Holidaymakers are ignoring the dangers of their destinations. Theresa Judge reports
About 60 per cent of Irish people travelling to southeast Asia do not get the vaccines doctors say they need to protect their health and only 25 per cent of people travelling to countries where malaria is endemic take malaria tablets.
It is findings such as these that have prompted travel medicine experts to warn holidaymakers and travellers to inform themselves about the health risks in countries they are visiting.
"People don't seem to really realise what risks they are actually undertaking," says Dr Nancy Gallagher, the president of the Irish Society of Travel Medicine.
"A lot of people are winging it, they see it as a question of do I have to get shots or not, and they take advice from friends or relatives or someone they're sitting beside in the pub, but they won't look up the internet sites or get advice from a doctor or go to a travel medicine centre," she says.
People may be mistakenly reassured by the fact that there is generally only one vaccine that is "required" and that is for yellow fever when visiting parts of Africa and South America. However, doctors stress that because other vaccines are "recommended" this does not mean they are any less important.
Dr Gallagher points out that regulations reflect the fact that countries do not want to import diseases such as yellow fever, but that it is up to individuals to protect themselves.
The advice given will depend both on the areas being visited and on the traveller's individual health profile. However, there is some general advice that can be obtained from recommended websites.
Dr Graham Fry of the Tropical Medical Bureau, which has 14 centres around Ireland, says, for example, that people going to India and southeast Asia should ensure they are vaccinated against typhoid, hepatitis A and tetanus.
Such precautions are also needed when travelling to tourist destinations nearer home. Dr Fry cites an example of a group of 219 German tourists who contracted hepatitis A while in Egypt. He says there are also more isolated cases involving Irish people.
Hepatitis A is spread through water or contaminated food and the World Health Organisation's website says it is the most common vaccine-preventable infection of travellers.
Dr Gallagher says many people are also unaware that the hepatitis A vaccine is recommended for Turkey. Only 4 per cent of people going to Turkey get vaccinated, she says.
Holidaymakers need to realise that because local people can drink tap water or eat certain foods this does not mean it is safe for visitors because the locals will have built up immunity. For this reason, advice on the Health Protection Surveillance Centre's websites states: "Only eat food that has been cooked all the way through or fruit and vegetables that have been washed and peeled. Remember: boil it, cook it, peel it, or don't eat it."
Dr Gallagher says she is concerned about the large numbers of young people going on extended round-the-words trips that include stays in countries where there are risks of which they may not be aware.
She cites rabies, which she says is "a very real problem" in southeast Asia and the Indian subcontinent. She says that in some parts of these countries the rabies serum - taken after a bite - may not be available. It is, therefore, recommended to get a preventative vaccine against rabies.
The World Health Organisation's website also mentions this risk, pointing out that dogs roam wild in large cities, and while it says that most travellers in tourist resorts are at very low risk, there is a greater risk for children who may have more contact with animals.
People also need to be aware of the risk of hepatitis B, which is passed through sexual contact but also through needles, razors or even toothbrushes.
In the event of an accident in parts of some countries it may be difficult to ensure medical equipment is sterile. Hepatitis B is much more infectious than HIV.
The risk of malaria and other illnesses caused by insect bites are also being ignored by many travellers. Dr Gallagher says a recent study found that only 25 per cent of Irish people going to malaria-endemic countries take anti-malaria tablets. When questioned about this, 22 per cent said they did not believe in taking tablets when they were not ill, and a further 10 per cent believed mosquitoes did not bite them. Some 23 per cent could not give any explanation as to why they did not take the tablets.
Dr Gallagher says it is also not enough just to take malaria tablets, as it is necessary to take steps to avoid bites because of diseases such as dengue, which is also spread by mosquito bites and occurs in many tropical countries but for which there is no vaccine or no cure.
Dr Fry also points out that there has been a very dramatic increase this year in the number of people presenting with malaria in Ireland. In the first 18 weeks of 2005 there were just 11 cases but for the same period this year, the number of cases has jumped to 33.
He believes this increase is due both to a greater number of holidaymakers going to more remote destinations off the beaten track in countries with malaria and also to the increasing number of immigrants in Ireland.
People who grew up in countries with malaria lose their immunity after about six months in a non-malaria country and are, therefore, at risk when they return to visit family and friends.
He says holidaymakers should be aware that the type of accommodation they choose can reduce the risk of getting mosquito bites - staying on the fourth floor of a good hotel, for example, is safer than on the ground floor of a hostel.
Bird flu is also posing a new risk for travellers to Asia and parts of Africa. The advice is to stay out of bird sanctuaries and markets where there are live birds.
Once people return from foreign travel it is important they bear in mind that this may be a factor if they do become unwell for up to 12 months afterwards.
The most common symptoms experienced include skin lesions, bowel problems, chronic fatigue and fever. Dr Fry says all of these can be caused by parasites or bugs picked up overseas, but many people do not present for months after returning and fail to tell doctors about their travel.
Without knowing about the foreign travel, doctors cannot make a correct diagnosis. However, once a condition is diagnosed they are usually easy to treat, he says.