Health advice for travel abroad

Research and planning

Country information

In these days of adventure travel, when it can seem as though travelling to somewhere unusual, remote or simply very different is a commonplace event, it is easy to forget the dangers and importance of being informed and prepared.

Read more about travelling to remote locations.

It is always advisable to know about the places you are travelling to, particularly if they are unfamiliar and even more so if you have never travelled there before. There are many sources of specific advice on the countries you are visiting.

Consider checking the UK government's Foreign Travel Advice by Country, which will update you if there are specific issues which might affect your safety in the countries you are visiting. Watch the news, pay attention and give yourself the opportunity to be aware of the things which might affect your decision to travel. Remember that if the UK government issues a travel warning regarding a particular country or area of the world, this may invalidate your travel insurance. Check, additionally, the CIA's World Factbook, which offers a slightly different view with information on history, people, government and transportation.

Insurance

Travel insurance is an important part of your trip. Insurance protects your possessions and travel arrangements, but also your health. Accidents and illnesses happen everywhere, including overseas. The cost of medical treatment can be very high. An uninsured patient may struggle to find treatment without paying upfront. The cost of medical repatriation, if needed, can be extremely high.

Adventure tourism and sports

Make sure that your insurance covers the type of holiday you are taking. Make sure that you understand the limitations of your policy.

• Some insurers will not cover high-altitude trekking holidays, for example. These travellers are strongly advised to obtain specialist insurance which includes helicopter evacuation.

• Most insurers charge an extra premium for dangerous activities, including winter sports.

• Many insurers will not cover travellers to any area if the Foreign Office has advised against travel there.

• Your insurer may also decline to cover you if you deliberately put yourself in harm's way by taking unusual risks without informing them. For example, a policy which covers scuba diving may only cover you to a certain depth and not below.

Medical conditions

Your insurer must be fully informed of any pre-existing medical issues which might invalidate your policy if not notified:

• Remember that if your doctor advises you against travelling on medical grounds then it is likely that your insurance, even if already in place, will become invalid.

Global Health Insurance Card (formerly European Health Insurance Card)

If travelling to Europe make sure you have a GHIC card. These may be applied for through the GOV.UK website (see 'Further Reading and References' below), and are free. The GHIC card is the post-Brexit version of the European Health Insurance Card (EHIC), which itself replaced the E111 form.

• It will not cover any private medical healthcare or costs, such as mountain rescue in ski resorts, repatriation to the UK, or lost property.

• It is also not valid on cruises.

• It is therefore important to have both a GHIC and a valid travel insurance policy in place before you travel.

• Some insurers now insist you hold a GHIC and many will waive the excess if you have one.

• If you need urgent health help during a visit to Europe, dial 112. The European emergency number is valid in all EU/EEA member states and is free of charge.

Reciprocal health agreements

Some non-European countries also offer 'reciprocal' health treatment for UK visitors. This means that if you're visiting any of these countries and need urgent or immediate medical treatment, it will be provided at a reduced cost or, in some cases, free. The range of medical services may be more restricted than under the NHS.

• A list of reciprocal agreements, by country, is available on the GOV.UK website (see 'Further Reading and References' below).

Personal documents

Obtain passports and visas well in advance. You may be refused permission to travel at the airport if you don't have the right documentation and visas. Keep a copy of the front page of your passport at home in case of loss. Check the requirements of the country that you are visiting - some will not accept a passport which is more than 10 years old, even if it has not yet expired, and some need you to have a passport which is valid for at least six months after you leave the country.

• It can be useful to take some passport photographs with you for unexpected visas and other permits. Some national parks, for example, will require a photo permit for entry.

Consider how you will obtain cash at your destination. Advise your bank of your travel plans and keep access to more than one way of accessing money overseas, in case you lose a card or a card fails to work. Keep a record of your credit card numbers, passport number, driving licence number and the 'stop' numbers for lost credit cards and phones.

Patient picks for Travel advice

Travel and vaccinations

Travelling to remote locations

Remote travel is easy and accessible. However, once you get to your destination you may find yourself in a very different environment from the one you're used to.

by Dr Toni Hazell

Personal safety when travelling abroad

Accidental injury

The greatest risk to travellers is not of tropical diseases, dangerous animals or high-risk sport, but of death on the road. Worldwide, road accidents are the most frequent cause of death amongst travellers. Less-developed countries typically have much higher rates of road deaths and injuries compared with their richer counterparts. Therefore, the more adventurous your travel plans, the more danger you are likely to face on the roads. This problem is compounded by the fact that poorer countries usually have less quantity and quality in their hospital and ambulance services too. Any badly injured person who cannot be transported rapidly to an adequate hospital is more likely to die. You can minimise the risks of driving abroad in several ways:

• Always wear a seatbelt (or a helmet if on a bike).

