Risks to your health when overseas

Gastroenteritis

An estimated 20 to 50 percent of travellers suffer from diarrhoeal infections caused by poor personal hygiene or by eating and drinking food and fluids contaminated with bacteria, viruses or worms. Travellers’ diarrhoea, dysentery, hepatitis A, Salmonella infections, giardiasis, typhoid and cholera are all transmitted by these routes.

Precautions

It is recommended that the following precautions are taken against gastrointestinal infections, particularly in areas where hygiene is poor:

• Always wash your hands with soap and water after using the toilet and before preparing or eating food
• Avoid eating or drinking, salads, raw or cold seafood including shell fish, raw or runny eggs, cold meat unpasteurised milk, dairy products, ice in drinks, ice-cream, and flavoured ice blocks, Fruit that you peel yourself is usually safe. Remember – “cook it, boil it, peel it, or leave it”
• If water disinfection is necessary, water should be kept at boiling point for at least 1 minute (or for at least 3 minutes at altitudes over 2,000 metres) before drinking. If this is not possible, then iodine tablets or water purifiers should be used - follow the instructions carefully
• In general, drinks that are usually safe from contamination include tea and coffee made with freshly boiled water, commercially canned or bottled water or carbonated drinks, beer and wine. Ensure that seals on bottles are intact, avoid ice in any drinks, and drink directly from the can or bottle (rather than use a potentially-contaminated glass or other drink container)

If you DO get sick

• In the event of diarrhoea, fluid replacement is the first priority
• Dehydrations from loss of fluids can be dangerous at any age, but particularly so in infants and young children who can dehydrate very quickly. Remember to increase fluid intake during episodes of diarrhoea. Oral rehydration solution (ORS) replaces salt and sugar from the body. It is important to follow the instructions on the packet and mix the solution correctly
• Breastfeeding mothers should continue to breastfeed as normal but should supplement breast milk with ORS using a cup and spoon
• Do not give anti-diarrhoeal medications to children
• See a doctor if diarrhoea and/or vomiting are severe or persistent

Diseases transmitted sexually or by blood

Sexually transmitted infections such as gonorrhoea, syphilis, chlamydia, genital herpes, hepatitis B and HIV, pose a significant risk to people who engage in unprotected vaginal, oral or anal sex. It is estimated that 33 million people worldwide were living with HIV/AIDS in 2009.

Blood-borne viral transmission of hepatitis B, hepatitis C and HIV may also occur through injecting drug use, body piercing or tattooing, the infusion of infected blood or blood products, and through the use of unsterile contaminated medical equipment. The early symptoms of HIV infection can include fever, muscle aches, rash and “flu-like” illness. See a doctor immediately if you have been placed at risk of HIV.

Precautions

The most important factor determining your risk of getting an STI or blood-borne virus is your own behaviour:

• Avoid having unprotected sex with a casual acquaintance (including other travellers) or prostitute. The proper use of condoms with water-based lubricant provides protection against most STIs, including HIV.
• Where possible, avoid any procedure which involves injections, transfusion of blood or blood products, surgery or skin penetration, including tattooing. Blood products in some countries may carry HIV.
• It is important to see a doctor on your return if you have had unprotected sex, been exposed to blood or blood products, or if you have undergone any procedure requiring puncturing of the skin with a needle or instrument.
• There is a safe and effective vaccine for hepatitis B

For further information is available on the Department of Health Sexual Health website and the pamphlet "Going overseas: Get it on" (PDF 141KB)

Rabies

Rabies occurs in most parts of the world, including Africa, the Americas, continental Europe and South East Asia, where many Western Australians are put at risk by dog or monkey bites and scratches. In 2010, over 200 Western Australians were bitten or scratched overseas by animals, mainly in Bali, Indonesia, and required a course of rabies vaccinations to help minimise the risk of infection. Around 100 Balinese have died from rabies in 2009-2010 after animal bites, mostly from dogs.

Any mammal, including dogs, cats, bats and monkeys, should be considered a potential source of rabies infection. Risky exposures include bites, scratches and contact with saliva of these animals.

Travellers bitten or scratched by an animal in a rabies endemic area, including Bali, should urgently seek medical attention, and will usually need to complete a course of several post-exposure vaccinations. Rabies is universally fatal once symptoms develop.

Diseases transmitted by mosquitoes

Mosquito-borne diseases are prevalent in many overseas countries and include: malaria, Japanese encephalitis, dengue fever and yellow fever.

