Occupational Health

Travel Advice for International Travellers

Don't let your holiday or travel be affected by sickness acquired while away or on return. For all travellers (regardless of destination) the following are sensible precautionary recommendations:

Handwashing

If hands aren't clean they can spread bacteria and viruses. But a quick rinse won't make sure they're really clean. So it's important for you to know how to wash your hands properly. You should spend at least 20 seconds washing your hands to ensure they are clean. More information on handwashing.

Eating and drinking

Only eat food that has been cooked all the way through or fruits and vegetables that have been washed and peeled. Remember: boil it, cook it, peel it, or don't eat it.

Only drink water or other drinks from sources you trust. In some countries tap water (which may also be used for ice) is not recommended for consumption and bottled or boiled water is recommended.

Vaccinations

Ensure you and your family are up to date with routine vaccination schedule including MMR (measles, mumps and rubella). More specific advice on travel vaccinations, depending on your destination, can be obtained from your GP or local travel health clinic.

In May 2014, the European Centre for Disease Prevention and Control (ECDC) issued temporary recommendations to EU travellers to polio-infected countries, upon request from the European Commission. These recommendations are based on the temporary recommendations from the World Health Organisation (WHO) who recently declared a Public Health Emergency of International Concern on polio.

Travellers from the EU who are fully vaccinated against polio according to the national immunisation schedule where they live and plan to travel to any of the 10 polio-infected countries should receive an additional dose of IPV. In order to comply with the WHO recommendations and avoid having to be vaccinated in the polio-infected country, it is important that travellers to polio-infected countries time this additional IPV dose so that it is given within 12 months of the date when they plan to leave the polio-infected country.

Avoidance of insect bites

Depending on what part of the world you are in, mosquitoes can spread malaria, yellow fever,dengue, Japanese B encephalitis, and West Nile virus, in addition to other infections (see here on measures to take to protect yourself against mosquito bites). Sandflies spread leishmaniasis and tsetse flies spread sleeping sickness. Ticks can spread Lyme disease, as well as other infections.

If you are at risk of biting insects (e.g. mosquitoes, ticks, sandflies) remember to cover up exposed skin areas (with loose clothes) use an insect repellent, and avoid unnecessary exposures if possible.

Many travellers are familiar with the most common biting insect - mosquitoes. Mosquitos can bite at any time of day; mosquitoes that carry dengue, chikungunya tend to bite during daylight hours. Those that carry malaria tend to bite either at dawn or dusk or during the night.

Tips on how to avoid mosquito bites:

Time: Take particular care at times of day when mosquitoes are most likely to bite - check locally to see when are the danger times. tropical mosquitoes bite all year round; temperate mosquitoes tend to bite between April and October.
Risky Areas: Avoid areas where mosquitoes are likely to be found, i.e. near water including ponds, outdoor swimming pools, lakes and marshes.
Use Mosquito Repellents: Spray onto exposed skin whenever you are in an area where mosquitoes may be present. See here if you are pregnant.
Dress Safely: If in areas where mosquitoes are likely, wear long sleeves, long trousers, socks and closed shoes to minimise skin exposure.
Indoors: mosquito bites can be reduced by air conditioning, insect-proof screens on windows and doors and spraying the room with insecticide.
Mosquito Nets: Bed nets and cot nets treated with insect repellent containing DEET or permethrin can be used if necessary.
Day Biting: Some day-biting mosquitoes also transmit infections, so reducing bites at any time is a sensible precaution.

Taking these simple measures will also help to protect yourself and your family against mosquito-borne diseases, which are may be encountered while travelling to destinations outside of Ireland.

Other behaviours that might put you at risk:

Casual sex. Condoms provide some protection, but not complete.
Injection drug use. Never share needles or equipment.
Other exposures such as ear piercing, tattooing, acupuncture, manicure and shaving with open razors should be avoided unless you are absolutely certain that the equipment being used is sterile.

Traveller's Diarrhoea

Traveller's diarrhoea (TD) is one of the commonest complaints in people travelling abroad, with as many as half of travellers being affected. It is caused by consumption of food or water contaminated by human faeces. Particularly risky foods include raw or undercooked meat, poultry, seafood, raw fruits and vegetables. The primary pathogens responsible for TD include E. Coli, Salmonella, Campylobacter, Shigella, Rotavirus and Giardia. Viruses are another common cause. TD is a self-limiting condition and symptoms generally resolve within 3 to 5 days. If diarrhoea continues longer than two weeks this suggests that the underlying cause is parasitic.

It is important to eat food that is fully cooked. Any fruit and vegetables should be peeled before eating.

Much of the time, the greatest risk comes from local water. When travelling to another country, particularly a poorer or less developed country remember that the treatment of water to make it safe to drink may well be a lot less that we are used to at home and in many instances water may not have been treated at all. Tap water therefore should avoided where possible. This means not drinking water from bathroom or bar taps in hotels and lodging houses, using bottled water to brush teeth and ensuring that you pay particular attention to children and elderly people. Safe drinks include bottled carbonated drinks (such as sodas), beer, wine, hot coffee or tea, or water boiled and appropriately treated with iodine tablets.

Since certain parts of the world are associated with particular diseases. More specific travel advice, including vaccinations, and other preventive measures, can be obtained from your GP or your local travel clinic.

Where can I get more information on this subject?

