  Chapter

 

Travel Abroad: Healthy Travel, Malaria & Vaccines

 

Some general remarks

  • Staying healthy during your trip to a foreign country is very important. For each trip you need to think what kind of medicine you have to bring and which extra measures you have to take to stay healthy.
  • Vaccines are not perfect. New vaccines are constantly being released but diseases continue to evolve
  • Some vaccines require a long period to take effect, but it is never too late to vaccinate
  • Health risks within a country can vary from locality to locality and local authorities may be slow to announce outbreaks of disease
  • Common infections contracted by travelers include those which follow contaminated food or water. Find out whether tap water and local food is safe to consume before you depart
  • There are a number of mosquito-born illnesses you can contract while overseas particularly in tropical areas. Be sure to take measures to avoid being bitten such as wearing light colored, loose fitting clothing that covers your arms and legs, regularly applying an appropriate insect repellent and staying in mosquito proof accommodation.
  • Travel websites, such as Lonely planet or Footprint, have useful health information as well.

Planning and organization

  • The World Health Organization (WHO) recommends that all travelers should be covered from diphtheria, tetanus, measles, mumps, rubella and polio, as well as Hepatitis B, regardless of their destination. Since most vaccines don’t produce immunity until a couple of weeks after they’re given, it is advised to visit a physician a couple of weeks before you travel.
  • Make an appointment with your doctor or travel clinic to have a basic check-up and find out if any vaccinations or health checks are required at least 6-12 weeks before you depart.
  • Not all travelers to countries where there is a potential risk of infection need to be vaccinated but it is important that you discuss your personal travel plans with a doctor so they can determine the correct vaccinations for your trip.
  • It is also possible to get your vaccinations at a JoHo service center. At the moment you can make an appointment at JoHo Service Center Utrecht for Saturdays, but soon the service will also be available at Service Center The Hague.

Traveling with medicine

  • Before leaving home, you should check that your medications are legal in the country you are visiting. You can do this by contacting the country’s embassy or high commission or by looking at official websites.
  • Since the National Health Act was amended in 1999, it is an offense to carry or post Pharmaceutical Benefits Scheme (PBS) medicines overseas unless they are for your personal use, or the use of someone traveling with you.
  • There are restrictions on the amount of PBS medicine that can be carried or sent overseas. When planning to travel overseas with PBS medicine it is important that you:
  • Talk to your doctor and discuss the medicine you will need to take (if you need to take any medicine at all).
  • Carry a letter from your doctor detailing what the medicine is, how much you will be taking, and stating that it is for your own personal use.
  • Leave the medicine in its original packaging so it is clearly labeled with your name and dosage instructions.
  • If you intend to travel with large quantities of medicine, including over-the-counter or private prescription medications, you should ask your doctor, dentist or pharmacist to provide you with a letter explaining why you need to carry such quantities.
  • If you have to inject your medication it might be preferable to carry your own needles and syringes but you should check with the embassy or consulate of the country you are visiting to make sure that this is acceptable. If you buy needles and syringes while overseas, be sure that you buy packs that are sealed and sterile. If you need to carry needles and syringes with you on the plane, inform your airline before you travel and if necessary, arrange a letter from your doctor explaining why you need to carry them.
  • It is important to be aware that some items purchased overseas may be packaged under a different brand name to those of the country of your destination. Keep an eye on the strength and active ingredients of similar-sounding medications overseas, they can vary.

The most common vaccinations

Yellow fever

  • Yellow fever is a potentially fatal disease carried by certain mosquitoes in parts of South America and Africa. If traveling to these areas you should check with your travel clinic or doctor whether a vaccine is required. Yellow fever vaccine is only available from approved medical practitioners and must be given at least 10 days before traveling to infected areas.
  • Yellow fever is contagious and can be spread by infected travelers, so if you are traveling to a country where yellow fever is a risk, you may need a certificate showing proof of yellow fever vaccination. Without this certificate you may be refused entry to some countries, or required to be vaccinated upon arrival.
  • If you have stayed overnight or longer in a declared yellow fever infected country in Africa or South America, within six days prior to your arrival, you will require a valid international yellow fever vaccination certificate.
  • The World Health Organization closely monitors reports of yellow fever infection and periodically publishes a list of countries where the disease occurs.

