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Travel health: Don't succumb to these old-world ills

Cholera, consumption, bubonic plague... While these ailments sound archaic, they still exist – and some are on the up, says Dr Jane Wilson-Howarth

Travel health: Don't succumb to these old-world ills (dreamstime)

Victorian Britain was a tough place to live. Cities were unsanitary, running water was a rarity, and scientists didn’t understand what caused diseases or how they spread – many ailments were considered divine retribution for lives of wickedness.

Thankfully, times have changed – which means it’s easy to assume that we’re now protected from many of the diseases our ancestors feared. But we should not be blasé. There are communities within emerging nations that still face ‘Victorian’ challenges. And although largely conquered in industrialised nations, the diseases that killed our forebears do still rage. Here’s how to avoid them.


Cholera was the most infamous infection to blight Victorian London. It is a disease of poor sanitation that especially hits undernourished people.

It was first documented in the early 19th century in India, where it killed many locals and British soldiers. It travelled to Europe by ship, and caused a devastating outbreak in East London in 1832; the area was put into quarantine. Initially doctors didn’t understand how the disease was transmitted: cholera hospitals discharged sewage into the Thames, from which drinking water was abstracted further downstream, ensuring the microbes thrived. An experimental cholera vaccine – one of the world’s first – was developed in 1879; by 1896 it was being used in humans.

These days cholera is only seen in Britain as an imported infection, and the basic Victorian cholera vaccine has been superseded by the far more effective, drinkable Dukoral. Furthermore, it’s been realised that people who are ordinarily healthy and reasonably well nourished will not develop the torrential watery diarrhoea that rapidly dehydrated and killed our ancestors. The importance of rehydration is now recognised by most clinicians within the communities still at risk. Cholera has not disappeared, but we now have the tools to manage it.

Top tip: Consider taking Dukoral – it gives two years’ protection against cholera, plus about three months partial protection against travellers’ diarrhoea.


This bacterial infection is another disease that the Victorians feared. It’s spread via respiratory droplets and causes the production of a strangulating pseudomembrane close to the tonsils. Untreated, up to 20% of those infected die of diphtheria.

The combined diphtheria/pertussis/tetanus vaccine is part of the UK’s national immunisation programme, so most of us are protected. However, some people refuse the routine jabs or overlook the need for ten-yearly boosters.

In certain regions vaccine delivery doesn’t reach those who need it; there have been diphtheria deaths in children in India this year, for example. Better housing has made it a rarity in Britain but it is a continuing risk to unimmunised travellers.

Top tip: Travellers spending prolonged periods with locals in emerging nations should ensure that they are immunised, and should also avoid consuming raw dairy products.


Stay up-to-date with all those boosters: keep a record of every jab you have, and when and if it needs updating.


Also called lockjaw, tetanus was once dreaded but, thanks to a widely promoted vaccine, should now be consigned to the history books. It’s a bacterial infection that strikes when a deep, dirty wound becomes contaminated by horse or cow dung. The microorganism reproduces in the wound and generates toxin that causes muscle paralysis; if left untreated, it will compromise breathing. It ought to be completely avoidable but I’ve seen a case – a footballer who would have died had he not been put on a ventilator.

Top tip: No country is tetanus free so maintaining immunity is vital, especially if you enjoy the outdoors and even gardening.


Whooping cough should be avoidable through immunisation but it’s occurring again in England and Wales – there were 9,747 cases in 2012, up from 1,119 in 2011. In adults it causes a ‘100-day cough’; if it infects infants it can cause irreparable lung damage. DPT boosters should give protection.

Top tip: Don’t be complacent. In 2008 it was estimated that 95% of cases were from industrialised countries, despite well-established vaccine programmes.


Polio was a scourge of Britain before the vaccine was developed in 1952. However, because this virus (largely transmitted via contaminated food or water) causes severe disease and paralysis in perhaps one in 50 of those infected, it can simmer in a community and emerge unexpectedly.

Top tip: Practise good food, water and personal hygiene. Only swim in chlorinated pools or open water.


We are seeing a return of measles, mumps and rubella to Britain. Poor science and scaremongering have worried many parents, causing a drop in immunisation uptake in the UK and the subsequent return of the diseases. Yet MMR is a safe vaccine, and it is good to be covered for travel. Most adult travellers will need to pay for boosters.

Top tip: Plan ahead – as MMR is a live vaccine it needs to be given at the same time or three weeks separate from other live vaccines.


Since plague is a disease that thrives in overcrowded areas, improvements in housing have seen it naturally decline, but there are still cases each year. In summer 2013, bubonic plague deaths were recorded in the USA and Kyrgyzstan.

The disease is harboured by rodents and spreads from rat to rat via flea bites. Pets can pick up rat fleas; the fleas may then bite the pet-owners.

Top tip: Worry not! Plague is not a risk to ordinary travellers.


The last person to die from locally-acquired rabies in Britain was in 1902. Strict quarantine control has kept the country free from the disease, and the only recent deaths caused by rabies in Britain have been in people who’ve been bitten or scratched overseas and failed to seek post-bite treatment.

There is one nasty exception. There is a rabies-like bat lyssavirus that seems to be as lethal as true rabies. It killed a bat handler in Scotland in 2002. There have been a couple of deaths due to a similar lyssavirus in Australia, normally considered to be rabies-free.

Top tip: Immunisation and/or prompt post-bite jabs are protective and highly effective against both rabies and lyssavirus. The rabies vaccine is a course of three injections that ideally should be started at least 21 days before departure.


The Spanish flu pandemic of 1918-9 killed more Europeans than the Great War; it’s reckoned between 50 million and 100 million people across the world died. And the reality is, there will be more pandemics.

Medical scientists strive to keep one step ahead of influenza virus evolution; we can hope that when the next one breaks out that the right vaccine will be available.

Top tip: It is wise to be immunised against flu, especially when travelling to South-East Asia. The vaccine provides immunity to certain flu strains for a year and can usually only be accessed during our winter. It can be obtained cheaply at pharmacies and clinics.


Tuberculosis killed both rich and poor; it was responsible for the early demise of many talented artists including Keats and most of the Brontës.

Following the development of the streptomycin antibiotic in 1948, the disease was controlled for some decades. However, with increases in global travel, patients living with immunosupression and the development of resistance to antibiotics, the disease is fighting back.

Top tip: Anyone spending extended periods in resource-poor destinations might consider BCG immunisation; it protects against the worse forms of TB.

Dr Jane Wilson-Howarth remembers having measles as a child. Her book, The Essential Guide to Travel Health (Cadogan), reviews all possible and imagined travel health risks. See www.wilson-howarth.com 

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