Travel to other countries
Travel to other countries
No matter where in the world you are travelling, it is worth knowing the health risks and taking a few simple precautions to avoid them.
Health Risks
Pre-travel preparation
It’s a good idea to discuss your trip with a travel doctor. They will provide a detailed travel health plan tailored to your specific itinerary. Your doctor will also discuss your immunisations, provide scripts for the vaccines you decide on and check that you have prescriptions for any recommended medications. Ideally, book your appointment at least six to eight weeks before you travel, so that if you need multiple vaccinations these can be spaced out. With less time before you travel it is still worth seeing a travel doctor, as accelerated schedules of some vaccinations can be arranged.
Food and water hygiene
By using a few simple precautions, it is still possible to enjoy the local cuisine while minimising your risk of gastroenteritis and other gastrointestinal infections. Always wash your hands or use antiseptic hand gel prior to eating. Avoid raw, undercooked or reheated food. Street food is safest when it has been cooked in front of you and fruits and vegetables are best when they can be peeled before consuming, like bananas and mangoes. In most locations it is best to drink only boiled, filtered or bottled water and avoid untreated tap water and ice made from it.
Insect avoidance
Dengue, malaria and Japanese encephalitis are some examples of the many diseases carried by mosquitoes in tropical and other regions. Avoiding insect bites is one of the key preventive measures for this group of infections. Strategies include sleeping in air-conditioned rooms or spaces with fly screens (and where this is not possible, under permethrin treated mosquito nets), wearing long sleeves and long pants when outside, and using insecticides containing DEET, picaridin or oil of lemon eucalyptus.
Rabies prevention
Australia is one of the few parts of the world which is free of rabies. Elsewhere, rabies can be carried by dogs, cats and other mammals and transmitted by their bites and scratches. The key preventive strategy is to avoid animals. Unless you will be working with animals or travelling to areas with limited health care, rabies vaccination may not be required prior to travel, but it is best to discuss this with your doctor. If you are bitten while in an affected country, you should seek medical attention. You can be protected from fatal infection using a specific treatment which includes rabies immunisation.
Our Travel Doctors
Our fully qualified doctors have an interest in travel medicine and immunisations. And they know travel. Their expert advice will be tailored for you, your travel companions and your trip.
Which shots do I need for my trip?
Routine vaccinations
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In Australia, the transmission of many common infections are kept at very low levels through widespread routine immunisation. This is not always the case in other countries, and rates of infections such as measles, mumps and rubella may be much higher than at home. The lead up to overseas trips is a good time to review your routine vaccinations and get boosters where you need them. These will include immunisations against influenza, COVID-19, measles, tetanus, polio and others.
Hepatitis A
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Hepatitis A is an acute viral infection of the liver acquired by ingesting contaminated food or water. Illness varies in severely and can occasionally be severe and life-threatening. While the prevalence in most Australian communities is low, the virus is more common in most other countries. People who haven’t previously received a two-dose course of Hepatitis A vaccination are recommended to be immunised prior to overseas travel.
Hepatitis B
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The hepatitis B virus can cause long-term infection of the liver. It is transmitted through sexual contact and sharing of personal items like shaving razors. Infections can vary in severity and may require prolonged courses of antiviral medication. Hepatitis B vaccination is now a part of the routine vaccination schedule in Australia and is recommended for travellers who have not had it previously and will be making frequent trips or spending prolonged periods in areas where hepatitis B is common.
Typhoid
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Typhoid is a systemic bacterial infection caused by Salmonella Typhi and Paratyphi in the tropics and other areas. Contracted through ingestion of contaminated food or water, it causes high fevers, fatigue, headaches, abdominal pain and gastrointestinal upset. A vaccine is available which provides two years of protection. This is recommended for most travellers to areas of typhoid transmission particularly if you are visiting friends and relatives, you will be staying for a prolonged period or you will be eating street food.
Yellow fever
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The yellow fever virus is spread by mosquitoes in Africa, South America and parts of Central America. It leads to infection of the liver and spleen and severe cases carry a case-fatality rate of 20 to 50 percent. Vaccination is recommended prior to travel to countries with yellow fever. This is conducted in specialised centres who will issue a certificate of vaccination. A certificate is required for entry into some yellow fever countries. It is also required for entry into other countries if travelling from a region where yellow fever is known to occur.
Meningococcus
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Neiserria meningitidis, or meningococcus, is a bacteria which causes a severe and rapidly progressive infection of the blood stream (meningococcal sepsis) and central nervous system (meningococcal meningitis). Both forms of the disease are rapidly life threatening. Two vaccines exist against different strains of meningococcus, MenACWY and MenB. Men ACWY vaccination is recommended for people travelling to high risk areas, such as the ‘meningitis belt’ in sub-Saharan Africa, and Saudi Arabia for the Hajj or Umra pilgrimages. Both vaccines should also be considered by travellers to any area who will be staying in hostel or dormitory style accommodation.
Japanese encephalitis virus
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For most people who contract Japanese encephalitis virus, the illness is mild and many do not even notice they have been infected. For a small number, however, it leads to life-threatening infection of the brain requiring admission to an intensive care unit. In areas of Japanese encephalitis virus transmission, prevention involves avoidance of mosquito bites, particularly at dusk and night time. A vaccine is available for relevant destinations and your doctor may recommend this depending on your length of stay and travel to rural areas.
Other vaccinations
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Immunisations can be accessed for other infections, including tuberculosis, cholera, dengue fever and tick-borne encephalitis, in a limited range of circumstances. Your travel doctor will discuss these with you if they are relevant to your trip.
