Travelling Healthy

Travel provides a unique human experience that is often difficult to define. It “broadens the mind” because we get to view “awesome sights”, immerse in a different culture, make new friends and sometimes provide community service to the local population. Mark Twain said “travel is fatal to prejudice, bigotry and narrow mindedness”.

It is no wonder that in our city state of 5.18 million persons that a large proportion of our population travel. Overseas departures by Singaporeans had increased from 6.96 million in 2009 to 7.34 million in 2010. There is business travel but we travel for leisure to put “distance between us and our comfort zone” and experience a “different culture and environment”. However, as we all know, not all travel is bliss!

Let us see how to stay healthy during our travels.

To start, obtaining background information on location (urban vs wilderness), type of travel (luxury vs backpacking), activities (multi-city organized group tour vs trekking or diving) and underlying personal health will be important in determining risks to health during your travel.

Good travel advice focuses on prevention and much of it is good common sense.

The following 6 “I” mnemonic is often used for discussion with travellers on healthy habits and preventive measures.

  • Insects: use of insect repellents to prevent bites as insects can transmit a variety of infections including dengue, Chikungunya, malaria, yellow fever, Japanese encephalitis, Ross River virus etc. Less common travel infections transmitted by vectors are Typhus, Leishmaniasis and Lyme disease.
  • Ingestion: extra care should be taken on what is ingested (fluids and food). A wide range of infections including viruses (Norwalk, Hepatitis A and E), bacteria (cholera, Shigella, Salmonella) and parasites (amoeba, Giardia) are transmitted through contaminated water and food.
  • Indiscretion: activities that increase risk of sexually transmitted infections and HIV infection.
  • Injuries: Physical injuries form a significant part of problems associated with travel. Knowing the political and security situation of the visited country, understanding traffic conditions and general avoidance of potential difficult situations are important to ensuring safe travel.
  • Immersion: swimming in rivers, lakes and sea can expose you to infections such as leptospirosis, schistosomiasis and other problems such as jellyfish stings and bites by sea snakes.
  • Insurance: Travel insurance should be considered when travel is prolonged and/or to developing countries. In an article published in 2005 on Australian residents who had travel insurance, Leggert et al reported that out of 100,000 travelers, 8000 made an insurance claim (8%); 2000 used emergency assistance (2%); 400 had overseas emergency room or clinic visits (0.4%); 200 were hospitalized (0.2%) and 50 needed aeromedical evacuation (0.05%). So do not underestimate the need for travel insurance!

The 7th “I” of travel advice focuses on the dreaded “infection”. Besides personal preventive measures as listed above, vaccinations against travel related infections are often recommended.

Briefly, vaccinations can be divided into the 3 “R”

  • Routine: these include annual influenza vaccinations for the at risk populations, update of vaccinations such as 10 yearly tetanus/diphtheria/pertussis etc.
  • Required: there are 3 that are required for travel to selected countries such as yellow fever vaccine to South America / subSaharan Africa and influenza with meningococcal vaccines for Haj travel (and certain universities for study travel).
  • Recommended: these vaccinations are recommended depending on the type of travel and assessment of risks. The recommendation of this category of vaccines may be “always”, “often” or “sometimes”.

Packing Medication for travel

For those with underlying medical conditions, having sufficient medication for your travel cannot be overemphasized.

For those travelling more than a week with children, it is recommended to prepare simple medications for fever, respiratory and gastrointestinal illness.

For those travelling to developing countries for more than a week, it is recommended to bring along medication for fever, respiratory illnesses and diarrhoea. In selected instances, your physician may advise you to bring along prescription medication for self administration in the event of severe diarrhoea or febrile illnesses.

Your physician can also advise you on “prophylactic (preventive) medication” against malaria, altitude sickness etc.
With the year end holiday season coming up, we hope that this simple primer will be helpful.

We hope that this simple primer will be helpful and wish everyone healthy travels!