Travel health

Every year, of hundred of thousands of people from Ireland travel overseas for business or leisure. When travelling abroad, it is easy to forget that many places do not provide the same access to medical facilities and treatments as Ireland

Before travelling overseas, it is important to be aware of the possible health risks and how to prevent problems or minimise the chances of them occurring. Most importantly, find out:

  • whether there are any specific health risks in the country you are travelling to for which you need to take precautions, such as malaria
  • how to avoid becoming ill when you are abroad
  • what to do if you become ill when you are abroad
  • how to get emergency medical treatment when you are abroad

The European Health Insurance Card (EHIC)

A European Health Insurance Card (EHIC) entitles you to free or reduced-cost medical treatment in a European Economic Area (EEA) country or Switzerland. The EEA includes all European Union countries as well as Iceland, Liechtenstein and Norway.

There is a country-by-country guide to EEA countries in the EHIC Section.

What the EHIC covers

The EHIC is usually valid for five years and covers any medical treatment necessary as a result of an accident or illness. The card entitles you to state-run medical services only, and you will be treated on the same basis as an 'insured citizen' of the country you are visiting.

This may not cover all the treatment and services you would usually get free of charge in Ireland, and you may have to contribute to the cost of your care.

What the EHIC does not cover

The EHIC is not a substitute for travel insurance. You are strongly recommended to take out a private travel insurance policy before you travel.

The EHIC does not cover:

  • the cost of bringing you back to Ireland
  • the cost of private healthcare or services that are not part of the country's healthcare system (for example, many European countries have private ambulance services that charge a fee for taking someone to hospital)

If you are travelling abroad to receive medical treatment (including giving birth), the EHIC will not cover your treatment.

Eligibility

Irish residents are eligible to apply for an EHIC, although it is not valid for people who are going to live abroad.

Applying for an EHIC

The quickest way to get an EHIC is to go the website of the HSE and apply on line.Alternatively you can download a form from the HSE website or get a form from you local HSE health office or health centre . www.ehic.ie

There are many health risks associated with travelling overseas including:

  • infectious diseases
  • food poisoning
  • heat-related conditions

Some conditions may be mild and will pass quickly with minimum treatment, whereas others may be more serious and need specialist care.

Some common conditions you may be affected by while travelling overseas are described in more detail below.

Malaria

Malaria is a disease that is caused by a parasite and is spread by mosquitoes. It is more common in tropical countries, such as parts of Africa, Asia and South America, although there have been cases reported in Europe.

In recent years, rates of malaria have fallen sharply due to improvements in preventing the spread of the condition. However, it still remains a significant health problem.

Malaria cases continue to be reported in over 100 different countries. In most of the countries, the major cities and towns are usually malaria-free and the risk is confined to rural areas. However, in Africa (and India to a lesser extent) malaria cases still occasionally occur in towns and cities. It is best to check with your GP or your local travel clinic as to what precautions you need to take.

Symptoms of malaria usually appear 10 to 15 days after you are bitten by an infected mosquito. However, depending on the type of parasite you are infected with, it can take up to a year for symptoms to show.

The symptoms of malaria are similar to those of influenza (flu) and include:

  • a high temperature (fever) of 38C (100.4F) or above
  • sweats and chills
  • generally feeling unwell

Many cases of malaria can be prevented using the ABCD checklist:

  • Awareness of risk. Know your risk of malaria.
  • Bite prevention. Take precautions to avoid being bitten.
  • Chemoprophylaxis. Take the right anti-malarial tablets. As different strains of malaria can be found in different parts of the world, each strain requires a specific medication to prevent it.
  • Diagnosis. Seek immediate medical advice for any symptoms you have.

Taking medicine to prevent malaria is essential for all travellers visiting areas where malaria is a significant risk. However, anti-malarial tablets are not 100% effective, so avoiding getting bitten is also important.

See the Health A-Z topic about Malaria for more information about treating and preventing malaria.

HIV and AIDS

There is a global pandemic of HIV and AIDS. This means that HIV and AIDS have spread across the world.

The World Health Organization (WHO) estimates that there are currently over 33 million people with HIV.

