By Dr. Yvette Lu.
We’re into the second month of winter, and a lot of people are talking about escaping to sunny climates. When planning a trip or holiday, it’s important to take health considerations into account and to plan for any infections that you might be exposed to on your journey.
In the video and my detailed article below, I discuss some of the diseases you may encounter while travelling and how to protect against them.
— Yvette Lu (@yvettelu) January 17, 2017
Travelling exposes us to new places and new experiences, but along with that may come exposure to diseases and infections that are not present in our home country. With some basic precautions and forethought, we can reduce our risk of contracting travel-related illnesses. Especially when going to tropical areas, it is important to find out if there are any vaccinations that you need to get prior to the trip or any medications that you should be bringing with you. You want to start this process as soon as you start planning your trip. Many vaccines require time to take effect, so you want to talk to your doctor or go to a travel clinic at least 6-8 weeks before your trip.
You want to start by making sure you have all your basic vaccinations, including vaccinations against tetanus and diphtheria (booster required every ten years), measles, mumps, rubella, polio, and pertussis; the yearly influenza vaccine; the HPV vaccine for young women and men; and the pneumonia vaccine for people over the age of 65. Other optional basic vaccines include the chicken pox or shingles vaccines, meningitis vaccines, and hepatitis A/B vaccines.
The Hepatitis A and B vaccines are frequently recommended to people who travel, and also to everyone as basic vaccinations, even if they are not travelling. The Hepatitis B vaccine is covered in British Columbia for children and people at high risk. The Hepatitis A vaccine is covered for people at high risk. Hepatitis is an infection of the liver that can cause liver failure, and in the case of Hepatitis B, chronic liver disease and cancer. Hepatitis A and B are transmitted by blood and body fluid contact, and Hepatitis A can also be transmitted by contaminated food and water. If you’re traveling to a country where these diseases are more common, it’s important to get these vaccinations.
When travelling, it’s important to look at what country you’re visiting, which area of the country you’re visiting, and what kinds of activities you will be doing. People visiting rural areas and families will often have different recommendations from people staying in large cities or resort areas. The CDC website is an excellent resource. You can look up the health and vaccination recommendations based on the country that you’re visiting.
Most of the countries in warm areas, Mexico, the Caribbean, South America, Africa, Asia, and particularly less developed countries tend to have more vaccination recommendations. Immunizations that may be recommended include vaccines against Typhoid, Yellow Fever, Cholera, and Meningitis.
If you plan to do adventure travel and will be spending time in nature, doing caving or other activities where you may be in contact with wild animals, or if you’re staying in more rural areas, or will be working with animals, then you want to consider getting the Rabies vaccination and if you’re going to Asia, the Japanese Encephalitis vaccination.
The other major consideration is exposure to mosquito-borne illnesses. We’ve already mentioned two viral infections that are spread by mosquitoes – Yellow Fever and Japanese Encephalitis. Another important mosquito-borne illness is Malaria.
Malaria prevention is very important if you are traveling to an area where malaria is common. Malaria is a serious illness caused by a parasite. It lives in blood cells and can cause serious illness that can lead to complications and death. If you’ve come back from a country that has malaria and have a flu-like illness that is not going away, it’s important to be checked for malaria.
Malaria is found in warmer climates such as Central and South America, Africa, and Asia. Your risk level is determined by where in the country you will be travelling, Tourist areas, large cities, and higher elevations tend to have less mosquitoes, so the risk is lower. Fortunately, malaria is preventable by taking medications, so it’s important to talk to your doctor beforehand and to find out if these are necessary.
Three other mosquito borne illnesses are Chikungunya, Dengue, West Nile Virus and Zika. These viruses are all transmitted by mosquitoes and the only way to prevent them is to avoid mosquito bites. It’s important to find out how common these viruses are in the locations that you will be travelling, so you can prepare and bring mosquito repellent, mosquito netting, and long sleeved clothing. Staying indoors at the times of day when mosquitoes are most active is also helpful.
The Zika Virus is a mosquito-borne virus that is known to cause birth defects. Women who are pregnant are recommended to avoid travel to Zika-affected areas. If a woman is thinking of getting pregnant, she should wait at least 8 weeks after travel to a Zika-affected area before trying to conceive.
Zika can also be transmitted via sexual activity and men can continue to transmit the virus for six months after a Zika infection. Couples wanting to have a baby should wait six months after travel to a Zika-affected area before trying to conceive.
Because you can have a Zika infection that is asymptomatic, it is important to follow the waiting period guidelines even if you haven’t had symptoms of an infection during or after your trip.
For women who are already pregnant, they should avoid sexual contact for 6 months if their partner has been in a Zika-affected area. Proper condom use may also be protective if used consistently and correctly for all forms of sexual contact.
For people who aren’t pregnant or wanting to conceive in the near future, Zika is usually a mild illness. There’s a small chance of a neurologic disease that can cause paralysis called Guillain-Barre Syndrome, but it seems to be infrequent. For this reason, and also due to the other mosquito-borne diseases that you can encounter, it’s important to prevent against mosquito bites. Like with malaria and other mosquito borne illnesses, your risk level will be determined by where in a country you are travelling and whether or not there are infected mosquitoes there.
Traveller’s Diarrhea prevention
Traveller’s Diarrhea is another common infection that can be acquired through travel. It’s usually acquired through food and water, so it’s important to take proper precautions like washing hands, only eating food that is well cooked and served hot, avoiding raw/undercooked food, peeling or cooking fruits/vegetables, avoiding food from street vendors, drinking water only if it has been boiled/disinfected or if it is in a commercially sealed bottle, brushing your teeth using purified or bottled water, and avoiding unpasteurized dairy products/fruit juices.
There is an oral vaccine available for traveller’s diarrhea. How useful and effective it is will depend on where you are travelling. Talk to your doctor about whether or not it would be appropriate. Another strategy is to bring a short course of antibiotics. Mild cases of traveller’s diarrhea can be treated with rehydration and symptom management with over-the-counter medications. More serious cases with fever and bloody diarrhea would benefit from antibiotic management and/or a visit to a doctor.
Other travel recommendations
- Check the Health Canada and CDC websites for travel alerts before you go.
- Prepare a travel health kit with basic medications and first aid supplies. These might not be readily available at your destination. I reviewed travel first aid kits in a previous article.
- Consider buying travel insurance.
- Consider registering your trip with the Registration of Canadians Abroad service – a free service that allows the Government of Canada to notify you in case of an emergency abroad or a personal emergency at home. It also allows the traveller to receive information before or during a natural disaster or civil unrest. Americans have a similar service called the Smart Traveler Enrollment Program.
And most importantly, have a great trip!