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As one of the UK’s first doctors to specialise in travel medicine, I’m endlessly amazed that, while booking a holiday, people will spend months obsessively researching dream destinations, flight deals and the most desirable boutique hotels, yet their health remains little more than an afterthought.
You only have to read a newspaper to see that disasters do happen while travelling, from the recent cruise ship hantavirus outbreak to the deadly food poisoning episode in Cape Verde in February and last year’s death of a British tourist who contracted rabies in Morocco. But if almost four decades working in this field have taught me anything, it’s that a little preparation can go a long way, and that many of the issues you might encounter are both predictable and preventable.
These are the most common travel illnesses – and the symptoms you should never ignore if you want to stop your dream holiday turning into a nightmare.
Jump to:
- Traveller’s tummy
- Malaria
- Rabies
- Respiratory tract infections (RTIs)
- Yellow fever
- Lyme disease
- Hantavirus
- Hepatitis A and B
- Typhoid fever
- Zika, chikungunya and dengue fever
Traveller’s tummy
Gastrointestinal issues caused by food-borne and water-borne infections are among the most common health problems encountered by travellers.
The symptoms
Diarrhoea, dehydration, nausea and vomiting.
The causes
Usually bacteria, viruses or parasites picked up from food, drinking water or surfaces contaminated with germs. In hot countries, the risk of infection is higher because of higher levels of gastrointestinal disease in the local population, a warm climate that encourages the growth of bacteria, and poor hygiene standards in food preparation and storage.
How to prevent it
Always wash your hands before meals and eat defensively. This means choosing food that has been freshly cooked at a high temperature. I remember one patient saying she couldn’t fathom why she had become ill, as she knew all about healthy eating and stuck to salads and seafood. But when you’re abroad, that can be the opposite of healthy eating. Street food that you’ve watched being deep-fried to order can be a better choice than a hotel buffet, where food is cooked behind closed doors, then left sitting out for hours while dozens of people use the same serving spoons.
When to seek help
Go prepared: pack oral rehydration solution, loperamide (Imodium) to treat diarrhoea symptoms and, ideally, standby antibiotics to take if your symptoms become more severe. Seek medical help if you’re unable to keep liquids down for 24 hours, have diarrhoea with a fever, confusion, lethargy or severe abdominal pain, or pass blood in your stools.
Malaria
A potentially fatal tropical disease spread by mosquitoes.
The symptoms
This can begin as a flu-like illness, with a high temperature, shivers, sweating, headaches, confusion, stomach pain, loss of appetite, vomiting and diarrhoea, a sore throat, cough, difficulty breathing, and jaundice (yellowing of the whites of the eyes).
The cause
Parasites transmitted to humans through the bites of infected mosquitoes. It occurs in tropical regions of the world, though 95 per cent of cases and deaths occur in sub-Saharan Africa.
How to prevent it
Check which countries carry a malaria risk before you travel. Book an appointment at a travel clinic four to six weeks before departure to get a prescription for anti-malarials. These reduce the risk of infection by more than 90 per cent, but once you are travelling, you should still take precautions against being bitten. Wear long sleeves and trousers in the early morning and after dusk, use a 50 per cent deet (N,N-diethyl-meta-toluamide) repellent, sleep under mosquito nets and use plug-in mosquito killers in your bedroom.
When to seek help
Because of its incubation period, if you become ill within a week of starting your trip, you are unlikely to have malaria. Most symptoms occur within eight to 18 days of an infected bite, although they can occur 40 or more days later. That said, any fever should be considered a medical emergency if you are in, or have been to, a malarial area, even weeks later, and should be assessed by a doctor.
Rabies
A rare but serious viral disease transmitted by infected mammals, including dogs, bats, raccoons, skunks, foxes and even humans.
The symptoms
These usually appear between three and 12 weeks after contact with a rabid animal, but they can occur within a few days or even years later. They include muscle spasms, hallucinations, difficulty swallowing or breathing and paralysis.
The cause
Bites or scratches from an animal with rabies – even a lick from a puppy on your nose, mouth or eyes, or on cuts or grazes – can be deadly. Even healthy-looking skin can have microscopic breaks that allow the virus to enter.
How to prevent it
The rabies vaccine is one of the travel vaccines that I feel most strongly about. It’s available privately at most pharmacies for around £50-£100 per dose, and you’ll need three doses. Avoid contact with unknown animals while travelling overseas. The UK Health Security Agency ranks countries by risk level.
