It’s true – we are lucky in Australia. Compared with most of the world, our health care facilities are good, our public health systems are strong and we have quality water supplies and sanitation. These things combine to reduce the burden of preventable illness. But what happens when you are travelling overseas to countries that may not offer the same high health standard? The common question asked in the lead-up to an overseas trip is, “Do I need to see a travel doctor?”
Health Problems that Exist Outside Australia
Globally, it’s estimated there are around 9 million cases of typhoid annually and 100,000 of these people don’t survive their infection. More than 600,000 people die from malaria, most of them children. Even something as seemingly innocuous as diarrhoeal illness kills 1.6 million people around the world each year. And, sadly, the health problems outside our borders extend far beyond just these few examples.
Pre-Travel Medication Consultation
It’s no wonder health authorities from the Australian Government Department of Health and Aged Care to the Royal Australian College of General Practitioners recommend pre-travel medical consultations.
For those travelling overseas, the Australasian College of Tropical Medicine has detailed guidelines advising on all aspects of preventive medical care when leaving Australia.
So why are they recommending pre-travel medical consultations and what does it mean for you?
The Five Reasons to See a Travel Doctor
In this article we’ll be covering the top five reasons Australians travelling overseas should see a travel doctor. We’ll look at how to assess your need for travel vaccinations and antimalarial tablets. We’ll examine the other advantages overseas travellers will get from a pre-travel consultation.
If you make your way through these five points and find there is nothing here for you, then your answer to the question, ‘do I need a pre-travel medical consultation?’ is no. Otherwise, you’ll see exactly how you might benefit.
1) Vaccinations for travel
2) Malaria Prevention
3) Prescriptions and a Customs Letter for Your Regular Medications
4) Advice on Reducing Other Health Risks
5) Recommendations for Medical Supplies to Take with You
Reason #1 to See a Travel Doctor
Vaccinations for Travel
The Value of Immunisation
Immunisation is one of the best ways to protect yourself from infection. In Australia, our widespread childhood vaccination program has successfully reduced transmission of many diseases to very low levels. These include measles, mumps, rubella, and many others. Polio has been completely eliminated here. It’s easy to miss the value of the herd immunity we enjoy. Other conditions have been controlled over the decades through the development of quality water and sanitation infrastructure. But overseas, many countries are not as fortunate, and circulating levels of many illnesses are much higher.
Hepatitis A Risk while Travelling
Take hepatitis A. Outside of specific risk groups, locally acquired infection is now uncommon in Australia. But worldwide there are around 159 million new cases each year. This is leading to 39,000 fatalities. The virus is contracted by ingesting contaminated food or water. So the incidence of Hepatitis A is highest where water and sanitation facilities are more limited.
What are the Symptoms of Hepatitis A?
The symptoms of hepatitis A include tiredness, fever, loss of appetite, nausea, vomiting and a yellowing of the skin and eyes called jaundice. These symptoms usually last for several weeks and a full recovery can take months. Very occasionally, hepatitis A infection causes severe infection and liver failure. In Australia, the case fatality rate is under one percent.
Hepatitis A Prevention
Hepatitis A can be prevented through immunisation. For adults, an initial dose is followed by a booster six months later to provide long-lasting protection. Adverse reactions after the vaccine are generally mild and include pain at the injection site, headache, fever and fatigue. Severe allergic reactions are very rare.
Routine vaccination in Australia does include hepatitis A, but only for certain high-risk groups. This means that many travellers are not immune. Further, many are missing the opportunity protect themselves. A study published in Australian Family Physician found that 49% of at-risk travellers were not vaccinated prior to their overseas trip.
Between 2012 and 2016, an average of 182 cases of hepatitis A were identified each year. Of these cases, 74% were acquired during overseas travel. In other words, one case of hepatitis A occurred in an Australian traveller every 72 hours.
‘One case of hepatitis A occurred in an Australian traveller every 72 hours.’
Hepatitis A is just one example of a vaccine-preventable illness your travel doctor will discuss with you. Other examples may include typhoid, hepatitis B, yellow fever, meningococcus, and Japanese encephalitis virus. For more information regarding the vaccines to consider for your particular destination, check our destination pages under the 'travel' tab.
Pre-travel Medical Consultations and Routine Immunisations
Regardless of where you are going, seeing a travel doctor for a travel medicine consultation is an opportunity to ensure your routine immunisations are up to date. Adults who have had their full schedule of vaccinations growing up may still need boosters of some vaccines prior to travelling overseas. These include immunisations against tetanus, polio and others. For COVID-19, seeing a travel doctor for a pre-travel consult is a great opportunity to review your vaccination status. Importantly, it will ensure you qualify for any vaccination entry requirements at your destination country.
