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Independent pharmacies can advise travellers on essential health considerations to ensure they are fully prepared for their trips abroad. By Kathy Oxtoby…

Travelling, whether for leisure, adventure, or spiritual fulfilment, can be a life enhancing experience. However, different types of travel come with unique health risks that require careful planning and awareness.

Pre-travel health preparations

“Planning ahead is key,” says Professor Claire Anderson, Royal Pharmaceutical Society (RPS) President.

Different countries have different requirements with regards to vaccination status, so it is important to check the NHS Fit for Travel website [https://fitfortravel.nhs.uk/destinations] for country specific information, she says.

Patients need to speak to their pharmacist well in advance to check which vaccines they may need, and how far in advance of travelling they may need these, together with any specific medicines recommended for their destination, for example antimalarials, she says.

Travel insurance is essential to cover medical costs in case of illness or emergency. If patients have a pre-existing condition, they need to ensure insurance policy includes coverage for it, she says.

Patients are advised to carry a copy of their prescription and pack medicines in their original packaging, keeping them in their hand luggage to avoid losing them or damage, says Professor Anderson.

Recommended but not mandatory vaccines

Hajj travellers will require the meningococcal vaccine and a certificate of vaccination, explains Lila Thakerar, superintendent pharmacist at Shaftesbury Pharmacy in Harrow.

Recommended but not mandatory vaccines for those going on pilgrimage, are MMR, typhoid, polio and tetanus vaccines, if it has been more than 10 years since the patient last had these vaccinations, she says.

When giving advice about travel vaccinations pharmacy teams need to keep up to date and regularly check for the latest information, says Ms Thakerar, who prints out updated guidance for staff at her pharmacy.

Pharmacists should ask patients about their previous medical history, and previous experiences with travel, for example if they have had a reaction to antimalarials, says Ade Williams, superintendent pharmacist at Bedminster Pharmacy in Bristol, who runs a travel clinic.

Ms Thakerar recommends patients carry a medication kit which includes treatment for diarrhoea, dehydration sachets, antihistamines and sunblock.

Heart conditions or respiratory issues

Patients should also have any prescription medication such as for diabetes, heart conditions or respiratory issues. Some medications, such as insulin, are temperature sensitive and will need to be stored correctly. A ‘cool bag’ for example, can be used to store insulin, and pharmacy teams need to be able to advise patients about their use, says Ms Thakerar.

“When crossing time zones, patients need to adjust medication schedules accordingly and keep emergency contact details and medicine information on hand,” says Professor Anderson.

For patients from different communities whose first language is not English, to help them plan for trips abroad, pharmacists could enlist the support of pharmacy team members who speak different languages, provide information leaflets, or signpost to portals where information is available in multiple languages, says Ms Thakerar.

“Those travelling are also advised to write down key health-related phrases in the language of their destination or download a translation app before travelling to make it easier to communicate with healthcare professionals if needed,” says Professor Anderson.

 “It is very important to think about how inclusive is our practice, and to ensure we are not disadvantaging anyone, just because English is not their first or most commonly spoken language,” says Mr Williams.

Travelling and health risks

Travelling can expose people to different health risks.

For altitude sickness, “it’s important for patients to stay hydrated”, says Professor Anderson. If patients start to feel symptoms, they should tell someone they are travelling with and rest until they feel better. If they are experiencing a headache from the altitude sickness, they can take paracetamol to help ease symptoms, she says.

Going through the different risk factors with patients is all part of a good travel health consultation, says Mr Williams.

Pharmacists should make sure the patient consultation is “holistic and inclusive”, and that they are “helping to inform patients of all the ways to make their trip as comfortable and enjoyable as possible, but also to reduce their risk”, he says. For example, they can educate patients about mosquito bites prevention.

Travellers are at risk of a wide range of infectious diseases, which could be bacterial, viral and include COVID. “There’s no better advice than to protect yourself,” says Ms Thakerar. She suggests advising patients to carry face masks and hand sanitisers, particularly if travelling in a close-knit environment.

“Extreme heat, different foods and close contact with large crowds can increase the risk of dehydration, heat exhaustion and the spread of infectious diseases, says Professor Anderson. “Those travelling should drink plenty of water, try to eat from reputable sources, and wash hands regularly or use hand sanitiser. They should also carry products like rehydration salts and sunscreen.”

Early signs of dehydration

To reduce the risk of food poisoning, travellers should opt for bottled or boiled water and avoid raw or undercooked food, says Professor Anderson. Early signs of dehydration or food poisoning include dizziness, nausea, or diarrhoea, she says.

“For foodborne illnesses, it’s important to drink lots of fluids to stay hydrated. Carrying oral hydration tablets can also help with dehydration from food poisoning or heat exposure,” says Professor Anderson.

Pilgrimages can be both physically and emotionally demanding, with potentially long walking distances, exposure to heat, and emotional stress.

Pharmacy can make patients aware of the “risks and benefits” of pilgrimages and give advice on wearing appropriate clothing and footwear, staying hydrated, pacing themselves during rituals, and the importance of continuing their medication, says Ms Thakerar.

Emergency preparedness

Patients need to research local pharmacies at their destination and to carry an emergency contact list, including their travel insurance details, says Professor Anderson.

If they rely on specific medicines, they should check whether they are available in their destination or if they need a doctor’s note to carry them across borders. Keeping a photo or copy of their medication packaging and instructions can also be helpful if they need a replacement, she says.

Patients should carry a written record of any allergies, medical conditions or procedures they have had in the past, says Mr Williams.

Supporting patients with their travel health needs is a “great opportunity” for pharmacy to become part of a positive experience for their patients, and to help to enhance and safeguard that experience, says Mr Williams. “We want people to see us as the ‘go to’ place for their health needs.”

Resources

NHS Fit for Travel website: https://fitfortravel.nhs.uk/destinations