Staying healthy during travels

Travel vaccinations are an important consideration for adults and children to ensure proper protection while on holiday, writes Dr Tabassum Khan

WHEN we go on holiday, let’s not forget to take care of our health. With the rise of various communicable diseases worldwide, a resurgence of diseases long thought extinct, and an emergence of “new” diseases, there is no better time to start taking control of personal health before embarking on any journey.

BOOSTING AWARENESS

AND IMMUNITY

While often overlooked, vaccination is an important consideration for travellers, especially those going abroad. This importance is exemplified by the public health departments of various countries, which issue vaccination travel advisories for its citizens. The influenza vaccine, for example, is now considered routine for travellers, young and old.

Nevertheless, there is still a lack of awareness on the benefits of travel vaccinations, particularly amongst adults. As a result, Malaysia still suffers from the existence of certain communicable diseases, despite the government adopting measures to eradicate them and providing vaccines within the National Immunisation Schedule.

The Ministry of Health’s data for 2011 showed that the incidence rates for measles, hepatitis B and pertussis were 5.42, 4.32 and 0.86 per 100,000 population respectively.

Beyond the rise in the anti-vaccine movement, these incidence rates can also be attributed to the misconception that Malaysians do not need protection as adults. This is given the fact that there is

Get your vaccinations in order before you travel.

a persistently high childhood immunisation coverage in the country through the National Immunisation Programme (NIP), Childhood Immunisation Coverage in the country ranges from as low as 94.33 per cent for HPV immunisation of girls aged 13 years to as high as 98.59 per cent for BCG immunisation of infants.

In reality, however, there are many common childhood diseases, such as chicken pox, hepatitis A and meningococcal disease that are not covered by the NIP and these have become more prevalent today.

Furthermore, certain vaccine protections will diminish with age unless boosters are given according to the specific vaccine schedule. For example, tetanus and diphtheria toxoids require periodic reinforcement or booster doses to maintain protective antibody concentrations.

On the other hand, certain vaccinations such as the seasonal flu vaccine should be taken regularly, regardless of whether one is travelling or not, given that the vaccine protects against influenza viruses that

Cholera is a major concern in many countries. Credit: www.epi.ufl.edu

research indicates will be most common during the season.

HOW AND WHEN TO GET PROTECTED

It will be virtually impossible to get yourself vaccinated against all diseases before travelling. But travellers can make smarter decisions by truly understanding the region that they are travelling to and getting protected from common diseases at their holiday destinations.

Those travelling to India and the Philippines, for example, should take the necessary precautions against cholera, an acute diarrhoeal infection caused by the ingestion of food or water contaminated with the bacterium Vibrio cholerae.

Beyond these countries, cholera is also highly widespread in most of subSaharan Africa and in countries such as Myanmar, Pakistan and Nepal in Asia. To date, it remains a significant public health problem in many parts of the world. In fact, according to the World Health Organisation, there are roughly 1.3 to 4.0 million cases, and 21,000 to 143,000 deaths worldwide due to cholera.

One of the best ways to mitigate the risks associated with this disease is vaccination. The WHO recommends options for oral vaccines that have good safety profiles, are effective, well-accepted and most importantly available for individuals of a wide age range. Travellers should take the initiative to consult their doctor and learn more about prevention options that could help protect them from contracting the disease.

Another serious public health issue faced by tropical and subtropical regions is leptospirosis; an infection caused by the Leptospira bacteria. The disease can be contracted through direct exposure to the urine of infected animals or from a urinecontaminated environment.

The disease can manifest as headaches, muscle pains, fever, a mild influenza-like illness and if left untreated, it can progress to severe stages leading to internal bleeding and organ failure, which could be fatal. It is also worth noting that leptospirosis has been associated with swimming, wading, kayaking, and rafting in contaminated lakes and rivers. As such, it is a recreational hazard for campers or those who participate in outdoor sports.

The magnitude of leptospirosis differs from country to country and depends on the awareness and attitude of public healthcare decision makers. Most cases have been reported in India, Indonesia, Thailand and Sri Lanka during the rainy season. There have also been major outbreaks in Asia in the past, such as in Jakarta (2003), Mumbai (2005) and Sri Lanka (2008).

Leptospirosis is also becoming a problem in Malaysia. According to the Ministry of Health, there have been an increasing number of reported cases and outbreaks which have resulted in significant number of deaths over the past decade. However, there is still a lack of information on the prevalence of the disease locally.

While there are no widely used leptospirosis vaccines currently, you can take necessary precautions to protect yourself against the disease before you travel to potentially high-risk areas, be it locally or abroad. For example, by avoiding exposure to the urine or blood of animals, staying away from contaminated water sources and wearing appropriate protective clothing when outdoors. Beyond that, you can also talk to your healthcare provider about other preventative options against leptospirosis.

Protecting your health before a holiday is just as important as ensuring that all necessary logistical details pertaining to your trip have been organised. So, do your research, get your necessary vaccinations or medications and rest assured that your holidays will be happy, healthy and exciting.