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Fly away with me

Now summer holidays are well and truly back on the agenda, here's the advice pharmacy teams can offer to keep travellers healthy

The demand for travel is now back in line with pre-pandemic levels, with the most popular holiday destinations for Brits including Spain and Turkey, according to research by the Association of British Travel Agents (ABTA).

For many people, this could be their first time abroad for several years due to the pandemic, so they may need a reminder of holiday health essentials, especially in very hot climates.

“When travelling abroad, preparing for any medical needs while away will save you time and potential problems, although most tourist areas will have pharmacies and medical attention available, if necessary,” says Karen Baker, Care’s expert pharmacist. “Depending on where you are going, your age, gender, destination and medical needs, what you need to pack will differ, but it is always worthwhile taking essential items to cover your basic healthcare needs and emergencies.”

Prevention is key 

Most people only think about travel vaccinations if they are visiting an exotic location or exploring somewhere remote. But in March 2023, the National Travel Health Network and Centre (NaTHNaC) issued a reminder for travellers to check that their routine UK vaccinations are up to date. Many infectious diseases prevented by routine vaccination are no longer common in the UK but are still reported in other countries, including diphtheria, measles, mumps, rubella and polio. 

Updated practical guidelines on malaria prevention in UK travellers were published by the UK Health Security Agency (UKHSA) in April 2023. Recommendations for antimalarials should be appropriate for the destination and tailored to each traveller, taking into account any possible risks and benefits. However, in some parts of the world, antimalarials are no longer recommended for malaria prevention and bite avoidance is more important.

Malaria symptoms can be similar to other infections, including Covid-19. If any customers with cold or flu like symptoms (e.g., a fever, sore throat, headaches, chills, sweats, tiredness or aches and pains) have recently returned from a malaria-risk zone, they should be advised to speak to their GP.

Care 30g Antiseptic First Aid Cream

Care 30g Antiseptic First Aid Cream can be used to treat minor burns, grazes and nappy rash, according to manufacturer, Thornton & Ross. The product contains cetrimide 0.5% w/w which has antibacterial properties and is suitable for use on children, adults and the elderly, the company adds.  

Thornton & Ross: 01484 848200

First aid action

An off-the-shelf first aid kit will contain basic items to deal with cuts and scrapes, but most holidaymakers will benefit from a tailormade kit to suit their needs. For example, they may want to pack specialist blister plasters if they are doing a lot of walking or take medicines for specific ailments. If someone is travelling further afield, they may want to pack a thermometer, malaria tablets, a water purification kit, emergency dental kit and needles
or syringes.  

“First-aid supplies are always useful for any trip away from home,” says Karen. “You don’t need a lot of items, just enough to be able to stop a wound from bleeding or getting infected before you can seek medical help, as well as pain relief. This includes paracetamol, ibuprofen, diarrhoea tablets, plasters and antiseptics. A few dressings, gauze and a crepe bandage are useful too.”

Bites

Insect bites can happen anywhere, even in the UK, and people are most at risk of being bitten from dusk to dawn. It’s important to cover up with long sleeves, long trousers and socks if spending time outside after sunset. All travellers to malaria-endemic areas should sleep under a mosquito net unless they are in a well-screened room with fine-mesh mosquito netting on windows and doors, or if there’s strong air conditioning (which stops mosquitoes from entering the room). 

It’s impossible to avoid insects completely, especially if your windows and doors are open in hot weather. The Advisory Committee on Malaria Prevention (ACMP) recommends using a 50 per cent DEET-based insect repellent. If DEET isn’t tolerated (or isn’t available), customers could use a repellent containing high-strength icaridin or lemon eucalyptus oil, hydrated, cyclized, or 3-ethlyaminopropionate instead. It’s important to use plenty of repellent on exposed skin and reapply regularly. When sunscreen and DEET are being used together, DEET should be applied after the sunscreen – use 30-50 SPF sunscreen products, as DEET can lower their effectiveness. 

Insect bites and stings are not only a nuisance, but they can be very itchy. Sometimes they get red, sore and swollen, and bites may develop into fluid-filled blisters, customers need to try to avoid scratching them as much as possible. 

Most bites and stings can be treated at home. They should be washed with soap and water and any sting left in the skin should be removed. Then cold compress (or even a bag of frozen peas wrapped in tea towel) should be applied to relieve the discomfort. Antihistamines, hydrocortisone creams and painkillers may also help. 

If someone has a severe reaction, or the bite or sting hasn’t cleared up after a week, it’s important they see a GP. They should also see a GP if the bite or sting is in the mouth, throat or near the eyes. A bite or sting may become infected, and some people may have an allergic reaction. If someone feels dizzy or has breathing problems or a swollen mouth or face, this is a medical emergency and needs immediate treatment.

Care 100g Aqueous Calamine Cream

Care 100g Aqueous Calamine Cream relieves mild sunburn and other minor skin conditions. The cream contains calamine 4% w/w and zinc oxide 3% w/w, works as a mild astringent and is suitable for people of all ages, says manufacturer, Thornton & Ross. The company adds that whilst the product is not considered likely to cause any undesirable effects during pregnancy, as with all medicines, those who are pregnant or breastfeeding should talk to their doctor or pharmacist before use.

Thornton & Ross: 01484 848200 

Too much motion 

Some travel associated health problems can strike before holidaymakers reach their destination. People may feel sick when travelling in a vehicle, aeroplane or boat. This may be worsened by anxiety, strong smells, trying to read a book or map or scrolling a phone screen. Children are more prone to motion sickness than adults.

The most common symptoms are feeling sick, sweating, headache, feeling cold, turning pale or feeling weak. These usually stop when the journey is over but occasionally last for several hours or even days.