Assessing the Need for Travel Immunisation
If you want to check your own vaccination record, you can ask your general practice clinic to provide you with a list. You can also consult the Australian Immunisation Register. The AIR is an Australian Government initiative that has been in place since 2016, it also includes data from the Australian Childhood Immunisation Register back to 1996. You can access a record of all the vaccinations you have received through participating locations since these dates. This is done by creating a myGov account and linking this to My Health Record.
‘Guidance in the complex area of vaccines for travel is
a common reason people seek a travel medicine consultation.’
How Can I Obtain Travel Vaccines?
While it is now possible in Queensland, New South Wales, Victoria and Tasmania to obtain some travel vaccines through your pharmacy without a prescription, clearly, it’s not straightforward. Deciding precisely what is required is complex and involves weighing up the risks and benefits of each vaccine. An assessment of the time available before travel, reviewing the costs involved vaccination, and other factors is also needed.
Your travel doctor is well placed to guide you through these intricacies and help you make the best decisions about travel vaccines. Guidance in the complex area of vaccines for travel is a common reason people seek a travel medicine consultation from a travel doctor. But this is not the only benefit a travel medicine consult can provide.
Reason #2 to See a Travel Doctor
Malaria Prevention
Malaria Risk When Travelling Overseas
It has been said that the female Anopheles mosquito is the world’s most dangerous animal. Species of this mosquito are the insect vectors for falciparum malaria. Malaria is an infection which has killed over 600,000 people annually in recent years. The burden of infection is overwhelmingly carried by sub-Saharan Africa, but falciparum and other types of malaria are present throughout the tropics in Southern and South-East Asia, Central and South America, and parts of the Middle East.
To find out whether your travel destination is affected, see the American Centres for Disease Control website.
‘The Anopheles mosquito is the world’s most dangerous animal.’
Partial Immunity to Malaria
Tragically, most of the deaths from malaria occur in children. People growing up in endemic areas who survive to adulthood can develop a partial immunity. Adults in these areas sometimes carry the parasite in their blood without experiencing any symptoms. This partial immunity is lost after only a few months, so those returning home to a malarious area to visit friends and relatives are often unaware of the risk.
Symptoms and Complications of Malaria
Children and non-immune adults who contract falciparum malaria experience high fevers, chills, fatigue, muscle and joint pains, and may have headaches, nausea and vomiting. Left untreated, severe anaemia can develop as the parasite goes through successive cycles of infection and rupture of red blood cells. Parasitised red blood cells can stick in the blood vessels of the brain leading to cerebral malaria. Malaria can progress very rapidly and people can go from their first symptoms to death in a matter of hours.
Pregnant women are at particular risk of complications. These include foetal loss, premature delivery, a low-birth weight baby and maternal anaemia. If you’re pregnant it’s advisable to avoid travel to regions with malaria.
Malaria prevention when Travelling
The keys to prevention of all forms of malaria are avoidance of mosquitoes and preventive antimalarial medication, referred to as prophylaxis. These prophylactic medications target the blood forms of the parasite and some are active against liver forms as well.
‘Your travel doctor will provide a prescription for the right anti-malarial tablets, directions on how to take them and advice regarding insect avoidance.’
Medications commonly prescribed for malaria include atovaquone-proguanil, mefloquine and doxycycline, all of which are prescription only.
The exact regimen selected depends on the following:
- Types of malaria at your destination
- The presence of drug resistant forms of malaria
- Side effect profile of the medications
- Duration of time you will have to take the malaria medication after returning. For example, many need to be taken for four weeks after your return, but atovaquone-proguanil is only required for one week.
- The cost
A medical travel consultation with your travel doctor will cover all these aspects when discussing which medication is best for you.
Malaria Medication Effectiveness
It's important to be aware that while these medications are highly effective, they are not one hundred percent effective. It’s still important to take measures to avoid insect bites and it’s vital to seek immediate medical attention if you develop symptoms while you are away or within four weeks after your return. Among returned travellers in Australia, there are between 700 and 800 cases of malaria annually.
As part of an overall assessment of the health risks involved in your trip, your travel doctor will provide a prescription for the right anti-malarial tablets, directions on how to take them and advice regarding insect avoidance.
Reason #3 to See a Travel Doctor
Prescriptions and a Customs Letter for Your Regular Medications
Travelling with Prescription Medications – Legal Aspects
Anyone taking regular medications, like asthma preventers or antidepressants, will be aware they need to bring enough supply to carry them through their trip. Your travel doctor can issue repeat prescriptions if you need them. But there are also a couple of other considerations to be aware of.
Did you know, for instance, that some medications used for attention deficit, hyperactivity disorder are illegal in Indonesia? You can be fined or detained for possession, even if you have a prescription from your doctor at home.
‘Some medications used for attention deficit,
hyperactivity disorder are illegal in Indonesia.’
More information about prescription medications at your destination is available at Smartraveller.
Tips for Travelling With prescription medications
Once you have checked that your medications are permitted, the Australian Therapeutic Goods Association recommends obtaining a letter from your doctor outlining the medications, their doses, and documenting that they have been prescribed by a doctor for personal use by yourself or someone in your immediate family.
