Travel health — before they go, and when they come back ill

Travel vaccines — NHS or private? start 6–8 weeks before travel

Use the TravelHealthPro country pages (NaTHNaC) for each destination; base advice on a risk assessment (itinerary, activities, length of stay, health and vaccine history), not on the country alone. First, bring routine vaccines up to date — see the immunisation schedule.

Malaria prevention UKMEAG guidelines, June 2026

The UK Malaria Expert Advisory Group (UKMEAG) replaced the Advisory Committee on Malaria Prevention (ACMP) and updated the UK guidelines in 2026, with new country risk maps. Advice follows ABCD: Awareness of risk, Bite prevention (DEET 50%, nets, covering up), Chemoprophylaxis where advised, and prompt Diagnosis of fever (during the trip and for up to a year after).

• Antimalarials are not prescribable on the NHS (FP10) for travel — issue a private prescription or signpost to a travel clinic or pharmacy. Choice (atovaquone-proguanil, doxycycline, mefloquine, chloroquine with proguanil) depends on destination, interactions, pregnancy, epilepsy, mental health and cost.
• Highest risk: people visiting friends and relatives — they often assume immunity, which is lost within months of leaving. Most UK malaria deaths are in people who did not take chemoprophylaxis.
• Pregnancy, asplenia and young children: avoid travel to falciparum areas if possible; specialist advice.

Fitness to fly

Travellers' diarrhoea

• Prevention: food and water hygiene; hand washing. Most cases are self-limiting in 3–5 days.
• Treatment: fluids and oral rehydration salts (especially children and older people); loperamide for adults for symptom relief — not with blood in the stool or high fever.
• Stand-by antibiotics (for example azithromycin) are a private prescription, only for selected travellers to remote areas or with conditions where dehydration is dangerous, with clear written instructions on when to use them and when to seek care.
• On return: bloody diarrhoea, fever, or symptoms lasting more than 14 days → stool microscopy, culture and PCR including ova, cysts and parasites; think of giardia, amoebiasis and post-infectious IBS. Notify suspected food poisoning. See gastroenteritis and chronic diarrhoea.

Altitude illness

• Risk rises above 2,500 m. Above 3,000 m, increase the sleeping altitude by no more than 300–500 m a day, with a rest day every 3–4 days ("climb high, sleep low").
• Acute mountain sickness: headache with nausea, fatigue, dizziness or poor sleep — stop ascending; descend if not improving.
• Descend immediately for HACE (confusion, ataxia, drowsiness) or HAPE (breathlessness at rest, cough, reduced exercise tolerance) — both can be fatal.
• Acetazolamide prophylaxis is off-label and a private prescription; it supports, not replaces, gradual ascent. Check sulfonamide allergy, renal function and pregnancy.

Returning traveller with fever

• Ask: where exactly, when they returned, activities (fresh water, animals, sexual contact, healthcare abroad), vaccines and prophylaxis taken, and contact with sick people.
• Viral haemorrhagic fever risk: fever within 21 days of returning from an area with a current outbreak, or contact with a case → isolate, do not take routine bloods in the practice, and phone the infectious diseases team and local health protection team immediately (UKHSA VHF risk assessment algorithm).
• Other causes to consider: dengue (avoid NSAIDs), enteric fever, rickettsia, leptospirosis, hepatitis A/E, HIV seroconversion, TB, schistosomiasis (fresh-water swimming in Africa) — and ordinary infections such as pneumonia and UTI.
• Many of these are notifiable — inform the local health protection team on suspicion.