Will and I love travelling. Prior to Miss S we smashed through Europe with backpacks (and a pillowcase of food – seriously, don’t ask!). The same backpacks took us to places like South America, India, Indonesia and Morocco. We’ve continued to travel since Miss S arrived but I can tell you the adventure dial has been turned right down whilst she is young. Despite our desires, we will not be taking her on an African safari tomorrow given the significant malaria and chikungunya risk (both mosquito transmitted diseases). We also won’t be jetting into Nepal as a family to hike to Mount Everest base camp (a dream of mine) given the potential for altitude sickness in our toddler. Planning a holiday for us now takes much more thought – how long is the flight? Is there access to easy English speaking medical care? Is there risk of malaria, Dengue and yellow fever and is it a risk we are willing to take with Miss S?
I often have patients including couples and families come in for a travel consultation, all booked and ready to go, with no idea about the health implications of their destination choice. Recently a patient of mine cancelled her trip as she was pregnant and did not realise that Fiji was on the zika virus list. I had another patient cancel flights and re-route her entire travel because she was not willing to have the Yellow Fever vaccination – it meant she could not enter several countries around her after leaving yellow fever affected areas. After a lengthy discussion about the vaccination she opted not to have this so had to change her travel plans. Many patients see cheap flight deals and book (I’ve done the same thing don’t worry) and realise only in my consulting room that they may need to take anti-malarial medication, have a Yellow Fever vaccine and consider taking tablets to prevent altitude sickness if they want to venture to certain parts of South America. The health aspect is an afterthought a lot of the time. Choosing a travel destination should be about the sites, beaches, food, culture – but taking your health, or your family’s, into account should be a big factor too.
So here it is:
Your Health Checklist to Guide your Next Holiday Destination:
Mosquitoes are more than annoying, and more than just malaria!
If you are pregnant or planning pregnancy then you should be completely avoiding areas with Zika virus (which is nearly everywhere now). By the same token males planning conception should avoid Zika areas for at least 6 months before they start trying. Unfortunately, right now nearly all the favourite baby moon spots outside Australia are Zika affected – Bali, Singapore, Fiji. Currently only Vanuatu and New Caledonia are Zika free though this might change so you need to keep an eye on this. There are not many close international destinations that are safe when pregnant so currently lots of my pregnant patients are remaining within Australia for their trip away. Now, do not let this blog deter you from your baby moon (please, its important stuff to have a chill out before life changes in a big way!!) but be careful with your destination choice.
Still talking about mosquitos, if you are travelling with young infants you should ideally avoid malaria ridden areas. Whilst the newer medications like Malarone come in paediatric formulations, between all the available medications there is nothing for infants under 5 kilograms which makes prophylaxis tricky; it’s all about mosquito avoidance but that might not be enough particularly when malaria can be lethal. Everyone knows mosquitos are malaria go hand in hand but Yellow Fever and Dengue Fever are 2 other infections that can be transmitted via mosquitos. The Yellow Fever vaccine is approved for use in children older than 9 months of age so taking a child younger than that to a Yellow Fever affected area is risky stuff. Whilst I don’t want mosquitos to be the first thought when you’re planning a holiday – they should certainly factor into the decision if you’re travelling with children!
The geographical location – is it safe?
People often don’t think about access to medical care if something goes wrong on a holiday. I know we all want to think nothing bad will happen (and I have my fingers and toes crossed for you) BUT you need to be prepared particularly if travelling with children. Whilst I recommend every single person have travel insurance it’s generally no good to you if you are in a distant remote area with your kids away from any medical assistance or easy evacuation. If you have any medical condition that is affected by climate then that should be taken into consideration when choosing a destination; are you particularly sensitive to the sun because you have lupus? Does your rheumatoid arthritis flare in cold weather? Does your dishydrotic eczema flare to the point of unbearable discomfort in the hot weather? Is your Raynaud’s disease particularly painful in the cold weather?
Also, if you carry medication with you plan for this – take enough of the stuff (we can give you increased supply if you are travelling for a long duration) and carry a medication letter with you to avoid any issues with customs.
This is a big consideration particularly when pregnant, travelling with young kids or if you have a chronic illness that is vulnerable to traveller’s diarrhoea (like inflammatory bowel disease). I’m not saying don’t travel if you fit into any of the aforementioned categories but perhaps remote areas of Papua New Guinea with poor access to safe food and water isn’t the best idea in pregnancy (if it can be avoided). By the same token travelling to remote areas of India with an infant (where sterilising is difficult) may also be ideally avoided. We took Miss S to India as a 6-month-old – but we made sure we avoided malaria prone areas and took food and water safety extremely seriously. We purposely stayed on the worn in well-known track (despite the heavily adventurous streak in both Will and I) and it paid off. With Miss in our life we have managed to continue travelling BUT the type of travel and destinations have been dictated by her health and safety and that’s how it should be.
There are so many wonderful places we all want to visit but is it worth a day in the plane with a toddler? Our current cap is 6 hours – we just know anything beyond that with the adventurous Miss S right now would be a struggle and not worth it for us! If you are pregnant are you still allowed to fly? Every airline has a different cut off for domestic and international travel for pregnant women, and the cut off is lower with twin pregnancies so you need to be aware of this if travelling when pregnant. If you are claustrophobic or an anxious flyer take this into account too – patients often come in to the GP asking for heavy sedatives just before flying – something I am not willing to prescribe given the risk for potential error (imagine trying a drug post a beer on a plane – the consequences can be pretty hairy!). Are you better of road tripping or going on a short flight? Think about it before you book that 24-hour journey!
So yes, let the cuisine, culture, beaches and shopping opportunities all be part of the decision process when you next decide on a holiday destination. But please (pretty please) let health be a factor in there too.
If you are looking for up to date health travel information the CDC is an excellent resource and can be visited at https://wwwnc.cdc.gov/travel