Sun, sand, sea and sickness

In an age of cheap, frill-free flights, more of us are venturing further on our travels than ever before, but what are the implications for our health? Joanna Moorhead offers some advice on how to stay healthy on holiday
Holiday preparation used to mean dusting down a suitcase and chucking in a few clothes. Now it's about weeks devoted to dieting, shopping, tanning and pedicures. But while we've expanded our vacation to-do list on most fronts, there is one increasingly neglected item. That, at least, is the view of travel health consultant Dr Jane Zuckerman, who believes that, in an age of frill-free travel, more and more of us are regarding health considerations as an optional extra - an attitude, she warns, that some will come to regret.

According to Zuckerman, of London's Royal Free and University College medical school, thousands of people who travel each year underestimate the risk to their health from infection or adverse conditions, either when they're travelling or at their destination. "People are far too complacent," she says. "They know what they should do, which is find out about the risks well before they travel and take appropriate action, but they've got this cavalier attitude which is that they'll be all right and that getting malaria or some other infection is a risk they'll live with." Meanwhile, says Zuckerman, the incidence of malaria among returned travellers is on the increase - 1,722 cases were reported in the UK in 2003, and the number of deaths was up to 16 from nine the previous year.

And it's not only malaria - conditions such as DVT (deep vein thrombosis), skin cancer and STDs contracted while on holiday are all also on the rise. All of which, say medics, could be reversed if travellers realised that while a trip might be an opportunity to let down your guard in most areas, it's definitely not the moment to throw caution to the wind where health is concerned.

Here we give a guide to some of the simple steps you can take when going on holiday in order to minimise the risk of any nasty health shocks.

Before you go

More people are booking long-haul travel at the last minute - but, says Zuckerman, you need between four and six weeks to prepare yourself medically before you go somewhere tropical. "I'd advise getting medical advice at least a month before you go, because some vaccines - for example, those for Hepatitis B and Japanese encephalitis - need more than one dose. And other drugs - especially malaria prophylactics, may need to be trialled before you go.

"There are lots of different malaria drugs around and they're not all suitable for everyone. If you're worried there might be a problem, it makes a lot more sense to try it out before you go when there's a chance to switch to something else and you're not fearing an adverse reaction - that way, you can go away confident you'll be OK," she says.

But it seems that, especially where malaria prevention is concerned, the reality is a long way short of the ideal - a survey out today from online pharmacy says four out of five UK holidaymakers aren't doing anything to find out whether their destination is a malaria hot spot, despite the fact that many holiday destinations - parts of the Caribbean, South Africa and Turkey, for example - are increasingly popular.

Dr Tom Blanchard, senior lecturer in tropical medicine at the Liverpool School of Hygiene and Tropical Medicine, warns it may not be straightforward getting hold of whatever you need - apparently there's a serious local shortage of yellow fever vaccine at the moment in the north west and people have been queuing for hours at his clinic for the jab. "We've been so busy we've had to turn people away," he says. "The numbers have been up 25% on this time last year."

Getting inoculations and drugs privately is the price many travellers have to pay, since only polio, diptheria and tetanus jabs are available routinely on the NHS. It's worth making an appointment to see your GP in the first instance, though, so you can find out what is available and get a referral or recommendation for a travel specialist if necessary.

Don't assume it's only those going to really exotic locations who need to worry - Zuckerman says even those going to southern or central Europe may find there's useful advice to pick up - for example, you may be going somewhere with a risk of tick-borne disease, and a Hepatitis A vaccine is sometimes recommended for southern Italy. Even people making relatively mainstream journeys might be well advised to check their immunity to diphtheria and tetanus. And as well as where you're going, make sure you describe precisely what you'll be doing while you're there. Staying in a big city, even in a developing country, could have quite different health implications from trekking in the nearby jungle.

Being the whiter-than-white specimen whose looks scream "I'm straight off the plane" is something most of us go to great lengths to avoid - but, says Jo Viner Smith of Cancer Research UK's SunSmart campaign, don't extend those lengths as far as stretching out on a sunbed because, like the sun itself, sunbeds carry a melanoma risk. Fake bake, whether out of a bottle or sprayed on in a booth, isn't thought to be dangerous - although Viner Smith warns that many holidaymakers still believe that a false tan (however achieved) provides some protection when you hit the beach. It doesn't.

If you're taking prescribed drugs it may be worth getting a letter of explanation from your doctor, however innocuous the substance seems. Last month 43-year-old Tracy Wilkinson from Sussex was freed after spending eight weeks in a Dubai jail. She was held there because codeine, a banned drug in the United Arab Emirates, was found in her urine after she was arrested at the airport over a passport irregularity. Her release only came after her lawyer, with a bit of help from her GP back home, eventually managed to convince the Dubai authorities that the drug had been prescribed for a back problem.

