Ask an expert about travel medicine (UCLH web chat) 

This one hour web chat took place at:
10.30am - 11.30am on Wednesday 10 July 2013.

Summer holiday booked? Bags packed? Don’t bring back more than you bargained for – you asked our travel medicine expert Dr Ron Behrens for advice about what you need to do to stay well and enjoy that trip of a lifetime.

Whether you’re going to Turkey or Tanzania, Dr Behrens advised you on all you need to know about pre-travel jabs, medication to prevent tropical diseases like malaria and how to best avoid the tummy troubles that can ruin your holiday. Dr Behrens is undoubtedly an expert – he’s the only NHS consultant in travel medicine and is based at London’s Hospital for Tropical Diseases (the hospital was featured in the 2009 ITV documentary ‘Help I Caught it Abroad’). 

Below is a transcript of the webchat.

Ask an expert about travel medicine

10:02 UCLH: 
Good morning and welcome to our web chat. We will begin at 10:30am but you can submit your questions now in preparation for the chat. Please note: your questions will not appear in the main chat window until after 10:30am.

Dr Ron Behrens will be joining us to take your questions on ‘Travel medicine’ and will try to answer as many questions as possible within the hour long web chat.
Wednesday July 10, 2013 10:02 UCLH 10:26 Dr Ron Behrens: 
Welcome to our web chat on the subject of travel medicine. My name is Dr Ron Behrens - and I am ready and waiting to take your questions.
10:26 [Comment From Charlotte Charlotte : ] 
Last month I was treated for Giardia at UCH and I am feeling fine now but i still have red small bumps on the back of my leg and was worried that they are connected to giardia, as they came up when i fell unwell. They do not hurt or itch and don't bother me in any way. I do realise that this email is for future travelling questions, i have just can't seem to find another email to contact. If you could find the time to reply i would be very appreciative for your help.
10:27 Dr Ron Behrens: 
As this is a medical problem, I would suggest a discussion with your GP and see if he will refer you for further assessment
10:28 [Comment From Gill Gill : ] 
Our 18 year old daughter is going to spend several months in Africa next year. She has reacted extremely badly to perfectly standard childhood vaccines (the polio/diphtheria/tetanus triple, twice: she hasn't had any other vaccinations) and been significantly unwell with ME-type symptoms for months immediately after the injections. She will need vaccinating against the risks of tropical diseases such as yellow fever and dengue fever, as well as taking anti-malarial drugs and her doctor has advised finding a classical homeopath to give her appropriate vaccines well in advance of her trip. What is your advice please? Is there any evidence these are effective? Are there any "normal" vaccines available which aren't provided in the usual forms which will help her avoid the mercury etc which she seems to react to so badly? Or, if she has to have normal vaccines, is there anything she can do in preparation or else after the vaccination to mitigate the ill effects?
10:29 Dr Ron Behrens: 
Hi Gill
Firstly Homeopathy cannot vaccinate you against infectious diseases. Many individuals who react to vaccines as children grow out o this sensitivity as adults so it is no longer a problem. She definitely will need vaccinating when travelling and should discuss this with a knowledgeable travel person. Most current vaccine don’t contain mercury and finally it’s the advice she will receive not the vaccines that is most valuable when travelling, as most problems encountered cannot be prevented by vaccines
10:29 [Comment From Nishma Nishma : ] 
Please can you advise which malaria tablets can be taken after the first trimester of pregnancy. I am travelling to Kenya.
10:30 Dr Ron Behrens: 
Hi Nishma
Travelling to malarious county when pregnant has important risks which you need to appreciate before making the final decision. In fact the World Health Organisation recommends pregnant women not travelling. You need to have a detailed discussion with and expert to decide the safety and risk of travelling and taking tablets which haven’t been tested in pregnancy.
10:33 [Comment From Tracey Tracey : ] 
Health-wise which country do you think carries the most risk for travellers?
10:33 Dr Ron Behrens: 
Hi Tracey
Not a simple answer. As most serious health problems relate to injury and accidents, the countries with most dangerous driving and the worst roads, particularly in Sub Saharan Africa would be my answer
10:35 [Comment From Guest Guest : ] 
