As a qualified nurse I get asked tons of travel health related questions every day. Some of these questions are very specific to the individual and based on personal medical histories so cannot be answered in a general way, but a great many of them are very common and get asked on a frequent basis. So in the interests of sharing information and helping as many people as possible, this article is devoted to answering just ten of your most common travel health questions.
So let’s get started.
Do I really need travel insurance?
Short answer? Yes.
This isn’t strictly a travel health question, but it gets asked so frequently that it makes the cut. Let’s face it, no one likes handing over their hard earned cash for insurance, I’m one of them. But I do it because it is essential.
There is no need to get into scare stories of how dangerous a gap year is because that is ridiculous. In general the majority of people travel the world and come home safe and sound. But the fact remains that no matter how small, there is still a risk that something may happen to you.
People do get sick, and they do have accidents. These are universal constants whether you are at home or whether you are travelling.
The difference is when you are travelling you won’t have the same safety nets you do at home. You won’t have your family or friends to turn to for help, you won’t have the safety net of the NHS, local health care or your personal local health insurance (unless of course it includes a travel policy). You will have to fend for yourself, and when you are stuck needing any type of emergency treatment and no way to pay then that fact really hits home hard. This is where travel insurance becomes essential.
If you need any type of health care or treatment abroad, then in the majority of countries you will be expected to pay for it. If you just need to see a pharmacist about buying some painkillers or an antihistamine then you can generally swallow the cost of that yourself. If however you need more serious treatment, if you fall of that rented moped, crack your head open when tubing or have an accident on one of those awesome adventure activities you decided to go on, then things can get really expensive, really quickly. Even routine procedures in a foreign hospital, from booking you in to taking an X Ray, can really hit your savings hard, and there have been many stories over the years of travellers needing parents to bail them out with life savings or even remortgaging their houses! This is not a scare tactic, costs really can go that high!
Personally I have been lucky enough that I have never had to make a claim (despite quite a few close calls) and odds are you will never need your insurance either – I hope you don’t – but if something does happen then you will be glad you have it! Just consider it one of those essential purchases alongside your plane ticket, because once you have it you can relax and travel with peace of mind.
I have bought insurance from STA Travel in the past, and World Nomads cover is good too. I am personally happy to recommend both of these, although there are a lot more out there. The best advice I can give is shop around and make sure the insurance is comprehensive.
Do I need travel vaccinations?
This is one of the most commonly asked questions I get asked, and the short answer is it really depends on three things, the vaccinations (and boosters) you already have, the country (or countries) you are going to, and individual factors such as what you will be doing when you are there.
Now, it is important to remember that the requirements of what is needed will change from country to country, region to region. But to give you a better understanding of how it is determined what you will need and what you will not, you should understand the different classifications of what is and what isn’t recommended. There is a little confusion here as some of the terms used are different dependent on what country you are from.
Routine vaccinations are pretty much the same everywhere, and it is advised that you have all of these – including boosters – no matter where you go. These are the basic vaccinations that you will be given throughout your life from 2 months onward. In the UK are known as vaccinations recommended for life in Britain, and are free on the NHS. These protect you from the majority of diseases through life, but do not cover those diseases you may come across abroad. You will be asked if you are up to date on all of these and you should assume that all of these vaccinations and boosters are essential.
Recommended vaccinations are a series of vaccinations that are not always required in every country, and recommendations do change from time to time as the spread and nature of certain diseases change. These often include vaccinations such as Hepatitis A, Typhoid and Cholera (which can all be given free on the NHS if you are a UK citizen), and a range of others such as Rabies, Japanese Encephalitis and many more which you will generally have to pay for. Dependent on the country or countries you are visiting, as well as individual factors such as your medical history, what you will be doing, how long you will be in any given area, any or all of these vaccinations may be classed as not required at all, sometimes recommended (which depend on a variety of individual factors), strongly recommended (if there is a high chance of the individual catching the disease) or recommended (which is to be read as essential). Alternatively you may see them described in just two categories, ‘recommended’ (which is to be read as those that are essential for your trip) or ‘to be considered’ (which includes everything else and should be considered based on personal risk).
A full list of these vaccinations can be found here for your information, but it is up to you to seek professional advice from a travel nurse or physician to see which are right for you and your trip.
Required vaccinations area little bit misleading. The vaccinations for Yellow Fever or Meningococcal vaccine themselves are recommended on the same level as other recommended vaccinations depending on the prevalence of the disease in certain destinations. It is the visa restrictions by the governments of particular countries making proof of these vaccinations mandatory for approved entry, which is what makes them ‘required’. If you are heading to or from a country that has disease control restrictions in place you will need to show proof of vaccination before entry known as an international certificate of vaccination or prophylaxis (ICVP).
