Information
Editors
Traveller's Infection Prophylaxis
Essentials
- To ensure adequate and specific protection against certain diseases
- To inform about other measures of health protection
- To start prophylaxis and protection early enough, no later than 3 months before travel, for those who will stay in the tropics for a long time and for chronically ill persons
General health guidance
- The greatest risks for a traveller: traffic, alcohol, sex
- The most common infectious health problems: traveller's diarrhoea and respiratory infections
- The existing primary diseases should be in good control before the travel.
- Ensure that the travel insurance is in order and its conditions known.
- Instructions on sensible eating and hygiene
- Diarrhoea prophylaxis and treatment Acute Diarrhoeal Disease in a Traveller
- Suitable clothing and footwear
- Skin care
- Wound cleansing
- First-aid of bite wounds in possible rabies exposure Suspicion of Rabies Exposure
- Sufficient sun protection
- Treatment of insect bites
- Mosquito repellents and nets
- Condom protects against STDs, hepatitis B and C and HIV.
- Disease-specific protection: malaria prophylaxis and specific vaccinations. See also national or local guidance.
- Malaria is a life-threatening disease. Protection against mosquitos and prophylactic medication are equally important in malaria prophylaxis.
- Anopheles mosquitos bite during dusk and dawn and at night.
- Mechanical prevention of mosquito bites
- Covering clothing, light-coloured clothes that cover ankles and wrists
- Nets on windows and doors, permethrin-treated bed nets, eradication of mosquitos in bedrooms
- Mosquito repellents for exposed skin areas
- At least products containing DEET and icaridin are effective.
- Initiated, depending on the medication, one day to one week before the journey and continued for 1 to 4 weeks after the journey Diagnosis and Treatment of Malaria.
- The choice of proper prophylactic medication varies from country to country, and up-to-date recommendations for the medication should always be checked. Prophylactic antimalarial drugs suitable for most regions include mefloquine, atovaquone-proguanil and doxycycline.
- Mefloquine
- For adults 1 tablet/week
- Started 1 week before malaria exposure and continued for 4 weeks after the exposure has ended.
- Should not be used if the person has a history of mental problems or convulsions Mefloquine for Preventing Malaria during Travel to Endemic Areas.
- If the person travelling to malarial region has no earlier experience in taking mefloquine, it is advisable to start the medication 3-4 weeks before travelling so that there is time to change the prophylactic medication before the travel if needed.
- Atovaquone-proguanil 250 mg/100 mg
- For adults 1 tablet/day
- Started 1 day before the exposure to malaria starts and continued for 1 week after the exposure has ended.
- Should be taken with food containing fat.
- For the time being effective in all malarial regions of the world
- Doxycycline 100 mg
- For adults 1 tablet/day
- Started 1 day before the exposure to malaria starts and continued for 4 weeks after the exposure has ended.
- Protection from sunlight during doxycycline use is important.
- For the time being effective in all malarial regions of the world
- A traveller should never enter the malarial regions in Africa without prophylactic medication.
- Factors influencing the individual choice of prophylactic medication include the length of stay, traveller's age, possible pregnancy, drug contraindications, chronic diseases, and traveller's own preferences regarding how frequently the drug needs to be taken, as well as the duration and price of the medication.
- Travelling to malarial regions should be avoided during pregnancy, if possible. If travelling cannot be avoided, use of prophylactic medication and protection against mosquitos is very important, since during pregnancy the infection may develop rapidly into a serious disease or lead to miscarriage.
- Products containing DEET can be safely used.
- In children, prophylactic medication and protection against mosquitos is very important, since in them the infection may develop severe symptoms more rapidly than usual.
- Products containing DEET are safe from the age of 2 months onwards.
- The traveller should always be reminded that no prophylactic medication provides full protection against malaria. If the traveller becomes feverish after returning home, he/she should see a doctor and ask to be tested for malaria.
- Tetanus, diphtheriadepending on the person's age and national vaccination programmes every 10-20 years for all travellers
- Vaccination against measles, mumps and rubella (MPR) for children over 6 months of age when travelling in areas endemic for measles or where wider epidemics of measles repeatedly occur. Vaccination of infants less than 11 months of age does not replace the MPR vaccine given in the general vaccination programme. For an adult, two doses of MPR vaccine are recommended at the minimum interval of 6 months but preferably of 2-3 years if he/she has not had the MPR diseases or has not previously been vaccinated with the MPR vaccine.
- Hepatitis A vaccination is recommended when travelling outside Western Europe, Australia and North America.
- The vaccine is administered in two doses at an interval of 6 to 12 months. According to current knowledge, the protective effect lasts for lifetime. A combination vaccine protects against both hepatitis A and B.
- Polio vaccination should be taken if travelling for more than 4 weeks in areas where exposure is possible (certain countries in Asia and Africa). A booster vaccination is needed if more than 12 months have passed since the previous vaccination. A booster is not needed for a travel that lasts less than 4 weeks.
- The vaccination of children should follow the vaccination programme of the home country. The schedule may be accelerated if considered necessary.
- There are plenty of vaccinations - choose those that are necessary for the individual traveller (see also Vaccinations).
- A vaccination certificate for yellow fever (WHO's ”yellow card”) may be required at border crossing of those who come from endemic areas.