Travel Health and Vaccinations

1. Introduction

The world is now a global village. With increasing travel between countries and the different disease patterns in different countries, it becomes very important to prepare well for your trip to reduce the risk of falling ill and spoiling your well-deserved vacation. This article will focus on the basics of preparation for your travel, and touch on travel vaccinations as well.

2.The basics

a. Have an Essential Medical Travel Kit prepared for your all trips. This should consist of a mixture of medications and first aid-related items. Below are my recommendations.

• First aid
i. Band aids/Plasters and non-woven gauzes for simple dressings
ii. Antiseptic solution for cleaning wounds
iii. Antiseptic ointment for wounds
iv. Thermometer

• Medications
i. Fever and pain medications like Paracetamol or Ibuprofen
ii. Antihistamines for allergy and flu-like symptoms like Cetirizine or Loratadine
iii. Throat Lozenges
iv. Diarrhoea medications like Charcoal and Loperamide
v. Motion sickness medications like Dimenhydrinate
vi. One’s usual chronic medications like blood pressure and cholesterol medications
• Protection from environmental elements
i. Mosquito repellents
ii. Water purifying tablets (as required)

b. Sun Protection. This is something essential but often overlooked. Protection from harmful UV radiation is important, especially if outdoor activities are expected.

• Choose a sunscreen with SPF of at least 30.  This protects from UVB radiation that causes sunburn and is a risk factor for skin cancer.
• Choose a sunscreen with broad spectrum coverage and a PA of ++ or above.  This protects from UVA radiation that causes ageing of the skin and is a risk factor for skin cancer.
• Oral sunblocks are a fairly new way of sun protection but a very useful form of added sun protection as they last longer and help to protect the whole body which sometimes topical sunscreens may miss out.  Polypodium Leucotomos and Phytoflorals are 2 very effective and medically proven supplements that help to reduce the harmful effects of UV Radiation.

3.Travel Vaccines

I divide travel vaccinations into routine vaccinations, which ALL travellers should have, and country specific vaccines, depending on where you are visiting.

Routine Vaccines for ALL travellers
Routine vaccines refer to vaccines within our childhood immunisation program like MMR, dPT, Hepatitis B, etc. It also includes influenza which is recommended to be taken every year for all individuals, especially travellers. Over time, some of these vaccines lose their immunity and hence, it is important to ensure these vaccines are updated prior travel to reduce your risk of catching these diseases.

Country specific vaccines are further subdivided into those for most travellers and those for some travellers.

Specific Vaccines for MOST travellers
Hepatitis A and Typhoid are 2 diseases that are easily transmitted through contaminated water and food and hence, for most travellers travelling to endemic countries, especially “adventurous eaters”, it is highly recommended to have these 2 vaccines taken before travel. Hepatitis A vaccine lasts for at least 15 to 20 years, while it is recommended to have a typhoid vaccine booster every 2 years.

Specific Vaccines for SOME travellers
Speak to your doctor or check the WHO or CDC websites for updated information on required vaccines or medications in specific countries.

a. Malaria
Malaria is a mosquito-transmitted disease which has been eradicated in Singapore since 1982. Sporadic cases of malaria reported in Singapore are imported cases of malaria by travellers. Malaria is still endemic in neighbouring countries of Singapore and around the world and can be a deadly disease. There is no vaccine available for malaria but there are preventive medications “chemoprophylaxis” to prevent one from getting malaria and these usually have to be taken between 1 day to 1 week before travelling.

b. Yellow Fever
Yellow Fever is a virus spread through mosquito bites as well and is present in certain parts of South America and Africa. It causes fever, headaches and muscle aches usually. 15% of patients who contract Yellow Fever can develop serious complications. It is mandatory for travellers going to these countries to get vaccinated against Yellow Fever which lasts generally for at least 10 years and obtain a stamped International Certificate of Vaccination before being allowed to enter the country.

c. Rabies
Singapore dogs are rabies free but rabies is still present in many other parts of the world and is spread by the saliva of infected animals. All mammals can get rabies, and is not just restricted to dogs. This is a deadly disease and if travel activities include getting in frequent contact with animals, it is recommended to consider the rabies vaccines which consists of a 3 injection series at days 0, 7, and 21 or 28.

d. Cholera
This disease causes profuse diarrhoea and is spread by contaminated water usually in limited outbreaks in certain countries. Travellers are rarely affected unless travelling to these limited outbreak areas.

e. Japanese Encephalitis
This disease is spread by mosquitoes and endemic in certain parts of Asia. It causes fever, headache and can cause serious complications such as brain swelling and eventually death. The risk of contracting this disease is fairly low unless rural travel and prolonged outdoor activities are expected.

4. Conclusion

Different countries have different health risks and they evolve regularly with time as well. It is important to prepare well for your trip and a visit to your Family Physician 6 weeks prior to travel to discuss the required vaccinations and medications is highly recommended as most vaccines take at least 2 weeks for full immunity to be present.

Be healthy and have an enjoyable trip.