Basically speaking not every vaccination is absolutely necessary in every country, but any professional advice will tell you it is important you get all your basic ‘routine’ and ‘strongly recommended’ vaccinations and boosters, and weigh up the risks of the ‘sometimes recommended’ vaccinations for yourself with help from a qualified professional.
The National Travel Health Network and Centre (NaTHNaC) may have a strange name but it is an excellent professional resource on finding out what vaccinations are needed in each country, and is a good place to start your research.
It is good to do your own research and get a good understanding of the vaccines you may need before you travel, but it is no substitute for one to one advice, and this is one of those questions that you really have to go and have a discussion with your travel physician or nurse to find the answer, as they will be able to speak to you about your past medical history and your specific individual needs.
Is it better or cheaper to get vaccinations abroad?
There is no real right or wrong answer here, but as a health professional I will always strongly advise to always get the necessary vaccinations before you go. Yes, it is possible you will find vaccinations slightly cheaper in places like South East Asia or South America compared to Western countries, but there are some logistical problems that you may need to consider, and it is because of these that as a professional I would always recommend getting protected before you travel.
If you buy vaccinations abroad it is important that you know exactly where you are going and what you are getting, and travelling to specific countries where the facilities and standards of healthcare are at least equal to their Western counterparts is essential. Major cities such as Singapore or Bangkok for example have excellent medical facilities, in many cases as good as or even better than in the West, but this may not be the case in every country.
Assuming the clinic you go to has the vaccines in stock (sometimes they can take a week or two to order), many travel immunizations need to be given in a series of shots given over a period of days or weeks. So unless you are planning on spending a lot of time in one particular city (or want to keep going back there), it is often a better idea to get them before you leave. Plus, vaccines take time to work so until your body does become immune you are leaving yourself completely unprotected! So travel health experts recommend giving yourself 4 to 6 weeks to meet with a travel health provider about how to plan for your travel and to get any needed travel vaccinations. You get vaccinations to protect you from certain diseases when you are travelling, so what is the point of traveling and leaving yourself unprotected for up to a month or even more just to save a few pounds?
Depending on the vaccination you need, how many you need and where you are going, you may need to get repeated doses timed weeks apart as well,
It is recommended you visit your travel health specialist at home at least 6 – 8 weeks before you set off. Personally I would say add an extra couple of weeks on top of that if you need more than one or you need to discuss other concerns such as antimalarials too. That way you know you are as protected as you can be before you arrive in your new destination and you can enjoy your travels instead of having to worry about vaccinations.
How do I protect myself against Malaria?
Malaria is a serious disease that is transmitted by the bite of an infected mosquito, and whilst the fatality rates are very low thanks to robust medical intervention, the fact remains that malaria is potentially lethal.
There are approximately 207 million cases of malaria every year, and there are still on average 627,000 deaths every single year too. That may technically be a low percentage but it is still a huge number, and one that shows how important it is to protect yourself.
The best way to protect yourself from malaria is to take the ABCD approach. That’s Awareness, Bite avoidance, Chemophrophylaxis (the technical name for antimalarials) and Diagnosis (if needed).
- That means first of all educating yourself as much as possible on malaria, and there is plenty of official and professional advice available from the CDC, the WHO and the NHS’ Fit For Travel website.
- Bite protection and prevention should be your next step, so make sure you wear loose, comfortable clothing that covers your skin, use 50% DEET spray and remember to reapply it intermittently and use coils and mosquito nets where appropriate. These measures are generally advised even in low to no risk areas, as mosquitoes can also carry a number of other diseases including dengue and yellow fever.
- The next step is to take antimalarials if you are heading to a high risk area. Speak to a professional if you think you may need to take them.
- The final way to protect yourself is to get a diagnosis quickly if you develop any symptoms of malaria such as flu like symptoms, fever, muscle aches, chills or sweating. remember that no method is 100% foolproof, and if you start developing any symptoms at all when travelling then seek out medical attention as soon as possible.
Do I need to take antimalarials?
The first thing to consider about antimalarial medication is that it is a vital part of the protection against – and the treatment of – malaria, and just because you may be taking antimalarials that doesn’t mean you shouldn’t be taking every other preventative measure too. Antimalarials are not medications to be dismissed on a whim or due to fear of the side effects. Whether you need to take them on any given trip is a more complex question however, and one that I get asked on a very frequent basis.
This is a common question and one that is quite difficult to answer in a general forum because the answer to this depends on where you go as well as a number of other individual factors. These can include:
- The level of risk in your destination.
- The time of year you are travelling.
- Whether there are any current outbreaks.
- How long you are staying in any high risk areas.
- What you will be doing (spending extended time in rural areas or cities).
