Health & Fitness Travel in the pink of health

Travel in the pink of health

By Dr Chester Lan, Resident Physician, DTAP Clinic

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Travelling overseas for a holiday has become a quintessential part of many Singaporeans’ lives. And for many, the neighbouring countries in South-East Asia provide an affordable and convenient place for a holiday.

While the word “holiday” stirs feelings of enjoyment and carefree bliss, holidays are not without risks. Today, we will be covering some common ailments and situations that a person might face on a holiday.

Diarrhoea

Travellers’ diarrhoea is the most common illness contracted abroad, affecting some 50% of overseas travellers. Chances are you might have had a bout of travellers’ diarrhoea on one of your holidays in the past. These infections are caused by bacteria in most cases. Viruses and parasites make up the rest. The prevalence of “street-food” and less-than-satisfactory food-handling practices in some of these places may present an increased risk of travellers’ diarrhoea. Sometimes, similar symptoms are caused by contaminated food as well. Symptoms may present as early as a few hours from exposure or a few days after and can include stomach cramps, nausea, diarrhoea, bloating, vomiting, fever and malaise.

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It can be hard to avoid travellers’ diarrhoea, but avoiding raw foods and salads, avoiding ice or ice cream, and drinking bottled water or drinks instead of tap water are some ways to decrease your risk.

If you do get these symptoms, you can try some over-the-counter anti-diarrhoea medications such as charcoal or prescription medications such as loperamide for diarrhoea and buscopan for the cramps. If you do have a fever, body aches or headaches, some antipyretic medications like paracetamol can help you feel better. The most important thing about the treatment of diarrhoea is hydration, hydration and more hydration. Oral rehydration salts work better than isotonic drinks in this aspect.

If you are feeling extremely unwell, feel your symptoms are intolerable, are or unable to hydrate yourself due to continuous vomiting or diarrhoea, please seek medical attention immediately. There are some other more serious diarrheal diseases like Typhoid and Cholera, which may be life-threatening in some cases. Taking the same precautions as mentioned above can reduce your risk of contracting some of these infections.

URTI (upper respiratory tract infection)

Just like how you can get the common cold at home, you can get the common cold while travelling as well. Over the counter (OTC) medications can ease your symptoms such as runny nose, sore throat, cough, fever, and nausea. Symptoms usually abate within the week. The best thing you can do is to keep your immunity up and you will be less likely to catch a cold on a holiday.

Mosquito-borne diseases and other vector diseases
Dengue is one of the most serious and endemic mosquito-borne diseases in South-East Asia. Symptoms usually present within a week and can include high fever, headaches, flu-like symptoms and a skin rash. Most cases are fairly mild and most people can get past the infection without any serious complications. However, some people may develop dengue haemorrhagic fever and dengue shock syndrome which may lead to a dangerous drop in blood pressure and death. There is no real treatment for dengue virus, but the purpose of the treatment is for symptomatic relief and supportive management. Regular antipyretics like paracetamol and copious hydration are encouraged. Should you start having bleeding gums or severe abdominal pain or feeling very unwell, please seek medical attention immediately.

Other infections like malaria are seen more frequently in travellers visiting forested areas, but you can still get malaria in cities. Most malaria areas are known to the US Centre for Disease Control, and on their website, they have information about high-risk countries and areas. Malaria usually causes a fever, headache, nausea and vomiting, muscle aches and fatigue. The fever may be high and start with chills and rigors. This may be followed by sweating as the fever declines. However, not everyone will follow this pattern. Malaria can be life-threatening. Malaria can be prevented by chemoprophylaxis (taking anti-malarial medications) before going to the area for travel. Check with your doctor if you are suitable for these medications. Malaria can also take a while for symptoms to show, sometimes a few weeks after the mosquito bite. If you are back from your travels and do develop such symptoms, tell your doctor about your travel history.

Other less common mosquito-borne diseases seen in South-East Asia include chikungunya, Japanese encephalitis and lymphatic filariasis. Sandfly borne disease (kala-azar) and snail-transmitted disease (e.g. schistosomiasis) are possibilities as well.

Prevention is always better than cure. It may be impossible to prevent all mosquito/insect bites, but there are ways to reduce your risk. Use insect repellent on exposed skin when you are outdoors. Mosquitoes also bite more often during dawn to dusk so staying indoors during this time can be helpful. There are also usually more mosquitoes in forested areas so avoiding such areas can reduce your risk. If you are outdoors, wear long-sleeved tops and pants. Insect repellents with DEET or picaridin are long-lasting and provide good protection. Lemon eucalyptus oil can also provide protection similar to products with low concentrations of DEET.

