Whether a person is travelling abroad for business or pleasure or is going to live in another country, he or she should obtain information about the climate, environment and health risks at their destination (including any stopovers that involve personal contacts with local people). Certain unexpected risks to health in another country can always be present; sometimes hazards to health may be temporary because of a local epidemic or sudden adverse environmental circumstance, such as a drought, earthquake, volcanic eruption, or even civil unrest and terrorism, any of which can cause problems in obtaining supplies of food, clean water and medicine.
Any intending travellers with an existing illness should find out from their doctors whether they are fit to travel; check that the country of destination will admit them; whether they need to make special arrangements to import necessary medication and whether they will be able to obtain appropriate treatment and pay for it.
Healthy travellers are also advised to enquire about health-care arrangements in their destination country in case they fall ill while away. Some countries, such as those in the EU, have reciprocal arrangements with the UK. Those visiting Europe need to have an E111 card, available at no cost from www.gov.uk/european-health-insurance-card. Other countries may pose specific problems, for example the reluctance of some insurance companies to cover what they see as excessive costs in the USA. Travellers should take sensible precautions about drinking water and food, as hygiene standards vary widely throughout the world. Pharmacists are usually helpful with advice on over-the-counter remedies for such problems as travel sickness and traveller's diarrhoea.
Many air travellers, especially those flying long distances, are aware of the risks of developing deep vein thrombosis (DVT), sometimes called ‘economy-class syndrome’. Sitting in a relatively confined position for several hours can cause blood clots to form in the deep veins of the legs: occasionally small clots break away and are carried in the bloodstream to the lungs where they form clots in the circulation called pulmonary emboli (see PULMONARY EMBOLISM; THROMBOSIS) – a potentially dangerous disorder. The risk of developing DVT is greatly reduced by exercising the feet and knees while sitting, by walking around the aircraft when possible, drinking plenty of water but little or no alcohol, and wearing (properly fitting) elastic stockings on the legs. Anyone who has already had a DVT should seek medical advice before travelling by air.
Travel agents have a responsibility to advise their clients about health risks, and the travel trade has access to directories giving up-to-date information on visa requirements, recommended immunisations (see VACCINE; IMMUNISATION), climate, current health hazards and currency allowances. They cannot, however, be expected to give detailed individual advice, especially if the traveller has an existing medical condition.
Travellers returning home who fall ill – even several months later – should always tell their doctor which regions they visited and when, in case their illness originated in another country.
Clinicians who advise travellers, such as GPs, nurses and pharmacists can obtain updated information from the National Travel Health Network & Centre (NaTHNaC) which is commissioned by Public Health England. NaTHNaC's partner organisations include the London School of Health & Tropical Medicine, the Hospital for Tropical Diseases and the Liverpool School of Tropical Medicine, all acknowledged experts in the field.
Individuals can obtain advice from various sources as well as from their NHS general practitioner or pharmacist. For example, NHS England provides information at www.nhs.uk/livewell/travelhealth and NHS Scotland provides a similar service at www.fitfortravel.nhs.uk. Up to date government advice on travel safety as well as health can be accessed country by country at www.gov.uk/foreign-travel-advice.
Depending on the countries to be visited, recommendations might include specific vaccines. Some can be obtained free from the NHS, including cholera, typhoid, hepatitis A (and some combined hepatitis) and diphtheria/pertussis/tetanus vaccines; others, possibly equally or even more necessary, must be purchased by the traveller, for example vaccines for hepatitis B, meningococcal disease, Japanese encephalitis, rabies, tick-borne encephalitis, tuberculosis and yellow fever. Antimalarials, which to be effective should be started in advance of travel, must also be purchased. Private prescriptions may be available from general practitioners or travellers may wish to consult specialist providers such as MASTA, the Medical Advisory Service for Travel Advice (www.masta-travel-health.com) which has a network of travel clinics.