• Never drive under the influence of alcohol. In many countries driving with any blood alcohol present at all is illegal.

• Rent cars from reputable car companies which regularly service their vehicles.

• Check the tyres, lights and brakes yourself.

• Make yourself aware of the rules of the road in the country you are in.

• Consider whether there is an alternative to driving yourself, particularly if conditions are very unfamiliar.

• Avoid hiring motorbikes and mopeds, which are statistically associated with a higher incidence of personal injury and death.

• Lock the doors of your car when driving, particularly after dark.

Alcohol and drugs

Consider your personal safety when using substances that can impair your judgement and common sense.

• Use alcohol in moderation only and never use it when driving.

• Remember that the effects of alcohol may be more marked if you are lacking in fluid in the body (dehydrated) and you may drink more than you intended to.

• Drink water, rather than alcohol, for thirst.

• Don't swim if you've been drinking alcohol.

• Avoid illicit drugs. Even if you are not breaking the law, you may be stepping outside your comfort zone and ability to take care of yourself. Don't make yourself vulnerable.

Crime

Most crime is minor and opportunistic; however, it occurs worldwide. Some destinations have a higher risk of violent crime and sexual assault than others. Be sensible and plan ahead. Be vigilant regarding personal security.

• Try not to stand out as a potential target.

• Consider whether wearing valuable or visible jewellery may be inappropriate for your destination.

• Keep your cash hidden and try to carry some low-denomination notes.

• Use only licensed taxis and don't share them with strangers.

• Be cautious with alcohol and don't leave drinks where they can be tampered with.

• Look as though you know where you're going.

• Keep your credit card in sight when using it to pay and ask for the printed receipt.

• Stay aware of your surroundings.

Don't commit a crime yourself, either deliberately or through ignorance of the law. Obey the law in countries that you visit; respect dress codes and traditions.

• Don't buy or use illegal drugs. Most countries take a very strong view on travellers carrying illegal drugs.

• Don't carry packages through customs for other people; pack your own luggage and don't leave it unattended.

• Be aware that some countries prohibit the consumption of alcohol.

• Be aware that flouting dress codes may break the law in some countries..

Climate and environmental hazards

Understand your destination and what you plan to do there. What risks will you face? There may be several aspects of your destination that are not only unfamiliar to you in everyday life but which also pose a risk. These include:

Sun

Remember that the sun can damage your skin at altitude, even in the absence of heat, in the shade and even when wearing sunscreen. See the separate leaflet called Sun and Sunburn for more details.

Sea

Observe sensible precautions when swimming:

• Pay attention to local signs alerting you to dangerous tides or currents, or to dangerous marine animals, including jellyfish, snails and biting fish.

• Watch children carefully: the sea is not like a swimming pool and it can be very easy to lose track of them.

• Don't swim beyond your capabilities.

• Don't swim when alone - particularly not in the sea.

• Take care when diving - consider hidden rocks. Don't dive in harbours and off jetties. Beware of swimming where there are jet skiers or other vessels.

• Don't swim immediately after a heavy meal.

Heat and humidity

• These can cause a number of adverse effects, including prickly heat, fainting, cramps, swelling of hands and feet and heatstroke.

• Risks are greater if undertaking strenuous activity in the heat of the day.

• Heat exhaustion and heatstroke cause headache, dizziness, feeling sick (nauseated) and sweating and, as the condition gets worse, dry skin, collapse and confusion. Heatstroke is a life-threatening condition and needs urgent medical help. Patients need to be rested, given sufficient fluids (hydrated) and cooled.

• Small children may just become quiet and listless.

Take suitable clothing to stay cool; avoid overexertion in the heat of the day. Remember to stay hydrated. Be aware of the dangers of overheating and don't overdo it. If trekking or backpacking, be particularly aware of the need for water, salt and energy replenishment. Whatever you are doing, stay hydrated and seek attention if you become unwell. See the separate leaflet called Sun and Sunburn for more details.

