Jane Chiodini's audio transcript

• Before you travel
• During your travels
• After your travels

Hello. My name's Jane Chiodini, and I'm a travel health specialist nurse. I teach doctors and nurses around the country on travel health, and I also work part-time in a doctor's surgery, where I see travellers within a travel clinic. I was Chair of the Royal College of Nursing Travel Health Forum between the years 2000 and 2006.

Before you travel

Travelling abroad brings many pleasures, but it's wise to be aware of the risks to your health, and I hope in this podcast I'll be able to give you some handy tips and advice, so that you're adequately prepared when you go.

It's essential to make an appointment for travel health advice well in advance of your departure date - I'd say at least eight weeks before you travel, if possible. Sometimes you may need a course of vaccines which may take several weeks to complete to ensure you have adequate protection, and also GPs' surgeries in particular are very busy, and won't have available appointment times for this routine type of care at the very last minute. When you visit for your appointment, we can provide a great deal of useful and practical advice to help you remain well when you're abroad.

Commonly, road traffic accidents and swimming and water accidents are major leading causes of death among travellers abroad. Sensible precautions include avoiding alcohol and food before swimming. Don't dive into water where the depth is uncertain. Only swim in water that's safe. Check the currents and presence of things like sharks and jellyfish. Never drink and drive. If you're hiring a vehicle, avoid motor cycles and mopeds, and select larger cars that are well-maintained. Use reliable taxi firms and know where emergency facilities are.

Diseases such as hepatitis A, typhoid and travellers' diarrhoea are all contracted through ingesting food and drinks that have been contaminated by these harmful organisms.

Travellers' diarrhoea is the most common of the infections you're likely to experience. It's not actually life-threatening, but you can be in bed for several days, and when a holiday has cost you a large amount of money, it's a high cost to pay.

So the basic advice is, unless you know the water supply is safe where you're staying, use only boiled or bottled water, or water treated with sterilising agents. This includes ice cubes in your drinks and water for cleaning your teeth. Only eat well-cooked fresh food. Avoid leftovers and reheated foods. Ensure meat is thoroughly cooked. Eat cooked vegetables. Avoid salads, unless you know the type of water they've been washed in. Only eat fruit that you can peel. Never drink unpasteurised milk.

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During your travels

There are some vaccines which you can have to prevent some of the common travel-related diseases. These would include hepatitis A. Now this is a highly infectious virus which attacks your liver, and sometimes it can make you jaundiced. Signs of this would be yellow eye-balls and itchy yellow-tinged skin. It can make you very tired and lethargic, and in some cases it can put you off work for up to six months.

Typhoid is a bacterial infection within your whole body, which can develop and be far more serious than hepatitis A, although it's less common and infectious. If untreated, though, sometimes severe complications can lead to bleeding in your intestines, and even perforation of the bowel, which could result in death.

Hepatitis B is a virus which can attack your liver, but sometimes you don't have any symptoms, so you can be unaware that you've got the virus. If you have the infection for longer than six months, you can go on to have a chronic infection, which in some circumstances leads to more serious medical problems, like cirrhosis or, worse, cancer of the liver. This virus is contracted through contaminated blood and bodily fluids.

Diseases such as hepatitis B and HIV infection can be serious, and can be transmitted by medical procedures performed on you using unclean equipment, inadequately screened blood transfusions, sharing of needles and unprotected sexual contact. So you can protect yourself by taking a sterile medical kit, if travelling to a resource-poor country, avoiding ear and body piercing, tattooing and acupunctures when you're away, avoiding sharing of needles, especially for intravenous drug uses, avoiding blood transfusions, unless they're absolutely essential, and avoiding casual sex, especially unprotected without using condoms.

Rabies is present in many parts of the world. If a person develops rabies, death is almost 100% certain. There are three rules regarding rabies: don't touch any animal, even dogs or cats. If you're licked on broken skin, scratched or bitten by an animal in a country which has rabies, wash that wound thoroughly with soap and running water for five minutes at least. Then apply an antiseptic solution, if possible. You must seek medical advice immediately, even if you've previously had some rabies vaccine.

The mosquito is responsible for transmitting many diseases, such as dengue fever, yellow fever, Japanese B encephalitis, but malaria is the most serious of these tropical diseases. The malaria parasite enters your body when the mosquito bites you, and the parasites first of all go to your liver, where they will stay for many days, and where they multiply over and over again. At this stage you have no idea you have malaria, as you have no symptoms. The parasites then come out of the liver and invade your red blood cells, and multiply again. After two or three days they will burst out of the red cells, and this is often when you get the symptoms of malaria: shivering, sweats and fever, muscle pain and tenderness, headache, and sometimes diarrhoea and a cough. There are four species of malaria, and one of them, called Plasmodium falciparum, is extremely dangerous. It is possible to die from this type within 24 hours of developing the symptoms of malaria. Each year in the United Kingdom, we see up to 2,000 cases of malaria in people who have returned from tropical areas with the disease, and we see on average nine deaths per year. None of these deaths needed to happen. They usually occur because people have not taken the correct precautions. People living in the United Kingdom will not have any protection against the malaria parasite, and indeed, people who used to live in a malarious country but have left there will also not have protection against the disease, as you quickly start to lose your natural immunity within a matter of months after leaving a malarious zone.

