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personal hygiene and the selection of
food and water are the main preventive
strategies for traveller's diarrhoea.
Self-treatment strategies involving
rehydration and, if needed, the use of
loperamide to prevent disruption to
travel or planned activities are effective
for most adult travellers15 (Table 1 lists
some of the food and water precautions).
Prophylactic antibiotics are generally
not recommended to prevent traveller's
diarrhoea, but antibiotics are sometimes
useful to treat it.15
Malaria is reported as being among the top
three diagnoses from every region of the
developing world and, like many tropical
diseases, it is carried by mosquitoes.14
Therefore, travellers to endemic areas
for malaria should be educated about
the risk, how to prevent mosquito bites,
the need for chemoprophylaxis and to
obtain medical attention should the
symptoms of the disease develop. Some
travellers may also be given emergency
standby treatment should symptoms of
the disease develop while visiting areas
where health care facilities are limited4
(Table 2 lists some of the precautions that
travellers should follow to reduce the risk
of mosquito bites).
Many of the other common travel-related
health conditions are preventable (with
vaccines or by taking precautions), or
are treatable with OTC or prescription
medicines, and some are self-treatable.16
Examples of self-treatable or preventable
conditions include prophylaxis of DVT,
altitude illness, jet lag, motion sickness,
some bacterial infections such as
respiratory and urinary tract infections
and skin infections.16 Some travellers
may even be given occupational post
exposure prophylaxis (PEP) for HIV if
working in high risk areas.16 The degree of
self-treatment offered to the traveller will
depend on a variety of factors including
the remoteness of the destination, the
difficulty of obtaining medical care at the
destination and the ability of the traveller
to assess the situation and appropriately
The individual assessment and provision
of advice and other travel health
services to each traveller generally
involves a three stage process: risk
assessment, risk communication and risk
Table 2. General precautions
for avoiding insect and
• Apply a suitable insect repellent
(DEET, Picaridin, Oil of Lemon
to exposed skin or clothing, following
the manufacturer's instructions.
-- If also wearing sunscreen,
apply the sunscreen before the
-- Do not use insect repellents
-- Never apply insect repellents over
cuts, wounds or irritated skin,
or to the eyes and mouth.
-- When using sprays do not spray
directly onto the face; spray onto
your hands first and then apply
to the face.
-- When applying repellents to a
child, apply the repellent to your
own hands first and then apply
to the child's exposed skin.
-- Repellents can be applied to
children older than 2 months of
age (3 years for OLE). To protect
younger children use an infant
carrier draped in mosquito netting.
• Suitable insecticides may be applied
to clothing and mosquito netting.
• Use knockdown sprays, insecticide
impregnated mats or mosquito coils
to clear mosquitoes from rooms.
• Avoid night time exposure for
Anopheles mosquitoes and day time
exposure for Aedes mosquitoes.
• Cover up arms and legs and wear
lighter colours and thicker materials.
• Sleep under insecticide-impregnated
• Sleep away from stagnant water that
could harbour mosquitoes.
• Be extra cautious during
the wet season.
• Do not use strong smelling perfumes
or aftershave lotion.
Table 1. General food and water precautions for travellers to reduce the risk of
traveller's diarrhoea and other food and water-borne conditions4,15,17--19
General food precautions4,15,17--19
General water precautions 4,17--19
• Maintain good personal hygiene with regular
hand washing or use alcohol hand rub.
• Wherever you eat, select food that is well
cooked, freshly prepared and served hot.
• Avoid raw foods or foods that have been
reheated (eating raw meat or seafood is risky).
• Dry foods are generally safer than moist foods.
• Thoroughly wash raw fruit and vegetables.
Avoid fruit and vegetables that cannot
• Initially it may be better to stick to your usual
diet, be careful of what and where you eat,
and gradually introduce local spices, fruit
and foods into your diet.
• The quality of the restaurant generally has
little effect at reducing the risk of diarrhoea.
Where possible avoid roadside stalls unless
the food is served hot and immediately
• Consider the risk from contaminated cutlery.
In extreme cases some travellers clean utensils
with alcohol swabs.
• If suspect, tap water should be
avoided, as should ice cubes,
ice blocks and milk products.
• Although chlorinated, swimming
pool water is not sterile and
should not be drunk.
• Bottled water is generally
considered safe, but only drink
bottled water from bottles with
intact seals that have not been
• Use bottled water to clean
• Soft drinks, carbonated water,
wine and bottled beers are
generally considered safe, but
make sure the bottle or can is
opened at the table.
• Hot drinks are usually safe.
• Be careful with fruit juices or
cordials that may have been
diluted with contaminated water.
This involves collecting information about
the itinerary and the traveller to help
identify the hazards they may face on
their journey, plus traveller-related factors
that may increase the risk of travel-
related health problems and/or cautions
or contraindications to certain vaccines
or medicines.12,21,22 Table 3 summarises
some of the key itinerary-related and
traveller-related factors that should be
considered. As part of the risk assessment
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