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Travel health

Introduction

Every year, millions of people from the UK travel overseas for both business and leisure. While we enjoy visiting different countries it is easy to forget that many places do not have the same easy access to medical facilities and treatments as the UK.

Before travelling overseas, it is important to be aware of any possible health risks, plus how to prevent problems or minimise the chances of them occurring. Most importantly, you should know:

  • whether there are any specific health risks in the country you are travelling to for which you need to take precautions, such as malaria
  • how to avoid becoming ill when abroad,
  • what to do if you do become ill when you are abroad 
  • how to get emergency medical treatment when you are abroad.
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Facts

The European Health Insurance Card (EHIC)

A European Health Insurance Card (EHIC) entitles you to reduced-cost or free medical treatment if it becomes necessary when you are in a European Economic Area (EEA) country or Switzerland.  The EEA includes all European Union countries as well as Iceland, Liechtenstein and Norway.

For further information see the country-by-country guide to EEA countries

What does the EHIC cover?

The EHIC is normally valid for five years and covers any medical treatment that becomes necessary due to accident or illness. The card entitles you to state-run medical services only, and you will be treated on the same basis as an 'insured citizen' of the country that you are visiting.

This may not cover all the treatment and services that you would normally expect to get free from the NHS, and you may have to pay a contribution to the cost of your care.

What the EHIC does not cover

The EHIC is not a substitute for travel insurance.  You are strongly recommended to take out a private travel insurance policy in addition to having a EHIC before you travel.

The EHIC does not cover:

  • the cost of bringing you back to the UK
  • the cost of private healthcare or services that are not part of the country’s healthcare system (for example, many European countries have private ambulance services that charge a fee for taking someone to hospital)

If you are travelling abroad for the purpose of receiving medical treatment (including giving birth), the EHIC will not cover your treatment.

Who is eligible for a EHIC?

All UK residents are eligible to apply for an EHIC, although it is not valid for people who are going to live abroad. Some non-UK nationals may not be entitled to treatment in Denmark, Iceland, Norway, Liechtenstein or Switzerland. Check with the government of your home country for further details.

Applying for an EHIC

The quickest way to get an EHIC is to apply for an EHIC online. Applying for an EHIC is free and you should not to have to pay a fee.

Your card will usually arrive within seven days. You can also apply by phone (0845 606 2030) or by post using an application form available from some Post Offices.

See the Healthcare abroad section for more information about the European Health Information Card.

Reciprocal healthcare agreements

A reciprocal healthcare agreement is where one country agrees to provide healthcare to visitors from another country in return for that country agreeing to do the same.

The UK has reciprocal healthcare agreements with the following non-EEA countries and territories:

  • Anguila
  • Armenia
  • Australia
  • Azerbaijan
  • Barbados
  • Belarus
  • Bosnia and Herzegovina
  • British Virgin Islands
  • Croatia
  • Falkland Islands
  • Georgia
  • Gibraltar
  • Isle of Man
  • Kazakhstan
  • Kyrgyzstan
  • Macedonia
  • Moldova
  • Montserrat
  • New Zealand
  • Russia
  • Serbia and Montenegro
  • Tajikistan
  • Turkmenistan
  • Turks and Caicos Islands
  • Ukraine
  • Uzbekistan

If you are visiting any of these countries and you need urgent or immediate medical treatment, it will be provided at a reduced cost or, in some cases, for free.

The reciprocal healthcare agreements do not cover the cost of return travel to the UK (repatriation) or the routine monitoring of pre-existing conditions.

The range of medical services in these countries may also be more restricted than those provided by the NHS. Therefore, always ensure that you have a valid private travel insurance policy. Find out more about reciprocal healthcare agreements.

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Risks

There are many health risks associated with travelling overseas including:

  • infectious diseases
  • food poisoning
  • heat-related conditions

Some of these conditions may be mild and will pass quickly with minimum treatment, whereas others may be more serious and need specialised care.

Some common conditions you may be affected by while travelling overseas are described in more detail below.

Malaria

Malaria is a disease that is caused by a parasite and spread by mosquitoes.  It is more common in tropical countries, such as parts of Africa, although there have been cases reported in the UK. 