I am going to Kenya and the Masai Mara. I know I need malaria medication. Which is the one with the least side effects? Thanks
10:35 Dr Ron Behrens: 
Hi Guest.
Depends on what you are willing to pay and if you like daily or weekly tablets.
The most expensive atovaquone/proguanil (Malarone) tend to have fewest side effects and for short trips are not extortionate in price
10:37 [Comment From Clara Clara : ] 
I've taken Malarone malaria tabs in the past - thankfully with no side effects. Is it worth paying extra for Malarone?
10:37 Dr Ron Behrens: 
Hi Clara
If it work and you have no problems with Malarone, taking it again makes sense. You make react to another one so not worth taking the risk.
10:39 [Comment From Michael Michael : ] 
I am going to Kenya and the Masai Mara. What is the best malaria prophylaxis to take?
10:39 Dr Ron Behrens: 
Hi Michael
You have a choice of three, Mefloquine (Lariam) Doxycycline and atovaquone/proguanil (Malarone). They all work equally well in preventing malaria. They vary in costs and side effects. The choice is yours.
If you don’t have side effects the cheaper option Mefloquine (Lariam) Doxycycline will cost you less.
10:40 Dr Ron Behrens: 
Did you know?:
Diseases prevented by vaccines are rare and most people even If not vaccinated don’t catch them. Most travel health problems are consequent to behaviour. So common problems such as sunburn accidents around the pool and resort , insect bites catching malaria because you forgot tablets. More importantly injuries from driving a motor bike without a helmet or in a car without a seatbelt are of most concern to me and are the commonest cause of death in travellers.
10:44 [Comment From Tracey Tracey : ] 
Hello Dr Behrens! Can travellers buy any useful additional items at the Hospital to take with them? Would you advise travellers to take things like syringes and needles to some countries?
10:44 Dr Ron Behrens: 
Hi Tracey
A basic kit would include some first aid items, plasters dressings scissors, safety pins antiseptic cream pain killers and tablets you need. Needles and syringes are not useful as invariably you don’t have them when you need them and most places now can provide safe needles. Obviously repellents and your anti-mosquito measures should travel with you.
10:47 [Comment From Guest Guest : ] 
Imodium, as a solution to tummy bugs. Does it do more harm than good? And Naturopaths swear by Optibac remedies which are purported to work better due to the live strains of acidophulus etc.
10:47 Dr Ron Behrens: 
Hi Guest
Travellers diarrhoea occurs in up to 50% of travellers!
The Lactobacilli based measures and there are many have been advised but there is very little scientific evidence of their value. I prefer a single antibiotic tablet as treatment of diarrhoea, but other suggest Imodium and similar “blocking” drugs
10:50 [Comment From Jane Jane : ] 
Whenever I travel abroad with my husband he gets bitten really badly by mosquitos whereas I hardly get bitten at all - why are some people bitten more than others?
10:51 Dr Ron Behrens: 
Hi Jane
You question highlights a very well known phenomenon, that of the different attractiveness of individuals to mosquitoes. This is related to the type of bacteria on their skin, mainly round the feet, which produce chemicals which attract mosquitoes. This attractiveness cannot be changed by garlic vitamin B12 or any other known dietary supplement so don’t waste your money
10:52 [Comment From Chris Chris : ] 
What is your take on the beat way to deal with stomach upsets by way of preventive medicine and treatment?
10:53 Dr Ron Behrens: 
Hi Chris .
I prefer a single antibiotic tablet as treatment of diarrhoea which will need to be prescribed for this purpose Imodium and similar “blocking” drugs do help but not as effectively in curing the symptoms of diarrhoea
10:55 [Comment From tracey tracey : ] 
I got a terrible ear infection once from swimming in an American lake. Should lakes be avoided generally? I imagine they are swarming with bugs!
10:55 Dr Ron Behrens: 
Hi Tracey
Ear and eye infections (conjunctivitis) are very common when travelling. I often recommend taking along eye cream and ear drops for kids who will be swimming and are particularly prone to this
10:57 [Comment From Guest Guest : ] 
I am unable to get typhoid vaccine. Is there anything I can do to not get ill?
10:57 Dr Ron Behrens: 
Hi Guest
The manufacturer has had problems with manufacturing it so it is in very limited supply. Don worry if you don’t have it though. It is not a very good vaccine and very few tourists catch typhoid and it is easily treated and rarely serious.
10:59 [Comment From Chris Chris : ] 
10:59 Dr Ron Behrens: 
Hi Chris.
Examples are Ciprofloxacin, Azythromyicin or Rifaxamin
