Key Facts

Approximately 70 million trips abroad are taken by UK residents annually. Travel health advice reduces the risk of travel-acquired infection, which affects approximately 10-15% of travellers to developing countries. Primary care delivers most pre-travel consultations.

Risk Assessment

• Destination: specific disease risks vary by country/region
• Duration: longer trips carry higher risk
• Type of travel: backpacking, visiting friends and relatives (VFR — highest risk group), adventure tourism, business
• Accommodation: rural vs urban, standard of hygiene
• Individual factors: age, pregnancy, immunosuppression, chronic disease, medications
• Activities: freshwater swimming (schistosomiasis), animal contact (rabies), altitude (acute mountain sickness)

Vaccine Categories

• Routine: ensure childhood vaccines up to date (MMR, DTaP/IPV, MenACWY)
• Recommended: based on destination risk (hepatitis A, typhoid, cholera, rabies, Japanese encephalitis, tick-borne encephalitis)
• Required: yellow fever (some countries mandate proof of vaccination for entry); meningococcal ACWY (Hajj/Umrah)

Common Travel-Related Illnesses

• Travellers' diarrhoea (most common; E. coli, norovirus, Campylobacter)
• Malaria (Plasmodium falciparum most dangerous)
• Dengue fever
• Hepatitis A
• Typhoid
• Respiratory infections (including TB)

Pre-Travel Assessment

• Planned itinerary with dates and destinations
• Previous travel and vaccination history
• Medical history including immunosuppression, pregnancy, allergies
• Current medications (drug interactions with malaria prophylaxis)
• Risk activities planned (diving, trekking, animal exposure)

Post-Travel Illness (Returning Traveller)

• Fever: malaria until proven otherwise (thick and thin blood films ×3)
• Diarrhoea: travellers' diarrhoea, parasitic infection
• Rash: dengue, chikungunya, rickettsial infection
• Respiratory symptoms: TB, COVID-19, legionella
• Eosinophilia: schistosomiasis, strongyloides, filariasis

Red Flags in Returning Travellers

• Fever from malaria-endemic area — urgent thick and thin blood films
• Fever with jaundice — viral haemorrhagic fever, hepatitis, malaria
• Fever with petechial rash — dengue, meningococcal disease
• Altered consciousness — cerebral malaria, encephalitis
• Severe diarrhoea with dehydration — cholera, dysentery

Pre-Travel

• Review existing vaccination records
• No routine blood tests required for healthy travellers
• Hepatitis B serology: if course needed and previous vaccination uncertain
• G6PD level: before prescribing primaquine for P. vivax/ovale malaria

Post-Travel (Returning Ill Traveller)

• Malaria: thick and thin blood films ×3 (12-hourly); rapid diagnostic test (RDT)
• FBC: eosinophilia (parasitic), thrombocytopenia (dengue, malaria)
• Blood cultures: if febrile (typhoid, bacteraemia)
• LFTs: hepatitis, malaria
• Stool MC&S, OCP: diarrhoeal illness
• Serology: dengue, schistosomiasis, HIV
• CXR: TB, pneumonia

Special Tests

• Schistosomiasis serology: ≥12 weeks after last freshwater exposure
• Strongyloides serology: if eosinophilia and travel to endemic area
• HIV test: offer to all returning travellers with risk factors

Vaccinations (NHS vs Private)

Available on NHS (free):

• Hepatitis A
• Typhoid
• Cholera (oral)
• Diphtheria/tetanus/polio booster

Private (travel clinic):

• Yellow fever (designated centres only)
• Japanese encephalitis
• Tick-borne encephalitis
• Rabies pre-exposure
• Meningococcal ACWY (if not already given)
• Hepatitis B (if not routine)

Key Vaccine Schedules

• Hepatitis A: single dose IM, booster at 6-12 months for long-term protection (25 years)
• Typhoid: single dose IM (Vi polysaccharide), protection for 3 years; or oral Ty21a (3 doses)
• Yellow fever: single dose at designated centre; lifelong validity
• Rabies pre-exposure: 3 doses on days 0, 7, 21-28; reduces post-exposure treatment needed
• Japanese encephalitis: 2 doses, 28 days apart

Malaria Prophylaxis

• Atovaquone-proguanil (Malarone): start 1-2 days before, continue 7 days after leaving endemic area; well tolerated
• Doxycycline 100mg OD: start 1-2 days before, continue 28 days after; photosensitivity; avoid in pregnancy
• Mefloquine 250mg weekly: start 2-3 weeks before, continue 4 weeks after; avoid if psychiatric history, epilepsy, cardiac conduction disorders
• Chloroquine: only for P. vivax-only areas (limited use due to resistance)

General Travel Health Advice

• Food and water hygiene: 'boil it, cook it, peel it, or forget it'
• DEET insect repellent (20-50%) + permethrin-treated bed nets for malaria/dengue areas
• Sun protection
• Safe sex advice, condom provision
• Altitude sickness prevention (acetazolamide 250mg BD, start 24h before ascent)
• DVT prevention on long-haul flights: hydration, movement, compression stockings

Referral Criteria

• Yellow fever vaccination: must be given at designated centre
• Complex itinerary or immunocompromised traveller: specialist travel health clinic
• Returning traveller with fever: urgent medical assessment (malaria screen)
• Post-travel eosinophilia: infectious diseases/tropical medicine

• Travellers' diarrhoea: self-limiting in >90% within 3-5 days
• Malaria (P. falciparum): mortality 0.5-1% overall; up to 20% in severe cases; early treatment is critical
• Hepatitis A: full recovery in >99%; mortality <0.1% (higher in elderly and those with chronic liver disease)
• Typhoid: mortality <1% with antibiotics; 10-20% untreated
• Vaccine-preventable travel illnesses: near-zero risk with appropriate vaccination
• Rabies post-exposure: 100% fatal without treatment; 100% preventable with prompt PEP (post-exposure prophylaxis)

Common Travel Vaccines Summary

Malaria Prophylaxis Comparison