There is currently no cure for HIV and AIDS, although medication can be used to slow the progress of the condition. Parts of the world where HIV and AIDS are particularly widespread include:

  • sub-Saharan Africa, particularly South Africa, Benin, Botswana, Lesotho, Malawi, Swaziland, Zambia and Zimbabwe
  • Russia
  • Burma
  • Thailand
  • Laos
  • Papua New Guinea
  • Guyana
  • Suriname
  • Honduras
  • Belize
  • Haiti
  • the Dominican Republic

Never assume that HIV and AIDS are limited to members of a country's gay community. In many countries, most people with HIV and AIDS are heterosexual.

In most of the countries listed above, rates of HIV infections are particularly high among prostitutes.

See the Health A-Z topic about HIV and AIDS for more information and advice.

Sunburn

Sunburn is the damaging effect of the sun on the skin. It is caused by the ultraviolet radiation in sunlight. If you are travelling to hot climates from countries such as Ireland, you may be at greater risk of getting sunburnt because your skin may not be used to the sun.

If you have fair skin, your risk of getting sunburnt is even greater. Severe sunburn can cause red, sore and tender areas, with blistering and peeling. It can also increase your risk of developing skin cancer in later life.

See the Health A-Z topic about Sunburn for more information and advice.

Heatstroke

Heatstroke occurs when the body becomes overheated very quickly. This can happen as a result of very hot temperatures, extreme physical exertion or sunburn. The symptoms of heatstroke include:

  • very high body temperature of 40C (104F) or above (a major sign of heatstroke)
  • heavy sweating that suddenly stops (being unable to produce any more sweat is a warning sign that the body has become over-heated and dehydrated)
  • tachycardia (rapid heartbeat)
  • hyperventilation (rapid breathing)
  • muscle cramps

Heatstroke is a medical emergency. If you or someone you know has the symptoms of heatstroke, call the emergency medical services of the country you are staying in.

In all European countries, the emergency number is 112. Other countries may have different numbers, so check with local staff or residents.

To reduce your risk of heatstroke in hot conditions, keep physical exertion to a minimum. Drink plenty of water or isotonic fluids (drinks that replace body fluids and essential minerals, such as salt, that is lost through sweating). Avoid drinking excessive amounts of alcohol in hot weather.

See the Health A-Z topic about Heatstroke for more information and advice.

Travellers' diarrhoea

Travellers' diarrhoea is a general term to describe symptoms of diarrhoea that occur during or shortly after travelling. It is usually spread through poor hygiene and lasts for about three to five days.

Most cases of travellers' diarrhoea are caused by bacteria that are passed from faeces (stools) to the mouth. This can happen when someone does not wash their hands after going to the toilet and then handles food that is eaten by travellers.

Travellers' diarrhoea is usually mild, but it is unpleasant and can ruin a holiday. It often clears up without treatment, but it is essential to drink plenty of fluid. More severe cases of travellers' diarrhoea are treated with a short course of antibiotics.

See the Health A-Z topic about Travellers' diarrhoea for more information and advice.

Bites and stings

In Ireland, most bites and stings are painful but harmless and only affect the area around the bite or sting. However, some people can have an immediate and more widespread allergic reaction, such as anaphylactic shock, which can be fatal. Anaphylaxis is uncommon, affecting approximately 3 people in 100, and usually only occurs after a wasp sting.

See the Health A-Z topic about Anaphylaxis for more information.

When abroad, be aware of other stinging and biting animals and insects, such as scorpions, snakes, spiders and jellyfish. Always look where you are walking or swimming, and follow the advice of local tourist information regarding safe places to visit and swim. It is also important to note that bites can infect you with diseases, such as malaria or rabies.

Seek immediate medical attention if you are bitten by an animal while you are abroad. Rabies is transmitted through an infected animal's saliva, but it is only spread if the salvia comes into contact with your eyes, mouth, nose or a wound. If this happens, seek immediate medical attention.

