Travel general advice

Food and drink

You should have a high level of suspicion of any food presented to you unless you know it is made from fresh ingredients and has been thoroughly cooked.

The following guidelines will help reduce the risk of contracting diseases from contaminated food:

1. Always wash your hands before eating and dry them thoroughly on a clean cloth.
2. Thoroughly wash all fruit and vegetables before eating.
3. Salads are best avoided but if eaten should be washed well and left to soak in water containing chlorine based sterilising tablets or household bleach (4 drops per litre). Washing in water at 60°C will reduce the risk.
4. Peel all fruit and vegetables to be eaten raw.
5. Protect food being left for any period of time with a fly net.
6. Residents abroad should make certain that house staff follow strict kitchen hygiene rules.
7. Don't eat raw vegetables or salads in public restaurants.
8. Don't eat under-cooked or raw meat, fish or shell fish even if they are the local delicacy. Inadequately cooked shell fish are a potential major source of infection.
9. Don't drink unpasteurised cow, sheep or goats' milk. If in doubt you can pasteurise by bringing almost to the boil and then cooling. Dairy products such as ice cream, butter and cheese, if from an uncertain source, should be avoided.
10. Don't eat food left un-refrigerated for more than 2 - 4 hours.
11. Do not make the mistake of assuming that because a meal looks and smells delicious it will be safe.
12. Avoiding Contaminated Water which is a frequent source of infection. Most cities and large towns have large piped water systems but the water is only safe to drink if it has been fully treated and chlorinated. Even in areas where the tap water is safe to drink the level of chemical treatment may be sufficient to render it unpalatable to the United Kingdom traveller. To be entirely safe the following alternative means of sterilisation are available. Bring it up to a rolling boil and allow it to cool, prolonged boiling is unnecessary. Disinfectants are often ineffective if the water is visibly cloudy. Iodine is very effective. 4 drops of 2% tincture of iodine should be added to each litre of water and left for 15 minutes. Prolonged use of iodine should be avoided (longer than 6 weeks). Sterotabs and Puritabs. These are chlorine based and are less effective against amoebic cysts than iodine. In an emergency use household bleach (2 to 4 drops per litre of clear water) and leave for 15 minutes, this is safe and effective but will taste of chlorine. Iodine resin water purifiers: These light modern systems both filter and purify fresh water from any source. They are convenient and effective (for example MASTA Travel Well Trekker).

The following guidelines may help in avoiding contaminated water:

1. Remember ice may be made from contaminated water and is therefore not safe.
2. Bottled water and drinks are normally safe, especially fizzy drinks.
3. Use safe water for brushing teeth and for washing vegetables or salad which are to be eaten raw.
4. The water from the hot tap in your hotel is likely to be safer than the water from the cold tap. Run it for a minute or so first. It can be used for brushing teeth in an emergency.

Sun

Overexposure to the sun can cause sunburn, leading to premature skin ageing and an increased risk of skin cancer. Try to avoid sun exposure in the middle of the day when the sun's rays are at their strongest. Where possible stay in the shade. Be careful in and around water as the ultra-violet rays are reflected by water. Wear loose-fitting, closely woven cotton fabrics that you cannot see through and a broad-rimmed hat to protect head, face and the back of neck.

Use a broad spectrum (blocks UVA and UVB rays), high protection factor sunscreen (SPF 15) and apply frequently especially after being in water. Wear sunglasses that filter out UVA and UVB rays to protect your eyes from sun damage.

Keep babies out of direct sunlight as their skin is easily damaged. Children should wear hats and sunglasses and be covered up when out in the sun. A broad spectrum, high protection factor sunscreen should be applied frequently especially after bathing.

Another risk of overexposure to the sun is becoming dehydrated. Avoid strenuous exercise during the hottest hours. Drink plenty of non-alcoholic fluids to replace the fluid lost through perspiration.

Travellers diarrhoea

Remember loose motions can also result from a change in diet including, for example, spicy or oily foods. Prevention depends upon effective drinking water sterilization and ensuring food is uncontaminated or cooked thoroughly. Personal hygiene when eating and drinking is also important including hand washing prior to eating and using sterile plates, cups and utensils.