Sea - boats and boards
Make sure that you know the rules of navigation and the waters that you are in. Understand the hazards, including dangers from marine animals and from other boats. If in charge of a motorboat, always wear the kill cord and make sure your crew members have the right flotation aids. Know how to use the radio and your flares.

Lakes and rivers
Understand your environment. Some lakes and rivers may not be safe for swimming, due to the presence of freshwater parasites which can cause serious infections in human beings. Parasites are living things (organisms) that live within, or on, another organism.

Snow and ice
Insurance is essential when taking part in winter sports, as mountain rescue services and helicopter evacuations in most countries are not free of charge. See the separate leaflet called Dealing with the Effects of Cold and the section providing advice for travelling to remote locations.

Altitude sickness
If you are travelling to altitude, see separate sections dealing with altitude sickness and advice for travelling to remote locations for more details. Follow the guidance on how quickly to ascend and when to stop or go back down. In some cases it may be appropriate to consult a private travel clinic (not your GP) for an altitude sickness medication prescription to take with you.

Building standards
Building construction in holiday destinations is not always as reliable as we expect it to be at home. Fire regulations may not be adhered to. Recent accidents abroad have highlighted risks of poorly maintained boilers, of dangerous balconies and of cloudy swimming pools:

• If you have concerns about where you are staying, move to different accommodation.

• Sleep with windows open and don't lean on balcony parapets.

• Don't swim in cloudy swimming pools or trust poorly constructed safety barriers.

• Check fire escapes and make sure that there is a way out and that you know what it is.

Extreme activities
Many holidaymakers now seek the thrill of 'extreme' adventures, such as bungee jumping, swimming with sharks or paragliding. If taking part in these activities make sure that you feel happy with the way the operation is being run - ask yourself:

• Do the guides seem sensible and experienced?

• Are they paying attention to safety?

• Do you feel comfortable that the activity is well organised?

If in doubt, go elsewhere.

Wildlife
Make yourself aware of the wildlife hazards in the places you are visiting.

• Large predatory animals may need particular precautions. Attacks are uncommon compared to other travel dangers and most are avoidable. In parts of the Northern USA, trekkers and campers should carry bear spray to ward off bear attacks. In parts of Australia, beaches are not safe for swimming, due to the presence of sharks and crocodiles. Large predators on African safari trips are a threat to life and limb if proper precautions are not observed.

• Biting animals (including dogs, cats, bats, foxes and monkeys) may carry rabies (see below). If you are bitten, seek help. Consider whether you need rabies vaccination (generally recommended for those more likely to come into contact with local animals, including those travelling 'off the beaten track' for prolonged periods).

• Venomous animals such as snakes and scorpions may pose a risk to health. Be aware of what you may encounter and know how to identify it. Never touch insects, caterpillars, spiders, snails or other animals you find on your path. It is best to assume that all snakes are both aggressive and venomous.

• Whilst large or venomous animals pose the most dramatic wildlife risk to travellers, mosquitoes are a much greater threat to travellers' health. Take all possible precautions to minimise insect bites, including covering your skin and using insect repellent and mosquito nets. Use prevention (prophylaxis) against malaria and vaccination against yellow fever where appropriate (see under 'Health', below).

• Remember also the dangers posed by marine life such as corals, jellyfish and octopuses.

Terrorism and civil unrest

Country-specific travel sites advise of specific dangers. However, in 2017 the range of countries where terrorism could possibly take place includes many places that UK travellers visit regularly (and of course terrorist attacks also occur in the UK). Also, the types of attacks we have seen were often impossible to predict.

Be alert to what is going on around you. Watch the news before you leave. Learn what you can about the country you are visiting.

Health

The NHS Fit for Travel website (see under 'Further Reading and References' below) offers updated information, by country, on specific and general health issues which you might expect there.

Vaccinations

Make sure that you have all the vaccinations you need. Book an appointment with your GP or practice nurse three to six months ahead of your holiday in order to plan a programme of vaccination. Some vaccinations are given as a course of separate jabs and some cannot be given together. See the separate leaflet called Travel Vaccinations for more details. If your GP does not have the resources to offer the appointments that you need then you may need to attend a private travel clinic instead. These costs should be seen as a necessary part of the cost of travel.

Air travel

Be aware of the risks of deep vein thrombosis and pulmonary embolism associated with air travel. Speak to a private travel doctor if you feel you may be at particular risk. Protective travel socks may be recommended and some patients are advised to take aspirin for travel.

