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Dr. Brian Aw, the medical director of the International Travel Clinic at Health 1st in Richmond Hill, Ont., has some expert advice on how to safeguard your health before and during your hard-earned holiday.
Q: What are the most common health complaints that can ruin a person's vacation?
A: The most common ailment that Canadian travellers get when going abroad is traveller's diarrhea. Statistics suggest that about 50 per cent of travellers will get a bout of traveller's diarrhea on a two-week trip. The other diseases that I tend to see are hepatitis A, which is another food and waterborne disease. More rarely, you'll hear about typhoid fever and malaria.
Q: What suggestions would you offer to travellers to avoid some of these diseases?
A: Essentially, what I tell travellers is "Boil it, cook it, peel it or forget it."
Boil it usually refers to water and is advisable for travellers who are going to developing parts of the world that don't have access to treated water. Avoid tap water. And if you're showering or swimming, try not to ingest any water.
Peel it is for fruit. If you're at a buffet, a lot of fruit and vegetables tend to be sliced and washed in local water, so there's risk of cross-contamination. I tell people to grab an orange or a banana and peel it themselves.
Cook it is for prepared foods. It's always advisable to eat food that's served piping hot, and to avoid salads and foods that are raw. Of course, avoiding street vendors is always a big tip for people who are going on day excursions off the resort.
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Q: Are there vaccines available that can help?
A: From a medical standpoint, there's one vaccine that's available to prevent traveller's diarrhea that focuses on enterotoxigenic E. coli, which is one of the most common forms of diarrhea that we see among travellers.
Dukoral is an oral, two-dose vaccine that gives you protection against E. coli as well as cholera. The cholera protection is usually aimed at higher risk travellers (such as aid workers), whereas the E. coli portion can pertain to a lot of travellers who are just going on a one-week all-inclusive trip.
Q: Are there any special requirements or restrictions that you can think of for taking Dukarol?
A: It's safe for individuals two years of age and older, as long as you're not allergic to the contents of the medication. There is no safety data currently available for pregnant women, but breast-feeding women can take it. Because it is a two-dose vaccine taken a week apart, you want to start taking it at least two weeks before you leave for your vacation. Otherwise, you're not going to have optimal protection when you arrive at your destination.
Q: When it comes to preparing for a tropical vacation, what should I keep in mind?
A: It never hurts to research the location you're going to. Certain itineraries have higher risks of developing things like traveller's diarrhea.
You can also look into which hotels have treated water, but it is sometimes still questionable, so you should watch the ice cubes and stick to bottled water if possible. It's always good to carry some over-the-counter medication like Imodium or Pepto-Bismol, in case you need to catch a plane or bus. Some people also like to bring a rehydration solution like Gastrolyte or Pedialyte for children.
A travel kit should always contain items for injuries, such as bandages, Polysporin, your antibiotic creams and an antifungal cream. Insect repellant is a must, because there are a lot of insect-related diseases like malaria or dengue fever. Tylenol is good for fever and pain.
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Q: What advice would you give to someone dining outside of the resort?
A: I always tell people to try to eat at designated tourist restaurants and to avoid the street vendors or the greasy spoons. Once you're in the restaurant, a lot depends on what you're ordering. Stick to things like bread and pasta as opposed to raw foods. I also tell travellers to avoid dairy products, because some of the dairy products can involve unpasteurized milk.
Even on the resort, it's best to stick to designated restaurants as opposed to eating from food stands near the beach because food will be sitting out in the sun. The bigger restaurant facilities will probably have better temperature and storage control.
Q: Any advice for someone who has a diet composed mainly of veggies?
A: You can still eat vegetables, just aim to have them in dishes like stir-fry where you know they'll be cooked. Cooked vegetables would be a better option than a salad.
Q: How necessary is it to go to a travel clinic? Should you go before you leave or once you're back?
A: A lot of travel clinics do assist with post-travel ailments, but the main purpose of them is actually for pre-travel. Travel clinics are all about prevention. We want Canadians to be aware of the risks involved with the destinations they go to so they enjoy their vacation, but also, from a public-health perspective, so they are not bringing diseases back to our local population.
A great, neutral website that lists the travel clinics across Canada by province is travelhealth.gc.ca. It indicates whether clinics offer yellow fever vaccine, which is required to get visas or entry into certain countries.
The other thing I love about the website is that it has all of the travel health notices, such as a warning for cholera in the Dominican Republic. It also has all of the latest outbreaks listed chronologically to warn people. It's a good resource for both naive and seasoned travellers.
Q: What should someone do if they get seriously ill and require medical attention on their vacation?
A: My first suggestion is for everyone to make sure they have travel health insurance. Secondly, if you're getting sick in the developing part of the world, quality of care can be variable, so it's always good to contact the local Canadian consulate in that country. They will have a list of designated clinics that they feel are recommendable to Canadians travelling in that country.
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