All individuals planning travel should seek advice on the potential hazards in their chosen destinations and understand how best to protect their health and minimize the risk of acquiring disease. Forward planning, appropriate preventive measures and careful precautions can protect their health and minimize the risks of accident and of acquiring disease. Although the medical profession and the travel industry can provide extensive help and sound advice, it remains the traveller’s responsibility to seek information, to understand the risks involved and to take the necessary precautions to protect their health while travelling.

Medical consultation before travel
Travellers intending to visit a destination in a developing country should consult a travel medicine clinic or medical practitioner before the journey. This consultation should take place at least 4–8 weeks before the journey and preferably earlier if long-term travel or overseas work is envisaged. However, last-minute travellers can also benefit from a medical consultation, even as late as the day of travel (see 9.1). The consultation will include information about the most important health risks (including traffic accidents), determine the need for any vaccinations and/or antimalarial medication and identify any other medical items that the traveller may require. A basic medical kit will be prescribed or provided, supplemented as appropriate to meet individual needs.
Dental, gynaecological and age-appropriate examinations are advisable before prolonged travel to developing countries or to remote areas. This is particularly important for people with chronic or recurrent health problems. Travellers with underlying medical problems are strongly advised to consult a travel medicine clinic or medical practitioner to ensure that their potentially complex travel health needs are met. All travellers should be strongly advised to seek comprehensive travel insurance.

Medical examination after travel
Travellers should be advised to have a medical examination on their return if they:
Return with a fever from a country where malaria is or may be present, so that malaria can be excluded as a cause of their illness
Suffer from a chronic disease, such as cardiovascular disease, diabetes mellitus, or chronic Respiratory disease or have been taking anticoagulants;
Experience illness in the weeks following their return home, particularly if fever, persistent diarrhoea, vomiting, jaundice, urinary disorders, skin disease or genital infection occurs;
They received treatment for malaria while travelling;
May have been exposed to a serious infectious disease while travelling;
have spent more than 3 months in a developing country.
Travellers should provide medical personnel with information on recent travel, including destination, and purpose and duration of visit. Frequent travellers should give details of all journeys that have taken place in the preceding weeks and months including pre-travel vaccinations received and malaria chemoprophylaxis taken.

Medical kit and toilet items
Sufficient medical supplies should be carried to meet foreseeable needs for the duration of the trip.
A medical kit should be carried for all destinations where there may be significant health risks, particularly those in developing countries and/or where the local availability of specific medications is uncertain. This kit will include basic medicines to treat common ailments, first-aid articles, and any other special medical items, such as syringes and needles (to minimize exposure to bloodborne viruses), that may be needed and can in some cases be used by the individual traveller.
Certain categories of prescription medicine or special medical items should be carried together with a medical attestation on letterhead, signed by a physician, certifying that the traveller requires the medication or the items for a medical condition. Some countries require that this attestation be signed not only by a physician but also by the national health administration.
Toilet items should also be carried in sufficient quantity for the entire visit unless their availability at the travel destination is assured. These will include items for dental care, eye care (including contact lenses), skin care and personal hygiene, including alkaline soap for washing wounds suspected of rabies contamination.

Contents of a basic medical kit
First-aid items:
Adhesive tape
Antiseptic wound cleanser or alkaline soap
Safety pins
Emollient (lubricant) eye drops
Insect repellent
Insect bite treatment
Antihistamine tablets
Nasal decongestant
Oral rehydration salts
Oral rehydration salts
Simple analgesic (e.g. paracetamol)
Sterile dressing
Clinical thermometer
Adhesive strips to close small wounds.

Additional items according to destination and individual needs:
Medication for pre-existing medical conditions
Antidiarrhoeal medication (to include an antisecretory agent, an antimotility drug, oral Rehydration salts, with appropriate written instructions regarding their use)
Antibiotics targeting the most frequent infections in travellers (e.g. travellers’ diarrhoea, and Infections of skin and soft-tissue, respiratory tract and urinary tract)
Antibacterial ointment
Antifungal powder
Antimalarial medication
Mosquito net and insecticide to treat fabrics (clothes, nets, curtains)
Adequate supplies of condoms and oral contraceptives
Medication for pre-existing medical conditions
Sterile syringes and needles
Water disinfectant
Spare eyeglasses and/or spare contact lenses (and solution)
Other items to meet foreseeable needs, according to the destination and duration of the visit.

Responsibility of the traveller
Travellers can obtain a great deal of information and advice from medical and travel industry professionals to help prevent health problems while abroad. However, travellers are responsible for their health and well-being while travelling and on their return, as well as for preventing the transmission of communicable diseases to others. The following are the main responsibilities of the traveller:

The decision to travel;
Recognizing and accepting any risks involved;
Seeking health advice in good time, preferably 4–8 weeks before travel;
Complying with recommended vaccinations and other prescribed medication and health measures;
Careful planning before departure;
Carrying a medical kit and understanding its use;
Obtaining adequate insurance cover;
Taking health precautions before, during and after the journey;
Obtaining a physician’s attestation pertaining to any prescription medicines, syringes, etc. being carried;
The health and well-being of accompanying children;
Taking precautions to avoid transmitting any infectious disease to others during and after travel;
Full reporting to a medical professional of any illness on return, including information about all recent travel;
Being respectful of the host country and its population;
Practising responsible sexual behaviour and avoiding unprotected sexual contact.

Insurance for travellers
Travellers are strongly advised to travel with comprehensive travel insurance as a matter of routine and to declare any underlying health conditions to their travel insurer. Travellers should be aware that medical care abroad is often available only at private medical facilities and may be costly. In places where good-quality medical care is not readily available, travellers may need to be evacuated in case of accident or illness. If death occurs abroad, repatriation of the body can be extremely expensive and may be difficult to arrange. Travellers are advised (i) to seek information about possible reciprocal health-care agreements between the country of residence and the destination country (see, and (ii) to obtain comprehensive travellers’ health insurance for destinations where health risks are significant and medical care is expensive or not readily available. This health insurance should include coverage for changes to the itinerary, emergency evacuation for health reasons, hospitalization, medical care in case of illness or accident and repatriation of the body in case of death. Travellers should discuss with the parties concerned any issues or claims as they happen and not upon return from the trip.

Travel agents and tour operators usually provide information about travellers’ health insurance and should advise travellers about the importance and benefits of travel insurance. It should be noted that some countries now require proof of adequate health insurance as a condition for entry. Moreover, some travel insurers require proof of immunizations and/or malaria prophylaxis as a condition of their approval for treatment or repatriation. Travellers should know the procedures to follow to obtain assistance and reimbursement. A copy of the insurance certificate and contact details should be carried with other travel documents in the hand luggage.