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Our lot is a perilous age … but where shall we fly to escape from pestilences that come and pestilences that do not come, from ships that bring us yellow fever, from cattle diseases that can only be exterminated by exterminating the cattle, from infectious patients whose pulses must be felt with a pair of tongs and their chests explored with tarred stethoscopes.



  • Advise the patient to plan early—at least 8 weeks beforehand.

  • Register with Smartraveller (provided by the Australian Department of Foreign Affairs and Trade (DFAT)).

  • Advise a dental check before departure.

  • Allow adequate time for consultation (e.g. 30–45 minutes).

  • Individualise advice.

  • Provide current information.

  • Provide written as well as verbal advice.

  • Provide a letter concerning existing medical illness and treatment.

  • Encourage personal responsibility.

Key facts and checkpoints

  • The main diseases facing the international traveller are traveller’s diarrhoea (usually relatively mild) and malaria, especially the potentially lethal Plasmodium falciparum malaria.

  • Register with Smartraveller (provided by the Australian Department of Foreign Affairs and Trade (DFAT)).

  • Most cases of traveller’s diarrhoea are caused by enterotoxigenic Escherichia coli, Shigella sp. and Campylobacter species.

  • Enteroinvasive E. coli (a different serotype) produces a dysentery-like illness similar to Shigella.

  • Traveller’s diarrhoea is contracted mainly from contaminated water and ice used for beverages, washing food or utensils, or cleaning teeth.

  • Poliomyelitis is endemic in at least 20 countries and thus immunisation for polio is still important.

  • One bite from an infected mosquito during a single overnight stop in a malaria area can result in a possible lethal infection.

  • Infections transmitted by mosquitoes include malaria, yellow fever, Rift Valley fever, Japanese B encephalitis, chikungunya, Zika and dengue fever. Avoiding their bites is excellent prevention.

  • Every year approximately 1000 Australians catch malaria while travelling overseas.

  • Malaria is a dusk-till-dawn risk only, but bites from daytime mosquitoes can cause dengue.

  • P. falciparum malaria is steadily increasing, as is resistance to newer antimalarials.

  • It is important for GPs to consult a travel medicine database to obtain specific information about ‘at risk’ countries.

  • Avoid tattooing, ear-piercing, acupuncture or any skin puncturing while overseas.

  • The commonest causes of death in travellers overseas are trauma (26%), particularly traffic accidents, and homicide (16.9%).

  • Travellers visiting family and relatives (TVFR) in some countries are at risk of contracting preventable travel-related illnesses.


The commonest problem facing travellers is traveller’s diarrhoea but other important diseases caused by poor sanitation include hepatitis A and worm infestations, such as hookworm and schistosomiasis.

Contamination of food and water is a major problem, especially in third world countries.

Reputable soft drinks, such as Coca-Cola, should be recommended for drinking. Indian-style tea, in which the milk is boiled with tea, is usually safe, but tea with added milk is not. The food handlers can ...

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