Health Advice for the Returning Traveller; When to see the GP?

It’s the time of year again when all our backpacking students return from the four corners of the world. Some will be arriving for the first time in Bristol, as international students of course, and many of you will have been traipsing through the jungles/ beaches and villages of the world’s most remote places, possibly even to Coca-cola free zones!

Unfortunately, even if you did everything right, had every last jab, and took all your malaria pills, you may still be at risk of post-travelling illness, so here is a quick summary of what to watch for and what to act on;

  • Tell the nurse/ doctor exactly where you have been, and dates
  • Tell them if you worked in ‘at risk’ environments, eg in a hospital/ clinic
  • Most illnesses will be common conditions like pneumonia/ fungal skin rashes
  • Be honest about malaria tablet history and compliance
  • Report any treatment tried or taken overseas
  • Fever is a common symptom requiring medical attention in returning travellers, especially if it is accompanied by; rash/ jaundice/ breathing difficulties/ bruising/ persistent vomiting/ altered conscious level or paralysis (the latter are extremely rare with only 0.3% of unwell travellers ever requiring hospital admission).
  • Malaria commonly presents with fever, chills, sweats, headaches, muscle pains, nausea and vomiting.
  • Jaundice (yellowing of the skin, and whites of the eyes) can indicate Hepatitis, most commonly type A, from infected food and water.
  • Arbovirus infections (Dengue, West Nile and Chikungunya fevers) are the main cause of viral fevers in returning travellers, and tend to have short incubation periods, typically less than two weeks .ie you will show symptoms within 2 weeks of being infected.
  • Diarrhoea is extremely common in travellers, and those who develop three or more loose stools in an eight-hour period, especially if associated with nausea, vomiting, abdominal cramps, fever, or blood in stools, may benefit from antibiotics.
  • Prolonged, severe diarrhoea with blood should be reviewed by a GP.
  • Skin rashes are very common, and should be reviewed by your GP if not settling, or if associated with fever.
  • The vast majority of travellers’ infections have a short incubation period, meaning that symptoms will start within 10 days or less from infection. The notable exceptions are schistosomiasis (bilharzia)/ malaria/ TB/yellow fever, and Q fever.



Therefore, if you continue to feel unwell despite being home, and eating and drinking normally for you, then please come and see one of the GPs. You may also find it useful to look at the following;




It only takes ONE bite!

“Off to Tanzania- leave in a couple of days! Sooo excited- mustn’t forget my yellow fever certificate- what was it the nurse said- Oh yes to photocopy it, keep this separate and put the original in my passport- good advice. I’ve been planning this trip for months- teaching English to children and construction work in a remote village. Not sure what to expect as staying with a local family- what will their home be like? What will I eat? How hard will the work be? Will they have internet close by??

Must start taking my malaria tablets… and remember to take them everyday.

 What an amazing country- full of colours, sights and smells… Love it! My host family are so welcoming and generous, I’ve settled in well- if a little homesick to start with- and enjoying the teaching. The children are sooo adorable. I have made a couple of friends here who are also doing charity work- one in particular Sarah who is staying with the same family as me.

We are sharing the same room which is rather basic but home to us now and it’s good to have the company- Luckily my little travel sewing kit came in useful as managed to tear a hole in my mosquito net on the first night!

Its such a different world here- so lovely eating dinner every evening outside under the stars- Although there are lots of mosquitoes so have been spraying myself with DEET and wearing my long shirt and trousers as the nurse in the travel clinic advised- mentioned this to Sarah, but she doesn’t seem that bothered with this- wearing vest tops and shorts- as says ‘she doesn’t usually get bitten’ and is taking her antimalarial tablets like me everyday anyway.

 We have now moved on to helping build another room for the school. Sarah hasn’t been well since waking up this morning- feeling a bit ‘fluey’ muscle aches and a headache- she reckons its too much sun as we spend a lot of our time outside now, she’s going home to bed- I’ll check on her at lunchtime…

 Sarah isn’t at all well – she now has a very high fever I’m really worried about her… I spoke to one of the charity organisers and they have sent her straight to hospital with suspected malaria. I cannot believe it! She only has a few mosquito bites- I know she didn’t cover up or use insect repellents, but she took her antimalarial tablets just as I did everyday.”



♦ Between 1990 – 2009, every year approximately 1,800 British travellers returned home with malaria.

♦ The UK is one of the biggest importers of malaria in Europe.

♦ The most severe form of malaria (plasmodium falciparum) accounted for 79% of cases amongst British travellers in 2009.

♦ Malaria is a preventable infection but can be fatal if left untreated – an average of nine people die each year from malaria in the UK.

♦ Malaria is transmitted by an infected mosquito. It only takes one bite from an infected mosquito to contract malaria.


Remember that antimalarial tablets reduce your risk of malaria significantly, but they are not 100% effective.

ABCD of malaria prevention:

Be Aware of the risk

Bite prevention

Compliance with Chemoprophylaxis

Recognising symptoms and prompt Diagnosis



Students’ Health Service ‘Malaria Advice’ patient information leaflet- available at the practice