Other health risks
Other health risks
Malaria
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Malaria occurs in most areas in the tropics below 2000 metres in altitude. It is a parasitic infection of the liver and red blood cells which causes high fevers, fatigue and muscle aches. In its most severe form, it can cause severe anaemia and brain infection which are rapidly life-threatening. Prevention involves mosquito avoidance, particularly at night, and taking preventive anti malarial tablets if you are travelling to an area where malaria is known to occur. Anti-malarial tablets are recommended for travel to most parts of the tropics, even for those who are returning to visit friends and relatives. The partial immunity gained by growing up in an area with malaria transmission is lost quickly on leaving the country. It is wise to check your itinerary with your doctor prior to travelling and obtain a prescription for anti malarial tablets if required.
Gastroenteritis
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Gastroenteritis or traveller's diarrhoea is usually caused by bacteria ingested in contaminated food or water. Bacteria commonly responsible include Campylobacter, enterotoxigenic Escherichia coli and Salmonella. In cases of bacterial infection, symptoms typically begin within 24 to 72 hours and include nausea, vomiting, diarrhoea and abdominal pain.
The most important aspect of treatment is maintenance of adequate hydration. This can be achieved with oral rehydration solutions which replaces fluid and salts. Antibiotics are usually reserved for cases of severe or pronged infection or when the patient has risk factors for complications.
The illness usually resolves on its own in one to three days. Medical attention is required, when symptoms are not typical, when they are prolonged or severe, or at any time when it is not possible to replace fluids faster than they are being lost. Prevention revolves around good hand hygiene before eating and avoidance of high-risk foods and drinks.
Dengue
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Dengue fever is a common infection among Australian travellers to the tropics. Transmitted by mosquitoes, the dengue fever virus causes fever, fatigue, muscle and joint pains, and rash. The first time they are infected, most people recover in one to two weeks. When more severe forms of dengue fever occur, it is usually in the context of repeat infection. In these cases, complications of bleeding and dangerously low blood pressure can occur which may be fatal without appropriate treatment. For Australian travellers, prevention generally relies on mosquito avoidance. Mosquitoes transmitting dengue fever virus are more common in urban areas and tend to bite during the day.
Rabies
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The rabies virus is carried by dogs, cats, monkeys and other mammals in most parts of the world, and transmitted mainly through their bites and scratches. Australia is one of the few countries where rabies transmission does not occur. Once symptoms have started, the illness is almost universally fatal. Prevention involves avoiding animals while overseas, particularly dogs, cats and monkeys. A vaccine is available for use prior to travel. It is recommended for those who will be working with or spending considerable time with animals and those travelling to areas with limited health care. After animal bites, vaccination is required to protect against the development of symptoms, even if the person has received earlier immunisation. This needs to be started as soon as possible, so those suffering an animal bite in India should seek immediate medical attention.
Non-infectious conditions
Altitude sickness
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Acute mountain sickness (AMS) comprises headaches plus dizziness, fatigue, loss of appetite, nausea, or vomiting. It occurs in around a quarter of non-acclimatized people entering altitudes of over 2450 metres. The condition needs to be carefully distinguished from high altitude cerebral oedema (HACE) and high altitude pulmonary oedema (HAPE). HACE affects the brain and involves symptoms such as confusion and altered behaviour and HAPE affects the lungs and involves shortness of breath, cough and other respiratory symptoms. Both HACE and HAPE can occur below 4300 metres, but this is rare. While AMS usually resolves in 12 to 48 hours if travellers do not ascend further, HACE and HAPE can be rapidly fatal without immediate descent, with or without other treatments.
Prevention of all three conditions involves gradual ascent to high altitudes. Preventive medications are also available on prescription by your travel doctor. For those travelling to areas above 4300 metres it is also a good idea to carry medication for treatment of HACE and HAPE in case they occur. If hiking in alpine areas above 4300 metres and unfamiliar with AMS, HACE and HAPE, it is best to travel with an experienced guide who is well versed in these conditions, their prevention and treatment.
The Centres for Disease Control in the US provides the following advice for travellers in order to reduce the risk of severe and life threatening illness:
1) Know the early symptoms of altitude illness and be willing to acknowledge when symptoms are present.
2) Never ascend to sleep at a higher elevation when experiencing symptoms of altitude illness, no matter how minor the symptoms seem.
3) Descend if the symptoms become worse while resting at the same elevation.
Deep vein thrombosis
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Prolonged air, rail and road travel all carry with them the risk of deep vein thrombosis (DVT). This involves a solidifying of blood inside a blood vessel, caused by relative stasis in the flow of blood. Prevention involves getting up to move around at regular intervals during a long trip, staying well hydrated and, for those at risk of DVT, below-knee compression stockings can be worn. DVT is usually treated with blood-thinning medication.
Safety on the roads and elsewhere
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Part of travelling is trying new activities and going on new adventures. But before setting out, it is wise to know the risks and take measures to reduce them. When contemplating motorbiking overseas ensure you have the necessary skills to ride, be aware of the road rules and always wear a helmet. For other road transport options, choose alternatives with functioning seatbelts. If surfing or diving for the first time, choose an instructor who is well versed in all the necessary safety aspects. And if unfamiliar with hiking, wear boots which are already worn in, use sunscreen and insect repellent, pack light and stay within your limits when choosing your route. Regardless of what you are planning, it is a good idea to have travel insurance which covers the cost of medical repatriation.
Crime and civil unrest
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In some countries, rates of violent crime can be high and the political situation can be volatile. Up to date information and travel advisories from the Australian government can be found on the Smartraveller website. All travellers should be aware of these risks before embarking.