11:01 [Comment From Billie Billie : ] 
I have a very sensitive stomach - I always get a dodgy tummy (which is manageable but uncomfortable) on holiday and unluckily have had proper food posoning numerous times (I've been hospitalised twice abroad and put on a drip the poisoning was so bad!). Is there something I can take before I go that would boost my system - making me less likely to be affected?
11:01 Dr Ron Behrens: 
Hi Billie
See previous discussion on treatment. Travellers diarrhoea is very difficult to prevent or avoid. You appreciate if you have it to avoid dehydration drink, drink and more fluids when you have it. The earlier antibiotics are used the quicker it gets better.
11:02 [Comment From Chris Chris : ] 
Are these Single Dose Antibiotic tablets available over the counter? And if not how can you be prescribed a medication for an anticipated ailment?
11:03 Dr Ron Behrens: 
Hi Chris
They need to be prescribed
11:06 [Comment From Michael Michael : ] 
Thanks, any vaccinations required for Kenya-Masai Mara?
11:07 Dr Ron Behrens: 
Hi Michael
Depends on what you have had before. Usually be up to date with DTP and have Hepatitis A. You may or may not need Yellow fever depending on a number of risk factors such as age and regions/countries visited. Each one requires a risk assessment and your willingness to decide what you would like (and pay for). No absolute requirement for Masai Mara
11:13 [Comment From Daniel Daniel : ] 
Is it true that drinking alcohol help prevent you from being bitten by Mosquitos?
11:14 Dr Ron Behrens: 
Hi Daniel
Alcohol stops you felling bites but not affect the mossies biting you. The only thing that stops them is liberal amounts of repellents on your skin
11:17 [Comment From Roger Roger : ] 
Good afternoon Dr Behrens, What medical kit and medecines would you advise a backpacking traveller to take with them on a six week journey to vietnam, cambodia, laos, burma and thailand. br
11:18 Dr Ron Behrens: 
Hi Roger
A basic kit would include some first aid items, plasters dressings scissors, tweezers and a sharp needle for splinter safety pins antiseptic cream pain killers and tablets. Bandages, NSAI gel and anti septic cream are useful as are crepe bandages. Pain killers and diarrhoea, treatment and other tablets you have in you bathroom cabinet may be worth taking along.
11:21 [Comment From Emma Emma : ] 
Dear Dr Behrens, do you have any advice please for individuals with sensitive skin who are particularly prone to insect bites and the subsequent development of cellulitis, which we know can lead to hospitalisation? Many thanks.
11:21 Dr Ron Behrens: 
Hi Emma
This is an common and serious problem associated with insect bites and other causes of broken skin. Firstly used a strong repellent I prefer 50% DEET. Them any bites or scratches apply ant-septic lotion or cream, something like iodine or savlon or similar. If it develops into a red and infected bite, antibiotics earlier rather than later, so seek medical advise before it becomes seriously septic
11:23 [Comment From Ann Ann : ] 
On the question of yellow fever vaccine- would you consider vaccinating a healthy 60 year old who had never had the vaccine before?
11:23 Dr Ron Behrens: 
Hi Ann
I would need more information on where you are travelling and is it required for entry to a country
11:26 Dr Ron Behrens: 
Here is a useful source for information, Remember its not the tablets and vaccines that are important. it’s the advice and measures you need to follow that will protect you
11:31 [Comment From Emma Emma : ] 
Sorry Dr Behrens another question if there's time! Are there any basic questions you would advise asking, if one suddenly needed emergency treatment eg surgery in a hospital in a location (which dare I say) did not have facilities of the level we are used to at UCLH - with a view to aiding the staff there. Very many thanks.
11:32 Dr Ron Behrens: 
Hi Emma

The best advise is have good health insurance and use the medical support team of your insurer to advise you. The medical discussions are difficult for a lay person to decide on in an emergency situation
11:32 [Comment From Ann Ann : ] 
Travelling through Nairobi airport going to Mombassa.
11:32 Dr Ron Behrens: 
Hi Ann
Don't need it so don't have it
11:33 Dr Ron Behrens: 
The Hospital For Tropical Diseases Travel Clinic will see travellers who have complex medical problems or other conditions that GP’s find difficult to advise on. Ask your GP for a referral to it.
11:33 Dr Ron Behrens: 
Thank you for joining us today in our live web chat. We hope you found the chat useful and some of your questions have been answered.

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