Prevention of infections while traveling

What is it about ?

Unfortunately, you can get sick while traveling. It even happens that a trip to a given region increases the risk of coming into contact with certain pathogenic germs. Many problems can often be avoided by being aware of certain illnesses and dangers before you leave and by ensuring you have adequate protection.

What is their frequency?

Infections are very common among travelers. The most common problems are traveler’s diarrhea (turista) and respiratory tract infections. It is not always possible to escape it, even when traveling in good conditions.

What can you do ?

General measures

Whether you are moving to a neighboring country or halfway around the world, it is always important to keep a few steps in mind.

• To prevent the traveler’s diarrhea, nothing like paying attention to what you eat or drink.
  • Wash your hands regularly.
  • Be careful with raw or undercooked foods.
  • Drink mineral water or water that is sufficiently boiled, rather than tap water.
• Take a basic kit for wound care so that all wounds, even the most trivial, can be cleaned and disinfected thoroughly.
• In case of animal bite, you should immediately clean the wound with soap and water, rinse it, and then disinfect it (with alcohol or povidone iodine). Then consult a doctor and contact your travel insurance. They will assess the need for a rabies vaccination.
• If you have some sex during your trip, use condoms to protect yourself from sexually transmitted infections (STIs) such as hepatitis B and C or HIV.
• Avoid swimming in standing fresh water, where you risk getting an schistosomiasis.
• Make sure you have a good mosquito protection, which transmit various diseases. Some important tips:
  • Wear clothes that cover your arms, legs, and feet.
  • Apply a repellent to any parts of the body that are exposed. Preferably use a product containing DEET at a concentration between 30 and 50%.
    • In pregnant women and children, a concentration of 20 to 30% is rather recommended.
    • Apply the product every 4 to 6 hours on average.
    • Avoid contact with mucous membranes (eyes, mouth), wounds or lesions ofeczema.
    • If you also use sunscreen, apply sunscreen first, then DEET. Use a sunscreen with a high protection factor (30 or more), as DEET decreases the effectiveness of the sunscreen.
  • Wear clothing impregnated with insecticide (permethrin) if necessary.
  • Sleep under a mosquito net impregnated with insecticide (permethrin or deltamethrin). You will easily find it in shops.
  • Keep mosquitoes out of your bedroom, for example by installing mosquito nets on windows and vents.

Preperation

A distant journey is prepared well in advance. You may need more than one vaccinations.

• Make an appointment with your doctor in time to discuss this.
• You can also consult the website of theInstitute of Tropical Medicine (IMT) and check which vaccines are needed for your specific destination.

What can your doctor do?

First, your doctor will ask you questions about your travel plans. He will provide you with the appropriate advice depending on your state of health at the time of departure, your destination, but also the type of trip you are undertaking.

Medications

Protection against malaria (malaria)

If you are going to an area affected by malaria, you can take – in addition to good mosquito protection measures – a medication as a preventive measure. The decision to start this preventative treatment depends on your destination, the length of your stay and the time of year.

Your doctor will work with you to decide which medicine is best for you. It is therefore entirely possible that you will not take the same treatment as your traveling companions.

• The most commonly used drugs are mefloquine (Lariam®), the atovaquone / proguanil combination (Malarone®) and doxycycline (Vibramycin®).
• You should start these medicines before you leave and continue to take them afterwards. Your doctor will give you the appropriate instructions.
• Be aware that no medicine offers complete protection against malaria. If you develop a fever after your return, it is advisable to see a doctor.

Travelers’ diarrhea (turista)

Sometimes you may want to consider taking antibiotics in your travel pharmacy when you go far and long. Ask your doctor in what situations these medicines are needed, in order to avoid unnecessary use and development of antibiotic resistance.

Vaccinations

If you are going far and for a long time, it is important that you are perfectly in order to be vaccinated. But short trips are also a good opportunity to check your baseline immunization status.