Diphtheria/Tetanus/Polio

  • Vaccination and validity: always recommended for far away destinations and Eastern Europe (also in East Europe)
  • Last minute travelers (=two weeks before departure) who have not received a standard vaccination before: 2 weeks before leaving there are 2 possible injections left. They protect you for a maximum period of 8 months.
  • Last minute travelers who are not going to diphteria endemic areas: If the trip is shorter than two months it is not necessary to get a DTP vaccination, except for persons who have never received the vaccination before. If your trip is shorter than 8 months only persons who have received just one DTP vaccination need an extra one.
  • Background information: Diphtheria is a common disease in certain countries. This bacteria can cause a seriously swollen throat that makes it more difficult to breathe. If this bacteria gets into the blood it can infect the heart and can lead to death. The bacteria can also cause serious skininfections, although this form of dipthteria is less serious. It is highly recommended get a vaccination against this disease.
  • Tetanus is found everywhere around the world. You can get this disease through street dirt, soil, manure or dust getting in a wound. When this happens the poison substances can cause the muscles all over your body to cramp. It can even cause breathing problems leading to death. A vaccination again tetanus every 10 years is recommended.
  • The polio virus is highly contagious. It is passed on through faeces, contaminated food or drinking water. Polio is very common in places of less hygienic places, such as certain areas in Asia and sub-Saharan Africa. Contamination with the polio virus can cause permanent paralysis of the muscles. If it has been more than ten years since you have had your last vaccination against polio you need another vaccination before you leave.

Hepatitis A

  • Vaccination and validity: Recommended when traveling to almost every far away destination. The gamma globulin injection is only effective for a few months and works passively. Nowadays you can also get a vaccination called Epaxal. It works actively for a minimum of 10 years and maybe longer. You can also get a vaccination of Hepatitis A+B (Twinrix) all at once.
  • Background information: Hepatitis is a liver infection caused by bad hygiene or transmitted by infected water or food. It does not only exist in the tropics, but also in Turkey and East Europe.

Stomach typhus

  • Vaccination and validity: Often recommended for Asia and Latin America. There is a medicine that you can swallow and an injection.
  • Background information: It is a life threatening disease of the gastro-enteric channel. This disease is caused by the Salmonella typhus bacteria. This is an infection related to bad hygienes. If you have had your vaccination, it will only protect you for about 70-90%. Therefore, you still need to be careful with what you take in.

Less common vaccinations

Hepatitis B

  • Vaccination and Validity: a form of jaundice. Only high risk groups, (such as doctors, certain expats, and people who have intercourse with different partners) and travelers who are traveling longer than three months in an hepatitis B area need to get this vaccination. It is also possible to get the vaccination for Hepatitis A+B at once.
  • Last minute: It is possible to get an accelerated injection, although this does not give similar protection.
  • Background information: Hepatitis B is caused by a virus spread through blood to blood or through sexual contact. For example non sterile applied piercings, tattoos etc.

Japanese encephalitis

  • Vaccination and validity: Recommended for people who are going to the countryside in the area between India and Japan.
  • Background Information: Japanese encephalitis is a virus infection that is spread by by mosquitoes. People who are staying on the the countryside for a longer period during the season when the disease is spread run a higher risk.

Tuberculoses (TBC)

  • Vaccination and validity: sometimes recommended to people traveling for a long time to areas where TBC can reign.
  • Details: The procedure is very complicated. Therefore, consult your personal doctor.

Rabies

  • Vaccination and validity: Only recommended to around the world travelers and expats.
  • Details: expensive vaccine

Meningitis

  • Rarely given vaccination and hardly ever recommended

Cholera

  • This vaccination is very rarely given, but some countries do ask for a vaccination stamp. This stamp is available at any vaccination institute.