En route

Car sickness blights many a holiday, especially for families on long-distance car journeys. According to Fleur Yen Pik Sang of the MRC Spatial Disorientation Group at Imperial College School of Medicine in London, motion sickness is caused by sensory conflict or a mismatch between what your eyes are telling your brain and what your balance centre is telling it. "What happens is your eyes say you're still, especially if you're reading something, and your balance organs say you're on the move," she explains. "The result is confusion and an alert in the brain's vomit centre."

Some swear by the wristbands available from chemists which work on acupressure points to relieve travel sickness but, says Yen Pik Sang, research evidence isn't compelling. And anti-sickness drugs, which work by interferring with the conflict mechanism in the brain, are note effective for everyone.

What does seem to work, according to Yen Pik Sang, is controlling your breathing (you simply focus on breathing gently and regularly); so too, according to her research, does listening to specially-marketed music tapes. "We're not sure why these methods work, although it may be diversion," she says. "And while they aren't a magic cure, they do seem to reduce the symptoms and delay vomiting."

DVT, according to Zuckerman, is a big worry for many air passengers because of all the recent publicity it's had. Most sufferers have at least three risk factors from a list that includes obesity, recent surgery or childbirth and a history of cardiac problems, varicose veins, cancer or a clotting disorder. The risks are lessened if you do leg exercises on board (rotate your ankle first one way, then the other), wear loose clothing and drink plenty of water. If you want to invest in special support stockings to reduce the risk of DVT, make sure they fit properly - socks that are too tight can do more harm than good.

Avoiding jet lag is another big concern for many holidaymakers, especially those going from west to east when the effects are generally worse. Dr Chris Idzikowski, a psychologist and sleep specialist, recommends making changes to your routine in the days before you travel to start acclimatising yourself before you've even taken off. Adjust your watch to your destination time as soon as you board the plane, he says - if you're flying at night and facing a short night because of the time difference, have a meal at the airport so you can settle down to sleep as soon as you're airborne, rather than wasting valuable sleep time on eating. Many experts, including Idzikowski, believe light exposure is a crucial element in your body clock adjusting to its new timezone - if you log on to you can use the jetlag calculator to work out when you'll need to maximise your exposure to light once you've landed. Various alternative remedies are worth trying to reduce jet lag - many people report success from a homeopathic remedy based on arnica, bellis perennis, chamomilla, ipecac and lycopodium.

While you're there

Preventing sunburn is a number-one priority for holidaymakers - and despite the news last week that a 10-minute blast of midday rays is a good thing, the SunSmart campaign is sticking by its advice that what matters is staying in the shade around the middle of the day (11am to 3pm is the time the sun's rays are strongest), covering up when you're in the sun and using a SPF of at least 15 and re-applying it regularly if you are out in the sunshine. If you're in the water a waterproof variety is crucial, says Jo Viner Smith.

She also warns against using a cream if it's been hanging around in your glove compartment day after day in the heat or was a souvenir of last year's holiday - sunscreens have a shelf life of around a couple of years, but less if they've been in high temperatures.

It's important, too, to be wary about the fact that US sun protection factor ratings are only half the strength of the UK equivalent number, something 84% of UK holidaymakers don't realise according to the survey. So a SPF 20 suncream in the US is only equivalent to a SPF 10 suncream in the UK.

According to Dr Blanchard, the mistake many travellers to malarial regions make is that, while they remember to take their prophylactic drugs, they forget that avoiding mosquito bites is the best way to avoid malaria. He recommends using insect repellent, cover-up clothing and sleeping under a permethrin-impregnated net. Wearing wrist and ankle bands impregnated with permethrin can also reduce the risk of bites.

Avoiding a tummy bug is top of every traveller's wishlist - but it's a lot easier, says Blanchard, if you stick to the peel it, cook it or leave it routine. Basic food hygiene is one habit you certainly can't afford to leave behind, especially if you're travelling outside Europe and north America.

Indulging in risky sexual behaviour is another health mistake made by an increasing number of holidaymakers - and unlike many vacation risks, it's not one that's lessened by travelling to a less glamorous location. Whether you're heading for Sri Lanka or Skegness, Brazil or Bognor, having unprotected sex can leave you with the souvenir you least hoped for.

Dr Karen Rogstad of the Royal Hallamshire Hospital in Sheffield published research last year showing that, while as many as 50% of under-25s reported having had sex with someone new while on holiday, and despite the fact that as much as 12% of STDs being reported in London clinics were due to sex abroad, most young people did not seek health screening when they returned home. "Casual sex is very risky and holidaymakers need to be more aware of that," she says. "The message is to use condoms but, if you do have unprotected sex, get a check when you return home."

When you're back

Making an appointment at the GUM clinic shouldn't be your only holiday health postscript. If you've been to a malarial region, says Zuckerman, it's crucial to keep on taking those tablets. "People think because they're home they're safe, but the parasite continues to multiply in your system if you've been bitten and you need to complete your course to stay safe," she says. "And because malaria can strike for up to three months and maybe even longer after your return, it's important to tell your GP that you're a returned traveller as it will make a difference to the diagnosis - malaria can present with flu-like symptoms, but it could also feel like a cold or diarrhoea."

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