From malaria to big hairy arachnids, there’s lots to think about when planning an extended bout of travelling – not least your health. Dr Jane answers the seven key questions...
Q. Does the immunity duration of a vaccine run out on a set date or do you have a few extra weeks/months protection afterwards, before the vaccine leaves your system?
A. The body probably has a lifetime’s memory of any immunisation, and end-dates will not be like switching off a light. However, for you to be properly protected, that memory needs reminding – via boosters or completion of courses.
People often come to our travel clinic having had ineffective partial courses, some started years before. This is not money well spent. That said, it is thought that courses don’t usually need starting from scratch so keeping careful note of what you have been given will make future courses shorter and cheaper. Discuss your immunisation needs with an expert well before any trip.
Q. What happens if I’m in a malaria area and I run out of tablets and then need to buy more locally – can I swap brands if I cannot source the same?
A. Yes. Swapping brands or even kinds of antimalarial is all right, although there is a problem in some regions with counterfeit and ineffective local meds. Buy them from reputable-looking clinics and take local advice on the quality of local medicines where you can.
Q. I understand that there are different types of malaria in different areas and these require different antimalarials. Will I ever need to switch from one type of tablet to another? And what happens in the swap-over period? Can I take both tablets at the same time?
A. Competent pre-travel health advice should recommend an antimalarial that will both suit you and cover your needs throughout your trip. Generally, the big three – doxycycline, atovaquone/proguanil (Malarone) and mefloquine (Lariam) – will protect people pretty much everywhere, whereas chloroquine and/or proguanil (Paludrine) is much less effective, although cheaper.
You shouldn’t need to take two kinds of tablets simultaneously and this isn’t necessary if changing from C&P to one of the big three. Malarone can be a good choice of antimalarial if moving in and out of malarial regions as you only need to take it for a week after leaving risk areas. Also, now that it is off patent the price has dropped.
Q. Space in my bag is limited – what are the absolute medical essentials for my year-long round the world trip?
A. Even an advanced first aid kit for use in very remote areas doesn’t need to be huge. However, it helps to have an idea of how far you might be from a clinic and for how long. Do you need only enough paracetamol for a couple of days or will it be weeks before you can replenish your kit? Also consider what you’ve needed for medical problems in the past and pack accordingly.
I’d recommend: comprehensive travel insurance (pick a policy with a telephone helpline, and keep the number handy); repellent; sunscreen; soluble paracetamol; throat lozenges; melolin, micropore and a few good dressings; a little cotton wool; steristrips; a digital thermometer; Sudocrem or Anusol; an eyebath; drying antiseptic (or potassium permanganate crystals); tincture of iodine (see below).
In (mostly) sanitary and fairly bug-free Britain, knocks and grazes will most likely heal even without antiseptic or dressings. In the tropics though, the slightest break in the skin – such as a scratched mosquito bite – will be a place for flies to snack; bacteria get in and infection starts. Proper disinfection of skin-breaks with a good drying antiseptic such as dilute iodine will stop this happening. Iodine dries out oozy wounds, and is better for your medical kit than antiseptic creams.
Q. As I’ll be away for a year, how can I keep up to date with outbreaks and changing medical situations that might affect my plans?
A. The best source of info on current disease status by country is www.fitfortravel.nhs.uk. Should you learn of a significant outbreak (any local English-language newspapers will undoubtedly cover it), there will be good day-by-day bulletins on the World Health Organization site (www.who.int). For those travelling in the Americas, www.tripprep.com gives another perspective and is user friendly, although may not be so up to the minute.
Q. I don’t want to buy bottled water for months on end. What is the best, most compact, most healthy way of purifying water as I travel?
A. I agree: bottled water is not a good option. It isn’t always safe, it’s an unnecessary expense and the plastic creates a big environmental problem. Instead, drink tap-water that has been brought to a good rolling boil, or travel with a metal thermos flask and ask for it to be filled with boiling water: keeping water at above 60°C for 30 minutes kills most things.
Also travel with some sterilisation tablets or tincture of iodine for when boiling isn’t practicable. I still prefer iodine, though it is difficult to buy iodine tablets now – the sale of iodine for water purification purposes was prohibited in the EU in 2009. This was not due to safety concerns but simply because the profits on selling this cheap product would not cover the expense of the testing required to gain a product licence.
The alternative, iodine tincture, is messy if the bottle is broken or leaks. Also, iodine destroys plastics so, if using it, you need a sturdy waterbottle (of known volume); Sigg bottles are good.
Q. I am terrified of big hairy spiders and have nightmares about waking up in bed with a snake. How likely is it I’ll encounter scary creatures?
A. In destinations where snakes and spiders are really dangerous, locals will generally deal with them, so they stay clear of people; encounters are rare unless you’re doing a jungle trek or are sleeping on the ground.
Find out about animal hazards at your destination (guidebooks often tell you), read up on the creatures listed and you’ll likely discover most are innocuous. For example, spiders don’t attack unless you disturb them and snakes would rather flee than fight. There are some excellent courses for phobics; for example, check out London Zoo’s Friendly Spider Programme (www.zsl.org – see the What’s On section).
Dr Jane Wilson-Howarth tweets travel tips and more @longdropdoc; her memoir, A Glimpse of Eternal Snows, has just been launched in the US.