All your holiday questions answered
Travelling to a far-flung destination can throw up all sorts of questions. Will I need vaccinations? Is it safe to drink the water? What tablets should I take? Whatever your health concerns, get answers here
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Q. Do I need typhoid vaccinations for South Africa?
’My doctor has advised we need typhoid vaccinations, but other sources, including my brother (who has lived there for several years), and travel agents have said this is not necessary. Are you able to advise?
A. Typhoid fever is an unpleasant disease usually transmitted through contaminated food and water.
Overall the risk of typhoid in South Africa is higher than in the UK but that risk will depend on the sort of accommodation you stay in. Assuming that you’re in a decent hotel or similar and that you follow general food and water hygiene rules, then the risk is low and I wouldn’t be too concerned about immunisation.
If you’re not sure what your living conditions will be like or expect to spend some time backpacking, you should have the jab. If you’re not fond of needles, you’ll be pleased to hear that there’s an oral vaccine against typhoid.
Q. What injections will I need for Tunisia?
’I am planning to go to Tunisia next year. Will I need malaria tablets too?’
A. Tunisia has become a top tourist destination, with around 250,000 British tourists visiting each year. It’s worth bearing in mind that this is an African country and that the health risk from infectious disease, particularly food and waterborne infections, is likely to be higher than in Europe.
In order to answer your question, I’ve assumed that you are going for a short break in the summer and staying in reasonable tourist accommodation. In this case I’d advise you to be up-to-date with routine polio and tetanus jabs and also consider immunisation against typhoid fever and hepatitis A.
If you’re going to visit other countries or are staying for prolonged periods of time there may be additional vaccination requirements.
You’ll be pleased to hear that malaria is not a risk in Tunisia but it may be worth taking some insect repellent with you, as biting mosquitoes and sandflies can be a problem in some areas.
Travellers’ diarrhoea can be troublesome, so choose your restaurants carefully and take the usual food and water precautions.
Finally, I strongly advise you to ensure that you have comprehensive travel insurance policy that includes the cost of local hospitalisation and medical evacuation if you’re unlucky enough to need it.
Q. What malaria tablets can I take?
’I took Lariam last time I travelled in Thailand and reacted badly to it. Is there an alternative to Lariam - ideally a natural remedy? Or is there some way the drug’s side effects can be minimised?’
A. Firstly, depending on where in Thailand you’re going, you may not need to take antimalarial tablets at all. Most of the major tourist areas (including Bangkok, Phuket, Pattaya, Chang Mai and the river Quai) are relatively safe and you need only take general precautions: cover exposed skin after sunset, use insect repellent and sleep under a mosquito net.
However, if you’re travelling to the areas bordering Myanmar, Laos and Cambodia or to the island of Ko Chang, you will definitely need antimalarial tablets.
As far as Lariam is concerned, there has been considerable media interest in its possible side effects, and it’s certainly true that some people do have problems taking this drug.
However, most of the malaria strains found in Thailand are now considered to be resistant to Lariam (mefloquine), and you may be better off taking either Malarone (proguanil) or doxycycline if you travel to high-risk areas.
Antimalarial treatments are changing quite rapidly so seek up-to-date information from the NHS and consult your doctor a few months in advance of when you plan to go. The most important thing to remember is not to take risks when visiting a malarial region: malaria can kill.
So far ’natural’ or homeopathic antimalarial treatments have not demonstrated protection against malaria during clinical trials, so it’s probably best to leave these alternatives for now. Malaria can be a life-threatening illness and should be taken seriously. Bear in mind that avoiding mosquito bites is as important as taking anti-malarial drugs so use insect repellent, mosquito nets etc.
Q. How soon before my holiday do I need to get my jabs?
’I’ve heard that if you have the typhoid injection twice within six months this lasts for 10 years - is this true?’
A. Ideally you should visit your travel health advisor about six to eight weeks before departure. This will allow plenty of time to ensure that you are in date for any recommended immunisations.
The typhoid injected vaccine is given as a single dose which needs boosting every three years. It is a vaccine against hepatitis A which is boosted at six to 12 months, and then provides 10 years protection.
Q. Is it safe to take malaria tablets during pregnancy?
A. Malaria in pregnancy is a potentially very serious disease which can have catastrophic consequences for both the mother and the unborn child. Pregnant women should try and postpone visits to countries where there is any risk of malaria.
If you absolutely have to travel, then it’s extremely important to avoid mosquito bites as much as possible (use insect repellents, bed nets etc). It’s also very important to take appropriate anti-malarials and this is best discussed with your travel health advisor, as the correct drug will depend upon your destination, and may be influenced by any pre-exsting medical problems.
The combination of chloroquine and proguanil are safe to take in pregnancy, as is Maloprim, but it is important to take a folic acid supplement at the same time. The anti-malarial drug Lariam is considered to be safe in the second and third trimesters of pregnancy.