Small overview of the most used vaccinations (for travelers):

• Diphtheria, tetanus, whooping cough
  • This vaccine is part of the ONE basic vaccination schedule and a booster injection is recommended every 10 years in all adults.
  • In Belgium, the booster vaccine is free.
• Polio
  • A vaccination booster is recommended for travelers going to places where they may be exposed (Asia and Africa).
• Measles, rubella, mumps (MMR)
  • Vaccination is recommended for children aged 6 to 12 months who travel to areas affected by measles.
  • Catch-up vaccination is recommended for people born after 1970 who have not received two doses of the vaccine.
• Hepatitis A
  • Vaccination is recommended for all travelers bound for Africa, Latin America and Asia.
  • If the vaccine was administered at least 14 days before departure, it offers close to 100% protection for at least 1 year. A second injection, after 6 to 12 months, provides lifelong protection.
• Hepatitis B
  • In Belgium, children born after 1987 and health professionals are systematically vaccinated.
  • When traveling, this vaccination is mainly recommended for people who:
    • travel often or for a long time;
    • go to work in the health care sector, in an orphanage or with street children;
    • have potentially risky behavior (sexual intercourse, piercings, etc.).
• Yellow fever
  • Vaccination is compulsory in some African and Latin American countries.
  • The yellow fever vaccine can only be given at an approved provincial health center or at theInstitute of Tropical Medicine (in Antwerp).
• Typhoid fever
  • Vaccination is only recommended in the following cases:
    • stay of more than 3 weeks in the Indian subcontinent;
    • traveler of foreign origin staying in his country of origin;
    • stay in very poor hygienic conditions.
• Cholera
  • This is an illness that you can get when you don’t have access to safe drinking water. As travelers hardly ever find themselves in this type of condition, the cholera vaccine is not recommended.
• Meningitis
  • Vaccination is indicated for some people leaving for sub-Saharan Africa, including:
    • travelers who will be in close contact with the local population (among others in public transport, a guest house) between December and June ;
    • migrants who are traveling in their country of origin and staying with the family;
    • travelers who stay there for more than 4 weeks.
  • Vaccination is compulsory for pilgrims going to Mecca (at least 10 days before departure).
• Rage
  • Vaccination is recommended for some travelers.
  • The main thing, however, is to avoid contact with dogs, monkeys or other stray animals.
• Japanese encephalitis
  • Vaccination against Japanese encephalitis is not recommended for all tourists.
  • It is especially useful for travelers who stay at least 3 to 4 weeks, between May and October, in rural areas of India and Southeast Asia.
• Tick-borne encephalitis
  • There is a risk of tick-borne encephalitis in most central European countries, Russia and the Balkans.
  • Vaccination is recommended before any stay involving many outdoor activities during the tick season (spring, summer or fall).
• Tuberculosis
  • Vaccination is very rarely recommended, in some cases only in very young children who move to a country at risk.
  • However, the vaccine (BCG) is currently no longer available in Belgium.

Want to know more?

VSadvice targeted by country:

• Traveling in good health – IMT – Institute of Tropical Medicine
• Ministry of Foreign Affairs, Foreign Trade and Development Cooperation

Prevention of sexually transmitted infections

• My Contraceptive – O’Yes
• LoveAttitude
• AIDS Prevention Platform

Others

• Your health during the trip – IMT – Institute of Tropical Medicine
• Healthy travel – IMT – Institute of Tropical Medicine
• Povidone iodine – CBIP – Belgian Center for Pharmacotherapeutic Information
• Good use of repellents – CBIP – Belgian Center for Pharmacotherapeutic Information (offers in particular a few names of specialties with a sufficient high concentration)

• Mefloquine – CBIP – Belgian Center for Pharmacotherapeutic Information
• Atovaquone / proguanil – CBIP – Belgian Center for Pharmacotherapeutic Information
• Doxycycline – CBIP – Belgian Center for Pharmacotherapeutic Information

Sources

• Your health during the trip – IMT – Institute of Tropical Medicine
• Foreign clinical practice guide ‘Prophylaxis of infections in travelers’ (2000), updated on 05.04.2017 and adapted to the Belgian context on 19.09.2019 – ebpracticenet