By Dr Eddy Bajrovic, Medical Director, Travelvax Australia.
Australians make around 7 million international trips each year and an estimated 15% of them are made by people aged over 65.
So, it’s not surprising then that we see many older – even elderly – travellers at Travelvax Australia’s clinics. Many are veterans of the skies; others are first-timers who have finally got the chance to spread their international wings.
Although most aspects of pre-travel advice remain constant regardless of age, there are some special considerations for older travellers. This is particularly true when it comes to protecting yourself against the vaccine-preventable diseases that travellers can encounter – especially in developing regions of the world.
The first step is to see a doctor experienced in travel medicine and see them early – ideally 2 months before you plan to leave.
In fact, book your seat at the travel clinic before you book your plane ticket or accommodation. Better to get a clear picture on any travel health issues before you pay your deposits.
A few preliminary questions…
Assuming your travel doctor is not your GP and is seeing you for the first time, he or she will ask:
Q – Do you have any co-existing medical illnesses that may cause problems overseas – even disrupt your travel plans?
Ask your regular GP for a letter outlining your medical history or get their okay for your travel doctor to call them for a summary.
Q – What medication are you taking?
Your daily medication may interact with antimalarial drugs or other preventative medications you might be advised to take in your first-aid kit. Bring a list of what medication you take regularly, including the dosages.
You should also bring along a detailed itinerary – even if you haven’t made any firm bookings. The discussion may help you firm up your travel plans.
Immunisation for older travellers
While they are protective and worthwhile at any age, vaccines may not work as quickly, as effectively, or for as long in older people as they do for younger people. There can also be an increased risk of side-effects, most notably with the yellow fever vaccine.
More good reasons to begin preparations early.
Travel vaccines are classified as being either required, recommended, or routine. The list is usually determined by the season of travel, the itinerary, type of accommodation, length of stay, and, of course, the traveller’s vaccination and medical history.
It’s tempting to assume older travellers may have had or been vaccinated against all of the routine or ‘childhood diseases’, such as measles, mumps and rubella (MMR), polio, diphtheria, and tetanus. While it is true that these sometimes fatal illnesses were more common in first half of the 20th century, it’s advisable for older travellers to check their immunisation status and get either a primary course or a booster, if required. (Tetanus is more common among older patients – even in developed countries like Australia – because many people aged over 55 missed out on primary tetanus vaccination. Most deaths from tetanus occur in people over the age of 70, especially women, so it’s better to have a 10-year booster here than have to have one overseas in the event of a minor injury.)
One exception is measles: People born before 1966 can be considered to be immune to measles and do not need to get tested or boosted.
Similarly, hepatitis A is one of the most frequently recommended travel vaccines for travel to developing countries. However, studies have found that more than 60% of Australians aged over 50 have protective antibodies to this common food- and water-borne disease (compared to around 5% of 20-year-olds) and so may not need to be vaccinated.
Australian health authorities suggest a blood test for people born before 1950 to check if they’ve already been exposed to Hepatitis A. If not, vaccination should be offered as the risk of severe – even fatal - infection from Hep A increases with age.
Some risks rare, some common
Other travel-related diseases, particularly yellow fever, Japanese encephalitis, pneumococcal infection, typhoid fever, and influenza can also be more severe for older people.
Yellow fever is a mandatory entry requirement in many countries of Africa and South America. Under certain circumstances, some older travellers may be exempted from vaccination, but will need to take a letter to show immigration officials on arrival and returning home if requested. If you are planning travel to Africa or South America it’s advisable to seek expert advice early regarding the risk of, and need for, yellow fever vaccination.
Most of these diseases present a low risk for short-stay travellers. The exceptions are typhoid and flu.
Usually contracted by swallowing water or food contaminated with human waste, typhoid vaccination is not likely to be advised for travellers spending a week exclusively in a hotel or resort. Vaccination is normally recommended for longer stays, especially if rural travel is involved, and for ‘adventurous’ eaters.
It is worth noting that typhoid is almost exclusively a disease of travellers, and in recent years the number of cases seen in Australia has gradually risen to 149 in 2013 – twice as many as a decade ago. There is also growing concern about antibiotic resistance, which is making treatment more difficult and less reliable, experts say.
Flu is the most common vaccine-preventable illness among travellers and older people are at higher risk of more severe illness. If you are planning to travel overseas after the flu season have the seasonal vaccine while it is still available (usually from March through November). Flu will be a potential risk throughout your journey – at your destination, in crowded aircraft cabins, and at airports – where you will encounter people from countries where outbreaks may be occurring.
Because of the risk of more serious illness, Australians over 65 are eligible for a free flu vaccination. Regardless of whether they are travelling around the corner or around the world, all older Australians should be vaccinated each flu season.
Other issues for older travellers
Malaria is also potentially more severe in older travellers, which makes preventative medication and avoiding mozzie bites another important aspect of pre-travel preparation. Your travel doctor will advise if your itinerary puts you at risk of malaria and if the exposure warrants you taking anti-malaria pills.
Achlorhydria, a condition associated with various medical problems, which results in low production of gastric acid in the stomach to the point where it is very low or even absent. Achlorhydria can increase the risk of travel-associated diarrhoea from infection with cholera, typhoid, or even the more common parasite, giardia.
The lower air pressure in aircraft cabins can bring on breathing difficulties for elderly passengers with declining lung and heart function. For those with severe respiratory disease and/or severe heart failure, we would recommend specialist assessment before considering air travel. Such travellers can undergo testing to determine the need for oxygen use in flight. As we age we also become more prone to travel-associated conditions such as deep vein thrombosis after long-haul flights, heat stress in hot climates, jetlag after crossing multiple times zones, and dehydration.
These are all manageable conditions, but it pays to know how to avoid or treat them to minimise potential physical or psychological distress far from home. Your travel doctor will have lots of good advice.
Older travellers are generally sensible, careful people who know their physical limitations. They rarely bite off more than they can chew when planning overseas travel.
Still, if you’re over 65, it is wise get the picture early on vaccinations and other issues that might impact on your holiday – or your health.
For advice on vaccinations and other travel health issues call Travelvax Australia’s free telephone advisory service (1300 360 164). You can also book an appointment with travel medicine professionals at your nearest Travelvax clinic.