Your Health

Bon voyage!

Health tips for travellers

Health tips for travellers

BY AUDRA KOLESAR
Winnipeg Health Region
Wave, January / February 2012

I'm planning to travel south for a holiday this winter. Where can I get information about vaccinations and other health-related issues?

The best thing to do is to call your doctor or the Winnipeg Health Region's Travel Health Clinic, located at 490 Hargrave Street. According to the clinic's website, the clinic offers:

  • A complete travel health risk assessment
  • All required, recommended and routine immunizations, with appropriate documentation
  • Vaccines on site
  • Information about how to stay healthy and safe while travelling including, but not limited to, information about preventing travel-related illness, e.g., malaria, hepatitis, traveller's diarrhea
  • Travel-related prescriptions for malaria prevention, altitude and diarrhea
  • Travel health products for purchase

All clinic visits are by appointment only. It is best to book an appointment at least six to eight weeks before departure. Although some vaccines can be given on short notice, most vaccines are more effective if given early. In addition, some vaccines have to be given on a schedule up to four weeks apart. There is a charge for travel health services, whether they are obtained from the clinic or through your doctor. For more information, call 940-TRIP (8747) or visit their website.

What health issues should I be aware of?

That will depend on where you are travelling. If you are heading to the United States, the main concern would be to make sure you update your routine vaccinations. This would include shots to prevent certain illnesses such as influenza, pneumonia diphtheria, tetanus, measles, mumps and rubella. You should also make sure you have adequate health insurance, such as Manitoba Blue Cross.

If you are travelling to Mexico, Central America or the Caribbean, you should make sure your routine vaccinations are up to date and consider additional vaccinations against the infections more common to these areas. These include:

Typhoid fever: This condition is generally caused by water- or food-borne bacteria. The Health Canada website notes that symptoms can take up to three weeks to appear, and generally include fever, headache and loss of appetite. If not treated with antibiotics, travellers may develop more severe symptoms such as high fever, a drop in heart rate, and enlargement of both the liver and spleen. The risk of developing typhoid can be reduced through vaccination, but not eliminated, so travellers are advised to take precautions when eating food and drinking water while in Mexico, Central America or the Caribbean.

Hepatitis A: Commonly found in Mexico and Central America, according to the Health Canada website, hepatitis A affects the liver and can cause mild to severe illness. Symptoms include fever, fatigue abdominal pain and dark urine. Travellers generally contract hepatitis A by drinking untreated water or eating improperly prepared food. It can also be transmitted through sexual contact. Ice made of tap water can pose a risk for hepatitis A in some countries.

Hepatitis B: This virus is often transmitted through sexual contact or through use of non-sterile injection equipment in both personal services (i.e., tattooing, body piercing, acupuncture) and health care settings. It infects the liver and can lead to chronic liver disease, cirrhosis, and liver cancer. Health Canada says symptoms can take up to six months to appear and usually take the form of loss of appetite, jaundice and fatigue. Many people do not have any symptoms at all, but some people may develop chronic hepatitis B and remain contagious for the rest of their lives.

What other health issues should I be concerned about?

Mosquito-borne illnesses can be a serious matter. These include:

Dengue fever: A viral disease spread by mosquitoes, dengue fever is usually associated with flu-like symptoms and can cause hemorrhagic fever, which is potentially fatal. There is no vaccine against dengue fever, so it is very important that you take precautions against mosquito bites, such as using insect repellent with DEET. According to Health Canada, there is dengue fever activity in Mexico and the Dominican Republic as well as in other parts of Central America and the Caribbean.

Malaria: A serious and potentially fatal disease, malaria is spread by mosquitoes and is usually associated with flu-like symptoms, including fever and a headache. You may also experience nausea and vomiting, diarrhea, joint pain and sore muscles. Again, there is no vaccine for malaria, although there is medication that can reduce your risk. You would need a prescription from your physician or from a travel health clinic. Nonetheless, it is important to take precautions to guard against mosquito bites.

What is the most common health issue Canadians face when travelling south?