In recent years, rates of malaria have fallen sharply due to improvements in preventing the spread of the condition. However, it still remains a significant health problem.

Malaria cases continue to be reported in over 100 different countries. An estimated 1,500 British travellers contract the condition each year.

Parts of the world where malaria is particularly widespread include:

  • African countries south that are of the Sahara Desert (sub-Saharan Africa), with the exception of South Africa, such as Angola, Kenya and Nigeria
  • countries in the northern part of South America, such as Brazil, Colombia, Venezuela, Peru and Ecuador
  • countries of Central America, with the exception of Mexico
  • most of the countries in South Asia, such as India, Pakistan and Afghanistan
  • most of the countries of southeast Asia, such as Vietnam, Thailand, Burma, the Philippines, Indonesia and Malaysia

In most of the countries listed above, the major cities and towns are usually malaria-free and the risk is confined to rural areas. However, in Africa (and India to a lesser extent) malaria cases still occasionally occur in towns and cities.

Symptoms of malaria usually appear 10 to 15 days after you are bitten by an infected mosquito. However, depending on the type of parasite you are infected with, it can take up to a year for symptoms to show.

The symptoms of malaria are similar to those of influenza (flu) and include:

  • a high temperature (fever) of 38C (100.4F) or above
  • sweats and chills
  • generally feeling unwell

Many cases of malaria can be prevented using the ABCD checklist:

  • Awareness of risk. Know your risk of malaria.
  • Bite prevention. Take precautions to avoid being bitten.
  • Chemoprophylaxis. Take the right anti-malarial tablets. As different strains of malaria can be found in different parts of the world, each strain requires a specific medication to prevent it.
  • Diagnosis. Seek immediate medical advice for any symptoms you have.

Taking medicine to prevent malaria is essential for all travellers visiting areas where malaria is a known risk. However, anti-malarial tablets are not 100% effective, so avoiding getting bitten is also important.

See the A-Z topic about Malaria for more information about treating and preventing malaria.

HIV and AIDS

HIV and AIDS is a global pandemic, which means that it is a condition that has been spread across the world.

The World Health Organisation (WHO) estimates that there are currently over 33 million people with HIV, and that just under 3 million people were newly infected in 2008.

There is currently no cure for HIV and AIDS, although medication can be used to slow the progress of the condition. Parts of the world where HIV and AIDS is particularly widespread include:

  • sub-Saharan Africa, particularly South Africa, Benin, Botswana, Lesotho, Malawi, Swaziland, Zambia and Zimbabwe
  • Russia
  • Burma
  • Thailand
  • Laos
  • Papua New Guinea
  • Guyana
  • Suriname
  • Honduras
  • Belize
  • Haiti
  • The Dominican Republic

When travelling abroad, you should never assume that HIV and AIDS is only limited to members of a country's gay community. In many countries, the majority of people living with HIV and AIDS are heterosexual.

In most of the countries listed above, rates of HIV infections are particularly high among prostitutes.

See the A-Z topic about HIV and AIDS for more information and advice.

Sunburn

Sunburn is the damaging effect on the skin caused by ultraviolet radiation in sunlight.  If you are travelling to hot climates from countries such as the UK, it is likely that you are at greater risk of getting sunburnt because your skin may not be used to the sun.

If you have fair skin, your risk of getting sunburnt is even greater. Severe sunburn can cause red, sore and tender areas, with blistering and peeling.  It can also increase your risk of developing skin cancer later in life.   

See the A-Z topic about Sunburn for more information and advice. 

Heatstroke

Heatstroke occurs when the body becomes overheated very quickly.  It can happen because of very hot temperatures, extreme physical exertion or sunburn.  The symptoms of heatstroke include:

  • very high body temperature of 40C (104F) or above (a major sign of heatstroke)
  • heavy sweating that suddenly stops (being unable to produce any more sweat is a warning sign that the body has become over-heated and dehydrated)
  • tachycardia (rapid heartbeat)
  • hyperventilation (rapid breathing)
  • muscle cramps

Heatstroke is a medical emergency. If you or someone you know has the symptoms of heatstroke, call the emergency medical services of the country you are staying in.

In all European countries, the emergency number is 112. Other countries may have different numbers, so check with local staff or residents.