If you have any doubts about whether you are fit to travel by air then speak to a private travel doctor. Your GP is very unlikely to be trained or insured to write a letter to say that you are fit to fly, and consultant assessment for this purpose is generally not available on the NHS. l. Some groups of people should not travel by air. These include:

• Women more than 36 weeks pregnant.

• Those with active communicable diseases, including tuberculosis, although the risk of transmission is generally low.

• Those who have angina or chest pain at rest, or have had a recent heart attack (myocardial infarction) or stroke.

• People with ear infections, or infection of the sinuses, nose and Eustachian tubes.

• Those who have had recent surgery or injury where trapped air or gas may be present. For example, gastrointestinal surgery, face and eye injuries, brain surgery or eye operations.

• People with severe chronic respiratory disease, or breathlessness at rest.

• People with air trapped between the chest wall and the lung (pneumothorax).

• Those who have sickle cell anaemia.

• Those who have psychotic illness, except where fully controlled.

Try to minimise jet lag: get maximum sleep on the flight and drink all the water you can. Read more about jet lag.

if you are affected by travel sickness, take the precautions which usually help you. If using medication, make sure that you tolerate your medication well. Remember, however, that medicine that makes you appear sleepy or drunk may result in you not being allowed to travel. See separate section on dealing with motion (travel) sickness for more details.

Malaria prevention

Take all necessary precautions against malaria. It is a serious disease which can, at the very least, spoil your holiday and, at the very worst, be fatal. This includes medication to prevent malaria and protection against biting mosquitoes. It is very important to protect yourself, even if returning to a country where you have family or where you have previously lived. Immunity is not inherited and is only partially acquired by living there for a long time.

Garlic and citronella do not prevent mosquitoes from biting you. Cover your skin to avoid bites, especially after sunset when malarial mosquitoes bite. Use mosquito nets and insect repellent devices such as candles and coil burners.

Consult the NHS Fit for Travel website for up-to-date advice on the malaria regimen recommended for the countries you will be visiting. There is normally a choice of medication. Make sure that you can tolerate the medication you choose before you go. Remember that malaria prophylaxis does not offer absolute protection: minimising exposure to mosquito bites is also important. The risks of mosquito-borne disease are always greater where there is disease in the human population.

See the separate leaflet called Malaria Prevention for more details.

Water, and traveller's diarrhoea

In the UK we are accustomed to trusting the water that comes out of the tap. However, this isn't possible all over the world. Stream water and river water are not usually clean enough to drink, unless you are so high up a hill that it is certain that no people, cattle or other animals have been in the water above you.

Travellers who drink the contaminated water may find themselves exposed to the organisms that cause travellers' diarrhoea.

• If you are not sure that you can trust the water in the countries you are visiting, obtain bottled water. Only drink this from a bottle if it was sealed when you purchased it. Alternatively, purify water yourself. Where bottled water is readily available, it may be a good idea to have a back-up system for purification. Purification is also more environmentally friendly than bottled water since the same bottle can be refilled.

• If water needs to be purified for drinking then it should also be purified for brushing teeth.

• The best ways to purify water are boiling, water purification tablets, ultraviolet devices or filtration using purpose-designed filters:

  • If boiling, a rolling boil for one minute is sufficient at normal altitudes (three minutes at altitudes above 2000 metres).

  • Water purification tablets are not palatable to everyone but are fast and effective.

  • Filtration is very effective, even for brackish or sandy water. Filters for sterilising water are usually sold by travel equipment shops. These filters must not be confused with those designed only to remove smells and chlorine from domestic water.

  • Battery-operated pen devices are easy to carry and can destroy bacteria, viruses and cryptosporidium parasite in clear water.

Diet and traveller's diarrhoea

It is important to find a middle ground between sampling local cuisine and avoiding 'traveller's tummy'. Be aware of the risks and apply commonsense when eating out. The most common causes of infection from food are salmonella, Escherichia coli (E. coli) and norovirus. Others, including campylobacter and giardia are also common, particularly in the developing world.

Whilst these illnesses are acquired from contaminated food, cutlery or plates, they may also be acquired from elsewhere. For example, your fellow travellers, from local people and even from touching contaminated lavatory flushers or taps.

• Take precautions around drinking water (see above). Don't have ice or ice cream in places where you wouldn't drink the tap water.

• Cook it, wash it, peel it or forget it. Eat freshly cooked food and fruit that you can peel.

