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If you’re planning a long distance trip, Dr Harriet Doyle explains how pre health planning is essential for a good holiday…
This tends to be the time of year, after the celebrations are over and whilst the dark wet weather continues, that we start to imagine, and if we are lucky, book holidays in the sun. From a health point of view, it is worth starting to prepare for the trip, especially a long one, at least eight weeks before travelling. This is particularly important for vaccines, some of which take several weeks to have a protective effect. Your GP practice might well be able to advise you on your needs, whether you need boosters and which infections are prevalent in the area you are travelling. They should be able to make arrangements for you to receive the injections you need, and give you information about malaria tablets. They will also be able to give you up to date travel advice, but here are a few tips to help keep you safe
Mosquitos
With regards mosquito borne infections such as malaria, zika and dengue fever, avoidance of insect bites should always be the first line of defence. Different types of mosquito bite at different times of the day and transmit different infections, so preventative measures are advisable at all times; malaria mosquitos tend to bite from dusk to dawn whilst mosquitos responsible for spreading other diseases bite during the day. Insect repellants containing DEET are the most effective with the duration of protection depending on the concentration So 20% DEET will give protection of 1 to 3 hours, whilst 30% DEET will last up to 6 hours and 50% will last 12 hours. When sunscreen and DEET are used together, DEET should be applied after the sunscreen. If using sunscreen together, an SPF of 30-50 should be chosen to allow for the reduction in SPF caused by DEET repellent.
Mosquito nets are also important, but they should be impregnated with insecticide. They need to be inspected for holes, and care needs to be taken to tuck them under the mattress or ground sheet. Covering as much of your skin as possible with clothes will give extra protection, as will ensuring windows and doors have effective shutters and screens. Air conditioned are the safest as they are effectively sealed
Pyrethroid products such as plug ins and candles may also be used, although if you are unsure of the reliability of electricity at your destination then candles, cones and coils may be a more suitable alternative. Citronella, electronic buzzers, yeast products, vitamin B and homeopathic treatment provide no protection at all.
Food and water
Nothing ruins a good trip like getting sick -- and we're not talking about a few extra bathroom stops. Contaminated drinking water is one of the leading sources of health problems for travellers, and can cause anything from mild gastrointestinal distress to serious infections diseases such as E.coli, cholera, salmonella, giardia and hepatitis A. In many cases, travellers become ill simply because the bugs in the water are foreign to their immune systems, while locals have adapted to the water supply and can drink it without problems.
The best way to protect yourself is to avoid local tap water and instead seek out bottled water. If this is not available, boiling water will reduce risks, as will water purification tablets and filters. Freezing does not eradicate bugs so you will need to be cautious of ice in countries where the water supply is a concern.
The traveler's mantra, attributed to colonial explorers, goes something like this: "Cook it, wash it, peel it or forget it." Freshly cooked foods are less likely to acquire airborne contaminants, and raw foods such as salads, and fruits and vegetables without peels, are often likely culprits for trouble. Fruits and vegetables you can peel yourself are usually safe.
Sun protection
The risks of sun burn and skin cancer are well documented. Sun burn can also spoil a holiday because of the pain and discomfort. When choosing sunscreen the label should have the letters ’UVA’ in a circle logo and at least four-star UVA protection. It should also have an SPF of at least 15 to protect against UVB rays. However sunscreen shouldn’t be relied on as the sole protection against the sun: covering up, including hats and sunglasses, and avoiding the mid day sun is also important.
DVTs
We are often asked what can be done to prevent DVTs. Journeys of any type lasting for more than 4 hours, will increase the risk of developing a blood clot in the leg and this risk goes up with certain medical conditions such as cancer, heart disease and recent surgery. Moving round the plane will help reduce risks as will flight socks which can be obtained for the pharmacy. Keeping hydrated is particularly important so drink plenty of fluid, avoiding caffeine and alcohol
Jet Lag
Jet lag is a physical reaction to a rapid change in time zones. It affects most travellers, including seasoned fliers like flight attendants and pilots. Common symptoms include disorientation, irritability, insomnia, fatigue, dry eyes, headaches, irregular bowels and general malaise.
Jet lag is worse when travelling from west to east because the body finds it harder to adapt to a shorter days than a longer one. To reduce the risk of severe symptoms try and leave for your holiday in good shape: exercise, sleep well, stay hydrated and stay sober. The worst thing you can do is get on a long flight with a hangover. Symptoms can also be reduced by changing your sleep routine a few days before your departure - if you're travelling east try going to bed and hour earlier and an hour later if travelling west, with the idea is to prime your sleeping routine with your destination in mind.
A general rule of thumb to keep in mind before any long trip is the 1:1 ratio: allow yourself one day to recover for every hour of time difference that you experience.
First aid kit
Finally when packing your bag, you may want to include a small first aid kit containing antiseptics, antihistamines, pain killers, rehydration salts, sterile dressings and plasters. Anti diarrhoea tablets can make a long journey manageable if you have a particularly bad attack of travellers tummy. Consider also taking condoms with you to avoid the risk of buying fake and potentially unsafe brands.
The latest health and safety advice for the specific country you're travelling using can be read on the following websites:
• GOV.UK