To reduce your risk of heatstroke in hot conditions, keep physical exertion to a minimum. Drink plenty of water or isotonic fluids (drinks that replace body fluids and essential minerals, such as salt, that is lost through sweating). Avoid drinking excessive amounts of alcohol in hot weather.

See the A-Z topic about Heatstroke for more information and advice.

Travellers’ diarrhoea

Travellers’ diarrhoea is a general term to describe symptoms of diarrhoea that occur during or shortly after travelling. It is usually spread through poor hygiene and lasts for about three to five days.

Most cases of travellers’ diarrhoea are caused by bacteria that are passed from faeces (stools) to the mouth. This can happen when someone does not wash their hands after going to the toilet and then handles food that is eaten by travellers.

Travellers’ diarrhoea is usually mild, but it is unpleasant and can ruin a holiday. It often clears up without treatment, but it is essential to drink plenty of fluid. More severe cases of travellers’ diarrhoea are treated with a short course of antibiotics.

See the A-Z topic about Travellers’ diarrhoea for more information and advice.

Bites and stings

In the UK, most bites and stings are painful but harmless and only affect the area around the bite or sting. However, some people can have an immediate and more widespread allergic reaction, such as an anaphylactic shock and this can be fatal.  Anaphylaxis is uncommon, affecting approximately 3 people in 100 and it normally only happens following a wasp sting.

See the A-Z topic about Anaphylaxis for more information.

When you are abroad, you need to be aware of other stinging and biting animals and insects, such as scorpions, snakes, spiders and jellyfish. Always take care to look where you are walking or swimming and take the advice of local tourist information about safe places to visit and swim.  It is also important to note that bites can infect you with diseases, such as malaria or rabies. 

Always seek immediate medical attention if you are bitten by an animal while you are abroad. Rabies is spread through an infected animal's saliva, but is only spread if the salvia comes into contact with your eyes, mouth, nose or a wound. If this happens, you should also seek immediate medical attention.

See the following A-Z topics for more information and advice:

Vaccinations

Depending on the areas you intend to visit when you are abroad, you may also need to take precautions, or be vaccinated, against diseases such as:

  • Rabies, a viral infection that is spread by animals
  • Bilharziasis, a condition that is caused by a parasite which lays eggs inside the human body,
  • Cholera, a waterborne bacterial infection
  • Dengue, a viral infection that causes fever, joint pain, and skin rashes,
  • Diptheria, a contagious bacterial infection that mainly affects the nose and throat
  • Hepatitis A, Hepatitis B and Hepatitis C, blood-borne viral infections
  • Japanese encephalitis, a viral infection that is spread by mosquitoes that can cause fever, headaches and, in some cases, coma
  • Legionnaires disease, a waterborne bacterial lung infection
  • Meningitis, an infection of the outer lining of the brain
  • Poliomyelitis, a viral infection that causes muscle and nerve damage
  • Tetanus, a bacterial infection that can develop if a wound or cut becomes contaminated
  • Tick-borne encephalitis, an infection of the central nervous system that is spread by parasites
  • Tuberculosis, a bacterial lung infection
  • Yellow fever, a viral infection that is spread by mosquitoes.

See the A-Z topic about Travel vaccinations for more information and advice.

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Treatment

Treatment while abroad

Malaria

The possible side effects of malaria can be serious, so you will usually have to stay in hospital for observation whilst being treated.

Malaria is almost always curable with anti-malarial drugs such as Chloroquine, Amodiaquine, Doxycycline and Mefloquine.  The health professional who is treating you will need to identify the type of malaria you have before deciding on the best medicine to prescribe.  It is very important that a quick diagnosis is made, if malaria is suspected.

See the A-Z topic about Malaria - treatment for more information and advice.

HIV and AIDS

It is sometimes possible to halt the development of HIV in the first 72 hours after infection. This is known as post exposure prophylaxis (PEP). PEP involves taking anti-HIV medicines for four weeks.

PEP is often used when a person knows that they have definitely been exposed to the HIV virus. For example, if they were having sex with someone who they knew had the HIV virus, and the condom broke, or they were accidentally stabbed with an HIV infected needle.

However, PEP is not guaranteed to work, and the medicines that are used often cause some unpleasant side effects, such as nausea, vomiting, diarrhoea and headaches.