• Avoid cold cooked meats, salad (which may have been washed in contaminated water), runny eggs and unpasteurised dairy products.

• Think about fish. Do you trust the source? Is it really fresh? Shellfish can accumulate contaminants whilst in the sea. Shellfish may be better avoided in many places. Smaller fish tend to be safer than larger fish where there is any doubt.

• Make sure hot food is thoroughly cooked and, ideally, not reheated. Be particularly wary of undercooked chicken or pork. In some developing countries food may not have been refrigerated. If you see evidence that food is left lying around uncovered where you are, take care.

• Avoid unsealed mayonnaise, although sealed condiments are fine.

• If purchasing from street vendors consider how the food has been kept and cooked.

• Generally, busier restaurants have a better throughput of food and so it's more likely to be fresh.

• it is easier, these days, for vegetarians and vegans to travel. However, the concept of what you are happy - or not happy - to eat may not be familiar wherever you go. This, combined with potential barriers of language, may make it difficult to obtain exactly what you want.

• If you have special dietary needs, particularly food allergies, consider in advance whether the countries you are visiting will be able to meet them. If you are uncertain, you may need to take energy bars and other supplements with you, or purchase food at a local store.

It is difficult to avoid all hazards completely, particularly if you are travelling off the beaten track. Therefore, it is best, whilst taking the necessary precautions, to travel prepared. Take treatments for traveller's diarrhoea in your medical kit. See the separate leaflet called Traveller's Diarrhoea.

Infections and diseases

See individual leaflets on this website for specific illnesses and conditions. Some of these may be illnesses to which you are not normally exposed when at home, such as malaria and typhoid. Others are conditions which you can acquire anywhere, such as the common cold.

It is important to remind yourself that most travellers do not acquire serious illnesses abroad and that with sensible precautions you are also unlikely to do so. These include:

• Make yourself aware of the risks of disease in the countries you are visiting: read the news, check country advice.

• Have the recommended vaccinations.

• Take the advised protective measures against malaria.

• Protect yourself against insect bites.

• Be careful where you swim, take local advice before swimming in fresh water.

• Take care with diet and hygiene.

• Take care when exposed to those who are infected (this is particularly important for aid workers - see below).

• Avoid areas where there are disease outbreaks, civil unrest and natural disaster.

If the worst happens and you develop symptoms, seek medical advice early. Avoid self-medication unless there is really no alternative. Local experts are more likely than you are to know what your symptoms are most likely to represent.

If you develop an unexplained temperature within six months of returning home from a malarial region, tell your doctor or health professional. The risk of this being malaria or another 'tropical' disease declines considerably after the first month. However, it does not drop to almost zero until six months.

Bites and stings

Most bites and stings are a nuisance rather than a serious threat to health. However, there are exceptions to this. See the separate leaflet called Insect Bites and Stings. Protect yourself against insects: take an effective insect repellent (at least 20% DEET) and cover your arms and legs as much as possible to minimise biting.

• Venomous bites. Make yourself aware of the biting animals that you could encounter on your travels. Find out what you should do if you are bitten. Don't panic - seek help urgently, as you may need antivenom or other supportive treatment. Remember that most venomous bites and stings are not lethal, as most are designed to disable smaller animals than you.

• Infected bites. A bite is a 'dirty' puncture wound and even a tiny insect bite can become infected. If redness around a bite continues to increase on the second and third day then it may be infected. Remember in particular to check boots for insects in the morning.

• Diseases acquired from insect bites. In addition to malaria there are many other insect and arthropod-borne diseases. These include yellow fever, dengue, Zika virus, chikungunya fever, West Nile virus and Japanese encephalitis. Be aware of what the risks are where you are travelling and seek advice if you develop symptoms. The best prevention for the avoidance of mosquito-borne diseases against which there is no vaccine is the avoidance of bites.

• Rabies is endemic in wild animal populations in many parts of the world. It can be acquired from the bites or scratches of various mammals, including dogs, cats, bats, monkeys and foxes. Rabies can, less commonly, be acquired through inhalation of bat droppings. Don't touch animals and if bitten seek medical advice (and if it is possible to isolate the animal for testing, do so.) If you think you are at increased risk of animal contact, consider rabies vaccination.

Sexual health

The risk of acquiring a sexually transmitted infection (STI) from casual sex when travelling is high. Condoms provide good but not complete protection. STIs like gonorrhoea, chlamydia and syphilis may cause serious long-term disability. Hepatitis B and HIV are also spread sexually.