Malaria

Mosquitoes which carry the disease are present in tropical and subtropical areas of Africa, Asia, the Pacific, and Central and South America. There is a risk of contracting malaria even after taking anti-malarial drugs. Symptoms can develop as early as six days after being bitten by an infected mosquito and as late as months after departure from a malarious area. Symptoms include fever, chills, headache, muscle ache, diarrhoea and malaise. Early stages of malaria may resemble the onset of influenza.

Travellers who become ill with a fever during or after travel in a high-risk malaria area should seek prompt medical attention and inform their doctor of their recent travel history. Malaria can be treated effectively in its early stages, but delaying treatment can have serious consequences, including death.

Preventive anti-malarial tablets can only be effective if taken exactly as directed. They usually need to be commenced prior to departure and should be continued for a period after return. See your doctor to discuss the best anti-malarial for your destination and length of travel.

Yellow Fever

Yellow fever occurs in parts of west and central Africa and South America. Although it is a rare cause of illness in travellers, vaccination is a requirement if travelling to or from countries where the disease is present. Most countries have regulations and requirements regarding the need for yellow fever vaccination. Your travel agent or doctor will be able to advise you if vaccination is necessary. A Yellow Fever International Certificate of Vaccination remains valid for 10 years.

Dengue fever

This disease occurs worldwide in tropical and subtropical regions. Many Western Australians acquire dengue fever overseas, mostly in Bali and other popular destinations in South-east Asia. Transmission is usually seasonal, during and after the rainy season. Symptoms include severe headaches, high fever, joint and muscle pain, nausea, vomiting and rash. Dengue haemorrhagic fever, a severe form of the disease, is rare among travellers, but can be fatal. The mosquito that carries dengue is usually found near or inside human dwellings and bites during the day. Because there is no vaccine against dengue fever, it is important to avoid being bitten by mosquitoes - use insect repellent and stay in airconditioned and/or screened accommodation.

Japanese encephalitis

Japanese encephalitis (JE) occurs chiefly in China, India, parts of South-East Asia and the Pacific, particularly in rural, rice growing areas where pigs are present. Occasional cases occur throughout the year in tropical areas, while in subtropical and temperate regions outbreaks tend to occur at the end of the wet season (April to October). Mild infections may go unnoticed. Symptoms of severe infection include headache, high fever, reduced consciousness, confusion and fits. Vacccination against JE is recommended for travellers who intend to spend more than one month in, or who plan to make frequent trips to, high-risk rural areas. Vaccination requirements should be discussed with a travel medicine specialist if an extended length of stay in a high-risk area is planned.

Precautions

Anti-malarial drugs and yellow fever vaccination are only partially effective and give no protection against other diseases transmitted by mosquitoes. The best protection is to avoid being bitten by mosquitoes.

Mosquitos usually bite between dusk and dawn, but the mosquitoes that transmit dengue fever typically bite during the day. Prevent being bitten by:

• Avoiding outdoor exposure between dusk and dawn
• Wearing loose-fitting, long sleeved shirts and pants and socks to cover feet and ankles
• Using an insect repellent on exposed skin and on clothing, eg on scarves and hat rims. Ensure that infants and young children are adequately protected, including infant strength repellents
• Using insecticide-impregnated mosquito nets if sleeping in accommodation that is not mosquito-proof. Insect sprays, mosquito coils and plug-in insecticide mats provide extra protection

Insect repellents containing up to 50 per cent DEET (diethyl-toluamide) or Picaridin are preferable for protection against mosquitoes. As with all chemicals, repellents should be applied in accordance with the instructions, especially on infants and young children. Do not depend on your repellent too much – it is safer to avoid dangerous times and places.

Schistosomiasis (bilharzia)

This disease is present in Africa, parts of Asia, South America and the Caribbean. Infection results from swimming, wading, rafting, washing and/or drinking water from freshwater streams, canals and lakes containing the schistosome larvae. Symptoms may include skin itch or rash at the time of exposure. Chronic infection of the liver or bladder can cause diarrhoea, abdominal pain, enlarged liver and spleen, and pain on passing urine, frequency and blood in the urine. To minimise penetration of the larvae after brief or accidental water exposure, towel vigorously and apply 70 per cent alcohol or methylated spirits to the skin. Avoid walking in the shallows or edges of any water.

Shoes should be worn in areas of poor hygiene to avoid skin penetration by hookworm and other parasites. Shoes also reduce the risk of needle-stick injury through stepping on discarded injecting drug equipment.

Illness on return

Symptoms of some diseases may develop days to months after returning home. If unwell after returning to Australia or upon reaching your destination, inform your doctor of any overseas travel undertaken within the previous 12 months.

For more information

See your doctor and discuss your travel plans well in advance.

← Previous page