Health
The health of any traveller abroad may not be protected by services and legislation well-established at home. Changes in food and water may bring unexpected problems, as may insects and insect-borne diseases, especially in hot countries. Few have at their fingertips the current detailed knowledge needed to advise the traveller going to a particular country and personal reminiscences may not always reflect current or common problems. A danger of generalising is that it may be forgotten, for example, that malaria is a risk in Turkey, poliomyelitis occurs in Europe, and hepatitis A virus occurs worldwide and is not destroyed by many methods of purifying drinking water. Specific advice on which diseases are present in countries to be visited is likely to be complicated. A practical starting point for the traveller seeking advice is to consider which diseases can be prevented by immunisation, prophylactic tablets, or other measures, and decide whether it is appropriate to do so for each individual. An unpredictable environment is especially a problem for the overland traveller who plans his own journey, and he needs greater knowledge of disease prevention and management than the traveller in an airplane or on a sea cruise, whose environment, food and drink are largely in the hands of the operator. Unforeseen changes in timetables may lead to stays in accommodation not of the expected standard. Delays at airports can take place in overcrowded and unhygienic conditions where the facilities have not kept pace with increased demand, and also insect-borne diseases may be contracted. Jet-lag and exhaustion may prompt a traveller to take risks with food and drink. More experienced travellers tend to have fewer health problems. Better planning, immunisations and experience in prevention may all play a part, as well as salutary lessons learnt on previous occasions. A questionnaire survey of returning travellers (most of whom had been to Europe, especially the Mediterranean countries) showed that half had had diarrhoea or respiratory symptoms while abroad. Excessive alcohol, sun and late nights can add to the problems. About one in 100 package holidaymakers who take out a health insurance policy make a claim. Diarrhoea and sunburn are principal reasons, but accidents are also common. Injuries occur especially in and around swimming pools, to pedestrians forgetting that traffic drives on the right, and from unfamiliar equipment such as gates on lifts. Sexually transmitted diseases may be contracted and may require urgent treatment. Long-stay travellers may adapt to these initial problems, but then find themselves suffering from diseases endemic in their chosen country, such as malaria, hepatitis, diarrhoea and skin problems. Two per cent of British Voluntary Service overseas personnel contract hepatitis A within eight months if they are not protected. Car accidents occur while driving on unmetalled roads, and some emotional problems may be resolved only by an early return home. The traveller should be insured against medical expenses and most policies include the cost of emergency repatriation when appropriate. Such insurance, however, rarely covers a service overseas similar to that available at home. Language and administrative differences are likely to present problems.
   Children
As children begin to crawl and walk they become more vulnerable to faecal-oral infections and hazards such as bites, accidents and burns. Open wounds should be kept clean and covered with dressings until healed. Deaths from scorpion bites are unusual but mostly occur in children aged under two years. Allowing toddlers to play outside unattended can be particularly hazardous. Taking adequate malarial prophylaxis should not encourage the traveller to ignore the risks from other mosquito-borne diseases such as dengue, which can be more severe in children. Protection from mosquito bites is also important in those children who are strongly allergic to them. Appropriate clothes and bed or window netting at night are usually more valuable in the long term than insect repellents.
   Pregnancy
Live vaccinations are best not given during pregnancy, although if someone unprotected against yellow fever is going to live in a high risk area, the theoretical risk of vaccination is outweighed by the serious nature of the illness. If the vaccine is not given, a doctor's letter endorsed with a health board or authority stamp to say the inoculation is contra-indicated is usually accepted. Inactivated poliomyelitis vaccine may be used instead of oral live vaccine. A mother immunised against tetanus passes on protection to her baby over the neonatal period and a booster can be given during pregnancy if necessary. Hepatitis A in pregnancy may be more severe and also result in premature labour. Prevention with normal immunoglobulin is generally encouraged for those at risk. Malarial prophylaxis should be maintained throughout pregnancy but the risks of some drugs have to be balanced against the type of malaria and likelihood of its transmission in different areas and specialist advice should be sought.