Sickening souvenirs: Dealing with post-travel illness

By Dr Eddy Bajrovic*

Travellers don’t always return from overseas refreshed and rejuvenated.
Instead of being fighting fit they’re fighting off jet lag, a fever, a rash, diarrhoea, or persistent pain.
At least 50% of travellers who’ve visited a developing country report a post-travel illness, according to the Manual of Travel Medicine.
By far the most common infections are gastro and respiratory infections, followed by skin diseases, and sexually transmitted or urinary tract infections.
But, not all post-travel illnesses are actually related to the trip: Many are routine infections just as easily caught at home. Most of these illnesses disappear in a few days without treatment.
So, it’s important to know when you don’t need to see a doctor… and when you do.

A fever needs urgent attention

Malaria is the most serious post-travel illness because the most severe strain, P. falciparum can be rapidly fatal.
If you arrive home from a malaria-infected region with a fever, you should see your doctor urgently because it’s important to (1) rule out malaria as the cause of the fever or (2) begin treatment quickly if it is. (Malaria is more common in Australian travellers than you might think: The annual average for the past 5 years is 482 cases – all contracted overseas.)
Other illnesses also require urgent attention. Meningococcal disease can become life-threatening rapidly – especially in infants – while the highly contagious measles virus can spread quickly on your flight, at the airport, among your immediate family and the wider community. 

Evaluating disease risk factors

Examining possible exposures to travel-related diseases means evaluating factors such as:
The destination country – developed or developing? The risk of exposure to infection is usually higher in a developing country.
The type and duration of the trip – a short, city-based business trip or lots of rural travel? Clearly, the latter holds a higher risk. The period of time spent travelling and the timing of the onset of the illness are important clues as infectious diseases have their own incubation periods.
The style of accommodation – western-style hotel or resort, or a family home? Post-travel illness is relatively common among people who’ve stayed with family and/or friends in their country of origin.
Precautions taken before or during travel (i.e. travel vaccines, malaria medication)? Diseases against which a traveller has been immunised can usually be ruled out as a cause of illness, and malaria is unlikely (but not impossible) in someone who has taken preventative malaria measures (i.e. taking medication and using repellent).
Individual susceptibility – Infants, the elderly, and those with a chronic medical condition are all at higher risk of more serious illness from an infection than a fit, healthy younger person.
These are all questions your doctor will want to ask. Your responses, plus a possible pathology test or two, will help to rule out the more serious possible causes of illness and help determine a course of treatment.

When to see a doctor – or not

TRAVELLER’S DIARRHOEA (TD) – Diarrhoea is common among travellers – even the most cautious. So, it’s not unusual to arrive home still experiencing TD. Often, it clears up without treatment, however a course of antibiotics may be advised if you have fever above 38°C, cramps causing severe pain, or blood in your bowel motions.
SEE A DOCTOR… if you have other symptoms or the diarrhoea persists for more than a few days after your return.

VOMITING – Typically, vomiting is caused by an infection picked up from contaminated food or water and usually lasts less than 12-24 hours. However, it could also be a symptom of a more serious illness or infection, such as malaria. Persistent vomiting may lead to dehydration, especially if accompanied by diarrhoea. To manage vomiting at home, stop eating and sip water, oral rehydration solution, or isotonic sports drinks. Once the vomiting has stopped, resume eating small amounts of bland food, rest, and avoid alcohol.
SEE A DOCTOR… if vomiting persists longer than 12 hours.

RASH – A post-travel rash could be the result of an insect bite, an allergy, or an infection. Bites from flying insects appear as itchy, red bumps – either singly or more widespread like a rash – and are more likely to appear on exposed skin, such as the ankles, wrists and hands or face. Bites from fleas, bed bugs or scabies can also cause a generalised rash. Rashes caused by an allergy to insects or medication will often settle down by avoiding the cause and applying an over-the-counter ointment balm, calamine lotion, antihistamine cream, or hydrocortisone cream, although an oral antihistamine may be needed. Viral rashes are usually widespread over the body, pink, not itchy, with no heads or crusting, and usually occur at the end of an illness. A mild fever, lethargy, aching muscles and joints can all be symptoms of a viral infection.
SEE A DOCTOR… if you also feel unwell with fever, lethargy, or joint pain as a rash may be a sign of a more generalised illness.

FEVER – Fever is the body's way of fighting off infections from viruses or bacteria and is often accompanied by headache, aches and pains and insomnia. Fever caused by a self-limiting virus needs no specific treatment, other than to maintain hydration by sipping water or isotonic sports drinks. Paracetamol can also help to lower body temperature and rest is also important to recovery.
SEE A DOCTOR… if the fever is prolonged or severe, or immediately if you visited a malaria-infected area – even if you took anti-malarial drugs. A consultation is particularly advisable if your fever is accompanied by vomiting, diarrhoea, rash, or a severe headache. Mention your recent travel history, even weeks or months after your return. The symptoms of typhoid and dengue often include fever within 1-2 weeks of returning from endemic regions, such as Southeast Asia.

PAIN – There are many causes of pain – anything from tension to poor posture from sitting in a cramped aircraft seat for hours on end. Headaches, cramp, or stiffness often disappear with rest, re-hydration and/or a couple of paracetamol tablets. However, some pains shouldn’t be ignored. Leg pain may be due to simple cramps, but calf and thigh pain may be a symptom of a blood clot (a deep vein thrombosis or DVT). If you experience persistent leg pain after air travel, see a doctor to exclude DVT. DVTs are more likely to occur in smokers, overweight people, pregnant women, people who have become dehydrated and those with pre-existing chronic medical conditions, but people with no risk factors get them too. Chest pain and breathlessness always needs to be checked with a doctor or hospital as soon as possible as it could be due to pulmonary embolism (blood clot in the lungs) or pneumonia. Headache may be transient and indicate tiredness, tension or a simple virus. Take paracetamol as directed and rest.
SEE A DOCTOR… if the headache persists, gets worse or is accompanied by fever, rash or vomiting.

* Dr Bajrovic is the Medical Director of Travelvax Australia.

Travelvax Australia can help you prepare for healthy travel. Our travel clinics are located Australia-wide and provide pre-travel consultation and vaccinations tailored to you and your destination. Find out more by calling our obligation-free travel health advisory service on 1300 360 164.