See the following Health A-Z topics for more information and advice:

Allergic
An allergen is a substance that reacts with the body's immune system and causes an allergic reaction.
Anaphylactic shock
Anaphylactic shock is a severe and sometimes life-threatening allergic reaction, causing swelling of body tissues and a drop in blood pressure.
Bacteria
Bacteria are tiny, single-celled organisms that live in the body. Some can cause illness and disease and some others are good for you.
Diarrhoea
Diarrhoea is the passing of frequent watery stools when you go to the toilet.
Fever
A high temperature, also known as a fever, is when someone's body temperature is 38C (100.4F) or above.
Jaundice
Jaundice is a condition that causes yellowing of the skin and the whites of the eyes, brought on by liver problems.
Kidneys
Kidneys are a pair of bean-shaped organs located at the back of the abdomen, which remove waste and extra fluid from the blood and pass them out of the body as urine.
Liver
The liver is the largest organ in the body. Its main jobs are to secrete bile (to help digestion), detoxify the blood and change food into energy.
Malignant
Malignant is a term used to describe a life-threatening or worsening condition. In the case of tumours, malignant means cancerous.
Vomiting
Vomiting is when you bring up the contents of your stomach through your mouth.

Vaccinations

Depending on the areas that you intend to visit when you are abroad, you may need to have vaccinations or take precautions against diseases such as:

  • rabies: a viral infection that is spread by animals
  • bilharziasis: a condition caused by a parasite which lays eggs inside the human body
  • cholera: a waterborne bacterial infection
  • dengue: a viral infection that causes fever, joint pain and skin rashes
  • diphtheria: a contagious bacterial infection that mainly affects the nose and throat
  • hepatitis A, hepatitis B and hepatitis C: blood-borne viral infections
  • Japanese encephalitis: a viral infection that is spread by mosquitoes and can cause fever, headaches and, in some cases, coma
  • Legionnaire’s disease: a waterborne bacterial lung infection
  • meningitis: an infection of the outer lining of the brain
  • polio: a viral infection that causes muscle and nerve damage
  • tetanus: a bacterial infection that can develop if a wound or cut becomes contaminated
  • tick-borne encephalitis: an infection of the central nervous system that is spread by parasites
  • tuberculosis: a bacterial lung infection
  • yellow fever: a viral infection that is spread by mosquitoes

See the Health A-Z topic about Travel vaccinations for more information and advice.

Malaria

The possible side effects of malaria can be serious, so you will usually have to stay in hospital for observation while you are being treated.

Malaria is almost always curable using anti-malarial medicine, such as chloroquine, amodiaquine, doxycycline and mefloquine. The healthcare professional who is treating you will need to identify the type of malaria you have before deciding on the best type of medicine to prescribe. If malaria is suspected, it is very important that a quick diagnosis is made

See the Health A-Z topic about Malaria - treatment for more information and advice.

HIV and AIDS

It is sometimes possible to halt the development of HIV in the first 72 hours after infection. This is known as post exposure prophylaxis (PEP). PEP involves taking anti-HIV medicines for four weeks.

PEP is often used when a person knows that they have definitely been exposed to the HIV virus. This could be if they had sex with someone who they knew had the HIV virus and the condom broke, or they were accidentally stabbed with an HIV infected needle.

However, PEP is not guaranteed to work and the medicines that are used often cause unpleasant side effects, such as nausea, vomiting, diarrhoea and headaches.

In some parts of the world, access to PEP may be limited or very expensive. Therefore, it may be a good idea to take out comprehensive travel insurance so that you can be flown back home if HIV exposure occurs.

See the Health A-Z topic about HIV and AIDS - treatment for more information and advice.

Sunburn

There are lotions, available from pharmacies and supermarkets, which may help cool your skin and reduce the itching caused by sunburn. You can also buy aftersun lotions, gels and sprays, which cool and moisturise the skin and help prevent peeling and blistering.

If you have severe sunburn, you may need to take painkillers, such as paracetamol or antihistamines. If you have very severe sunburn, you may require hospital treatment. It is important to avoid any further exposure to the sun until the burns have healed.

See the Health A-Z topic about Sunburn - treatment for more information and advice.

Heatstroke

If you think someone you are with has heatstroke, get them to a cool place as soon as possible. If their skin is dry and hot and is over 39.5C (103.1F), shower or immerse them in cool, but not cold, water (15-18C or 59-64.4F). Gently massage their skin to encourage circulation.