- Your personal medical history.
- Past experience with antimalarials.
- And many more factors.
This is why it is really important that you discuss your plans with a health professional before you go, because it is not a black and white issue.
Basically speaking, if the area you are heading to is considered ‘high risk’ for malaria then yes, antimalarials are usually strongly advised. If you are visiting an area that is low to no risk, then antimalarials aren’t usually advised. It is that simple.
Again, if you look at these maps for the destinations you are going to, and if you are heading to a ‘high risk’ area, then it is strongly advised that you take antimalarials. Then it has to be decided if antimalarials should be advised based on all these other factors, and also which antimalarial is right for you as an individual. There are a number of personal factors involved with this decision, so it is important that you talk to your travel physician or nurse about which antimalarial is right for you as an individual. Do this in good time before you actually leave for your trip, as you may need to take a tester dose.
In very general terms however, assuming the absence of any problems or medical histories that would stop you taking antimalarials, and assuming all the other factors are indicating that you will need to take them, then the malaria maps from the CDC and Fit For Travel amongst others are excellent indicators of whether you need antimalarials or not. So if it the country you are going to is a high risk area, then the answer is probably yes.
I’m worried about the side effects of antimalarials, are they worse than malaria?
This is probably one of the biggest misconceptions I have to deal with when people contact me. There is so much unqualified advice and misinformation out there, and a lot of horror stories about the side effects of antimalarials that they often put a lot of people off taking them altogether.
The fact is antimalarials affect different people very differently.
All medications have side effects. All of them. It is just a matter of degree and severity. Antimalarials are no different in this respect and there is a whole range of different antimalarial prophylaxis that can have completely different side effects to each other, some much more powerful and serious than others.
For example there are a lot of horror stories about Doxycycline, a common antimalarial that has potential side effects including sun sensitivity, stomach cramp and diarroeah amongst others. Personally I never had side effects at all from taking it, although I do know of others who have had very mild symptoms. The problem is some people, a minority, have taken them and had very severe side effects, and this is where the fear comes from.
The point to remember however is that not everyone will react the same way to any antimalarial. Some people may suffer very serious side effects from one particular antimalarial, but the next person may only get mild side effects, if any at all. The majority of people who do get side effects only suffer mild versions of them, a great many people who take antimalarials don’t suffer any side effects at all. Those that do are actually in a very small percentage.
So do not listen to any horror stories about antimalarial side effects and go and have a word with your travel physician or nurse about which antimalarial is right for you instead. Take a tester dose a couple of months before you go, see how the medicine affects you and see if it is right for you and your trip.
Should I be worried about Dengue fever?
Worried? No. Prepared, yes.
Dengue fever is a virus that is spread by the Aedes aegypti species of mosquito, which bites during the day – as opposed to malaria carrying mosquitos which bite during twilight hours or at night. There are 4 types of dengue fever, labelled quite simply as dengue 1,2,3 and 4, and all present as the basic form of dengue fever but have the possibility to develop without treatment into the more dangerous form of the disease, dengue haemorrhagic fever (DHF).
There is no vaccine or cure for dengue fever yet and there is no treatment,but you can protect yourself from it.
The way to protect yourself from dengue is to stop yourself from getting bitten in the first place. That isn’t a facetious remark, honestly. What you need to do is take every precaution to try and prevent being bitten by mosquitoes as much as possible. So if you are in a dengue infected area – and this area is very widespread – you should take all the precautions you can to protect yourself from mosquito bites such as appropriate clothing, 50% DEET spray and nets and coils. It’s all about minimising the risk as much as possible.
It is important to remember that dengue is a horrible disease and it is serious, but excluding DHF, it is not fatal and will usually resolve itself within a few weeks. There are no specific medications to treat dengue, but the symptoms themselves can be eased by staying hydrated and taking paracetamol. I was unlucky enough to catch dengue in India and it wasn’t pleasant, but I got through it.
Basically if you take all the precautions you can take, you should be fine. If however you are in a part of the world where dengue is present and you do start developing flu like symptoms, severe aches and pains or a rash, then go and seek medical attention at the nearest hospital or clinic as soon as possible.
I have a long term medical condition, can I travel?
This is becoming an increasingly popular question as increasing numbers of middle aged and older demographics join the backpacker and independent traveller ranks, and the short answer is yes, it is possible to travel with pre existing medical conditions.
There are a variety of long term medical conditions such as diabetes, heart conditions or lung conditions for example, which can be managed quite well at home by the individual. This means with certain conditions attached, there is no reason anyone should let well managed long term conditions be a barrier to travel.
There will of course always be conditions so severe that it precludes you travelling, and there will probably be specific logistical hoops you will need to jump through such as carrying enough insulin with you, not to mention the travel insurance hoops, but none of that is necessarily a barrier.