Tips to prevent motion sickness include:

  • Eat light, carbohydrate-based foods such as cereals an hour or two before travelling
  • Break up long journeys by getting some fresh air, drinking some cold water or, if possible, taking a walk
  • Sit in the front seat of a car, over the wing of a plane or on the deck in the middle of the boat to limit motion
  • Avoid strong smells, especially petrol and diesel fumes
  • Close the eyes (and keep them closed for the whole journey)
  • Avoid reading or watching a screen.

Pharmacy customers can buy several different motion sickness medicines (e.g., hyoscine or some antihistamines). They work better if taken before the journey and customers should follow instructions on the packet, as some medicines don’t work straight away or last longer than others. Some medicines for motion sickness can cause drowsiness. Another option is to try acupressure bands that are worn on the wrist. Homeopathic medicines (e.g., nux vom) help some people too. 

Protect your neck

Up to nine in 10 cases of melanoma skin cancer could be prevented by enjoying the sun safely, according to Cancer Research UK. This involves spending time in the shade, covering up by wearing loose clothing, a wide brimmed hat and UV-protection sunglasses, and using sunscreen (at least SPF15 and four or five stars).

“For a warmer climate, pharmacy teams should advise customers to always apply sufficient sunscreen – ideally sunscreens containing UVA and UVB filters,” says Karen. “Customers should be applying at least 30ml of sun cream all over the body for each application, and to always ensure they use a high factor. Sunscreen typically has a shelf life of six to 12 months, so it’s important for teams to communicate the importance of replacing sunscreen every year as the SPF efficacy can drastically reduce over time.”

Damage control

Too much sun can lead to sunburn. This is when the skin feels hot and sore and may flake and peel after a few days. White skin may look red or pink, while brown or black skin may not change colour but feel hot, sensitive and itchy. If customers get sunburn, they should keep out of the sun and drink plenty of water to avoid getting dehydrated.

“Pharmacy staff can recommend cooling the skin with cool water and following up with applying aftersun to moisturise the skin,” says Karen. “For customers seeking sunburn relief, calamine aqueous creams are effective product recommendations. These lotions provide moisture and will relieve the itching and peeling associated with sunburn. If you keep them in the fridge, they also provide relief by cooling the skin. Painkillers such as ibuprofen can also reduce pain and inflammation.”

If the sunburn is severe, the skin may also blister. Any blisters should be kept clean and protected with a non-stick gauze or bandage. If there are any signs of infection, it’s important to speak to a GP.

Period delays

If customers wish to delay their period while they’re on holiday, they should speak to their GP. If they’re taking the combined contraceptive pill, they may be able to take two packets back-to-back (skipping the usual seven-day break between them), or they may be able to start taking the combined contraceptive pill if they’re not already using contraception (but this needs to be several weeks before they are going away to make sure it’s working properly).

Otherwise, their GP may prescribe a medicine called norethisterone to delay their period. They’ll usually need to take the norethisterone tablets three days before they expect their period to begin and take three tablets a day for a maximum of 20 days – their period will then start two or three days after they stop taking the tablets.

Norethisterone isn’t suitable for everyone – such as those with a history of blood clots. It also isn’t a form of contraception, so people still need to use condoms, or another form of contraception, to prevent pregnancy. Some women get side effects while or after they take norethisterone, including irregular periods, breast tenderness, nausea, headaches and mood changes. Women shouldn’t take norethisterone regularly. If they want to delay their periods more often, they will need another approach, such as taking the combined contraceptive pill back-to-back (as mentioned above) or considering an intrauterine system (IUS).

Digestive upsets

Food poisoning can be more common on holiday, as bacteria flourish in hot weather. It’s important to replenish lost body fluids by drinking plenty of water – or even using rehydration sachets. This is particularly important for young children and older people who are more prone to dehydration.

Other digestive problems can become more common on holiday too, as eating habits change and people eat different foods. Customers may wish to pack some remedies for constipation or indigestion, especially if they’ve had these conditions in the past. 

Additional health supplies

If customers take medicines (prescribed or over-the-counter) for any chronic health conditions, they should pack enough supplies for their holiday, plus some extra in case their return is delayed. They should keep a list of their medicines with them (generic names as well as brand names). Essential medicines should be stored in their hand luggage. 

Allergies often occur in new environments – especially to foods or plants – so even if customers aren’t prone to allergies, including hayfever, they should pack some non-drowsy antihistamines. 

Eyes and throats can feel dry from air conditioning abroad, especially if customers are travelling by plane. Travellers often find that they get a stuffy nose on holiday, or even catch a cold, so they may wish to pack some decongestants.

Clot concerns

Long-haul travel carries with it a risk of blood clots in a deep vein known as deep vein thrombosis (DVT). This risk isn’t just with air travel, but any travel that involves being immobile for prolonged periods. The blood clot is most common in the legs, but part of the clot can break off and travel to the lungs, causing a blockage (pulmonary embolism). This is a life-threatening condition. Signs of a blood clot include swollen, painful legs and breathing difficulties.

DVT is more common in older people, pregnant women or people with cancer (treated or being treated), recent surgery, varicose veins, mobility problems, obesity, a history of blood clotting problems or a close family history of DVT. Other risk factors include taking combined oral contraceptives (the pill) or hormone replacement therapy (HRT). Customers who have an increased risk should wear graduated compression stockings (flight socks). They should check that they are wearing the correct type and size and know how to wear them properly – if the stockings don’t fit properly, this can increase their risk of a blood clot.

To prevent blood clots on long-haul travel, the pharmacy team should recommend that customers move around as much as possible, choose an aisle seat so they can stretch their legs, and do calf muscle and ankles exercises. It’s important to drink plenty of water to prevent dehydration – drinking lots of alcohol or taking sleeping tablets increases the risk of blood clots by reducing movement.

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