If they start to have convulsions (shake), move nearby objects out of the way to prevent injury occurring, but do not use force or put anything in their mouth. If they are unconscious and vomiting, move them into the recovery position by turning them on their side and making sure their airways are clear. You can also cover them with wet towels or sheets and fan them until it is possible to get them to a hospital or to see a healthcare professional.

If their skin temperature is above 41C (105.8F), they are in a critical condition and require immediate emergency medical attention.

See the Health A-Z topic about Heatstroke - treatment for more information and advice.

Travellers' diarrhoea

Most cases of traveller's diarrhoea resolve themselves in three to five days without the need for treatment. Taking paracetamol or over-the-counter (OTC) remedies, such as loperamide, (Imodium), may relieve your discomfort.

If you have had persistent diarrhoea, you may need to replace lost fluids with rehydration drinks. If your stomach upset lasts for longer than three days, seek medical advice from a healthcare professional. Anti-diarrhoea medications should be used with caution and only for a short time.

If your diarrhoea is caused by an infection, the medication can slow the flushing-out process of the micro-organisms from the intestine. Drink plenty of water even if you take anti-diarrhoea medicines.

See the A-Z topic about Travellers' diarrhoea - treatment for more information and advice.

Antihistamines
Antihistamine medicine counteracts the action of histamine (a chemical released during an allergic reaction). Examples include loratadine and hydroxyzine.
Diarrhoea
Diarrhoea is the passing of frequent watery stools when you go to the toilet.
Drip
A drip is used to pass fluid or blood into your bloodstream, through a plastic tube and needle that goes into one of your arteries or veins.
Intravenous
Intravenous (IV) means the injection of blood, drugs or fluids into the bloodstream through a vein.
Painkillers
Painkillers, or analgesics, are medicines that relieve pain. Examples include paracetamol, aspirin and ibuprofen.

Useful Links

Malaria

You can reduce your risk of getting malaria and other insect-borne diseases by using insect repellents and wearing long-sleeved shirts and long trousers whenever possible. Insect repellents that contain diethyltoluamide (DEET) are the most effective.

If you are visiting a malaria-infected region (see Travel health - risks), your GP can tell you which anti-malarial medication is most suitable for you. Make an appointment with your GP as soon as you know which countries you will be visiting as some anti-malarial medication needs to be taken several weeks before you leave homeK.

Protection against malaria cannot be guaranteed and some strains of the disease have become resistant to medication. Tell your GP as soon as possible if you develop a fever or an unexplained illness while you are away or indeed for up to a year after your return.

See the Health A-Z topic about Malaria - prevention for more information and advice.

HIV and AIDS

The best way to avoid getting HIV and AIDS on your travels if you are having sex is to always use a condom, including anal and oral sex. In some parts of the world, locally produced condoms may not be as reliable as the ones available in Ireland, so take your own supply.

See the Health A-Z topic about HIV and AIDS - prevention for more information.

Sunburn and heatstroke

Ultraviolet light (UVA and UVB rays) is radiated by the sun. The ozone layer filters out most of the harmful UVA and UVB rays before they reach earth, but some rays are still able to get through and can cause skin damage. It is very important to take precautions when travelling to hot climates.

Some useful tips for avoiding sunburn are listed below:

  • Do not wait until your skin feels uncomfortable before taking preventative action. Defence is the best form of protection. Once your skin is burnt, the damage has already been done, so cover up with loose-fitting clothes. Make sure your legs and arms are covered. Tightly woven fabrics provide the best protection from the sun.
  • Avoid direct exposure to sunlight when the sun is at its strongest. Remember that the sun can be strong during the early and late part of the day, so you still need to take adequate precautions if you go out in the sun in the morning or evening. Cover your arms and legs with clothes, wear a wide-brimmed hat and a pair of good-quality sunglasses, and apply plenty of sun lotion with the right skin protection factor (SPF) for your skin type.
  • Always use a sun protection lotion with an SPF of at least 15. If you have very fair skin, use lotions with an SPF of up to 40. This is also the case for children, whose skin is very sensitive. Most skin damage caused by the sun occurs before the age of 18.
  • Make sure that your entire body is covered by sun protection lotion. This includes your face, hands, feet and neck. The most vulnerable parts of your body are those that are not usually exposed to sunlight.
  • Apply sun lotion at least 30 minutes before you go out in the sun. Reapply it every couple of hours because sweat and contact with clothing and towels will cause it to wear off. Reapply sun lotion immediately after swimming, even if your lotion is waterproof. Use waterproof sun lotion while swimming because UVA and UVB rays can penetrate through about a metre of water.
  • Cloud and fog do not protect skin from ultraviolet rays. Cover up with clothing and use SPF 15 sun lotion, even on cloudy days.
  • Wear a hat and sunglasses that have UVA and UVB filters when you are in the sun. Ultraviolet rays can damage the retinas in your eyes, causing cataracts.
  • Drink plenty of fluids, particularly after exercise. Isotonic drinks that replace the salt lost through sweating are ideal, but water is also sufficient. Avoid drinking alcoholic drinks when you are out in the sun.

