Holidays are as popular as ever, and according to the 2016 Holiday Habits report by the Association of British Travel Agents (ABTA), 86 per cent of Britons took a holiday either at home or abroad in the 12 months to August 2016. Yet preparing for ill-health while away isn’t always at the top of everyone’s checklist. In fact, a survey by Superdrug in August 2016 revealed that 53 per cent of Brits take health risks when travelling abroad.
In the Superdrug survey, the most commonly reported illnesses that ruined holidays were diarrhoea, vomiting, a sore throat and infections. All of these should be easy to deal with, as long as holidaymakers have the right medicines available. But 62 per cent of people in the survey admitted to not packing a first aid kit, 60 per cent didn’t take diarrhoea relief, 71 per cent didn’t pack antihistamine creams (for instance to help soothe mosquito bites), and 72 per cent forgot antiseptic products.
A pre-holiday trip to the pharmacy to purchase some travel health essentials should be a key part of holiday preparation. Here’s a checklist of what customers need to think about buying before they travel, whatever their destination.
A survey last year by Gocompare.com travel insurance found that over one in five UK holidaymakers have needed to seek medical treatment while abroad, but many don’t have travel insurance in place. What’s more, many people overestimate the benefits a European Health Insurance Card (EHIC) provides. An EHIC covers treatment that is medically necessary until the planned return home. It is not an alternative to travel insurance, as it won’t cover being flown back to the UK, and is also not valid on cruises. And, after Britain leaves the EU, British citizens may no longer have access to the EHIC card and its benefits.
“Some people complain that travel insurance is expensive, but it’s important to have full medical cover,” says Dr Jane Wilson-Howarth, GP and travel health expert. “An EHIC card will support emergency medical care in the EU holiday destination, but not much else. Customers should be advised to shop around. Some insurers will cover older people, including those with pre-existing medical conditions, as long as their condition is well controlled.”
Travel vaccinations protect against a range of potentially serious illnesses, and customers should check whether they need any specific ones for their holiday. “The types of vaccinations required will vary depending on the destination, length of trip and types of activities,” says Superdrug nurse Catherine Turner. “Some of the most routinely offered vaccinations are hepatitis A, typhoid and DTP [diphtheria, tetanus and polio]. These provide protection from food- and waterborne illnesses and other commonly encountered illnesses. An individual consultation with a travel health expert will identify any other vaccinations that should be considered prior to travel. It is important to allow sufficient time to obtain vaccinations prior to travel as some involve more than one injection and others may need at least two weeks to become effective.”
If fear of flying is mild, most travellers will find that a combination of keeping distracted and chatting to fellow passengers or cabin crew should help to reduce their anxiety. But travellers with a significant fear of flying should be advised to see their GP before travelling.
“If someone has a fear of flying, many GPs will prescribe diazepam,” says Dr Wilson-Howarth. “Some people are very sensitive to diazepam, while others need a larger dose, so it’s best to try it out before you travel. Diazepam lasts in the body for only four hours, so multiple doses may be required for a longer flight. It’s a [potentially] addictive drug and there are restrictions in some countries, so people should carry with them a GP letter or a stamped print out of their GP consultation. Those anxious about the journey can also go on a ‘fear of flying’ course. These are run by airlines and seem to be very effective. Some GPs will prescribe sleeping pills, but these increase the risk of deep vein thrombosis [DVT] when travelling.”
Antimalarial medicines are not available on an NHS prescription but can be bought from a pharmacy or obtained via a private prescription. It’s important to check their suitability for the destination, contraindications (including scuba diving) and side effects. Customers need to be aware that they must complete the full course – some tablets need to be started up to three weeks before travelling and must be taken for seven days after returning from the risk zone. Customers should visit their doctor immediately if they experience a fever or any flu-like symptoms on their return, as these could be a sign of malaria.
“Antimalarial pills are not 100 per cent effective, so customers should always try to stop themselves being bitten,” says Dr Riccardo Di Cuffa, director and GP at Your Doctor. “Mosquitoes carrying the disease often bite after sunset, so it is a good idea to wear strong repellent and long-sleeved clothes in the evenings. The Advisory Committee for Malaria Prevention (ACMP) strongly recommends DEET-based insect repellents.”
Customers should aim to take enough medication to cover their whole trip. If people are travelling with prescribed medicines, they should carry with them a letter from their GP listing the generic and brand names. “If they run out of medicines, or lose them, they can then find a doctor at their destination to get replacements,” says Dr Wilson-Howarth. “A lot of people don’t know what they are taking their medicines for, which causes problems if they don’t have the right information with them. Ideally, keep medicines in their original packets. On the NHS, patients can only get one or two months’ supply of their medicines at a time (six months of the contraceptive pill). If they need more than this, they will have to get a private prescription.”
Travel sickness is a common problem in adults under 50 and children between three and 12 years. Symptoms can include dizziness, vomiting and cold sweats when travelling by car, boat or plane. Travel sickness medicines are readily available from pharmacies, but they aren’t suitable for all age groups, so customers or pharmacy teams should check the packaging before taking or recommending a product. Customers should be warned that travel sickness medicines can cause drowsiness. Self-help measures include getting plenty of fresh air and avoiding activities such as reading or doing other close work.