When to seek help
By the time you show symptoms, rabies is usually fatal. There is no treatment that works once you become symptomatic. Seek help as soon as possible after exposure, even if you’re vaccinated. If you’re unvaccinated, you will need post-exposure rabies immunoglobulin (proteins that attack the rabies virus at the site of the bite or scratch), followed by a course of rabies vaccine, as well as antibiotics to prevent secondary infection and a tetanus booster. If you’re vaccinated, you’ll only need booster doses.
Respiratory tract infections (RTIs)
Infections of the sinuses, throat, airways or lungs.
The symptoms
Congestion, coughing, a tight chest, wheezing, sore throats and high fevers.
The cause
Travel itself. There’s some interesting research showing that you’re six times more likely to catch a cold or respiratory infection while you’re away than when you stay at home. Every step of the travel process can contribute, from the confines of the aircraft cabin to simply coming into contact with more people. Air travel dries the airways, allowing viruses to enter more easily. The relatively enclosed environment of a cruise ship can also facilitate the spread of infection, as the recent hantavirus outbreak vividly demonstrated.
How to prevent it
Flu is present year-round in the tropics, so make sure you get vaccinated. You could also have the pneumococcal vaccine to help prevent pneumonia and consider updating your Covid protection.
When to seek medical attention
Most RTIs will get better without treatment, so travel with cold remedies such as decongestant nasal spray and paracetamol. If you’re getting worse rather than better – becoming short of breath, for example, or coughing up blood – then it’s time to seek help. It can also be difficult to distinguish these symptoms from those of malaria, so if you’re in a malarial area and develop a fever, always see a doctor.
Yellow fever
A deadly virus found in certain areas of Africa, and South and Central America.
The symptoms
Yellow fever presents as fever, headaches, nausea and vomiting, and muscle aches. In serious cases it attacks the liver, so patients will develop jaundice as well as dark urine, stomach pain and even bleeding from the eyes, nose and mouth (or you will notice your vomit or stools go black from blood).
The cause
Like malaria, yellow fever is spread by mosquitoes.
How to prevent it
As the disease has a 40 per cent mortality rate, you will not want to be in symptomatic territory. Check whether where you are travelling puts you at risk and get vaccinated before you travel if it does (it costs £60-85). However, as the yellow fever vaccine is live (meaning it contains a weakened form of the actual virus), it can have rare side effects in people who have reduced immunity, such as those aged in their mid‑60s or older. So if you plan to start doing a lot of travelling in retirement, it’s worth getting the vaccine early as it provides lifelong immunity.
When to seek medical attention
If you experience any of the symptoms listed above after travelling in a country where the virus is found, get yourself seen by a doctor as soon as possible.
Lyme disease
A bacterial infection that can cause serious, long-term complications if untreated, including neurological issues, arthritis and heart problems.
The cause
Bites from an infected deer tick, usually picked up while walking in woodland or grassy areas. Lyme disease is prevalent across North America, Europe, Russia and large parts of Asia.
The symptoms
Some (but not all) of those exposed to Lyme disease develop a circular or oval rash after being bitten. It also causes flu-like symptoms – a high temperature, shivering, headaches, and muscle and joint pain, as well as tiredness and lethargy.
How to prevent it
Wear light-coloured clothing to make ticks easier to spot, tuck trousers into socks, check your body for ticks after going outdoors. If you find a tick, use a special tick removal tool to detach them from your skin. Don’t just try to pick them off or you could leave the head behind and cause infection.
When to seek medical attention
If you find a tick or develop symptoms after spending time in areas known for Lyme disease, see a doctor to discuss antibiotic treatment with doxycycline. Getting treated early is key to preventing more serious health issues.
Hantavirus
A group of viruses carried by rodents in some areas of Europe, Africa and Asia.
The symptoms
These vary depending on the strain, from a mild, flu-like illness to severe respiratory conditions such as pulmonary syndrome, a potentially fatal lung condition.
The cause
It’s transmitted through mice and rat droppings and urine – most often through inhalation of dust or aerosols. Person-to-person transmission is also rare, only occurring with the Andes virus strain (as seen during the recent cruise ship outbreak in the South Atlantic).
