My opinion

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Introduction: International travel can be exciting but poses health challenges peculiar to an individual or country. Travel consultation is advisable before setting off to a new city or country. The steps taken for a safe trip begin with preparations from home to the mode of travel and the travel destination and continue until a safe return home. However, the trip's impact remains with the traveller for years after return in the form of chronic diseases acquired during the sojourn (for example, lime disease) to any traumatic events experienced during travel (as in post-traumatic stress disorder). Conditions in the country of travel, including climatic conditions, common diseases, type of food available and activities during travel are important determinants of the health precautions and care needed. Hiking, horse riding, marathons and swimming all require different precautions. The following health advice applies to most travellers.

Discussion: The 10 Travel Check-list

1. Water: Water is an inevitable need of a traveller. Travellers interact with water in different ways and hence can acquire water-related diseases. Examples of ways travellers can acquire water-related diseases are; Water-borne (Amoebic Dysentery and Cholera), waster-bath (Typoid, yaws and relapsing fever), water-bred (Malaria, Yellow Fever and Trypanosomiasis) and water-based (Schistosomiasis and Dracunculus). These diseases are prevalent in areas of the world without pipe-borne water. Suggested ways to prevent water-related diseases are; brushing teeth and drinking only boiled/bottled water. Avoid ice made from un-boiled tap water. Drink only sealed carbonated beverages, beer, and wine (Pimazoni-Netto & Zanella, 2014). Other ways of preventing these diseases are; avoiding swimming in rivers and stagnant water and staying away from pools of water around living areas.

2. Food: Reduce the risk of gastrointestinal infections by avoiding unpeeled fruits or fruits not peeled by others. Avoid raw vegetables, unpasteurized ("raw") dairy products, raw meat, fish, shellfish and other unfamiliar food. Exercise caution while eating unknown meals because of the danger of diarrhea and allergic diseases.

3. Communicable Diseases: In certain areas, insects (mosquitoes, flies, fleas, bugs, and lice) and arthropods (ticks and mites) can transmit serious diseases like yellow fever and malaria. Avoid bites by using insect repellants, treated mosquito nets, long sleeve shirts and trousers. Reduce time spent outdoors, stay on the last floor of the hotels, and check skin regularly for insect bites. Avoid walking bare-footed; avoid stagnant waters, dogs, cats and pets. Practice safe sex always (HIV and other STIs).

4. Vaccines & Prophylaxis: Some countries have specific diseases that may require vaccination by law, like Yellow Fever which occurs in most tropical areas of the world, and travellers from these areas or returning from these areas must possess proof of vaccination before entering the country of destination. Other vaccines for the safety and convenience of the traveller are also important and can prove invaluable (like Typhoid, Pneumococcal, Meningitis, and Cholera, Hepatitis A). Some diseases require prophylaxis; a good example is malaria (Walldorf et al. 2017). Most common travel diseases have vaccines available in SA; please consult and enquire about all the compulsory and recommended vaccines for the destination country.

5. Medical Insurance: Medical insurance may or may not provide cover at the travel destination- Medical insurance must be engaged before travel if unsure. Travel insurances are also available at most travel agencies.

6. Emergency Medications: Travellers must take some emergency medications during travel; for example, medications for diarrhoea, pain, allergy and vomiting (Bobroff, 2010). Identify the closest health facility on arrival at the destination and write down emergency numbers for the country, including police, fire and ambulance services.

7. Chronic Health Problems: Discuss chronic health problems with a treating doctor before travel. Extra medication or treatment adjustment may be needed. Medications should be in the hand luggage for access and safety. Persons with chronic diseases may require adjustments in treatment and eating habits (e.g. Diabetes) and may be susceptible to new health problems and complications during travel with exposure to new food (Pimazoni-Netto & Zanella, 2014). Generally, stick to known food items and use new products sparingly

8. Medical Problems Associated with Air, Water and Road Travel: The mode of transport may be associated with peculiar health problems. Air travel-related problems include jet lag, motion sickness, ear, lung and sinus barotraumas, leg clots and problems with low oxygen pressure (lung disease and heart attacks) (Das & Suma, 2008). It is advisable to contact the hostess immediately if anyone feels sick during a flight. During road travel, all road safety measures must be taken to avoid accidents and an international driver's license is required to drive in the destination country. Avoid or take care with outdoor activities with the risk of accidents during travel. The activities must consider the driver's age, health status and chronic medication side effects. For a visitor in a new destination, risky activities must be avoided, especially those that may lead to accidents and hospitalization.

9. During Travel: Sit comfortably, loosen tight clothing and take a walk/stretch every 2hrs of flight (Ker & Kerr, 2002). It is important to have chronic medications within reach, as adherence to prescribed medications must continue unless advised otherwise by a health professional.

10. The Returned Traveler: A returned traveller with a flu-like illness, fever, diarrhoea, and headache must consult immediately. Travel diseases may manifest acutely in hours like Barotrauma, Jetlag and Pulmonary embolism (Gorbach, 2010). They can present sub-acutely in days like Malaria, Lyme disease, Babesiosis, hemorrhagic fever and diarrhea diseases. It can also take months or years to manifest, like schistosomiasis and Falciparum Malaria (Mwaiswelo et al., 2020). A returned traveller presenting with fever and diarrhoea must consult and volunteer the travel history so that investigations can focus on the common diseases in the country of travel.

Conclusion: While travelling is a good exercise for families, partners and friends, it is, however, important that all must return in good health. Travel health starts with anticipation and planning for the possible condition at the travel destination, and such planning can only be possible with a clear understanding of the possible health needs of the traveller, epidemiology of common diseases and health peculiarities of the destination of choice; this is the services One Health Travel Center, and other travel clinics offer to all travellers to ensure a safe and enjoyable stay in whichever destination chosen.

References

Bobroff, L.B. (2010) 'Remembering to take your diabetes medications', EDIS, 2010(6). doi:10.32473/edis-fy1206-2010.

Das, K.V. and Suma, T.K. (2008) 'Motion sickness, problems due to air travel and road accidents', Textbook of Medicine, pp. 106–106. doi:10.5005/jp/books/10921_21.

Gorbach, S.L. (2010) 'Diarrhea in a returned traveler from Mexico', Infectious Diseases, pp. 1154–1155. doi:10.1016/b978-0-323-04579-7.00257-4.

Kerr, A. and Kerr, K. (2002) 'Sit-to-stand and sit-to-walk',Physiotherapy, 88(7), p. 437. doi:10.1016/s0031-9406(05)61283-7.

Mwaiswelo, R.O.et al., (2020) 'Sickle cell disease and malaria: Decreased exposure and asplenia can modulate the risk from Plasmodium falciparum', Malaria Journal, 19(1). doi:10.1186/s12936-020-03212-w.

Pimazoni-Netto, A. and Zanella, M.T. (2014) 'Diabetes guidelines may delay timely adjustments during treatment and might contribute to clinical inertia', Diabetes Technology & Therapeutics, 16(11), pp. 768–770. doi:10.1089/dia.2014.0092. 

Walldorf, J.A. et al. (2017) 'Lessons learned from emergency response vaccination efforts for cholera, typhoid, yellow fever, and ebola', Emerging Infectious Diseases, 23(13). doi:10.3201/eid2313.170550. 

'Infestations, insect bites and stings' (2003) Roxburgh's Common Skin Diseases, 17Ed, pp. 66–78. doi:10.1201/b13512-9. 

Source(s) of Funding

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No Funding

Competing Interests

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No Competing Interest