• How long are they going for? The average duration of holidays from the UK is 10 days, anything longer than this would mean the traveller is rolling the dice of risk more frequently than the average traveller.
• What might be the prevailing hygiene conditions? What type of accommodation are they staying in?
• What season are they going in? In many places, malaria transmission is seasonal, with the peak during and just after the rainy season.
• How is their current underlying health? Do they have a chronic disease or are they taking any medication?
• What mode of transport are they using? If they are transiting through a malarious area via a plane this is very different to if they are going through the area on a motorbike.
• What are they doing out there? The behaviour of the travellers can widely vary whilst many are holidaymakers, whilst some can be “visiting friends or relatives” or emergency relief personnel, vastly varying their risk category.
• What are the governmental recommendations for travelling to the country? Using the foreign and commonwealth office website, recommendations for terrorism or natural disasters can be checked.

The question we get asked a lot at Voyager is at what point would you deem the risk to be so substantial that you would give a specific vaccine, this is a hard question to answer as each risk is weighted to each disease, for instance if you are going to a remote place you may not be able to access the rabies immunoglobulin treatment in time, therefore increasing your risk for that specific disease. Also where is the boundary of remote? As a travel health clinician should I calculate the exact time it takes to get to a suitably stocked hospital and vaccinate appropriately? There needs to be some common sense applied here. Risk is very patient specific but also practitioner specific.

Below is a crude picture we found of someones analysis of risk evaluation dependendent on a persons profession. At the top is a close representation of risk and below that, dependent on the profession how this becomes distorted.

The key to being an excellent travel health practitioner is not just understanding the “actual risks involved” from looking at up to date information on the subject, but also understanding your own biases thinking anecdotally that a friend of yours who went to Austrlia said he got Hepatitis A from eating oysters is not enough!

Lastly, the rarity of these tropical diseases needs to be taken into account, whilst they are preventable, travel warnings from governmental sources should be taken seriously; they are likely to have implications for travel and for travel insurance.

At Voyager we try to support all our members with travel health support by employing two full time, independent prescribing pharmacists to manage our clinical line. If you have any questions or issues please get in touch on +4420 7971 7777.

References:

• Common Health Risks, Required Precautions of Travelers and their Customs Towards the Use of Travel Medicine Services, 2012: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3732362/
• WHO recommendations on internation travel health, 2018: https://www.who.int/ith/precautions/travel_related/en/