Keep a careful eye on any moles on your body and visit your GP if you notice any changes in their appearance. Signs to look out for are darkening of the mole, an increase in size, ragged edges, multiple colours within the mole, itchiness, redness and swelling or bleeding.

For more information, see the Health A-Z topics on Sunburn - prevention and Heatstroke - prevention.

Travellers' diarrhoea

If you are travelling in a country that has low standards of public hygiene and there is a risk of water contamination, such as in some African and Asian countries, avoid the following food and drink as they could trigger travellers' diarrhoea:

  • tap water
  • fruit juice (if sold by a street vendor)
  • ice cream and ice cubes
  • shellfish
  • eggs
  • salads
  • raw or undercooked meat
  • peeled fruit
  • mayonnaise
  • sauces

Food and drink that are generally safe to eat include:

  • sealed bottled water that is produced by a recognised international manufacturer
  • cooked food, such as soup or stir-fry
  • canned food or food in sealed packs
  • fresh bread
  • unpeeled fruit
  • tea and coffee
  • alcohol

See the Health A-Z topic about Travellers' diarrhoea - prevention for more information and advice. 

Antiseptic
Antiseptic is a substance that reduces the growth and development of germs.
Fever
A high temperature, also known as a fever, is when someone's body temperature is 38C (100.4F) or above.
Retinas
The retina is the nerve tissue lining the back of the eye, which senses light and colour and sends it to the brain as electrical impulses.
Sutures
1. A suture is a seam-like join between the bones in the skull. 2. A suture is a stitch used to hold together a wound or cut.
Swelling
Inflammation is the body's response to infection, irritation or injury, which causes redness, swelling, pain and sometimes a feeling of heat in the affected area.

First aid

When travelling abroad, it is advisable to carry an emergency first aid kit with you, particularly if you are visiting a non-EEA area. The kit should contain:

  • adhesive dressings
  • insect repellent
  • antiseptic cream
  • water-purification tablets

Medical travel kits that contain sterilised and sealed medical equipment, such as syringes, sutures (stitches) and needles, are available from pharmacies. These are particularly useful when visiting developing countries or areas where the safety of medical equipment cannot be guaranteed.

Some parts of the world are sometimes at risk of terrorist activity, civil war, insurgencies (armed uprisings against the government) and other types of public disorder. The Department of Foreign Affairs website provides useful up-to-date advice on what you should do if you find yourself in diffciulty.

In case of an emergency, it is a good idea to keep a list of important telephone numbers with you when you are travelling abroad. These should include:

  • the local emergency services number
  • the representative of the travel company that you booked your visit with
  • your travel insurer
  • the Irish Embassy or Consulate in the area that you are visiting

Also keep a list of the contact numbers of family members and friends in case Irish Embassy or Consular representatives need to contact them. If you have a mobile phone, it is a good idea to take it with you for use in emergencies. Check with your mobile phone service provider to see whether they operate in the countries that you intend to visit, and which areas of those countries they cover.

If your trip involves travel to developing countries, avoid travelling to rural or isolated areas without a reliable guide who will know how to get help if it is needed. If you have to travel on your own, learn a few useful words of the local language, such as 'help', 'doctor' and 'hospital'.

Content provided by NHS Choices www.nhs.uk and adapted for Ireland by the Health A-Z.

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