So if you do have a long term condition but can live with it and manage it on a daily basis, then there is no reason you can’t travel with it too. The NHS website Fit For Travel has excellent general advice for travelling with a range of conditions, and it is essential you go and see your own GP as well as get advice from travel health specialists before you travel.
Will street food make me sick?
No. Not necessarily anyway. I really don’t know why I get asked this so much but I do. I suppose it is a mixture of horror stories and peoples natural fear of the unknown. The fact of the matter is any food can make you ill, even your local restaurant or takeaway isn’t immune from that fact so I don’t know why non travellers are so against eating food abroad. I have eaten street food all over the world and more often than not it is the cleanest, healthiest and tastiest food you will ever have, and I have never specifically gotten sick off it once, as far as I know. A good dose of common sense still needs to be applied when eating street food – just as it does with any prepared food – and the universal rules of food hygiene should still apply. If the food is fresh, cooked (and piping hot) in front of you and everyone involved (including you) practices good hygiene, then street food is as safe as anywhere else, probably more so than many places where you can’t see how the food is prepared.
Go out there, travel the world and enjoy the local cuisine in whatever form it comes in. Street food, cafe, food court or fancy restaurant, it doesn’t matter. You’ll seriously miss out if you don’t.
If you are travelling to a country you have never been before and find yourself at a street stall, food court or small eatery where you aren’t sure of the food, a good rule of thumb I always use is follow the locals. If there is a large queue of locals, then it’s probably really good! And it is probably safe and hygienic too.
What do I do if I get sick abroad?
The specific answer to that would depend on the specific bug or illness, but in general most travellers will at some point get some form of minor complaint that doesn’t need medical attention and it can be a little nerve wracking when you have to look after yourself outside of your comfort zone.
First thing’s first. Don’t worry.
The most common traveller illnesses and complaints are in general easily dealt with, and are often relatively trivial ailments such as traveller’s diarrhoea, a cold, a sore throat or something similar. things that can generally be treated with rest and plenty of fluids and often don’t need prescribed medication.
For many of these basic bugs, the best thing to do is rest for a day or two, stay well hydrated and get some nutrients back into your body with good, healthy food. I know it sounds counterproductive to the usual advice of pump medication down you but trust me. That old adage of doctors prescribing rest is true for a reason! That is why I generally recommend travelling slowly and adding a few extra ‘just in case’ days to your itinerary so you can just hole up, rest and get better without it impacting your itinerary too much.
If you are a little worried or you do need to get some basic medication such as pain relief or an antihistamine, then pharmacists are excellent sources of advice for minor complaints, so don’t be afraid of going in and asking them questions too. Most major towns and cities all over the world usually have some form of pharmacist or clinic within easy access.
It may also be a good idea during these times to upgrade yourself to a private room and bathroom just for your own comfort. You don’t want to be sat around a crowded dorm room with share facilities when you have a case of Montezuma’s revenge or Delhi belly! And let staff in the hostel or guesthouse know you aren’t too well. Most decent places will keep an eye out for you.
If the symptoms are more serious than that (such as blood in your stool, or severe or prolonged cramps for example) or they last longer than a few days, then you will need to seek professional advice. Unless you are really off the beaten track it shouldn’t be too difficult to find a clinic or hospital. I tend to make a quick mental note of where they are whenever I arrive somewhere new, just in case.
And that’s it, those are the most commonly asked questions I get on an almost daily basis. There are many more of course, and you should remember that whilst I am a qualified nurse, this is only general informational advice. It is in no way a substitute for a personal consultation with your own travel nurse or physician who can take into account your personal medical histories and other individual factors which can influence the advice we give.
Did you enjoy this article? I would love to hear your thoughts in the comments section below or on my Facebook or Twitter pages and please feel free to share it with any or all of the social media buttons. If you want to get more great backpacking tips, advice and inspiration, please subscribe to updates via email in the box to your right.
Have you read all the information but still need a little more specific advice? Need to discuss an issue in a confidential one to one environment? Is there a travel health issue that you are worried about and need a little reassurance on? Need some information on malaria, or which vaccinations you will need? Is there a travel health issue you would like to ask about in complete confidence?
Well I am here to help.
Apart from being an experienced backpacker with almost 15 years travel experience, I am also a qualified and experienced charge nurse with an interest in emergency nursing and travel medicine and practical experience volunteering as an expedition medic.
The Bemused Backpacker Travel Clinic is an indispensable online resource for you to gain a one on one consultation with a medical professional giving you personal reassurance, expert information and qualified advice for any and all of your travel health related questions. To head into the Travel Clinic, click here.