TWO cases of child meningitis reported from the same holiday apartment block in Spain recently caused much heart searching destination and a debate ensued on Radio 1's Lifeline on whether or not they should travel. While the traditional problems most likely to arise on holiday are sunburn, insect bites, and a case of the runs from dodgy paella, increasingly, the world medical map is showing global diseases on the march which means taking even more care when leaving home.
Changing political regimes can also damage your health. For instance, poor post glasnost sewage and garbage disposal in cities in Russia, Ukraine and Eastern Europe has led to an increased risk of typhoid and other bacterial conditions. Equally, malaria caused by bites from infected mosquitoes used to be generally restricted to Africa, Asia and South America. But an increasing number of travellers are coming from or through malarial regions.
So if wandering anywhere off the beaten track, check if the country you're visiting requires vaccinations. This information should be available from your GP, relevant embassy, a recognised vaccination centre, or from the Community Health Services Division, Department of Health, Hawkins House, Dublin 2
tel 01-6714711.
The main infectious diseases we need protection from are diphtheria, malaria, cholera, typhoid, polio, and Hepatitis Type A.
Diphtheria is a bacterial throat condition. "Most adults were vaccinated against diphtheria as children, so people would normally be offered a booster," says Dr Graham Fry, lecturer in Tropical Medicine in Trinity College, Dublin. "There is a diphtheria vaccine with tetanus protection as well".
The cholera vaccination is so unreliable that the WHO does not recommend it, but two new vaccines against typhoid have fewer side effects than in the past. Cholera and typhoid are bacterial infections of the intestine, prevalent in Asia, India, Central and South America and guarding against them will also lower the risk of food poisoning. Avoid tap water, (which may contain bacteria and parasites), and water products, including ice cubes. Peel fruits and vegetables.
"Avoid shellfish," says Dr Fry. "It often contains water born faeces, it's steamed for 40 second's to open it, then eaten. So you're basically eating raw sewage.
"Also, don't buy fruit juice drinks from street vendors which may be topped up with tap water."
Use bottled waters. Some are too high in sodium for a baby's feed, and if you need to, use a low salt brand. You could also carry water disinfectant tablets.
Guarding against malaria means beginning a course of prescribed anti malarial tablets before departure to Asia, Africa or South America, taking them during your stay abroad, and 4-6 weeks after you return home. Protection is not 100 per cent. Avoid mosquito bites as far as possible cover arms and legs in the evening sleep under a mosquito net use insect repellent or spray and see your doctor if you feel unwell even months after your trip.
Holiday makers on a two week holiday outside North West Europe, America and Australia have a one in a million chance of contracting polio, but a one in 300 chance of contracting Hepatitis Type A which is prevalent in the Middle East, Central and South America. A dose of antibody gamma globulin will give some protection against Hepatitis A for 3-6 months, while the vaccine will protect for over a year, and should be the option for long term travellers.
Immunisation against tetanus, TB and rabies is recommended if living in a country with primitive sanitation or poor medical facilities. Finally, Dr Fry says to beware of tick born encephalitis, a viral brain disease, in some middle, European countries including Austria and Switzerland. A vaccination is available.
An international vaccination form is available through your doctor or vaccination centre. There are over 25 approved vaccination centres throughout the country, and your local GP can direct you. Short term holiday makers needing vaccination should contact such a centre three to four weeks before departure. Expect to spend £50-£60. More long term travellers should begin vaccination six months before departure, their vaccines will cost about £120. These costs are not covered either by medical card or VHI.
Should you fall ill abroad, you are covered for emergency treatment and care in another EU country but not for transport costs home. To qualify, you must have a Form €111 from your local health board. Most tour operators now insist on medical insurance. A typical policy which covers both personal accident and medical treatment abroad will contain exclusions. These can be pre-existing illness, injuries caused by adventure sports, accidents under the influence of alcohol, drugs, allergies or HIV, and certain pregnancy related complications. VHI members are covered for some holiday emergencies.
Finally, guard against HIV infection in rural areas of developing countries by avoiding, if possible, treatment involving transfusions, injections or surgery. And know that every summer the numbers taking a test for HIV at home are swelled by those who had risky sex abroad. If you can't be, chaste, be careful and practise safe sex. Don't fall for waiters called Mario, Claus or Zorba. You are not Shirley Valentine.