So when we advise travellers within a consultation, we focus on malaria advice, with an A, B, C, D approach. A is for awareness, understanding the risk and seriousness of the disease. B is for bite prevention, because you significantly reduce your risk of malaria if you minimise the potential to get bitten.

C is for the drugs we refer to as chemoprophylaxis. Making sure that the most appropriate drug is selected, and that the course of tablets is always finished - this is absolutely essential. And D is for diagnosis: understanding the symptoms of malaria and knowing to seek medical help immediately. In the medical profession we regard this as a medical emergency.

When you come to see us for travel advice, it's really helpful to know exactly where you're going. This is because the severity of malaria can vary within just one country. Or alternatively, if you're travelling to a number of countries, where the risk of malaria varies, we can advise you where you need to take malaria tablets, and where it might not be necessary, so that you don't have to end up on medication for the entire trip.

Some of the malaria drugs for prevention have been around for a long time, and as a result, some of the parasites have become resistant to these drugs in certain parts of the world. This is particularly important in Africa, and so there are stronger drugs that we would recommend as a first-line choice. It's really important that you discuss these options with your healthcare professional, to find the drug that is most suitable for you.

People sometimes are concerned about the side effects of antimalarial tablets. This is important to discuss with your healthcare professional, but please do remember that malaria is such a serious disease and it can easily kill you, and it's much better to put up with a few side effects than it is to die from malaria.

Many people look for different options to prevent malaria. There are myths around the use of vitamin B12, garlic capsules, savoury yeast extract spread, like Marmite®, being useful against mosquito bites. There is no scientific evidence that any of these products are effective, so we would always advise you to adopt the recommended products to provide protection. Similarly, electronic buzzers that emit high-frequency sound waves are completely ineffective as mosquito repellents, and companies have been prosecuted and fined under the UK Trades Descriptions Act. Guidance for malaria prevention is issued by an advisory board of malaria experts from the Health Protection Agency in the United Kingdom, and they also strongly advise against herbal and homeopathic remedies for the prevention of malaria.

When we come to talk about malaria prevention, it's very advisable to follow certain precautions. Avoid going out during the times when the mosquitoes are likely to bite. That's mainly between dusk and dawn. And if you have to go out, cover up your skin as much as you possibly can. Wear clothing that goes down to your wrists and your ankles, loose clothing: it all helps to avoid the mosquito biting you. You can use insect repellents, and the ones recommended by the Advisory Committee for Malaria Prevention are Deet-based products. Deet stands for diethyl toluamide. They recommend Deet-based products up to 50% content, for anyone from two months of age.

Insect repellents should be applied to exposed skin, and it's a good idea to apply them very frequently, particularly if you're in a hot and humid climate, because you'll sweat off the repellent more frequently. If you're using sun-blocks, make sure that you put your repellent on top of the sun-bloc, and if you go swimming, then re-apply the repellent after you come out of the water.

It's really important to sleep under an impregnated mosquito net. This is one that's treated with a drug called Permethrin. It means that as a mosquito comes near the net, it gets veered away or possibly even killed, and so it can't come up to you and bite you. Mosquito nets can be bought, impregnated, and they will only start to work from the time that you open them and use them. They should actually be re-treated, re-impregnated with Permethrin, about every six months. It depends very much on how much you use them, and whether you wash them in the meantime. Mosquitoes don't actually discriminate, they will bite anyone, even if you are staying in a five-star hotel, so taking adequate bite-prevention advice is vitally important.

When you're at your destination, you've started to relax and enjoy your holiday, just remember to be vigilant about your bite-prevention precautions, and keep on taking those malaria tablets. Very often people do become complacent, and they stop taking those measures, but it is important to stick to them.

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After your travels

When people come back from their holiday, and they're back into work, and they're feeling fine, they often decide there's no need to carry on with their malaria tablets. It is absolutely essential to complete the course of malaria tablets, to help prevent malaria breaking through.

Remember, malaria presents like a 'flu-like illness. Don't be confused by this. If you get the symptoms, it's essential that you go to your GP's surgery and say that you have been abroad. You will need a test for malaria.

This will enable a speedy diagnosis and could potentially save your life. Look out for the symptoms of malaria, particularly in the first three months, but up to a year after your trip, and make sure that you visit the doctor's surgery and let them know that you've been to a malarious zone.

I hope you've found this information helpful. For further details, visit www.malariahotspots.co.uk, which has links to other useful sites, such as Fit for Travel and NaTHNaC. Travelling can be a wonderful experience, and you will hopefully have a safe and healthy trip, if you follow this simple advice. I've been Jane Chiodini, have a great time, and thanks for listening. This podcast has been sponsored by GlaxoSmithKline Travel Health.