Malaria and how to avoid it

Malaria 'Facts'

  • Mosquito stings spread the malaria disease.
  • Malaria is one of the most common causes of death in the world and exists in any (sub)tropical area.
  • Malaria is caused by parasites, plasmodium, which are being spread from human to human by a mosquito sting (it can also be spread by blood to blood contact of blood transfusion). These parasites first multiple in the liver and then in the red blood cells.
  • Not all forms of malaria are equally dangerous. Malaria tropica is the most common form of malaria and, in general, the most serious form. It is caused by a parasite, called the Plasmodium falciparum. If malaria tropica is treated properly a person will recover completely. If this disease is not treated on time a person can die in a couple of weeks (depending on the time of diagnoses, in some cases a person can die within a few hours)
  • If you take anti malaria tablets it will reduce the chances of getting malaria dramatically.
  • There are no malaria tablets that offer full protection. The chance that you get malaria while taking tablets is still there.
  • Avoiding mosquito stings will reduce the chance of getting malaria dramatically. You still have to take anti mosquito measures when taking malaria tablets.
  • Malaria is becoming more and more difficult to fight as mosquitoes are becoming resistant to anti-malaria means.
  • Cases of malaria usually occur with travelers (and people who mostly stay abroad) who take no (or insufficient) malaria medicine.
  • Most fatal malaria cases among travelers are caused by an incorrect or late diagnoses.
  • Malaria is extremely dangerous to pregnant women and children. Pregnant women are advised not to go to malaria areas.
  • Malaria does not occur above 2500 meters.
  • In certain countries there can be different malaria recommendations in different areas (such as Thailand, coastal areas much safer than the northern part)
  • Malaria mosquitoes are mainly active at night (although dengue mosquitoes are active during the day).
  • If you take a malaria tablet do keep in mind that you will have to take another dosage when you vomit within an hour.
  • For more information about Malaria please check the WHO, Malaria en de CDC website.
  • Don’t panic; almost every traveler will return home safe and healthy. Take the right precautions and enjoy your trip!


Types of Malaria


Malaria tropica

  • Malaria tropica is the most dangerous form of malaria. If not treated properly it can lead to death in a couple of weeks. Malaria tropica is caused by a parasite, called Plasmodium falciparum. The fever attacks are unpredictable.
  • If you take the malaria tablets as prescribed, chances of getting malaria tropicana are very slim. When traveling through resistant areas you have to be aware that that malaria can still strike.
  • Malaria tropica is very common in areas such as tropical Africa, South East Asia and South and central America.

Malaria tertiana

  • Malaria tertiana is a form of malaria caused by a parasite, called Plasmodium vivax and/or Plasmodium ovale. This disease is characterized by fever attacks that occur in frequent peaks of 48 hours. The parasites can stay in your liver and cause a “delayed first attack” months or even years later. Malaria tertiana can only be prevented by taking profylaxe.
  • Malaria tertiana can mainly be found in South East Asia, Central and South America and Ethiopia.

Malaria quartana

  • Malaria quartana does not differ from malaria tertiana, except for the characteristic fever attacks that occur every 72 hours (instead of every 48 hours.) Malaria quartana is caused by a parasite called Plasmodim malariae and is a very rare disease.
  • At the moment Malaria quartana is prevented by decent malaria tablets.

Malaria Symptoms

  • Malaria can occur as a severe attack of cold shivers and fever, but also as a feverish feeling with headaches, but without any clear fever. It usually starts as a fever attack, cold shivers, muscles aches and headaches. This symptoms will return frequently every few days, if the infection is not treated. It can also be accompanied with vomiting, diarrhea, coughing and jaundice.
  • It is very important to know that Malaria can spread to different parts of the body in as short as 24 hours!!! Any cold or fever that lasts longer than 2 days should be considered as malaria, until the contrary has been proven. If you think that you might have malaria you have to get your blood tested in the hospital or by a doctor. Malaria can be treated very well as long as it is discovered on time.

