Heading home: Why more migrants get the travel bug

By Dr Eddy Bajrovic*

True or false: You were born overseas, so you already have immunity against any diseases that occur there when you return to visit family and friends. 
Answer: False. 
Your ethnicity does NOT provide any in-built protection against the food-, water-, and insect-borne illnesses that might be present in your country of origin, especially if it is in a developing region of the world.
It’s a fact naturalised Chinese Australians, international students, and other Chinese migrants should be aware of as they prepare to return to their countries of origin in Asia to visit family and friends for the 2015 Lunar New Year, which begins on February 19. 
A quarter of Australians were born overseas. Many emigrated here from developing regions for the chance to study, work, or raise a family in a stable, democratic country.
However, when they leave Australia to travel ‘home’ to visit family and relatives, migrants potentially endanger themselves and their adopted Australian community by not recognising the potential health risks they could encounter overseas.

Australian and international studies over many years show conclusively that migrants travelling overseas to visit friends and relatives (in travel health they are referred to as ‘VFRs’) are at significantly higher risk of illness than any other category of traveller.

Only 1-in-4 seeks advice

Although they make up only a quarter of outbound travellers, they are heavily over-represented in cases of infectious diseases like hepatitis A and typhoid fever, as well as serious malaria infection requiring treatment in hospital. 
Yet, the studies also reveal that less than a quarter of VFRs obtain pre-travel medical advice or take any measures to protect their health.
So, why are migrants returning home at greater risk than other travellers? Mainly because they:
- Live more like locals rather than like conventional tourists.
- Often stay longer than the average tourist.
- Frequently spend time in rural areas with poor sanitation, making them more likely to come in contact with common infectious diseases.
- Eat home-cooked meals and drink the local water.
- Are more likely to be staying in malaria-infected areas.
- Have greater exposure to other mosquito-borne diseases like dengue and Chikungunya.
- Are often unaware of their risks, less likely to seek pre-travel advice, and are more likely to decline recommended vaccines.

Home-grown immunity quickly lost

It’s time to dispel a few other misconceptions attached to migrant travel:
- Even if a parent born overseas had one of the most common travel-related infectious diseases, Hepatitis A, in childhood their subsequent life-long immunity to it is not shared by their own kids. A study of more than 600 cases of travel-related hepatitis A between 1997 and 2005 found the highest incidence (70-91%) was among VFR travellers, particularly their children. (Hepatitis A is one of the few diseases where past infection provides life-long immunity. Many others can be contracted more than once.) 
- Any immunity migrants develop to malaria or typhoid through infection while growing up in their country of origin is quickly lost – usually within just 6 months of leaving.
- Migrants born overseas are less likely to have received the standard childhood immunisations, putting them at greater risk of highly contagious diseases like measles, mumps and whooping cough when they travel.
- Other diseases, such as tuberculosishepatitis Bcholera, and various sexually transmitted infections are more common in VFR travellers. 

Staying healthy – the do’s and don’ts

My advice to VFRs is much the same as it is for other travellers who want to avoid illness overseas.
- Make an appointment to see a doctor – ideally one experienced in travel health – to discuss and arrange for any vaccinations. Six weeks is ideal, but closer to departure is still worthwhile because today’s vaccines are not only highly effective, but will build up your immunity to infection and offer some protection during your stay. Accelerated schedules are available for some vaccines, too.
- Take out appropriate travel health and medical evacuation insurance. Medicare will not pay any medical or hospital bills you might incur while overseas.
- Talk a first-aid kit suitable for your destination, the length of your stay and, if it’s to be shared, the number of people travelling.
Choose safe transportation: Motor vehicle crashes are the leading cause of death of otherwise healthy foreign travellers overseas. Wear seatbelts, avoid the temptation to hire motorcycles or scooters, and NEVER drink and drive or travel with someone who is drunk or affected by drugs. (If you are involved in a motor accident while abroad, you may not be refused permission to return home until any legal issues are resolved and costs covered.)
Reduce your exposure to germs: Wash your hands often – especially after using the toilet and before eating – avoid close contact with people who are sick. Read more about hand washing and good hygiene
Avoid insect exposure: Make a conscious effort to avoid insect bites: They can carry nasty (even fatal) diseases. Mosquitoes spread malariadengueChikungunya, yellow fever, and Japanese encephalitis, among others. Your doctor can advise if anti-malaria medication should be considered. If staying in a family home that’s not screened or air-conditioned, take along a permethrin-treated bed net to sleep under.
Follow safe food and water guidelines: Consuming contaminated food or water can cause illnesses such as hepatitis Atyphoid fever, and travellers’ diarrhoea. Food cooked to high temperatures is usually the safest option, but be wary of meals involving raw seafood, dairy products and salads.
Don’t handle poultry or birds, and avoid farms and live animal markets: Avian influenza strains, such as H7N9 and H5N1, are flu viruses that have emerged recently in China and elsewhere. Most human cases have been the result of close contact with live or dead poultry or birds. While bird flu has a high case fatality rate, infection is generally a low risk for most travellers. (Seasonal flu is a much more common risk.)
Don’t pat or feed any animals: Rabies is present in many countries, but the highest incidence occurs in the sub-Continent and other parts of Asia. Human cases occur in both urban and rural areas of China, including its major cities. An extended stay may warrant vaccination against this deadly disease – discuss this with your doctor. Vaccinated or not, if you’re accidentally bitten or scratched by any animal (domestic or wild) follow the post-exposure treatment guidelines for rabies, then seek expert medical treatment as soon as possible.
If you feel sick overseas: Talk to a medical professional if you feel seriously ill, especially if you have a fever. Avoid contact with others until you’re well again.
Post-travel illness is not uncommon. See a doctor as soon as possible – especially if you’ve developed a fever.
It’s important to detail your travel history, including visits to areas with malaria, and bites from insects (i.e. mozzies, ticks), dogs or other mammals.
If you were taking malaria prevention tablets while away, keep taking them until you have completed the full course. (Malaria can be deadly. If you travelled in an area where malaria occurs and develop a fever back home – even up to a year later – see your doctor urgently.)

On the Chinese calendar, this year celebrates the Year of the Goat. Before you travel overseas, get timely, personalised travel health advice from a medical professional – no butts.

Call Travelvax Australia’s free travel health advisory service on 1300 360 164. You can also make an appointment at a Travelvax clinic to receive any vaccines or medication required or recommended for your trip.

* Dr Bajrovic is the Medical Director of Travelvax Australia.