High proportions of sex workers are infected with STIs. Large numbers of the population in many parts of Africa are infected with HIV, and AIDS is common. Infection is widespread in many countries in Asia and South America.

It is safest to avoid casual sex when travelling. You are taking a risk which, if you were not on holiday, you might find unacceptable. If you do have sex with a stranger, always use a condom.

Needing emergency treatment abroad

In some developing countries medical supplies, including needles and syringes, are cleaned and re-used. Travel packs are available from some chemists and travel clinics. Packs contain sterile equipment for use in an emergency. A needle kit should be supplied with a certificate showing contents and the reason for its purchase - useful for clearance at customs.

In most of Western Europe, North America, Japan and Australasia all donated blood is now screened for HIV antibodies. However, in most developing countries much of the blood donated is unscreened. The risks from blood transfusion may be high. Points to consider are:

• Accidents are the most common reason for needing a blood transfusion.

• Blood transfusion should only be accepted when essential.

• Pregnancy or any medical condition which may lead to heavy blood loss should be taken into account before travelling to destinations where good medical facilities will not be available.

• Knowing your blood group in advance may make it easier to find a blood donor in an emergency.

Special groups of travellers

Travelling with children

This presents different challenges, depending on the age of your child or children. Of course travel broadens the mind and can teach children a great deal. It may, however, be easier for adults to tolerate or forget the difficulties of travelling than it is for children. When making any journey with children consider what special risks, if any, your journey and destination may mean for them. Ask yourself, are the benefits of your trip worth this, or should you delay or go elsewhere? Children will need special consideration - in particular, in areas of:

• Vaccination.

• Malaria prevention.

• Motion (travel) sickness.

• Managing long journeys.

• Air travel, including ear pain.

• Diet and hygiene.

• Water purification.

• Adventure tourism.

• Environmental hazards, including sun, sea and altitude.

• Understanding risk (clearly this will vary with the age of the child).

• Safety in motor vehicles (for example, child seats).

Planning ahead

• Allow plenty of time for journeys with young children.

• Book ahead to be sure of your accommodation.

• Arrange vaccinations well in advance and explain the purpose to children old enough to understand.

• Take something to occupy your child on the journey.

• Avoid sweets. Use savoury snacks instead.

• Consider investing in a child location device for your journey. The child wears a small device fixed to their clothes and you keep the transmitter. When you have a small wandering child in a busy airport consider writing your mobile number on their arm in case they wander off and become lost.

• Take the child's usual painkilling medicine (nothing else will taste the same).

• Keep them involved in your plans and experiences.

• Take appropriate clothing for them.

• Children generally find antimalarial medication difficult. Chewable tablets taste bitter, and liquid preparations are often even worse. Make sure your children can cope with the recommended medication before you arrive in the malarial zone. The Further Reading resources section contains information on how to teach children to swallow tablets.

Travelling with medication

Permission to carry drugs
Travellers carrying prescribed controlled drugs carry a letter of confirmation from their doctor. This includes personal details, travel dates and the drug/s and amount to be carried.

• The Home Office allows you to take up to 90 days of controlled drug medication abroad. However, you must also comply with the entry requirements of the countries you are visiting, which may be different. It is also advisable to contact the embassy/consulate/high commission of the destination country to check regulations. Some countries have specific lists of restricted medicines and may confiscate your supply.

• A copy of a recent prescription should be carried for any prescribed psychotropic including antidepressants.

• For other prescribed medicines it is unlikely that any restrictions will be imposed although carrying a copy of the prescription is advisable.

• For suspected restricted medication check the International Narcotics Control Board (INCB) website (see 'Further Reading and References' below) for the requirements. In many cases the regulations allow you to take up to 30 days' supply as long as you are carrying a prescription or doctor's certificate. Carrying greater than 30 days' supply may require special importation licences.

Travelling with medication
Always keep medicines in packaging together with the patient information leaflet. If taking liquid medication through an airport try to take volumes of less than 100 ml, with your name and dose clearly indicated on the bottle.

Crossing time zones
Travel may significantly lengthen or shorten your day through the crossing of time zones. If you are taking regular medication then seek advice from your health professional regarding whether you need an extra dose or a reduced dose to address this. For many medications this won't be necessary. However, for some, such as patients with diabetes who are taking insulin, a change of four hours or more to the length of the day is likely to need addressing. Keep sufficient medication in your hand luggage for your journey, allowing for delays.