Malaria tablets (Profylaxe)

  • Which malaria tablets are most suitable for you depends on your destination and the period of your stay. There are different forms of malaria in each area and in some areas mosquitoes can be resistant to anti-malaria tablets.
  • Main Malaria tablets
    • Paludrine (Proguanil-hydrochloride
    • Nivaquine (chloroquine
    • Lariam (Mefloquine)
    • Malarone: (Combination of Atavaquon-Progunail)
    • Doxycycline:
    • Other
      • Fansidar: Not prescribed against malaria because of the serious side effects, but is still used to cure malaria.
      • Maloprim: Due to the heavy side effects only used as a spare remedy.
      • Halofantrine: Due to the side effects it is not used very often any more.
      • Quinine: Used as a treatment against malaria.
      • Artemesia annua (sweet wormwood) natural product available in many tropical countries. It has very little side effects, but it is not tested enough to pass western tests.
      • Qinghaosu: A natural product
      • Arteflene
      • Artemether
      • Artesunate

What to do during a long stay in a malaria are

There are two options:

  • Keep taking malaria pills, especially Lariam is suitable for longer periods, if you don’t suffer from any negative side effects. This can be expensive.
  • Stop taking malaria tablets. If you do this you have to make sure to: avoid getting stung by mosquitoes. And make sure that you know where to find a doctor or hospital in case you get a malaria attack.
  • PS: Be aware that no matter how long you stay in a malaria area, you do not become immune to malaria. You always run the risk of getting malaria.

9 Healthy Travel and other problems

 

1. Acclimatize

  • What ever kind of medicine you take, do keep in mind that for hundreds and hundreds of years people still get ‘tropical frenzy’ (due to food, climate, tiredness, new impressions etc). Take into account that some people just cannot stand tropical conditions. This is something you don’t have to be ashamed about. On your arrival take it easy for a few days, so that you can adjust to the new conditions. Do not start doing heavy duties, make sure that you have a relaxed program.

2. Travel sickness

  • Anti-motion sickness pills are usually indispensable in every medical box, even though you think that you might never get nauseous. A bus ride through the mountains of Nepal, a boat ride in a tropical storm or a flight during rough weather can even break the toughest guys. Also the fact that you will be able to read a book on an eight hour bus ride on a winding road will make anti-motion sickness worth carrying with you.

3. Sun, Heat & Dryness

  • A basic rule for travelers who are going to travel to the tropics is that you need to drink a lot of water, this way you will avoid a lot of problems.
  • Make sure that you urinate enough. This is the best indicator for dehydration. Diarrhea is an important cause for dehydration. A package of Oral Rehydration System (ORS) can create miracles. If you suffer from dry eyes during your flight, bring some cucumber slices and put them on your eyes, or you can buy sleeping glasses/eye mask.

4. Sun allergies & Sun buns

  • In countries near the equator, such as Australia and Indonesia, there are very big chances of getting your skin burned. Every skin gets burned if it is exposed too much to the sun. How long it takes for this to happen depends on what kind of skin you have and where you are (in the mountains and around the equator the sun is much more there). The protection factor (Sun Protection Factor) mostly indicators how long you can stay under the sun. You can duplicate the time you would like to stay under the sun by applying more of the sun cream. During the first days your skin will get burned within 5 minutes without sun cream. If you use sun scream factor 15 than you can stay for about 75 minutes without getting burned to much. Do not take a lot of risk when you are traveling, for your own safety make sure you have done enough research. A backpack might not feel very nice when carrying it, if you are burned. When burned you consume more heat.

5. Sun stabs

  • This comes around because you are loosing a lot of moisture (without you noticing).

Symptoms:

  • Headaches
  • Dehydration
  • Nauseous / throwing up

Treatment to dizziness

  • Get the person out of the sun
  • Cool them down by giving them a cold shower.
  • Drink a lot, or use ORS.

