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The cost of far-flung travel

For Rhona Aikman, one of the disadvantages of providing travel advice is seeing a lot of people go on great holidays, especially at this time of year...!

This week in particular, when many areas are struggling to cope with heavy snow and very cold weather, it is hard not to be a bit envious when discussing a patient's need for yellow fever immunisation and malaria prophylaxis for an up and coming Caribbean cruise that ends with four days in the Amazon. I have carried out two to three times the usual number of yellow fever immunisations in the last couple of months – so much for the credit crunch!

The practice in which I work has been a yellow fever centre for around 15 years, and I recently attended a one-day course arranged for practices offering this. I must admit, when we first got the details of this compulsory training day, I did think it was a bit strange because we have been providing the service for so long. However, as I am the person who does most of the vaccinations, I found myself signed up.

I enjoy as much travelling as time and money allow, and I also quite enjoy discussing travel and immunisation advice with patients. It is always good to hear about other people's plans, especially the ones that are a bit exotic or different. In the last couple of weeks I have had enquiries on immunisations for Cuba, Brazil, Egypt, China and Vietnam.

Most people do not complain about paying for yellow fever and malaria tablets, but there are always some who are not happy. On one hand, you could argue that if they can afford the often very expensive holiday, then this additional expense is small in comparison. However, often these travellers are healthy people who are not regular users of the health service in other ways and feel it is unfair when the NHS picks up the tab for conditions that some regard as self-inflicted.

Some people will inevitably travel without seeking any advice, and some come for advice and then decide not to follow it. For those travelling to countries such as Kenya and Gambia, where immunisation against yellow fever is recommended rather than compulsory, it can take some time discussing the risks and benefits. I regularly see people who have found a great package to one of these destinations, and have booked before enquiring about immunisations. If they are a family of four, they could face an additional spend of several hundred pounds on yellow fever and malaria tablets.  

Just a couple of weeks ago, I saw a patient who had done his homework on the internet regarding immunisation for yellow fever for a trip that was to include a week in the Masai Mara game park. He was hoping to avoid having this immunisation. Maybe some research is being done, or will be done, to discover to what extent it is still present in the monkey host; but until then, current recommendations stand.

Few would argue about the risk of yellow fever transmission in Amazonian regions, but it made me think about the trip I took on the Amazon in Peru, aboard the Amazon Hope 2. The trip had a Peruvian nurse aboard doing childhood immunisations at each village. This role is funded by the Peruvian government and the charity helps by providing a means for remote villages to be reached by boat. Children over the age of nine months were immunised against yellow fever as part of the childhood programme. Hopefully, in years to come, there will be no human cases reported there either.

I had originally wondered how a training course could take a whole day just to cover yellow fever - but it could have gone on and on as more questions were asked. As I often find on study days, there is always something new to discover.

So, I wonder where the next travellers will be heading? I'm off to the travel agent to get some brochures ...