Health & beauty

Travel health

Updated: 02 Nov 2007
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Introduction

Thinking about a summer holiday abroad? A healthy trip starts here ...

Our guide tells you everything you need to know about travel vaccinations - when and where you need them, how effective they are, and where to get your travel shots.

Plus we've got a handy checklist for the perfect travel first aid kit, and a selection of top travel tips.

Preparing for your trip

The best way to avoid infection with many bugs you'll encounter while travelling overseas is to be thoroughly prepared before leaving home.

Some vaccinations need a few weeks to take effect and others require a course of injections. Health wise, it's not just vaccinations that you'll need to consider. Anti-malaria tablets, first-aid kits and travel insurance all take time to sort out.

Ideally, you need about two months' lead-in time before departure.

Travel insurance

Travel insurance isn't the most glamorous part of planning a holiday - but it's essential to arrange insurance before you go. The most important cover is for medical expenses. Suitable insurance for your holiday depends on where you're travelling, the activities you enjoy, and any pre-existing medical conditions.

For more information, see our report on travel insurance.

Case study - dengue fever in Thailand

Consumer writer Hamish Wilson had four days left in Thailand when he came down with what he first thought was the common flu: "But after two days in bed, I was still sweating bucket loads and an intense ache had developed in my legs."

Hamish was taken to the local hospital where he was pleasantly surprised: "The doctor spoke excellent English and had previously studied in the UK. After some blood tests, he confirmed that I had dengue fever."

Dengue fever is spread by mosquitoes that bite mainly during the day. The virus is also called "break bone fever" and Hamish recommends that you avoid it if at all possible: "There's no vaccine for dengue fever, but you can get travel alerts that warn of outbreaks before heading overseas."

Vaccinations

Do you need a vaccination?

The risk of infection varies with the countries you're visiting, the time you'll be spending abroad, your accommodation, and your activities.

If you're visiting New York on a business trip, vaccination won't be necessary. But you'd be foolish to go backpacking in the heart of Africa without the proper vaccines. Some countries in Africa won't let you cross their borders unless you've had a yellow fever vaccination.

See our bug-by-bug guide for starters. You can get updated reports online that tell you what vaccinations are recommended in a particular country.

We found two good websites:

Researching country reports is a good starting point. And you can get a complete picture of the vaccines you'll need by talking to the country's embassy, visiting your GP, or consulting a travel medicine clinic.

How effective are vaccinations?

No vaccination is 100 percent effective. The point of a vaccination is to reduce the risk of illness to an acceptable level. The widely used flu vaccination gives about 80 percent cover on the first jab. That percentage can be increased on a second jab to about 90 percent. But few people have more than one jab.

Different vaccines also offer different periods of protection. The Hepatitis B vaccine can offer immunisation for a lifetime. The Japanese B encephalitis vaccine lasts only two to three years. And some common infections aren't covered by vaccination at all. You combat malaria by taking a course of anti-malarial tablets and slathering yourself in insect repellent.

You can reduce the likelihood of infection even further with basic measures such as:

  • sleeping beneath a mosquito net
  • being scrupulous about personal hygiene
  • watching what you eat

The World Health Organisation (WHO) says: "General precautions should be taken by the traveller regardless of whether any vaccinations or medications have been administered."

Where should I go to get my shots?

Both GPs and travel health specialists are able to provide vaccinations.

GPs
It's cheaper to see a GP (about $40 for a check-up, plus cost of the vaccinations) than a travel health specialist ($80 for a check-up, plus cost of the vaccinations). But GPs won't necessarily have all the required vaccines on hand.

If you've already been to the country before, or if you're certain you need only one or two vaccinations, then you might consider getting the jabs through your GP. Dr Tim Mason says: "I sometimes recommend my patients contact a travel health specialist for advice, which they can get for a fee, if they're going somewhere obscure. But I can then give them the vaccinations."

Travel health specialists

The GPs we talked to said that visiting a travel health specialist was useful, particularly if you're heading off the beaten track. Dr Mason: "Places like the Travel Doctor are often more up to date than me. They know, say, of an outbreak of dengue fever in some place I haven't heard of. They can also give very specific advice about malaria risks in a particular region."

