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;




World Health Day 7th April 2014: safer travel for all Bristol students

World Health Day is celebrated on 7 April every year to mark the anniversary of the founding of the World Health Organization in 1948. Each year a theme is selected that highlights a priority area of public health. In past years themes as diverse as road safety, climate change and high blood pressure have been chosen. The topic for 2014 is vector-borne diseases, which could be of great personal relevance to a large number of students who make international journeys whilst they are studying at the University of Bristol.

Vectors are organisms that transmit pathogens and parasites from one infected person (or animal) to another. Vector-borne diseases are illnesses caused by these pathogens and parasites. Vector-borne diseases account for a massive 17% of the estimated global burden of all infectious diseases.

The most well known and deadly vector-borne disease is of course Malaria but the world’s fastest growing vector-borne disease is Dengue with a 30-fold increase in disease incidence over the last 50 years. Others you may have heard of are Yellow Fever and Schistosomiasis. Vector borne diseases are most commonly found in tropical areas and places where access to safe drinking-water and sanitation systems is problematic. However, globalization of trade and travel and environmental challenges such as climate change and urbanization are having an impact on transmission of vector-borne diseases, and causing their appearance in countries where they were previously unknown.


So World Health Day 2014 has a particular relevance for people on the move, which includes many UoB students. Large numbers of you will travel to countries where vector borne diseases pose a threat. This includes some of our International Students who return home during the course of their degree. Many of the risks of global travel can be minimized by precautions taken before, during and after travel. Whether you are a student planning an exciting trip during one of the university holidays, or whether you are an International Student intending on going home during your degree, it is important that travellers to developing countries consult a travel medicine clinic well in advance of the intended journey. We run travel clinics at Students’ Health service, which are open to our International Students too.


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