The priority in treatment is preventing dehydration especially in young children. Clear fluids or ideally oral rehydrating solutions should be drunk liberally. Anti-diarrhoeals such as immodium or Lomotil should be used sparingly since paralytic ileus and/or systemic spread of organisms may be encouraged.

Ice may be made from contaminated water and should therefore be avoided where possible. Bottled water and drinks are normally safe, especially fizzy drinks. Use safe water for brushing teeth and for washing vegetables or salad which are to be eaten raw.

Malaria provention

Mosquitoes can transmit several diseases including dengue fever, Japanese encephalitis, malaria and yellow fever. To reduce the chance of being bitten, wear long sleeved shirts and long trousers after dusk. Spray your room or tent before going to bed with a knockdown spray (flyspray).

Sleep in a screened room if possible, otherwise use a bed net. The new wide mesh nets impregnated with residual insecticide (permethrin) are particularly effective. Use mosquito nets to cover cots in orderessential to protect babies. Use a plug-in electric insecticide vapouriser or smoke coil. Air conditioning eliminates mosquitoes in sleeping areas.

The new, natural, eucalyptus based insect repellents have been shown to provide many hours protection when applied to skin. DEET impregnated into cotton is effective for many hours. Ankle and wrist bands are very useful for local protection. Spraying of walls by the local authorities with residual insecticides is practiced in many towns and cities and greatly reduces the risk of being bitten.

Remember mosquitoes breed in stagnant water, long term residents should therefore ensure that breeding areas within 500 yards of accommodation are regularly sprayed or eliminated

Check with your GP or Travel Clinic whether a prophylactic antimalarial drug should be takenb. A description of the recommended antimalarial drugs for UK travellers is available.

Safe sex

Diseases such as HIV and hepatitis B are more prevalent in some parts of the world than in the UK and the risk of infection may be much higher. It is best to avoid casual sexual intercourse and, in particular, activities where the skin may be damaged or there may be contact with bodily fluids.

The risk of transmission of HIV, hepatitis B and other sexually transmitted diseases is reduced but not eliminated by the use of a condom which should be used throughout sexual contact. Condoms purchased abroad may not be as reliable as they may not be of the same high standard as those purchased in the UK.

Accident Prevention

In all but a very few countries, a blood transfusion can leave the traveller vulnerable to infection. Being involved in an accident is the commonest reason for a traveller to require a blood transfusion. The avoidance of accidents is, therefore, the most effective way of avoiding a transfusion.

1. Driving on the road. If you are driving in a foreign country take extra precautions, always remembering that you may have to drive on the opposite side of the road from that which is correct in your own country. Always wear seatbelts, don't drive in the dark, don't drive too fast, and never drink and drive. This is especially true when you are holiday, as there is always a temptation to go out to a restaurant or a bar. In many countries holidaymakers are encouraged to hire mopeds. If you do, always wear a crash helmet and protective clothing. Peace Corps volunteers have recently been banned from driving mopeds or motorcycles, and there has been a dramatic reduction in their injury rate.
2. Exploring on foot. One of the commonest causes of road accidents amongst travellers is looking the wrong way when crossing the road. If the traffic drives on the opposite side of the road to that to which you are accustomed, take great care as your natural instinct is to look in the wrong direction and then step off in front of oncoming traffic. As you will be unfamiliar with the surrounding area, keep to well-lit streets where there are plenty of other people. Do not venture into areas where you are likely to be attacked.
3. Hazardous sports. Avoid hazardous sports, especially if you are not being properly supervised. Take care when going off on mountain walks or hill climbing.
4. Disease. Ensure that you avoid catching any disease that might require a blood transfusion as part of the treatment. The most common such disease is malaria, so when you are in an area where malaria is endemic, take adequate malarial prophylaxis, wear long sleeved shirts and long trousers after dark and always sleep under a properly impregnated mosquito net.

To cover yourself, you should consider joining the Blood Care Foundation, a charity that provides sterile instruments, fluids and blood if necessary.

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