In some parts of the world, access to PEP may be limited, or very expensive. Therefore, it may be a good idea to take out comprehensive travel insurance so that you can be flown back to the UK if HIV exposure occurs.

See the A-Z topic about HIV and AIDS - treatment for more information and advice.

Sunburn

Calamine lotion, which is available from pharmacies and supermarkets may help to cool your skin and reduce the itching caused by sunburn.  You can also buy aftersun lotions, gels and sprays, which help to cool and moisturise the suburn and help prevent peeling and blistering. 

If the sunburn is severe, you may need painkillers, such as paracetamol or antihistamines.  If the sunburn is very severe, you may need hospital treatment.  It is important to avoid any further exposure to the sun until the burns have healed.

See the A-Z topic about Sunburn - treatment for more information and advice.

Heatstroke

If you think someone you are with has suspected heatstroke, you should get them to a cool place as soon as possible.  If their skin is dry and hot and over 39.5C (103.1F) shower or immerse them in cool (but not cold) water (15-18C or 59-64.4F).  Gently massage their skin to encourage circulation.

If they start to have convulsions (shake), move nearby objects out of the way to prevent injury occurring, but do not use force or put anything in their mouth. If they are unconscious and vomiting, move them into the recovery position by turning them on their side and making sure their airways are clear. You can also cover them with wet towels, or sheets and fan them until it is possible to get them to a hospital or to see a health professional.

If their skin temperature is above 41.C (105.8F) they are in a critical condition and require immediate emergency medical attention.

See the A-Z topic about Heatstroke - treatment for more information and advice.

Travellers’ diarrhoea

Most cases of traveller’s diarrhoea resolve themselves within three to five days without the need for treatment.  Taking paracetamol or over-the-counter (OTC) remedies such as Diocalm, may relieve your discomfort.

If you have had persistent diarrhoea, you may need to replace lost fluids by drinking rehydration drinks.  If your stomach upset lasts for longer than three days you should visit a healthcare professional for further advice. Anti-diarrhoeal medications should be used with caution and only for a short time.

If the diarrhoea is caused by an infection, the medication can slow the flushing-out process of the micro-organisms from the intestine. You should also drink plenty of water whilst taking anti-diarrhoeal medicines.

See the A-Z topic about Travellers' diarrhoea - treatment for more information and advice. 

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Prevention

Malaria

You can reduce the risk of malaria and other insect-borne diseases by using insect repellents and wearing long-sleeved shirts and long trousers where possible.  Insect repellents that contain DEET (diethyltoluamide) are most effective. 

If you are visiting a malaria-infected region (see Travel Health - Risks,) your GP will be able to advise you about the most suitable anti-malarial medication for you.  You should make an appointment with your GP as soon as you know which countries you will be visiting, as some anti-malarial medication need to be taken several weeks before your departure.

It is important to remember that you cannot guarantee protection from malaria and  some strains of malaria have now become resistant to medication. Inform your GP as soon as possible if you develop a fever or unexplained illness during your time away, or up to three months after your return.

See the A-Z topic about Malaria - prevention for more information and advice.

HIV and AIDS

The best way of preventing HIV and AIDS is to always use a condom when having sex, including anal and oral sex. In some parts of the world, locally produced condoms may not be as reliable as the ones available in the UK, so you may want to take your own supply.

See the A-Z topic about HIV and AIDS - prevention for more information.

Sunburn and heatstroke

Ultraviolet (UVA and UVB) rays is radiated by the sun.  The ozone layer filters out most UVA and UVB rays before they reach earth, but some can still get through and can cause damage to our skin. It is therefore very important to take precautions when travelling to hot climates. 

Some useful tips for avoiding sunburn are:

  • Do not wait till your skin feels uncomfortable before taking preventative action. The best form of protection is defence.  Once your skin is burned the damage has already been done, so cover-up up with loose-fitting clothes.  Make sure that your legs and arms are covered. Tightly woven fabrics will provide the best protection from the sun.  
     
  • Avoid direct exposure to sunlight when the sun is at its strongest.  Remember that the sun can be strong both early and late in the day, so you still need to take adequate precautions if you go out in the sun in the morning or evening. Cover your arms and legs with clothes, wear a wide-brimmed hat and a pair of good-quality sunglasses, and apply plenty of sun lotion with the right protection factor (SPF) for your skin type.
     
