Foreign Matters to Travel Health

By Dr Eddy Bajrovic, Medical Director, Travelvax Australia.

Many of the world’s 7 billion people still do not have access to safe drinking water and effective sanitation.
Despite global progress in the last 20 years, sharp geographic, socio-cultural, and economic inequalities persist between the ‘haves’ and ‘have nots’, according to a new report from the World Health Organization (WHO) and UNICEF entitled ‘Progress on Drinking Water and Sanitation 2014’.
Among its key findings, the report revealed that:
– 2.5 billion people, living mainly in Asia (66%) and sub-Saharan Africa (25%), still use ‘unimproved sanitation facilities’.
– 1 billion people (82% of whom live in rural areas of 10 countries in Asia and Africa) defecate on the open ground.
– 748 million people must drink contaminated water. Again, most live in rural areas of sub-Saharan Africa and Asia.
So, why should Australians care? After all, we live in a wealthy, developed country with clean air, effective sewage treatment and effluent disposal systems, and safe drinking water.

Why travellers should care

Well, there are a couple of reasons why we should care.
Firstly, EVERYONE deserves the improved health outcomes that come with good sanitation and safe water.
Secondly, the countries the report refers to are among Australians’ favourite travel destinations.
Poor levels of sanitation, hygiene, and water quality have a direct impact on the health of travellers because they are the principle means by which Hepatitis A, typhoid, cholera, polio, diarrhoea, dysentery, and a host of other diseases common in the developing world, are spread from an infected local person to a foreign visitor.
So far this year, Australia has recorded 106 cases of Hepatitis A, 51 cases of typhoid, and a case of cholera – all directly or indirectly linked to overseas travel. 
There’s a safe, effective vaccine for each of these three diseases and whether or not vaccination is recommended will hinge on the areas you are visiting, your style of accommodation, how you are getting around after you arrive, and how long you’ll be staying and your personal medical history will also be a factor.
(Smart travellers also take the ‘long view’ with travel vaccination and cover themselves for unplanned side trips and for future travel. Call it a short- and long-term health ‘investment’.)
Ideally, discuss your travel plans and vaccinations with a doctor experienced in travel medicine, or your GP, 6 weeks before your departure.
But, vaccines don’t prevent all the health risks linked to sanitation, hygiene and water quality.

Travel bugs are hard to avoid

As careful as you might be, it’s difficult to avoid the impact of poor sanitation and hygiene.
Even if you’re staying in an upmarket resort or hotel, inevitably local people work as kitchen hands and maids; they cook at local markets, operate street food stalls, drive taxis, count money, grip the same railings, and open the same doors as you do. And, once you pick up a germ, it’s a simple matter to infect yourself by transferring it from your hands to your mouth, nose, or eyes.
Which brings us to 2 very simple things every traveller can do to greatly boost their chances of avoiding illness overseas.

1 – Clean your hands really well – and frequently 
Faecal bacteria can survive on hands and hard surfaces for hours, especially in warmer tropical climates.
That makes hand washing one of the most simple and effective precautions every traveller can take to protect their health. The critical times to wash them are after using the toilet and before handling food or eating.
But, observational studies have shown that only around 1-in-5 of us wash our hands properly. The gold standard of hand hygiene is soap, warm water and vigorous scrubbing along the full length of the hands and between fingers for 20 seconds.
However, if soap and water aren’t available, the next best option is using alcohol wipes or gels to clean the top and bottom side of each hand, as well as between fingers. To be effective, the wipes should contain at least 60% alcohol.
Read more on effective hand washing and watch a hand hygiene video on YouTube

2 – Be selective about what you eat and drink
Part of the joy of travel is trying new cuisines. But, there are some definite dos and don’ts:
Food: DO EAT food that is cooked through to the middle and served piping hot; fruits and vegetables you have washed in clean water or peeled yourself; and, pasteurised dairy products. DON’T EAT food served at room temperature; raw or undercooked eggs, meat or fish; leafy salads; or local ‘bush meat’ (monkeys, bats, or other wild game). Eating food from street vendors can be risky, but many adventurous travellers and backpacker enjoy it as part of the cultural experience. The rule here is to eat only hot food that has been cooked while you wait.
Drinks: DO DRINK water, soft drink, or sports drinks that come bottled and sealed (carbonated is safer than still - water should be boiled, filtered, or treated); ice made with bottled or disinfected water; hot coffee or tea, pasteurised milk.DON’T DRINK water from any tap, well, creek, stream or river; ice or drinks made with untreated water (such as reconstituted juice); or unpasteurised milk.
Not all of the items of food or drink in the ‘don’t’ lists will make you ill. But, they are the things that have consistently been found to be the most likely cause of problems for travellers.
For the sake of your health (not to mention your holiday) give them a miss for the duration of your trip. The gamble simply isn’t worth the risk of getting sick in a foreign country.
Read more in Travelvax Australia’s safe food and beverage guidelines

TD or not TD – the big travel question

Even if you avoid one of the vaccine-preventable diseases mentioned earlier, travellers’ diarrhoea or ‘TD’ can be more than a nuisance. And, it’s a case of the longer the stay, the higher the risk, which makes TD one of the most common causes of illness for travellers visiting a foreign country.
Most cases of TD are caused by a specific organism, usually toxin-producing bacteria (70-80%), or a virus or parasite (10-12%). The symptoms typically include loose, watery, frequent bowel movements, and sometimes vomiting.
The good news is that TD is generally a short, mild illness lasting an average of 3 - 5 days. Of course, that can be just long enough to ruin a short holiday, so it’s wise to have oral rehydration fluids on hand to replace lost fluids and electrolytes and help you to get back on your feet more quickly.
However, TD can also be more severe and debilitating, particularly for children and young adults.
If diarrhoea lasts longer than 8 hours – especially if there are other symptoms like nausea, vomiting, abdominal cramps, fever, or there is blood in the stools– a course of antibiotics may be called for. Ask about the appropriate medication and dosages during your pre-travel medical consultation.
If diarrhoea persists despite therapy, the cause may be a parasitic infection. See a doctor as soon as possible.
Learn more about how to avoid and treat TD.

Important global challenges remain

As well as describing the challenges, the WHO/UNICEF report acknowledged the successes of recent years, including: 
- By 2012, 116 countries had met the Millennium Development Goal (MDG) target for drinking water, 77 had met the MDG target for sanitation and 56 countries had met both. 
- In 1990, more than 76% people living in urban areas had access to improved sanitation, as opposed to only 28% in rural ones. By 2012, 80% urban dwellers and 47% rural ones had access to better sanitation.
- In 1990, 95% people in urban areas could drink improved water, compared with 62% people in rural ones. By 2012, 96% people living in towns and 82% of those in rural areas had access to improved water.
By 2015, the Millennium Development Goal aims to halve the proportion of the population without sustainable access to safe drinking water and basic sanitation. 
All travellers – indeed, all Australians – should hope these important global goals can be achieved.

Read the WHO/UNICEF statement or the full report.