Relief workers

Relief workers are at greater risk than other travellers. They may face greater hazards and health risks because of flooding, unstable buildings, debris, lack of electricity, water, sanitation, health facilities and law enforcement. They are in close contact with local people and may share their exposure to infectious disease and lack of access to clean water for washing and drinking.

Those undertaking this work should consult with a travel health advisor as soon as practicable for advice on vaccine and malaria recommendations and other advice on protecting their health. Relief workers should ideally be in good physical and mental health, well briefed, and equipped as necessary to deal with the challenges of their environment.

Travelling when pregnant

Travelling when pregnant needs special consideration and planning. You should research your intended destination and consider whether it is right for you. Consider the medical facilities in the country you are visiting and any outbreaks or travel warnings. Advise your doctor or a doctor specialising in pregnancy and childbirth (an obstetrician) of your intention to travel. In particular:

• There are restrictions on the vaccinations pregnant women can receive.

• Pregnant women and their babies are at increased risk if they contract malaria.

• Pregnant women can take some kinds of malaria prophylaxis, although others are not safe in pregnancy.

• Pregnancy carries an increased risk of deep vein thrombosis.

• Some diseases such as Zika virus are a particular threat to pregnancy.

• Most commercial airlines accept a pregnant traveller up to 36 weeks of gestation (up to 32 weeks for multiple pregnancies). Some airlines require documentation from your doctor or midwife to confirm you are in good health, and the due date. Your GP will not be trained or insured to write a letter to say that you are 'fit to fly' - they will only be able to give you a letter stating the facts of your pregnancy. If the letter needs to contain the words 'fit to fly' then you will need to visit a private travel doctor.

Travelling to visit relatives abroad

If you are normally resident in the UK but are travelling to visit relatives abroad, it's easy not to think of this as a 'holiday' and not to think of it as needing the same level of planning.

Remember that if you travel abroad to visit relatives - even if this is to a country in which you yourself were formerly resident - you need to do much of the same planning. In particular:

• Insurance: your residence in the UK may mean that you have no more entitlement to healthcare on your trip than any other traveller.

• Vaccinations: protect yourself against disease with a normal travel vaccine schedule - you are as vulnerable as the next person. Consider rabies vaccination if you are likely to encounter stray dogs, and educate your children about the risks of petting stray animals.

• Malaria: don't be tempted to ignore the recommended precautions because your relatives say they never get malaria. They may be immune or partially immune due to repeated infections. However, you will not be, even if you once were.

• Food and water: the food and water in the country you are visiting is now as foreign to your digestive system as it is to anyone else's, so you have the same vulnerability to traveller's diarrhoea as any other traveller. Take the usual precautions.

• Cultural and social differences can be a challenge to you and to your children, even if your ethnic origin is in the country you are visiting. You and they will be adjusting to a different climate and possibly to other situations:

  • Seeing different religious practices.

  • Separation from family and friends at home.

  • Changes in living standards.

  • Different social amenities.

  • Language differences.

  • Economic inequalities.

  Many problems can be overcome through experience and sympathetic support from family and friends.

And finally

The key to a successful holiday is careful, thorough preparation. This is true even if you are off on a carefree, backpacking, 'go where the mood takes me' trip. The NHS Fit for Travel website offers the following 'Ten Tips' to help you remain safe and healthy:

Before your trip

• See a health professional specialist several months before travel.

• Ask about vaccinations that are recommended for your specific destinations.

• Make up a first aid and medical kit containing regular and special medication for the trip - carry it in your hand luggage.

• Make sure you have evacuation and travel insurance.

During your trip

• Take precautions against malaria when needed. Prevent mosquito bites and take malaria pills as advised.

• Road safety is important - wear safety belts in cars, helmets on bikes and avoid night-time driving and driving under the influence of alcohol.

• Abstain from casual sex or practise safe sex with condoms to prevent HIV and other STIs.

• Verify and consume safe water and food. Have a supply of medicine for self-treatment of diarrhoea.

• Use sunscreen. Sun can be more intense over water, over snow and at altitude.

• Leave animals alone, as they may transmit rabies. Seek help if bitten.

If fever develops during or after a trip, seek medical help immediately.

Dr Mary Lowth is an author or the original author of this leaflet.