The Department of Foreign Affairs and Trade website provides excellent international travel advice.
The WHO's International Travel and Health section provides information on health risks for travellers.
The UK's National Travel Health Network and Centre (NaTHNaC) provides travel health information and is run by the Health Protection Agency.
The US Centers for Disease Control and Prevention (CDC) provides a portal on travellers health advice and updates on disease activity across the world.
The EUROPA portal site of the European Union provides excellent and simple advice for travellers in Europe.

Travel Vaccines

Vaccination can protect you against becoming infected with a range of serious diseases, such as cholera, yellow fever and tick-borne encephalitis.

In Ireland, there is a childhood vaccination programme that protects against a number of diseases, including tetanus, diphtheria and polio. However, this does not cover most of the infectious disease that are found overseas.

For specific travel advice, including vaccinations and malaria prophylaxis you should contact your GP, practice nurse or travel clinic.

International travel and health is a WHO publication is a reference book for doctors and nurses, giving health advice. Available at http://www.who.int/ith/en/

Travel abroad

As foreign travel increases to more far-flung places, more Irish travellers than ever need vaccinations. For example

Travel to tropical and sub-tropical destinations is becoming more popular. Dangerous diseases are more likely to be in these areas.
Longer holidays abroad, such as gap year trips, are becoming more common. This leads to greater exposure to the diseases that are found in the country, or countries, that are visited.
Holidays involving overseas travel to rural areas, where standards of hygiene and sanitation may be lower, are now more common. Medical treatment may also be more difficult to find in rural areas.

Some countries require anyone wishing to enter to have an International Certificate of Vaccination or Prophylaxis (ICVP). For example, Saudi Arabia requires proof of vaccination against certain types of meningitis for visitors arriving for the Hajj and Umrah pilgrimages (religious journeys).

Many tropical countries in Africa and South America will not accept travellers from an area where there is yellow fever, unless they can prove that they have been vaccinated against it.

Book an appointment to discuss your travel health requirements as soon as you have booked your holiday. Some vaccines are given as a course of injections, so allow plenty of time. Tel: 045528088

Malaria Prophylaxis

The risk of malaria for people travelling to affected areas is significant, so it is important to take precautions to prevent it. Most of the malaria imported to the UK is caused by plasmodium falciparum and is acquired in Africa.

Many cases of malaria can be prevented by the ABCD approach:

Awareness of risk: know your risk of malaria.
Bite prevention: avoid bites as much as possible.
Chemoprophylaxis: take the right antimalarial tablets.
Diagnosis: get immediate medical help for symptoms.

Awareness of the risks

You can check whether you need to take preventative malaria treatment for the country that you are visiting by looking at thetmb.ie or travelhealth.ie websites.

Visit your GP or local travel clinic for advice on malaria and other health risks as soon as you know that you are going to be travelling.

Bite avoidance

While you will not be able to avoid bites completely, the less you and your family are bitten, the less likely you are to catch malaria. Below are a number of things you can do to help prevent being bitten by mosquitoes:

Ideally, stay somewhere with effective air conditioning and screening on doors and windows. If this is not possible, try to stay somewhere with doors and windows that close.
If you are not sleeping in an air-conditioned room or if the air-conditioning is not effective, you must sleep under an intact mosquito net that has been treated with insecticide.
Use insect repellent on your skin and in sleeping environments. Remember to reapply frequently.
The most effective repellents contain diethyltoluamide (DEET) and are available in sprays, roll-ons, sticks and creams.
Wear light, loose-fitting trousers, rather than shorts, and shirts that have long sleeves. This is particularly important during early evening and at night, as this is the mosquito's preferred feeding time.

Garlic, vitamin B and ultrasound devices do not prevent bites.

Chemoprophylaxis: taking appropriate antimalarial tablets

Taking medicine to prevent catching malaria is essential for all travellers who are visiting areas with malaria. However, antimalarials are not 100% effective, so avoiding bites is also important.

Taking antimalarial medicine:

Make sure you get the right antimalarial tablets before you go.
You will have to pay for your antimalarials, so include the cost in your trip budget.
Follow the instructions included with your tablets carefully.
It is important that you continue to take your tablets after you return from your trip. This is to cover the incubation period of the disease.
Most tablets need to be taken for four weeks after you return, although atovaquone plus proguanil (Malarone) needs to be taken for only one week.

Talk to your doctor to make sure that you are prescribed a drug you can tolerate. You may be more at risk from side effects if you have:

AIDS/HIV
epilepsy or any type of seizure
depression
heart problems
liver or kidney disease
porphyria (an inherited condition that causes sensitivity to sunlight)
psoriasis
psychiatric problems

You may also be more at risk from side effects if:

your spleen has been removed or does not work properly
you take medicine (such as warfarin) to prevent blood clots
you are a woman using combined hormonal contraception, such as the pill or patches

If you have taken antimalarial medicine in the past, do not assume that it is suitable for future trips. The medicine you need to take depends on the strain of malaria carried by the mosquitoes and drug resistance in the region that you are travelling to.

Diagnosis: get prompt medical advice

f you become ill when you get back from travelling, even if you took the right malaria prevention tablets, you must see your GP or a hospital doctor straight away.

Tell the doctor that you have been exposed to malaria. It is important that you tell them which countries you have travelled to in the last 12 months, including brief stopovers.

Malaria can develop very quickly, so it is important to get medical advice, diagnosis and treatment as soon as possible if you think you may have malaria.