Allergies

Travelling to different countries exposes you to different cultures and foods. The most common allergy is in from food. Food allergies can present with itching of the eyes, mouth and throat, puffy eyes, a rash (hives), swelling of the lips, face, tongue and throat or other parts of the body. More serious food allergies may cause swelling of the throat, leading to difficulty in breathing, wheezing, giddiness, abdominal pain, diarrhoea, nausea or vomiting, or loss of consciousness. Simple allergies can be treated with over-the-counter antihistamines. More serious allergies have to be treated by a medical professional immediately. Some allergies can even lead to death.

Environmental allergens may worsen pre-existing conditions like asthma and allergic rhinitis. Remember to bring your regular medications for your allergic conditions and your rescue therapy for asthma as well.

In Singapore, bee and wasp stings are not as common but may afflict travellers at the countryside and forested areas of South-East Asia. In most people, these stings result in pain and swelling for a few days. But for certain people, a bee sting allergy can kill them. Prevention is always better than cure. If you see or hear a beehive, avoid it. Should you already be stung by a bee(s) and feel unwell, faint or feel short of breath, seek medical attention immediately!

Rabies and animal bites

Rabies is a viral infection that is present not just in South-East Asia, but all over the world. It is usually transmitted by an infected animal bite and rural areas carry the biggest risk. Early symptoms may include tingling around the bite, flu-like symptoms, fever, headache, muscle aches, loss of appetite, nausea, and fatigue. Later symptoms usually affect the neurological system and can include altered mental state/confusion, agitation, aggression, unusual posturing, muscle spasms and weakness. Once it reaches the late stage, it is fatal. There is a vaccination available, which must be given before exposure or directly after exposure (before symptoms start).

Seek medical attention should you have an animal bite. Animal bites are likely to get infected by other types of bacteria as well. If are bitten, wash the wound immediately and cover the bite with a clean bandage. Go to the nearest emergency department. Anyone with a possible rabies infection must be treated in a hospital. If the doctor deems it necessary to treat for rabies, the vaccination or immunoglobulin therapy will be initiated. In addition to possible rabies treatment, antibiotics are usually necessary for animal bites.

Trauma 

While infectious diseases play a role in only five percent of visitor deaths, half the visitor deaths in Asia are the result of road accidents. Avoid jaywalking, avoid riding scooters or motorcycles if you are inexperienced, and always be aware of your surroundings. Even if you are involved in a minor road traffic accident, it is still important for a doctor to assess you to make sure there are no injuries to the internal organs or injuries that are not visible to the naked eye.

Pre Existing medical conditions

Thirty per cent of the deaths of travellers are due to heart attacks. If you have heart problems, get thoroughly evaluated if you are fit for travel before booking your flight and ensure you have your long-term medication and prescriptions with you. Travel can be stressful to the mind and body, which can lead to an increased chance of a heart attack if you have existing cardiac conditions. If you have a history of fainting spells, low blood pressure or seizures, avoid water activities, hot springs and saunas, and activities in high and precarious places are advised.

Vaccination and chemoprophylaxis

The US CDC publishes a list of vaccines that are recommended for travellers to each country according to how prevalent that disease is in the region. Here are some vaccinations most people commonly get before travelling – the Flu vaccine, Hepatitis A vaccine, Typhoid vaccine, Tetanus vaccine and Meningitis vaccine. These are in addition to the vaccines that you have already received as part of the National Immunization Schedule. The list of countries and their recommended vaccine can be found here.
If you are going to an area which is malaria-prone, it is advisable to start the appropriate anti-malarial to reduce your risk of contracting malaria.

Sexually transmitted infections

When travelling, you never know if you might meet someone whom you feel attracted to. And if things are going great, remember that as long as you are having sexual intercourse, you can get an STI or HIV. This applies to your travels, as well as for your day-to-day life.

The most effective way to prevent contracting an STI or HIV is abstinence. Should you partake in sexual activity, practice safe sex – use a condom, and learn how to use it properly.

What do you know about HIV in Singapore

Specifically, for the reduction in risk of contracting HIV, pre-exposure prophylaxis (PrEP), has been shown to reduce that risk. These are anti-HIV medications that if taken prior to sexual exposure, can reduce the risk of contracting HIV.

High-risk activities like usage of injectable illicit drugs and high-risk sexual encounters with commercial sex workers should be avoided. If there has been a high-risk sexual encounter, post-exposure prophylaxis (PEP), which are also anti-HIV medications that have to be taken for a month after the encounter, can reduce your risk of contracting HIV.

Conclusion

As the world becomes more interconnected and the ease of travelling increases, more and more of us are bound to get on a plane and visit another country. Travelling can be a safe and fun experience if you take the necessary precautions and measures. The last tip we have for you is to buy travel insurance and put your heart at ease!

Dr Chester Bio: Dr Chester Lan is the resident doctor at DTAP Clinic Holland V, he believes in holistic care individualised to each patient. This patient-centric approach, along with his friendly persona, has earned him the trust of many of his patients. He sees patients from all age groups over a variety of sub-specialties and understands that building trust and rapport, along with good communication, is the key to a successful patient-doctor relationship.

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