Health June 2013

Planning a Trip to Paradise?

Take shots and common sense

  • Even top spots can have health hazards
  • Hepatitis, malaria, tetanus, diarrhoea
  • Avoid tap water, ice and fresh salads
  • Warning: deep vein thrombosis and driving
  • Check health insurance has overseas cover

Summer is on its way and it’s time to make holiday plans. One of the many benefits of living in Japan is the opportunity it gives to explore South-east Asian countries without having to endure long-haul flights and jet lag. However, there are health hazards.

Patients who talk to me about their holidays often say they don’t need any vaccinations as they will be staying in a five-star hotel. Wrong. You can pick up contagious diseases anywhere, including in the most up-market establishments.

My colleagues and I have all seen patients who, even though they stayed in South-east Asia’s most luxurious resorts, contracted hepatitis A—a condition that could have been prevented by proper immunisation.

So what vaccinations will you need? Travellers should update their routine vaccinations (such as tetanus) and obtain vaccinations specific to their planned destination prior to travelling.

It is important to consult your doctor at least one month before you set off to allow enough time for any necessary immunisations to take effect. Many clinics in Tokyo don’t stock travel vaccines, so call and check whether the injections you need are available.

While vaccinations prevent certain infections, there are some serious ones that can be transmitted by insects and for which no vaccinations are available. A notable example is malaria, which is transmitted by infected mosquitoes.

Anti-malaria medications are essential for those visiting certain areas in Asia. Many people worry about the side effects of anti-malaria tablets, and so decide against taking them.

However, the medications are generally well tolerated and the inconvenience of any minor side effects should be weighed against the potential serious consequences of becoming infected with malaria.

The more information you give your doctor about your travel plans, the more accurate will be the advice you are given. Thus, for example, even if you visit only one country, it may be advisable to obtain anti-malaria medication if you go to certain regions, while travel to other parts may place you in no significant danger of contracting malaria.

That said, simple precautions to avoid mosquito bites should be taken even where the risk of malaria infection is low to minimal. Wearing trousers and long-sleeved shirts, as well as using repellents containing DEET are recommended.

Some 40–60% of travellers who visit developing countries will suffer from diarrhoea. Although most episodes are minor and self-limiting, they can still cause significant discomfort and disrupt one’s itinerary.

Contaminated food and water are the culprits, so it is best to avoid tap water, ice cubes and fresh salads (the ingredients of which probably will have been washed using tap water).

In addition, you should avoid food from street stalls and sauces, such as ketchup, on restaurant tables. It is best only to eat fruit that you peel yourself.

If, despite all precautions, you nevertheless get a bout of diarrhoea, rest assured that in most cases it should be over in 1–5 days.

During this time, it is most important to stay well hydrated. However, if symptoms are severe, antibiotics and anti-diarrhoea medications are available.

For travellers visiting remote areas, ask your doctor to prescribe these medications, so that you can use them if necessary.

Besides infections, travel itself can cause medical problems, notably deep vein thrombosis. Although this condition is usually associated with the relative immobilisation endured on long-distance flights—hence the term “economy-class syndrome”—it can occur as a result of prolonged car or train journeys.

One should drink lots of water and move around periodically. Routine use of aspirin is not recommended.

In addition, make sure that in your carry-on luggage you have an adequate supply of any medication that you take on a routine basis.

Remember, too, that the incidence of car and motorbike accidents is higher in developing countries, where they account for about 25% of the deaths of American travellers.

Take time to familiarise yourself with local conditions before driving, and always wear a helmet when on a motorbike.

Lastly, before you jump on the plane, make sure that your health insurance provides cover overseas. If you are planning any high-risk activities, additional insurance is advisable. Enjoy!

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