  • Always use a sun protection lotion with an SPF (sun protection factor) of at least 15. If you have very fair skin, you need to use lotions with an SPF of up to 40. This is also the case with children because their skin is very sensitive, and most skin damage caused by the sun occurs before 18 years of age. 
     
  • Make sure that your entire body is covered by sun protection lotion.  This includes your face, hands, feet and neck.  The most vulnerable parts of your body are the places that are not usually exposed to sunlight.
     
  • Apply sun lotion at least 30 minutes before going out in the sun.  You should also reapply it every couple of hours because sweat and contact with clothing and towels will cause it to wear off.  Reapply sun lotion immediately after swimming, even if your lotion is waterproof.  Wear waterproof sun protection when swimming because UVA and UVB rays can penetrate through about a metre of water. 
     
  • Cloud and fog do not protect skin from ultraviolet rays. Therefore, you should cover up with clothing and use SPF 15 sun lotion even on cloudy days. 
     
  • Wear a hat and sunglasses that have UVA and UVB filters when in the sun.  Ultraviolet rays can damage the retinas in your eyes, causing cataracts. 
     
  • Drink plenty of fluids, particularly after exercise.  Isotonic drinks that replace the salt lost through sweating are ideal, but water is also sufficient.  Avoid alcoholic drinks when you are out in the sun.

Keep a careful eye on any moles on your body and visit your GP if you notice any change in their appearance.  Signs to look out for are darkening of the mole, an increase in size, raggedy edges, multiple colours within the mole, itchiness, redness and swelling or bleeding.

For more information, see the A-Z topics on Sunburn - prevention and Heatstroke - prevention.

Travellers’ diarrhoea

If you are travelling in a country where the standards of public hygiene are low, and there is a risk of water contamination, such as in some African and Asian countries, avoid the following food and drink as they could trigger travellers’ diarrhoea:

  • tap water
  • fruit juices (if sold by a street vendor)
  • ice cream and ice cubes
  • shellfish
  • eggs
  • salads
  • raw or undercooked meat
  • peeled fruit
  • mayonnaise
  • sauces

Food and drink that are generally safe to eat include:

  • sealed bottled water that is produced by a recognised international manufacturer
  • cooked food, such as soup or stir-fry
  • canned food or food in sealed packs
  • fresh bread
  • unpeeled fruit
  • tea and coffee
  • alcohol

See the A-Z topic about Travellers' diarrhoea - prevention for more information and advice.

First aid

When travelling abroad, it is advisable to carry an emergency first aid kit with you, particularly if you are visiting a non-EEA area.  This should contain:

  • adhesive dressings
  • insect repellent
  • antiseptic cream
  •  water-purification tablets

You can buy medical travel kits from pharmacies, which contain sterilised and sealed medical equipment such as syringes, sutures(stitches) and needles.  These are particularly useful when visiting developing countries or areas where the safety of medical equipment cannot be guaranteed.

Some parts of the world are sometimes at risk of terrorist activity, civil war, insurgencies (armed uprisings against the government) and other types of public disorder.  The Foreign and Commonwealth Office (FCO) website provides up-to-date travel advice by country on the dangers in particular areas.

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Getting help

In case of an emergency, it is a good idea to keep a list of important telephone numbers with you when you are travelling.  These should include:

  • the local emergency services number
  • the representative of the travel company that you booked your visit with 
  • your travel insurer
  • the British consulate in the area that you are visiting

The Foreign and Commonwealth Office website provides contact details of all British Consulates and Embassies in foreign countries. 

You should also keep a list of the contact numbers of family and friends, just in case the British consular representatives need to contact them. It may also be wise to take a mobile phone for emergencies if you have one. Check with your mobile phone service provider to see if they operate in the countries you intend to visit, and which areas of those countries they cover.

If your trip involves travel to developing countries, avoid travel to rural or isolated areas without a reliable guide who will know how to get help if it is needed.  If you have to travel on your own, it is useful to know a few words of the local language. For example, words such as 'help', 'doctor' and 'hospital'.

See the Healthcare abroad section for more information and advice.

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