Many countries require you to declare your medications at customs, so this letter can be useful in ensuring the travel process goes smoothly.
The TGA also advises keeping your prescription medications in their original packaging and packing them in your hand luggage.
As part of your travel consult, your travel doctor will be able to guide you through the process of travelling with your medications, issue any repeat prescriptions you need, and provide you with a letter for the authorities if required.
Reason #4 to See a Travel Doctor
Advice on Reducing Other Health Risks
Preventive Health Advice
In order to look after all aspects of your health, your travel doctor will also provide advice on prevention of other health problems while you’re away. This depends a lot on your destination and can include advice regarding food and water, how to avoid insects, why to avoid dogs in the street and what you need to know if you’re travelling to high altitude.
Food and Water Hygiene
Being careful with food and water is one of the key health promotion strategies for Australian travellers to areas where the water and sanitation infrastructure are less developed or maintained than at home. But why is it so important?
Food-and-water-borne illnesses, include traveller’s diarrhoea, hepatitis A, typhoid, and others. To look at just one example, traveller’s diarrhoea (or TD) is the commonest travel related infection. On a two-week trip, between 30 and 50% of travellers experience it. For most, symptoms of diarrhoea, nausea, vomiting, and abdominal cramps, last three to four days. But ten percent of people are still experiencing symptoms after seven days. In high risk destinations like Central America and North Africa, up to 80% of people will suffer from TD at some stage.
‘Traveller’s diarrhoea is the commonest travel related infection.’
Fortunately, symptoms are usually self-limited and the vast majority of people make a full recovery. For most, TD is an inconvenience which mars their trip and prevents them from enjoying their holiday. Other food-and-water-borne illnesses like hepatitis A and typhoid can be more serious.
The Value of Written Travel Advice
Your travel doctor will provide you with detailed advice regarding hand hygiene before eating, what to eat and drink, and what not to. If this is new advice for you, most doctors will provide it as written information. That way rather than having to remember everything on the spot, you can go back to the recommendations at an appropriate time.
A pre-travel consultation is the best way to make sure you are across the myriad of preventive health strategies that are available to you for your trip. Your travel doctor will go through the details of your itinerary and provide written advice. This will to help you manage risks ranging from TD to malaria, dengue, rabies, high-altitude pulmonary oedema, and many others.
Reason #5 to See a Travel Doctor
Recommendations for Medical Supplies to Take with You
There are many medical supplies you could take when travelling overseas. But which ones are most useful when you need them? And which are you most likely to use? A pre-travel medical consultation with your travel doctor will help you answer these questions.
Standby Treatment for Traveller’s Diarrhoea
Given the frequency with which travellers experience traveller’s diarrhoea, it’s worth being prepared. Oral rehydration salts are compact and can be added to boiled or filtered water to treat the dehydration associated with TD. Loperamide and other anti-diarrhoeal medications can be useful for controlling symptoms in some situations. Additionally, the Australasian College of Tropical Medicine recommends many travellers should carry standby antibiotics to treat the infection and be given advice on the circumstances in which they should be used.
‘The Australasian College of Tropical Medicine recommends many
travellers should carry standby antibiotics to treat traveller’s diarrhoea.’
Avoiding Vector-Borne Infections
Insect repellent is recommended for many destinations and needs to be chosen carefully. Your doctor will recommend only the types for which their effectiveness is backed by scientific evidence. These include repellents containing DEET, Picardin, and oil of lemon and eucalyptus.
Other Considerations for Travel Medical Supplies
Jet lag and motion sickness are common problems when travelling overseas. While some over-the-counter treatments are available, others require a prescription. Other items to consider carrying include over-the-counter analgesics like paracetamol and ibuprofen. Hand sanitiser is useful when you are stuck without hand-washing facilities. Face masks are a consideration for reducing your risk of COVID-19 and other respiratory infections, particularly in airports and on the plane. A small first-aid kit is also useful for preventing infections after cuts and scratches.
Your travel doctor will provide advice regarding precisely which medical items you should take with you. They can also arrange prescriptions for preventive therapies and stand-by treatments if you need it.
The Other Reason to see a Travel Doctor
These five reasons demonstrate the value of a travel consultation as preventive medicine. There are so many ways to protect your physical health when you travel, it’s worth getting professional advice. But there’s another less tangible reason. It doesn’t fit neatly on the list – because it’s the result of the whole list.
It’s the peace of mind you get from knowing that you’ve done everything you can to reduce your risk of health problems while your away.
And maybe that’s the best reason of all.
Dr James Knox is an Infectious Diseases Specialist with a Diploma of Tropical Medicine. As an experienced Australian doctor who has worked in countries such as Angola and Sudan, Dr Knox founded Glide Online Travel Clinic. Dr Knox saw a need to better inform and educate Australians travelling abroad, providing an innovative way to deliver pre-travel medical consultations.