Cholera

The International Certificate of Vaccination no longer has a space for details of cholera vaccination. The World Health Organisation states that the vaccines currently available are unreliable and of short duration and therefore they do not recommend its use as a means of protection. However, some countries still require proof of vaccination if travellers are arriving from infected areas, certificates are valid from 6 days to 6 months

Diphtheria

Diphtheria is a bacterial caused disease which appears in two forms, in the throat or on the skin. The latter is found most commonly in dry, semi-desert regions where washing facilities are scarce. Infection is spread by direct skin contact with contaminated dust or by inhailing infected droplets from an infected person e.g. when they cough. Diphtheria of the skin can be prevented by daily washing and by keeping the skin clean and dry. Travellers, especially to the tropics are at risk from all forms of diphtheria and medical advice should be sought before travel.

Hepatitis A

Hepatitis A is the most common disease to prevent through vaccination. It may be contracted from contaminated food or water or from direct contact with infected persons. Travellers from developed countries are likely to be prone to infection and should be vaccinated if travelling to areas outside Australia, Canada, western Europe, Japan, New Zealand and United States. There are two forms of vaccination, one giving immediate but short-lived protection, the other given in three doses giving up to 10 years protection.

Hepatitis B

Hepatitis B is widespread in all of Africa, much of South America, eastern Europe, the eastern Mediterranean area, south-east Asia, China and the Pacific Islands except Australia, New Zealand and Japan. It is transmitted in a number of ways, sexual transmission is a high cause, as is transmission through the skin e.g. blood transfusion, invasive medical or dental treatment, injections, acupuncture or tattooing etc. Vaccination is given in three doses and will provide protection for 10 years

Malaria

Malaria is a common and serious tropical disease and is transmitted via mosquitos biting mostly between sunset and sunrise. In many countries of Asia, the eastern Mediterranean area and South America where there is malaria, the main urban areas are free of transmission, however this may not be true of surrounding areas especially in Africa and India. While there is generally much less risk of malaria at altitudes greater than 1500 metres, the disease can occur in hot climatic conditions at altitudes up to 3000 metres. The risk of infection may also vary according to the season. All travellers should be told that protection from biting mosquitos is their first priority and the use of nets and insect repellent containing "deet" is advisable. The correct form of vaccination should be sought and the appropriate drugs should be taken exactly as prescribed even after returning home. Travellers should also be aware that no antimalaria drug regimen gives complete protection.

Polio

The Polio virus still occurs continually in areas with low levels of hygiene and low immunisation programmes. Most travellers will have received immunisation as a child however anyone travelling to a developing country should never assume that they are immune.

Rabies

Rabies is a virus infection of mammals that can be transmitted to humans, usually as the result of a bite from an infected animal. Rabies occurs in most parts of the world, in Greenland, Canada and North America, throughout the former USSR states, China and New Territories of Hong Kong, as well as the main tropical regions. Travellers involved in animal expeditions, cave exploring or walking or cycling through urban or rural areas where rabies is endemic should consider pre-exposure vaccinations against rabies.

Tetanus

Tetanus is common in many developing countries, especially in hot, moist tropical areas. It is caused by the infection of wounds with the tetanus bacteria. Travellers should check that they have received an initial immunisation course and that they have had a booster injection within the last 10 years. Tetanus is rare in travellers taking conventional holidays, but it is a greater risk for those going on safari, trekking, climbing or exploring holidays.

Typhoid

Typhoid is endemic worldwide. Transmission occurs in areas where many of the local population are carriers of the disease and hygiene standards are poor. In areas with good public health standards such as northern Europe, United States, Canada, Australia, New Zealand and Japan immunisation is not necessary. Outside these areas risk of infection depends on local hygiene and lifestyle. Travelling or living rough and living in rural areas increase the risk of transmission, however staying in reputable hotels even within these areas reduces this risk.

Yellow fever

Urban and jungle yellow fever only occur in parts of Africa and South America. Urban yellow fever is an epidemic disease transmitted to humans via mosquitos. Jungle yellow fever is essentially transmitted among animals and occasionally to humans via mosquitos. The international certificate of vaccination against yellow fever is valid for 10 years, beginning 10 days after vaccination. Immunisation in the United Kingdom is undertaken only at recognised yellow fever vaccination centres.

Food hygiene

Food should never be assumed to be safe unless it is known to have been freshly and thoroughly cooked. Make sure meals have not been re-heated and re-arranged. Aviod complicated delicacies that have received much handling during preparation, and cold platters left out in the open as they are likely to be contaminated. Shellfish can be a particular hazard especially where water quality may be poor. Fruit and vegetables should be freshly cooked or peeled.

Water

Drinking water

Water quality from the public drinking supply can not be guaranteed for most countries outside northern Europe, North America and Australia. Travellers should be aware of the risks and precautions associated with water quality whether for drinking, washing, preparing food or swimming. Travellers on short trips to areas with water supplies of uncertain quality should avoid drinking tap-water or untreated water from any other source. It is best to keep to hot drinks, bottled or canned drinks (carbonated drinks are slightly safer). Boiling is a good way of treating water and this can be used for drinking or brushing teeth. Ice is only as safe as the water from which it is made and drinks should be cooled by placing them on ice rather than adding ice to them.

Bathing water

Swimming-pools, fresh-water or sea-water require filtration and cleansing unless the water is frequently changed. If this is not done infections of the eyes and ears are a hazard. If the general cleanliness and hygiene standards of a hotel are satisfactory, its swimming-pool is likely to be safe. Fresh-water lakes, dams and slow-flowing rivers are likely to be infected with bilharzia in countries where it is present, namely throughout the tropics and subtropics. Sea-water is usually safe from infection unless it is close to sewage outlets or highly populated areas where sanitary conditions are poor.