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Travelling healthily: the real price of a bargain holiday

Liz Rosies
RGN MSc(Travel Med)
Bank Nurse
Travel Clinic - InterHealth
London
Author of www.travelhealth.co.uk

With the rise in bargain-priced travel to exotic destinations, travellers are increasingly putting themselves at risk.(1) Many fail to understand which health items they need when venturing overseas.
The role of the travel health professional is to offer advice to "safeguard the health of international travellers through the prevention of illness, accidents and injuries".(2) Therefore many opportunities exist for health promotion in the selling of travel health products. The cost of purchasing items for travel can alarm the novice traveller who is unsure of what is really needed for a trip. Nurses should therefore have a ­working knowledge of merchandise, enabling them to recommend products in an informed manner.

Vaccination costs
While many vaccinations are available under the NHS, those going to tropical destinations will often incur a cost for non-NHS vaccinations.(3) Although vaccinations are competitively priced in most travel clinics, many travellers still remain confused about price variations. The rabies vaccine, for example, differs in price according to the method of administration. A traveller can save as much as £48 on a full course of three rabies injections if they choose the intradermal method, as opposed to having the injection intramuscularly.(4)

Malaria prevention
Malaria prophylaxis is essential for those travelling to malarious areas. Some malaria prophylaxis, such as chloroquine, can be obtained over the counter fairly cheaply. However, prices for Malarone (atovaquone; Glaxo Wellcome) are much higher and vary extensively from £3 to £5 for each tablet. In the general practice setting, prescription-only medication may also incur a private prescription charge.
While prophylaxis can be expensive, no medication offers 100% protection.(5) In countries where diseases such as malaria and dengue are endemic, insect repellent is an essential part of the holiday kit.
Insect repellents usually fall into two categories: those that are synthetic - such as diethyltoluamide (DEET) - and those derived from plants, such as lemon eucalyptus. Along with repellents, a good impregnated mosquito net is essential for endemic areas. For travellers looking for protection against daytime biters, repellents should be worn on top of sun protection cream - a further cost of around £10 for a factor 15.(6)

Deep vein thrombosis prevention
With intense media attention on the potential risks associated with travel-related deep vein thrombosis (DVT), it is not surprising that many people are looking for products that will offer protection. There are many different products on the market at the moment.
Research has shown that correctly fitted antithrombosis stockings increase blood flow, thus lowering the risk of DVT in those at risk.(7) Owing to a lack of verified evidence, however, it is still unproven whether DVT is related solely to air travel. Therefore advice related to stockings and exercise equipment should apply to all forms of travel when an at-risk traveller is immobile for long periods of time. Before any products are purchased, it is essential that individuals assess their personal risk factors for DVT and obtain advice from their own doctor as to whether they are fit to fly.
 
Safe water
It is essential for the traveller to a high-risk area to take along a method of water purification. There are many different methods, from iodine tablets to sophisticated water purification and filtration methods, each varying dramatically in price.
It is estimated that some 30-50% of travellers to tropical regions will suffer from travellers' diarrhoea.(8) Travellers to at-risk destinations should consider purchasing a diarrhoea treatment kit containing anti-diarrhoeal medication, at a cost of around £10.
 
First-aid kit
All travellers should think about purchasing a first-aid kit. Kits vary in size and content, and the choice should be determined by the destination and risk factors the traveller will experience. For those travelling to remote areas of the world, a sterile medical pack can be bought from a specialised centre for around £17.

Insurance
Insurance should be specifically designed for the traveller's needs, providing cover for the pursuits they are planning to take part in while they are away. While many travellers look for the cheapest option, it is essential that they are advised to obtain the best cover for their individual circumstances.(9)

Implications for practice
When all of these costs are added together, it is no wonder that many travellers go abroad partially unprotected. It is essential that health professionals are aware of the costs and are able to advise and explain the benefits of each product, advising the traveller on those items that are fundamental for health protection.
While it is not practical for all practices to set up a travel shop within their practice, some retailers are increasingly keen to work alongside nurses in helping to set one up.(10) Nurses can also obtain catalogues of products and offer preventive advice to patients while directing them to essential items required for travel. While proper advice on products is a good revenue centre for clinics and surgeries, it must not be forgotten that advice and health promotion also reduce the long-term treatment costs to patients.

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References

  1. UK 'faces tropical disease threat'. http://news.bbc.co.uk/
    hi/english/health/newsid_1751000/1751188.stm
  2. Steffen R, Dupont HL. Travel ­medicine: what's that? J Travel Med 1994;1:1-3.
  3. Department of Health. Immunisation against infectious disease. London: HMSO; 1996.
  4. Prices from Thames Medical, 157 Waterloo Rd, London, T: 020 7902 9000.
  5. Guidelines for the prevention of Malaria in Travellers from the United Kingdom for 2001. Available from www.phls.co.uk
  6. Prices from www.wellbeing.com
  7. Scurr J, et al. Frequency and ­prevention of symptomless deep-vein ­thrombosis in long-haul flights: a randomised trial. Lancet 2001;357:1485-9.
  8. Farthing M. Travellers' diarrhoea. In: Locke C, et al, editors: Travel medicine and migrant health. London: Churchill Livingstone; 2000.
  9. Prices from www.costout.co.uk
  10. Homeway Ltd. T: 01980 626360. www.TravelwithCare.co.uk

Resources
Homeway Ltd
W:www.TravelwithCare.co.uk
InterHealth/ Thames Medical
E:info@interhealth.co.uk
Nomad W:www.nomadtravel.co.uk
Boots
W:www.wellbeing.com