How to prevent it
Cases are uncommon – I’ve never seen one – and you simply can’t plan your travels in a way that guarantees avoiding exposure. For this type of unforeseen risk, make sure you have good medical insurance in place so that you can be evacuated if the unexpected happens.
When to seek medical attention
If you develop flu-like symptoms within one to eight weeks of potential exposure. There is currently no specific antiviral treatment available, so treatment is for symptoms only.
Hepatitis A and B
Contagious infections that cause liver inflammation.
The symptoms
Both hepatitis A and B have either no symptoms or mild ones, including fever and jaundice, tiredness, stomach pain and nausea, dark urine or pale yellow or grey faeces.
The causes
Hepatitis A is caused by consuming food or water contaminated with faeces from someone else who carries the virus. Hepatitis B is blood‑borne so can be spread through bodily fluids. The main risks for travellers are from accidents and injuries, medical and dental treatment, piercings, tattooing, needle sharing and sex.
How to prevent them
There’s a very safe and effective hepatitis A vaccine available on the NHS for those at risk. The hepatitis B vaccine has been included with the standard childhood vaccinations since August 2017, so anyone under the age of nine will already be covered, but I do encourage young people who go travelling to get vaccinated as they are more likely to be exposed through the activities listed above.
When to seek medical attention
If you have symptoms of hepatitis A or B and have recently travelled to a country where hepatitis is common – including parts of Africa, Asia, the Middle East, and Central and South America – seek medical advice.
Typhoid fever
An easily treatable infection spread through unclean food or water.
The symptoms
Within six to 30 days of exposure you would experience fever, diarrhoea or constipation, coughing, headache and chills. Later, you might develop a pink rash and diarrhoea.
The cause
Typhoid is caught through drinking contaminated water, or eating food that has not been cooked thoroughly or has been washed in dirty water. It is common in parts of Asia, Africa, and Central and South America. Most people in the UK who report symptoms have recently been to Pakistan, India or Bangladesh.
How to prevent it
Make sure you’re vaccinated before you travel if going to an area where it is prevalent. Regardless, you should wash your hands regularly and use hand sanitiser when you can’t, drink bottled water, avoid ice, salads and uncooked fruit and vegetables you can’t peel or wash yourself, and unpasteurised dairy products.
When to seek medical attention
If you have a fever that lasts more than a couple of days after travelling to a high-risk area. It’s easily treated with antibiotics, but delayed diagnosis can lead to complications such as internal bleeding, so it’s best not to wait too long if you experience symptoms.
Zika, chikungunya and dengue fever
Three mosquito-borne viral infections.
The symptoms
Dengue (or breakbone) fever is the most severe of the three, causing sudden high temperatures, intense headaches, pain behind the eyes, and severe muscle and joint pain. In the worst cases, patients develop internal bleeding and shock.
Chikungunya also causes fever and agonising joint pain, with pain and stiffness lasting weeks or even years after infection.
In most people, Zika causes no or only very mild symptoms (headache, fever, sore eyes and rashes), but it can cause birth defects if passed on during pregnancy. In rare cases, it can cause Guillain-Barré syndrome, an autoimmune disorder where the immune system attacks peripheral nerves, leading to muscle weakness, tingling and even paralysis.
The causes
Spread by mosquitoes, primarily Aedes mosquitoes. While mostly found in Latin America, the Caribbean, Africa and Asia, dengue and chikungunya have been found in parts of southern Europe including France, Italy, Spain and Portugal from early spring to November. Three cases of Zika were reported in France in 2019.
How to prevent them
Unlike the mosquitoes that spread malaria, which tend to be most active at dawn and dusk, the Aedes mosquitoes that transmit Zika, chikungunya and dengue are aggressive daytime biters, so you’ll need to take precautions at all times by covering up with long, lightweight clothing, using a 50 per cent DEET repellent, and using mosquito nets and plug-in mosquito killers in your bedroom. There is now a dengue vaccine suitable for travellers (Qdenga). Two new chikungunya vaccines became available last year. IXCHIQ is suitable for some travellers aged 18-60, and Vimkunya is suitable for those aged 12 and over. There is currently no licensed vaccine for Zika, though trials are ongoing.
When to seek medical attention
As soon as you become symptomatic during or after travel in areas known to be an infection risk. There are no antiviral treatments or medications, so care is focused on relieving symptoms.
Dr Richard Dawood is a travel medicine specialist and medical director of Fleet Street Clinic.
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