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Travel

Travel health

In 2016 there were 70.8 million visits overseas by UK residents, the highest figure recorded by the International Passenger Survey (IPS). 

The main reason is holidays, Europe remains the most popular destination, Spain, France, Italy, the Republic of Ireland and the USA, remain the top five most popular countries. Visiting friends or relatives is the second most popular reason. Trips to Poland increased by 19%.  

The UK Foreign and Commonwealth Office (FCO) provide advice for travellers, includingsafety and security issues in individual countries. Nurses should be aware of this advice.

Travel health medicine is a fast growing specialist area of practice. In the UK it is predominantly delivered by nurses. UK travellers of all ages are becoming more adventurous. Some present with illnesses at short notice and some have pre-existing medical conditions. Therefore the art of delivering accurate and current advice to travellers is becoming more complex.

Guidance from the RCN on Travel health nursing: career and competence development defines the standards of care expected for a competent registered nurse, experienced/proficient nurse and a senior practitioner/expert nurse delivering travel health services. A recent audit and evaluation of this resource demonstrated that it was useful to practice, benchmarking the minimum training requirements and the complexity of travel medicine as well as providing useful practical tools. See: Executive summary: perceptions of the RCN Travel Health Competencies Document

The Faculty of Travel Medicine (FTM) of the Royal College of Physicians and Surgeons of Glasgow (RCPSG) has also produced a position paper, Protecting the health of travellers from the UK and Ireland which acknowledges that injury and illness sustained both during travel and on return, causes a considerable medical and economic burden. High quality pre travel advice can help to mitigate and reduce this risk. The report recognises that the lack of structure and delivery of travel medicine services in the UK and the absence of a formal training pathway to a recognised professional standard needs to be addressed.

Related RCN resources / publications

RCN Library subject guide: Travel Health

RCN public health resource: immunization

Malaria 

Malaria, a preventable but potentially fatal disease, remains an important issue for UK travellers. As a nurse advising travellers, you should make every contact count and use every opportunity to engage, especially with those in vulnerable groups likely to return home to visit family in their country of origin (VFRs).

Further resources:

Malaria imported into the UK 2016: implications for those advising travellers. Public Health England has published details of malaria imported into the UK in 2016 and the implications for those advising travellers. A total of 1618 cases were reported, 15.6% higher than in 2015. Consistent with previous year’s most cases were caused by P. falciparum. The number of deaths was six, the same number as in the previous year, all from falciparum malaria acquired in Sub-Saharan and Southern Africa. Of the 1,044 cases that travelled abroad from the UK, reason for travel was known for 893 (86%). Of these 712 (80%) had visited family in their country of origin (VFRs), 85 (10%) travelled for business and 96 (11%) travelled for a holiday. The burden of falciparum malaria falls heavily on those of Black African ethnicity, an important group to target for pre-travel advice. There is a strong association between increasing age and mortality, so elderly travellers should also be considered a particular risk group. Among those with malaria who had travelled abroad from the UK, where the history of chemoprophylaxis was obtained, 609/731 (83%) had not taken chemoprophylaxis.

The World Health Organization (WHO) highlights World Malaria Day each year on 25 April.

The World Malaria Report tracks progress towards the 2020 malaria goals of the "Global Technical Strategy for Malaria 2016-2030". 

The Public Health England (PHE) Advisory Committee on Malaria Prevention (ACMP) published updated UK Guidelines for malaria prevention in travellers from the UK in 2017.  This is an essential tool for nurses advising travellers. 

As the global incidence of malaria is falling the ACMP undertook a review of country recommendations and accordingly NaTHNaC has produced new malaria maps.

Imported malaria cases and almost all deaths in the UK resulted from visits to Africa. Emphasis should be placed on engagement with travellers planning to visit Africa and relaying the message that the malaria situation is serious there and requires rigorous personal preventive measures. The Visiting Friends and Relatives (VFR) group of travellers who tend to stay for longer periods in endemic areas are more risk of contracting malaria than short term travellers visiting the same location. Once infected the risk of severe or complicated malaria is higher in some groups, e.g. those over 70 years of age, those with co-morbidities or immunosuppression and pregnant women. 

 NaTHNaC provides a comprehensive overview of the key changes with updated information on individual countries.

In Scotland Travax provides malaria information.

The APPG group on malaria and neglected tropical diseases acknowledges the work of the UK in supporting and strengthening health systems in countries where malaria is endemic and where neglected tropical diseases can be identified and treated.

Hajj, the annual pilgrimage to Makkah (Mecca) in the Kingdom of Saudi Arabia occurs between the 8th and 12th day of the twelfth month of the Islamic calendar every year. This year it is predicted that Hajj 1438H will take place between 30 August and 4 September 2017. See: NaTHNaC Factsheet

Female Genital Mutilation

Travel health organisations, clinics and health care professionals (HCPs) will find the following resources useful as they highlight how important it is for processes within travel health settings to be reviewed to ensure services provide an effective safeguarding process around FGM.

