and transmitted through mosquito bites. Though malaria does not occur naturally in the UK, figures show that there were 1,400 cases in 2015, most of which were due to those who had travelled abroad2 and had not taken malaria prophylaxis.
The most recent guidance from Public Health England emphasises that malaria prophylaxis involves a combination of measures including awareness of the risk, bite prevention measures, chemoprophylaxis and prompt diagnosis where the disease is suspected.3 Advice on the specific regimes to use in different countries is detailed in the British National Formulary.
Travelling related health problems
Deep vein thrombosis
Traveling for any length of time invariably results in long periods of immobility that can increase the risk of a deep vein thrombosis (DVT), which is a partial or even complete blockage of a vein due to a blood clot. Prolonged episodes of immobility slow blood flow through the veins, leading to blood pooling and coagulation, increasing the likelihood of clot formation. A pulmonary embolism is a serious and life-threatening complication of a DVT that occurs when a part of the clog breaks and travels to the lungs.
Risk factors for a DVT include increasing age (over 60 years), pregnancy, obesity, use of oral contraceptives and a history of a DVT. Fortunately for healthy individuals, the risk of a DVT is very low and for a flight longer than four hours, the risk is estimated to be 1 in 6,000.4 The risk of a DVT can be reduced by regularly walking during travelling. Flexing and extending the ankles encourages blood flow from the lower legs.
The risk of a DVT can be minimised if people wear loose fitting, comfortable clothing, walk around as much as possible and maintain adequate hydration. Many travellers now wear compression stockings for flights, which are thought to work by exerting a graduated pressure on the leg (which is greatest at the ankle) and when combined with movement, helps displace blood from the superficial to deep venous system.
There is good evidence that using compression stockings can reduce the incidence of an asymptomatic DVT by as much as 90%.5 Compression class 1 should be sufficient for flights and this will also reduce leg oedema – though it is important that are stocking are measured to ensure that the correct size is used.
This is a common problem especially among children but it can also affect adults. The constant movement during travel, whether in rough seas or as a car or bus travels around corners or over bumps in the road, causes the brain to receive conflicting information from the inner ears (which detect motion) and the eyes, leading to nausea, sweating, feeling cold and paleness.
General advice to help reduce motion sickness includes sitting in the front seat of a car, over the wings of a plane and in the middle of a boat. It is also advisable not to read or watch a film and to try, wherever possible, to avoid heavy meals or alcohol.
There are a range of potential treatments for motion sickness from a pharmacy including hyoscine (Kwells®, Joy Rides®), which is considered to be the most effective, and various anti-histamines such as promethazine (which is useful for children) and cinnarizine and cyclizine that can be taken by adults.
Author: Rod Tucker