Recommendations for preventing traveller's diseases before packing your bags

In recent years, the number of people travelling long distances around the world has increased significantly. Specifically, more than 50% of international travel is to tropical or subtropical areas, which, according to Dr Ignacio Barbolla Díaz, specialist in internal medicine and assistant physician at the Family Medicine Unit of the Ruber Internacional Hospital, causes ‘a significant number of people to be exposed to emerging and re-emerging infectious diseases, posing a risk to their health’.
In fact, he stresses that ‘infections are the leading cause of morbidity during or after travel and account for up to 2-3% of mortality’. However, in many cases, these infections can be prevented, so it is important for travellers to be aware of the risks in order to take the appropriate preventive measures. In this regard, both infectious disease specialists and vaccination centres, it adds, ‘have a fundamental role to play in providing comprehensive care to citizens, focusing on the area being visited, the time of year, the duration, the type of trip and the characteristics of each individual’.
Among the most common traveller's diseases is diarrhoea, which occurs in 10-70% of cases and is usually caused by enterotoxigenic Escherichia coli (ETEC) bacteria. ‘It usually appears in the first week of travel in environments with poor sanitary habits due to contact with contaminated water or food, being more frequent in Southeast Asia and in warmer and more humid seasons,’ explains Dr. Barbolla.
It is defined by the presence of three or more loose or liquid stools in a 24-hour period, for three or more days, and may be accompanied by fever, abdominal pain, nausea and vomiting, tenesmus, and blood or mucus in the stool. As the expert points out, ‘episodes are almost always benign and self-limiting, but dehydration can be severe.’
Fever is one of the main reasons for travellers to seek medical attention and hospitalisation. It covers both trivial and lethal diseases or those with a high risk of transmission and usually appears during the trip or within two weeks of return. ‘The differential diagnosis ranges from universally distributed infections to tropical diseases, and the most common causes are arboviruses, i.e. diseases caused by viruses transmitted by arthropods (mosquitoes or ticks), with dengue being the most common. Other causes include malaria and rickettsiosis,’ he points out.
Malaria is a disease caused by parasites of the genus Plasmodium, transmitted by the bite of mosquitoes of the genus Anopheles. According to Dr Barbolla, ‘any traveller who has been in an endemic area and has a fever with no clear cause in the weeks following their trip should be evaluated urgently to rule out this condition’.
To prevent these conditions, the internal medicine specialist considers pre-travel planning to be essential. In this regard, he recommends the following:
- Consult a doctor four to six weeks before travelling.
- Take out international travel medical insurance and carry a basic first aid kit consisting of painkillers, repellent, disinfectant, antibiotics, chemoprophylaxis, oral rehydration salts and personal medication.
- Vaccination: update your vaccination schedule (tetanus, diphtheria, measles, influenza, COVID-19, hepatitis B and polio) and consider specific vaccinations depending on your destination, including hepatitis A, cholera, typhoid fever, yellow fever, rabies, meningococcal meningitis, Japanese encephalitis and tick-borne encephalitis.
- Chemoprophylaxis or prevention with medication: when indicated depending on the destination and risk, it is essential to prevent malaria by taking antimalarial medication before, during and after the trip. In addition, according to the doctor, ‘emergency antibiotics are generally not recommended to prevent traveller's diarrhoea’.

On the other hand, Dr. Barbolla emphasises planning during the trip, highlighting some tips such as:
- Take precautions with water and food, thus avoiding diseases such as traveller's diarrhoea, hepatitis A, typhoid fever or cholera, among others. ‘Contaminated food and drinks are the most common cause of illness in travellers,’ he says. To this end, travellers should follow some basic preventive measures such as personal hygiene, washing their hands frequently with soap and water and using hydroalcoholic gel; not drinking tap water; treating potentially dangerous water by boiling, chlorinating or purifying it with tablets; not eating raw or undercooked food, meat, fish and seafood; drinking packaged milk and being careful with sauces; washing fruit and vegetables thoroughly or peeling them; and avoiding eating at street stalls with poor hygiene.
- Avoid contact with animals, bites, contaminated bodily fluids or excrement, and the consumption of food of animal origin, especially meat and dairy products.
- Do not bathe in stagnant fresh water.
- Do not walk barefoot and wear closed shoes.
- Avoid insect bites. To do this, it is recommended to wear long-sleeved clothing at dusk and dawn, avoid dark colours and strong perfumes, as they can attract mosquitoes; use repellent; sleep under insecticide-treated mosquito nets, especially in rural areas; use sprays, mosquito coils and vaporisers containing pyrethrins; and use air conditioning or screens on windows and doors.
- Sexually transmitted infections (STIs): according to Dr Barbolla, these have been on the rise in recent years, including hepatitis B, HIV/AIDS, syphilis, monkeypox and Zika. He therefore stresses the importance of taking care ‘not only with sexual practices, but also with utensils, tattoos and acupuncture’.
In short, to minimise the impact of a possible infection during travel, this assistant physician at the Internal and Family Medicine Unit of Ruber Internacional Hospital considers it ‘essential to make adequate plans in advance at a specialist consultation,’ where key elements in the traveller's medical history will be evaluated, such as personal history of interest, previous illnesses and vaccinations received, medication taken by the traveller, and pregnancy.
In addition, the countries and areas to be visited will be analysed, as well as the risk factors related to the destination, and information will be provided on current outbreaks in the place visited. It is also important to take into account both the date of travel and the duration of each stay, and the risk exposures of the activities to be carried out will be discussed. As Dr Ignacio Barbolla concludes, ‘preparing for the trip with a specialist reduces the impact of a possible illness and improves the quality of the trip’.