“Anti-sickness tablets or medicines taken between 20 minutes and two hours before travel, depending upon the chosen medication, often help,” says pharmacist Steve Riley. “There are also acupressure bands available, which apply pressure to a point on the wrist to help ease symptoms.”
Long periods of immobility when travelling on any mode of transport can increase the risk of DVT (deep vein thrombosis). “Travellers are advised to move about as much as possible, either stretching regularly or walking about,” Catherine says. “Keeping hydrated is also important. For long journeys, some people may choose to wear flight socks, which can be bought off the shelf in the appropriate size. Those with underlying health conditions or a previous history of DVT should be advised to seek advice from their doctor if they are planning to take a long journey, as they may require medication adjustments or made-to-measure compression garments.”
Jet lag can disrupt sleep patterns and also cause digestive problems and difficulty concentrating. Lifestyle changes can often help to reduce the impact of travelling across several time zones. “High protein meals increase alertness and lots of carbohydrates make you feel sleepier,” says Lisa Artis of The Sleep Council. “Whether on the journey there or on the way home, customers should eat according to the normal mealtimes of their destination, avoid alcohol and take regular walks up and down the aisle.”
Lisa explains that for destinations closer to home, comfort levels are more likely to cause sleep issues than jet lag. To combat this, she says: “Having an eye mask and ear plugs will aid sleep if noise or light outside may be an issue. Keep the bed as a ‘sleep zone’ and check the temperature. Ensure the bedroom is cool – the ideal sleeping environment is 16-18 degrees. Try to keep to regular hours as much as possible and remember it’s still important to factor in some wind down time – spend at least 15 minutes doing something relaxing before bed.”
A first aid kit is an essential holiday purchase. Pharmacy staff are ideally placed to help customers gather together a kit that suits their needs. “Most first aid kits don’t get used on holiday, but it’s important to travel with the basics, such as an antiseptic, dressings and plasters, a crepe bandage and SteriStrips to close a wound and stop any bleeding,” says Dr Wilson-Howarth. “People don’t realise that they need to be more scrupulous about wound care on holiday, especially in humid environments, as there’s a higher risk of infection. They need to clean wounds carefully with an antiseptic wipe or alcohol and keep the wound covered. A dry antiseptic spray is more effective than an antiseptic cream at preventing infections in warmer climates.”
According to Dr Wilson-Howarth, travellers often develop a cold two or three days after their flight because of microbes in the shared air on the plane. Customers should pack paracetamol for pain relief. Soluble products can be used for gargling if a person has a sore throat, and they may also benefit from packing some cough, cold and sore throat remedies.
Bite avoidance plays a key role in protecting travellers from a number of illnesses, including malaria. “Insect repellents containing DEET can minimise the risk of being bitten or stung,” says Steve. “Customers can also get plug in devices and mosquito nets for hotel rooms. It is also advisable to cover up if out when it is dusk to avoid bites.”
Natural ingredients such as citronella and lemon eucalyptus have been shown to provide only short-lived protection so shouldn’t be used on their own. If customers are applying insect repellents and sunscreen, they should apply the sunscreen first, leave it to dry and then put the insect repellent on top.
Customers with severe allergies should always carry an adrenaline pen if it’s been prescribed. “Some people may also wish to wear medical ID bracelets to highlight their allergy to others, especially if they are travelling alone,” says Catherine.
Even if customers are not usually prone to allergic reactions, it’s important to be prepared. “If someone has an allergic reaction to a mosquito bite, they should take a long-acting non-sedating antihistamine, such as cetirizine or loratadine, rather than chlorphenamine,” says Dr Wilson-Howarth. “Oral anthistamines will be more effective than anti-bite creams, which can potentially cause allergic reactions themselves. If these aren’t strong enough, customers will need to go to a doctor for prescription-only alternatives.”
Diarrhoea is a common holiday illness, especially when visiting less developed countries. To prevent diarrhoea, customers should choose what they eat and drink very carefully and practise strict food hygiene measures. Carrying hand sanitiser gel and/or wipes may help to reduce the spread of infections.
If diarrhoea strikes, Steve recommends anti-diarrhoeal tablets to stop the symptoms in the short term, as long as these are suitable for the customer. “Oral rehydration solutions are a good way to replace lost glucose, essential salts and minerals to help avoid dehydration, which is particularly dangerous for the young and elderly,” he says. “An unexpected heatwave in the UK, or travel to tropical climates, can mean people sweat more than usual, causing their body to lose fluid. Feeling thirsty or having dark coloured urine are both early signs that the body is trying to increase water intake and decrease water loss.”
Any amount of sun damage to the skin can be dangerous, with a risk of serious health problems such as skin cancer in later life. “If you start to feel as if you are getting burnt, then get out of the sun as soon as possible and sit in a shaded area,” says Steve. “The best way to prevent sunburn is to use a strong sunscreen with a high SPF and stay out of the sun during peak times between 11am to 3pm.”
Gillian Nuttall, founder of Melanoma UK, says that if customers are not fully aware of their skin type and the kind of sunscreen they should be buying, they should be encouraged to ask the pharmacist for help. “Most pharmacists will be fully trained to advise on skincare, and it is right to treat sunscreens as a health commodity, not a beauty product,” she says. “Most pharmacists should have information on what to be mindful of when it comes to all forms of skin cancer, not just melanoma.”
If people are travelling with prescribed medicines, they should carry with them a letter from their GP listing the generic and brand names