Each vaccination course must be tailored - even when two people are heading to the same destination. And if you're travelling to a developing country then the number of vaccines required might double or triple. Travel health specialists can tailor the cocktail of vaccinations to you and your trip. They can also give additional country-specific advice (like laws governing prescription medicines in certain Middle Eastern countries).

Side-effects

The decision to vaccinate is a matter of judgement - weighing the risk of contracting the infection against side-effects and cost. Vaccinations are evolving and improving. Most of the jabs available nowadays are "dead" purified vaccines rather than the "live" vaccines of the past, so the severity of common side-effects is reduced.

The side-effects that you may encounter from a jab include fainting, itchiness or discomfort at the point of injection, or a slight rash. The yellow fever inoculation can also cause mild flu-like symptoms in up to 10 percent of people.

Any jab can cause rare and less common side-effects. Reactions such as swelling of the throat, difficulty breathing, or limpness (in the case of children) require an immediate trip to the hospital.

Bug-by-bug guide

Our guide to vaccination requirements for the common travel bugs.

Use this guide for starters. But be aware that vaccination recommendations can change. For regularly updated reports on what vaccinations are recommended in a particular country see these websites:

Hepatitis A

  • Where: Worldwide; but more common where sanitary conditions are poor
  • Details: Hepatitis A is spread through contaminated food and water. It causes liver inflammation and jaundice. You should consider innoculation if good hygiene is going to prove difficult. The Hepatitis A jab is often combined with a typhoid jab.
  • Cost: $95 each for a two-jab course.

Hepatitis B

  • Where: Worldwide; but more common in developing countries
  • Details: Hepatitis B is transmitted through infected blood, contaminated needles and sexual intercourse. It affects the liver, causing jaundice and occasionally liver failure. All travellers should consider this vaccine.
  • Cost: $32 each for a three-jab course.

Japanese B encephalitis

  • Where: Asia
  • Details: Japanese B encephalitis is spread by mosquitoes. It's a serious infection of the brain. We recommend vaccination if you're travelling to a high-risk area for a long time - you won't be able to avoid mosquito bites.
  • Cost: $125 each for a three-jab course.

Malaria

  • Where: Endemic in many parts of South and Central America; throughout Africa; throughout central and South-East Asia; and parts of the Pacific (Papua New Guinea, the Solomon Islands and Vanuatu). The geographic distribution of malaria is constantly changing - be sure to check country reports (available online) before leaving.
  • Details: Malaria kills around 1.3 million people a year and is spread by mosquitoes. There's no vaccination for it.

    The first measure is to avoid mosquito bites. Cover up at dusk with full-length clothing and wear insect repellent. We recommend insect repellents that contain 30 percent diethyl toluamide (DEET). You should also consider sleeping beneath a permethrin-impregnated mosquito net. Both the net and the repellent are available from travel health specialists and some outdoor stores.

    Anti-malarial drugs are prescribed by GPs and travel health specialists. It's important to organise anti-malaria drugs early in your travel preparations. Different brands have different side-effects, so you'll need to investigate a suitable course. The most commonly prescribed anti-malarial courses in New Zealand are mefloquine, doxycycline, and malarone

Meningococcal

  • Where: Worldwide; especially in Sub-Saharan Africa
  • Details: Meningococcal is spread by person-to-person contact (for example, sneezing or kissing). The risk of infection decreases with age - children and young adults are the most susceptible. Meningococcal meningitis has a sudden onset of intense headache, fever, nausea, vomiting, stiff neck and light sensitivity. The disease is fatal in up to 10 percent of cases.
  • Cost: $50

Rabies

  • Where: Africa, Asia (especially India and China), and the Americas
  • Details: Rabies is spread by an infected animal biting you, or licking your broken skin. It's always fatal. You should be vaccinated if you're going to a high-risk area away from a reliable source of vaccine. Rabies can lie dormant for months or even years - so while you need to seek urgent medical treatment after a bite; it may not be too late to receive treatment a few months later. There is currently a shortage of rabies treatment worldwide so travellers should discuss pre-travel vaccines, especially for children.
  • Cost: $60 each for a three-jab course six weeks before departure (only available at travel health clinics); or $140 each for a three-jab course three weeks before departure.

