Travel health: attitudes and behaviour

Citation

Zuckerman, J. (2000), "Travel health: attitudes and behaviour", Nutrition & Food Science, Vol. 30 No. 6. https://doi.org/10.1108/nfs.2000.01730faf.001

Travel health: attitudes and behaviour

Travel health: attitudes and behaviour

Introduction

UK residents are travelling abroad, whether for holiday or business, in ever increasing numbers. In 1998, more than 50 million trips abroad were made – an increase of 25 per cent in just three years (Office for National Statistics, 1998). Further analysis of these travel trends shows an increase in trips made to further afield destinations, such as the Caribbean, Asia and Africa.

Travel outside western Europe and North America to such destinations is associated with an increased risk of contracting travel-related infectious diseases such as hepatitis A, typhoid and hepatitis B (Salisbury et al., 1996). While the principal route of transmission for the latter is blood borne, infection with hepatitis A and typhoid is predominantly associated with ingesting contaminated food and drink.

Effective and safe vaccines exist to protect the traveller visiting countries where there is a risk of infection with these diseases. The following market research was conducted to explore further the travel trends to "at risk" areas as well as individuals' attitudes and behaviour towards seeking travel health advice and preventive health measures before undertaking travel.

Methodology

Interviews were conducted face to face involving 3,904 adults aged 15 years and over. This cohort was geographically and demographically representative of all adults in the UK. The research was conducted by the independent market research agency, Ipsos RSL. The fieldwork was conducted in two waves – 27-31 August and 3-7 September 1999. All questions related to travel during a 12-month period between September 1998 to August 1999.

"At risk" destinations are defined as those destinations posing a medium or high risk of contracting hepatitis A, hepatitis B or typhoid and where immunisation against these specific diseases is currently recommended.

Results

During the period September 1998 to August 1999, around one-third of all adults travelled outside the UK at some time. An estimated 5.4 million adults (approximately 11 per cent of the UK adult population (48 million)) travelled to an area of the world which has been classified as an at risk destination for hepatitis A, hepatitis B or typhoid.

Of the group questioned, 51 per cent claimed to have travelled unprotected on their last trip. A total of 45 per cent of this group claimed to return to an "at risk" area of the world every year.

Over two-thirds (67 per cent) of "at risk" travellers failed to seek advice from anyone regarding travel health prior to their last trip. A total of 18 per cent sought advice prior to booking their travel, 4 per cent did so when booking and 8 per cent sought advice having already booked their travel arrangements.

Of unprotected travellers visiting at risk destinations, 24 per cent failed to get vaccinated because they were unaware of the risks to their health. Nearly one-third (31 per cent) of this group considered the risk to their wellbeing too low to justify getting protection, while 30 per cent had been advised that immunisation was not needed. Only 3 per cent cited fear of needles as a reason for not being vaccinated.

One-quarter (24 per cent) of all travellers who sought travel health advice did so within two weeks of departure. A total of 36 per cent did so a month or less before leaving the UK to visit "at-risk" destinations.

Discussion

Transmission of food- and water-borne diseases, primarily associated with the ingestion of contaminated food and drink, is responsible for a significant level of the morbidity experienced by UK residents travelling abroad.

Traveller's diarrhoea is estimated to affect 30-40 per cent of all travellers (McKee, 1996), which if not treated can cause severe dehydration and significant morbidity, especially in vulnerable patients such as young children and the elderly.

On an average planeload of 333 unprotected tourists returning from a high-risk destination for hepatitis A, there is likely to be one passenger who has contracted the disease (Steffen, 1993). The risk for those eating and drinking under less hygienic conditions, such as hikers and backpackers, is considerably higher, at around one case for every 50 visitors per month of stay (Steffen, 1994). While the number of notified hepatitis A cases in England and Wales fell by 85 per cent during 1990-1998, the proportion accounted for by those with a history of travel rose from 7.6 per cent to 13.7 per cent.

As well as causing significant morbidity in those who contract the disease, with many patients taking months to recover, "travel-imported" hepatitis A represents an important public health issue (Packham, 1996).

The risk of typhoid, a disease also transmitted by ingesting contaminated food and water or by accidental contact with infected human faeces, is also often found in those countries which pose a risk of hepatitis A. Globally, the World Health Organisation estimates that about 16 million cases of typhoid fever occur annually in the world, causing more than 600,000 deaths. Approximately 160 cases of typhoid fever are notified in England and Wales each year, which are directly related to travel (Public Health Laboratory Service Web site).

The sequelae following infection with typhoid may be serious. In 0.5-1 per cent of cases, complications such as intestinal perforation and haemorrhage may occur (WHO Web site). In come cases, where the patient remains a chronic carrier, the disease may progress to cancer of the biliary tract, colorectum, pancreas, lung and other sites.

The principal prevention strategies to help minimise the risk of contracting such diseases include immunisation where appropriate (i.e. for typhoid and hepatitis A), and the adoption of sensible and safe eating and drinking measures, i.e. "cook it, peel it, boil it".

However, this new market research highlights that a significant number of adults who are travelling abroad are placing themselves at risk of contracting these diseases, having not sought travel health advice and appropriate preventive measures before leaving the UK.

It also highlights that a significant number of those who do present for travel health advice do so relatively late in the day. This may compromise the effectiveness of some preventive strategies, e.g. individuals are often required to begin anti-prophylaxis medication for malaria two weeks before travel.

On a larger scale, strategies to raise awareness of the importance of travel health amongst the travelling public in order to encourage timely presentation at their family practice or local travel health clinic should be considered. To maximise the effectiveness of such messages, these should be timed to coincide with spring/early summer, when a significant number of UK residents plan travel abroad.

At a practice level, the primary care team should be encouraged to discuss proactively patients' travel and holiday plans, as well as developing in-surgery awareness displays in advance of the "holiday season" which highlight sensible and safe eating and drinking measures.

Jane ZuckermanTravel Medicine Consultant/ Director of the Royal Free Travel Health Centre, London

References

McKee, M. (1996), "Travel-associated illnesses", BMJ, Vol. 312, pp. 925-6.Office for National Statistics, International Passenger Survey 1998, Travel Trends.Packham, C. (1996), "Notification of travel-associated infections", Travel Medicine International, Vol. 15 No. 5, pp. 195-9.Public Health Laboratory Service Web site, available at: www.phls.co.ukSalisbury, D. and Begg, N. (1996), Immunisation against Infectious Diseases, HMSO, London.Steffen, R. (1993), "Hepatitis A and Hepatitis B: risks compared with other vaccine preventable diseases and immunisation recommendations", Vaccine, Vol. 2 No. 5, pp. 518-20.Steffen, R. (1994), "Epidemiology and prevention of Hepatitis A in travelers", JAMA, Vol. 272 No. 11, pp. 885-9.World Health Organisation Web site, International Travel and Health, available at: www.who.int