6. Food

  • Do not eat vegetables or fruits that are not washed. You might come across it during your journey. You might consider the possibility of becoming a vegetarian or being very selective with where, when and what kind of meat you eat.
  • Make sure that you always have enough food when you are traveling (it can happen that during a slow bus ride, slow boot ride, closed shops or restaurants you find yourself short of food or drinks).

7. Drinking water & water purification

  • Purifying water has become less and less necessary. Even in the most remote areas, you can buy bottled water. They might not be cheap but water is some that you do not economize, especially in tropical areas, drinking water is very essential.
  • Are you going to the jungle or to mountainous areas, climbing a volcano or are you going to an island where they have limited water supplies, a water purification equipment is the best way to purify tap water.

How can you purify water?

  • Sodium is the best way to purify water, but it will make the taste different from normal water. Tincture of iodine (2%, 4 drops in a liter of water, wait for half an hour before you drink it). Note: Sodium for disinfecting water is not suitable for pregnancy. Chlorine purifies water from viruses and bacteria’s, but not from parasites.
  • Micro infiltration can be found in equipments where water is very shattered. Here the bacteria’s and parasites are caught. Because there are a lot of viruses that still stay behind in the water, micro infiltration is used to capture the remaining viruses that stay behind. A very popular combination is sodium resin and micro infiltration coal brush where the coal brush takes away the chemicals. With this combination also pregnant women can drink the water.

Tips:

  • When you have treated the water, pour it in a cup with a tea bag and let most of the dirt disappear.
  • To boil water abroad it is better to use kettle in combination with a cosmic plug. This way you can make a cup of coffee or tea.
  • When purchasing bottled water make sure that the seal has not been opened; it happens that people sell water that is refilled or water that is not pure for drinking. Try and buy water that have a seal on them.
  • Watch out for local drinks, it can happen that they are diluted with unpurified water.
  • If you have a drink that is open make sure that you have it with you at all times. When asking for ice blocks, first ask from what kind of water they have been made from or just ask for a drink without ice blocks. Freezing does not kill any kind of bacteria.

8. Infections, accidents, Wounds

  • If you are going on a trip to a remote and primitive area it is very convenient to have a variety of antibiotics with you. Discuss with your doctor which ones are the best to take with you.
  • Small skin wounds can grow into a bad infections in the tropics. Treat every wound that you might get very well. Protect infected wounds well from any type of bacteria. If the wound is still there after a couple of days it best to take antibiotics. Watch out for wounds that have been caused by chorister, because this can slowly lead to a very bad infection. Clean it very well and make sure that you get rid of all the chorister that is there.

9. Ticks

  • If you are going to travel in Europe, be aware of ticks. Ticks can be found in forests, gardens and on the beach and can bite into your skin. If a tick is long enough on your skin, you can obtain diseases such as the Lyme disease, CEE or RSSE encephalitis, Ehrlichiose and Fièvre boutonneuse.
  • You can protect yourself from ticks by wearing long sleeves and pants and by using anti-tick spray on non-covered body parts. Always check yourself after spending a day in the forest or on the beach, as young ticks can only be 1 mm.
  • In case you find a tick on your body, remove it with a special tick picker or a tick spoon. Make sure to not damage the tick, as the tick can still inject its poison into your skin. Do not treat the tick with oil or alcohol. However, after you have removed the tick with a picker, you should disinfect your skin with alcohol. If you do not have a tick picker or spoon, you should remove the tick by softly making circles on the tick with a wet finger. After a few minutes the tick will let go of your skin. Make sure to kill the tick between your nails, because the tick is not dead yet.
  • If you have removed the tick within 24 hours, without damaging it, the chances for Lyme disease are small. In case a red circle is developing around the bite, or if you are experiencing symptoms of Lyme disease (head ache, stiff neck, fever etc.), you should contact a doctor.
  • A vaccin excists against CEE or RSSE encephalitis . In some European countries this is even part of the national vaccination program.

 

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