The most common ailment is probably traveller's diarrhea, a sudden intestinal infection. Other names for this problem are gastroenteritis, Montezuma's revenge, turista, or the GI trots. About 20 per cent to 50 per cent of international travellers get traveller's diarrhea. High-risk destinations include low-income countries in Latin America, Africa, the Middle East, and Asia.

How does it occur?

Like some of the other conditions mentioned, traveller's diarrhea occurs when one consumes contaminated food or water that has not been properly treated. The cause of the infection can be a virus, parasite, or bacteria. Escherichia coli (E. coli) bacteria are often a cause of traveller's diarrhea. E. coli bacteria are normally found in the human intestine. There are many varieties of E. coli bacteria. Usually your body becomes used to the E. coli in your environment and the bacteria do not cause intestinal problems. However, exposure to new varieties of E. coli may cause diarrhea. Sometimes traveller's diarrhea is caused by the stress of travelling, jet lag, a different diet, or other factors. Symptoms include loose stools, as many as 10 a day, stomach cramps, bloating and gas, nausea, occasionally vomiting, fever, weakness and headache (sometimes).

How is it treated?

You may become dehydrated by the diarrhea. Dehydration occurs when your body loses more fluids and salts than it takes in. Dehydration can cause serious problems, so it is very important to try to prevent it.

To replace lost fluids and salts, you can make a rehydration solution with packets of oral rehydration salts, which you can buy at a drugstore. You can also make a rehydration solution by mixing:

  • 1 quart or litre of clean water (boil water until it bubbles if you are not sure it is safe to drink)
  • 2 tablespoons of sugar
  • 1/4 teaspoon salt
  • 1/4 teaspoon of baking soda.

Drinking other non-alcoholic drinks made with purified water will also help prevent dehydration, but you may not get all the salts you need. Try to drink at least eight ounces of fluid for each watery stool you have.

Use non-prescription antidiarrheal medicines such as loperamide (Kaopectate or Imodium) as needed. The prescription medicine Lomotil is not recommended.

Seek urgent medical attention if the diarrhea is bloody or you have a high fever over 38.5 degrees Celsius. Do not overuse these medicines to control diarrhea - they can easily lead to constipation. Do not give antidiarrheal medicine to small children unless directed to do so by a physician.

How can I protect myself against water- and food-borne infections such as typhoid fever, hepatitis A and traveller's diarrhea?

Follow these guidelines:

  • Do not drink untreated water, including ice cubes in drinks.
  • Bring some means to purify water, such as a filter or purifier, chlorine or iodine tablets, or a pot and stove for boiling water. If you are buying a water filter or purifier, buy one that can filter out organisms as small as those that cause giardia, cholera, and amoebic diarrhea. Water filters will not filter out viruses such as hepatitis A or norovirus.
  • Carry a litre of purified water.
  • Avoid food and beverages from street vendors.
  • Eat only foods that are cooked and still hot, or fruits and vegetables that you peel yourself.
  • Do not eat raw or partially cooked fish or shellfish, including such dishes as ceviche. Fully cooked fish and shellfish are safe.
  • Brushing your teeth with untreated water is not recommended. Carbonated soft drinks and water, bottled water, wine, and beer are usually safe without ice. Do not add ice that has been made from tap water.
  • Avoid uncooked dairy products.

Audra Kolesar is a registered nurse and manager with Health Links - Info Santé, the Winnipeg Health Region's telephone health information service.

The information for this column is provided by Health Links - Info Santé, in consultation with the Winnipeg Health Region's Travel Health Clinic. It is intended to be informative and educational and is not a replacement for professional medical evaluation, advice, diagnosis or treatment by a health-care professional. You can access health information from a registered nurse 24 hours a day, seven days a week by calling: Health Links - Info Santé, 788-8200 or toll-free 1-888-315-9257.

Wave: January / February 2012

About Wave

Wave is published six times a year by the Winnipeg Health Region in cooperation with the Winnipeg Free Press. It is available at newsstands, hospitals and clinics throughout Winnipeg, as well as McNally Robinson Books.

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