Tetanus/diphtheria

  • Where: Worldwide
  • Details: Tetanus is contracted through dirty cuts and scratches or contaminated food and water. It's a serious infection of the nervous system. Diphtheria is spread by an infected person coughing, sneezing, or breathing on another. It's an infection of the upper respiratory tract (the throat and nose).
  • Cost: The combined tetanus/diphtheria jab is $10.

Typhoid

  • Where: High risk in North and West Africa, South Asia, and Peru. Common wherever sanitary conditions are poor.
  • Details: Typhoid is spread through contaminated food or water. Pollution of water sources may produce epidemics of typhoid fever. Vaccination is often combined with the Hepatitis A jab.
  • Cost: $55

Yellow fever

  • Where: Tropical areas of Africa and South America
  • Details: Yellow fever is spread by mosquitoes. For most people, yellow fever results in fever, muscular pain, headache, chills, anorexia, nausea, and vomiting. Yellow fever is fatal in rare instances. Some countries require a yellow fever certificate as a condition of entry.
  • Cost: $70 - not all GPs are authorised to give yellow fever jabs.

First-aid kits

The most common problems people encounter while travelling abroad aren't serious infections but minor illnesses. Stomach problems like diarrhoea, the common cold, and strains and sprains are the most likely. So a good first-aid kit is essential.

Here's our checklist of what a good travel kit will contain. We give brand-name examples of medications - you'll need to consult a doctor to see if these brands are suitable for you.

Medication:

  • Mild pain-killers (Panadol)
  • Antacids
  • Fluid replacement powders (Gastrolyte)
  • Anti-diarrhoea tablets (Noroxin, Loperamide)
  • Water sterilisers (Aquamira, Iodine)
  • General antibiotics (Rulide)
  • Cough lozenges (Cepacol cough discs)

Bandages and dressings:

  • Anti-malarial tablets
  • Band-aids
  • Waterproof dressings
  • Gauze
  • Crepe bandage
  • Non-adherent dressing
  • Tape
  • Antiseptic solution

Miscellaneous:

  • Scissors
  • Tweezers
  • Safety pins
  • Sun block
  • Condoms
  • Gloves
  • Hand sanitiser
  • Insect repellent
  • First-aid information booklet
  • Customs clearance for prescription medications

Note: Check what you're allowed to pack in your carry-on luggage first.

Top travel tips

Getting there

  • Read up on the country you're about to visit. You'll enjoy your stay more if you know a little about your destination and culture. You'll also know what steps to take on arrival (when you're tired and grumpy from a long flight).

  • Pack sensibly. Allow room for purchases you'll make overseas and check what you can take in and out of a country - for instance, some prescription medicines may be restricted, so carry proof of prescription such as a letter from your doctor.

  • Relax. Get a good night's sleep before your flight and be at the airport with plenty of time to spare. Realise that a large part of your travel time will be spent on the ground, passing through customs and waiting in transit.

Overseas

  • Travel safely. Motor vehicle accidents are the biggest risk of injury for travellers. Avoid scooters and motorbikes if you're an inexperienced rider; think twice before catching that overcrowded Kombi van; look BOTH ways before you cross a road.

  • Drink lots of clean water. If you're not convinced about the purity of the local water supply, stick to boiled or bottled water. Sterilise drinking water with iodine tablets if there's no other options. The good news is that hot tea and coffee, as well as wine and beer, are usually safe.

  • Eat well. Make sure that food - especially fish and meat - is thoroughly cooked. Avoid leftovers and steer well clear of buffets.

  • Wash your hands regularly. Good personal hygiene limits the risk of stomach bugs, common colds and more serious infections. It's helpful to take some antibacterial hand-gel with you.

  • Think before touching the wildlife. Stray dogs, cats and other animals often carry disease. You should rinse any bite or scratch with hot soapy water and disinfect it with an alcohol-based solution. In regions with rabies, consider all bites and scratches a risk. Get medical attention as soon as possible - you may still need further doses of vaccine even if you've had pre-exposure vaccinations.

More help


Report by Luke Harrison.