Could our rise in travelling aid an outbreak of diseases, like bird flu?
The number of international journeys made by British travellers will soon hit one billion per year. With so much travel, the scope for a disease outbreak spreading rapidly and globally is huge and increasing, as we saw in the spring of 2003 with the emergence of SARS.
The rumblings of this virulent respiratory virus started in February, and by March journalists were writing about this new plague with its horrific death rate and unknown means of transmission. Predictions were that it would kill more people than the 1919 flu pandemic – which killed more people than the First World War. What spooked everyone – including the doctors – was that, early on, a World Health Organisation medical advisor died of it.
In the East people wore face masks in public places and patients were detained in hospitals against their will. Passengers were thermally scanned at airports and quarantined for colds. In some countries travellers were forced to have their temperatures taken without the thermometer being sterilised between one person’s mouth and the next. There was no thought about how this screening method itself might spread the disease.
What was impressive about the SARS outbreak was how well international scientists cooperated. The coronavirus that was responsible for the disease was identified and accurate diagnostic techniques developed so that we began to understand our foe. By the end of 2003 there had been 8,093 confirmed cases of SARS, and 774 deaths. This is clearly 774 deaths too many, but on a global scale this number is considerably smaller than the scaremongers were predicting.
And it pales into relative insignificance when compared with some other global death statistics, or with mortality statistics for India alone where there are around 25,000 deaths each year due to rabies.
I don’t want to dwell on death rates – though that’s what really interests us, isn’t it? – but rather to highlight the importance of getting good health information about any destination before you travel as an immunisation against the scaremongers. The problem with having a big-news outbreak is that it pushes other health risks into the background. During the SARS furore it was easy, perhaps, to forget about the three million people who fall ill with malaria each year. Or the 10,000 tourists infected each year with schistosomiasis (bilharzia) from Lake Malawi’s waters. Or the outbreak of sleeping sickness in the Serengeti.
So do such outbreaks really worry us enough to do our homework before we set out for developing countries? The current issue of the International Journal of Travel Medicine published the results of a vast clutch of international airport surveys suggesting that we don’t know much about the health risks of travel. So what? Does it matter?
Of 5,465 passengers leaving nine European airports, only half (52%) had sought travel-health advice before their trips. Although generally they thought that vaccines are protective, safe and a good idea, most travellers were not properly immunised. Only 42% reported being immunised against hepatitis A, despite the fact that there’s a good vaccine with few side effects and which gives at least ten years’ protection from an infection that often debilitates victims for months – a vaccine that in Britain can be obtained free on the NHS.
Furthermore, only a third of the travellers going to malarious destinations were carrying any kind of antimalarial tablet. Perhaps even more surprising was that one in two travellers to regions with no malarial risk were unnecessarily worried about malaria – and that seems a great pity.
Travellers departing from Johannesburg were little better prepared, yet most (86%) of them had sought advice before travel. The airport survey showed that an alarming 22% had been unnecessarily immunised against yellow fever; this vaccine itself can be risky, especially for older travellers. Since a third of those surveyed were over 50 years of age, these travellers did not seem to have been well advised. These African adventurers knew a fair amount about the symptoms of malaria, and knew that they should cover up and apply repellent at dusk, but one-third said they would wear deodorant, perfume or aftershave – which are likely to attract mosquitoes and should therefore be avoided.
Again, a significant number (80%) of those travelling to a non-malarious destination were unnecessarily worried about malaria. One-fifth were carrying inappropriate malaria pills that probably would not have given proper protection. This rather debunked my assumption that my colleagues who work in Africa would be pretty well informed about the local health scene.
Another arm to this series of surveys was organised in the Asia-Pacific region; travellers were questioned in Singapore, Kuala Lumpur, Taipei, Melbourne and Seoul airports. Only a third of respondents had sought any travel-health advice and fewer than 5% were properly immunised against diseases they might encounter at their destination. Only 40% of travellers going to high-risk malarious regions were carrying any kind of malaria pills, and although many expressed the intention to protect themselves from mosquito bites, few were actually carrying repellents.
Similar themes were seen in a survey conducted among international travellers leaving John F Kennedy airport in New York. Only a third (36%) had sought pre-travel advice despite the fact that most had been preparing for their trip for many weeks. Three-quarters of those going to a high-risk malaria destination perceived the disease as a serious health risk, yet less than half carried any kind of antimalarial preparation. Conversely, a few were carrying antimalarials to regions that did not require their use. Only 14% were immunised against hepatitis A.
The message coming from these surveys is that most travellers to malarious regions are not as well protected as they should be. One of the reasons for this is that people are not seeking expert advice – but in a few cases travellers had not received the best advice.
It is worth attending a travel clinic where staff will have immediate access to expert sources of information; ideally you should go with some idea of what you require from the clinic, just in case. A quick look on the net should give you an idea of the vaccines and prophylactics that will be suggested, so you will be armed with knowledge and better able to negotiate. Travel clinics in Britain charge a consultation fee to help fund the service. This fee is usually offset against the cost of immunisations. Although most of us in Britain are unused to paying for such health facilities, this allows the clinic to buy into expert information sources and to advise against unnecessary vaccines rather than offering all possible jabs.