RCN. Female genital mutilation: RCN guidance for travel health services. This publication acts as a supplement to Female Genital Mutilation: An RCN Resource for Nursing and Midwifery Practice (2016) and focuses on professionals working in travel health services. Travel health organisations, clinics and health care professionals (HCPs) will find it useful as it highlights how important it is for processes within travel health settings to be reviewed to ensure services provide an effective safeguarding process around FGM.
 
RCN. Female genital mutilation: RCN travel health services pathway. This travel health services pathway has been produced as a quick reference tool to help care for girls and women who may be at risk of, or have been, abused through FGM.

Barnardos National FGM Centre. The National FGM Centre is a partnership between Barnardo’s and the Local Government Association (LGA) to achieve a systems change in the provision of services for girls and women affected by female genital mutilation (FGM).

Zika virus (ZIKV)

On 1 February 2016, the World Health Organisation (WHO) declared that the recent cluster of microcephaly cases and increase in neurological disorders and neonatal malformations reported from Brazil, constituted a Public Health Emergency of International Concern (PHEIC).

With information on Zika virus changing regularly NaTHNaC has posted information for travellers and health professionals. Nurses advising travellers should be aware of the most current information.

Further information is available from Public Health England and NaTHNaC

Zika virus advice for travellers to India updated as a moderate risk for pregnant women who should consider postponing non-essential travel until after the pregnancy. See: WHO Classification Table (24 May 2017)

Yellow Fever

NaTHNaC (England Wales and Northern Ireland) and Health Protection Scotland's (HPS) TRAVAX (Scotland) are the designated State Parties for Yellow Fever provision in the UK under the WHO International Health Regulations (IHRs).

These parties have designed a mandatory training programme for designated Yellow Fever Vaccinating Centres (YFVCs). Information is on vaccination regularly updated and it is recommended that nurses remain up to date.

In July 2016, changes came into force regarding the International Health Regulations (IHR) and the duration of protection from the Yellow Fever vaccine. NaTHNaC has posted updated information and published a new HowTo guide on issuing the IHR yellow fever certificate: Getting to grips with the Yellow Fever certificate. This is also freely available on YouTube and iTunes.

NaTHNaC has updated clinical and administrative resources for healthcare professionals running or managing a YFVC, see: NaTHNaC launches the Yellow Fever Zone.

The conditions of Designation and Code of Practice for YFVC have been reviewed, revised and re-formatted.

See also: The NaTHNaC Training Portal.

CDC training the CDC Yellow Book and the World Health Organization's International Travel and Health 2017 updates all contain useful information for nurses on Yellow Fever. NHS Wales users can gain free access to TRAVAX resources via the NHS Wales website Health in Wales

As a nurse, you should stay alert to current information and the possibility of the risk of exposure to other diseases. For travellers returning ill from affected areas a full travel history should be taken before appropriate referral.

The Foreign & Commonwealth Office (FCO)

The FCO is a valuable source of advice for travellers and advisers and produces information on a variety of subjects.

The FCO provides useful pre-travel advice and and how to stay healthy and safe when abroad. See: Travel Aware - staying safe and healthy abroad.

Travel resources, courses and study days

Update from NaTHNaC

The National Travel Health Network and Centre (NaTHNaC) continue to update their website. Recent changes include:
 
Changes to the Country pages:

  • the ability to download each complete country page to enable viewing offline or printing a hard copy 
  • new antimalarial recommendations have been added for some countries
  • quick access to the country page index

Changes to the World overview:

  • quicker search results
  • multiple outbreaks or for a specific location
  • outbreaks with exact location data
  • search options by day, week, month, 6 month or year

Updated TravelHealthPro eBook:

  • all TravelHealthPro factsheets are contained in one eBook
  • opportunity to subscribe to email alerts for eBook updates

The Faculty of Travel Medicine at the Royal College of Physicians and Surgeons of Glasgow (RCPSG) offers lifelong learning, which includes educational courses and examinations to support travel health professionals throughout their careers. See: FTM courses. Nurses can also join the FTM as Affiliate Members and benefit from access to publications and reduced fees for conferences.

Other organisations that offer courses, include:

Forthcoming travel health conferences

Travel Health Roadshow

14 September to 9 December 2017
Joint Royal College of Nursing and Travel Health Training Ltd taking place at six locations around the UK

28th National Immunisation Conference for Health Care Workers

1 December 2017
The Manchester Conference Centre 

12th Asia Pacific Travel Health Conference

21-24 March 2018
Plaza Athénée Hotel, Bangkok, Thailand 

The 7th Northern European Conference on Travel Medicine (NECTM7)  a Travel Medicine educational conference

The RCN Public Health Forum is a partner in this event and registration is open for NECTM7 2-4 May in Stockholm 2018. RCN Members are eligible to apply for preferential rates and encouraged to apply for the early-bird rate available until 28 February 2018. Abstract submissions are open until 15 January 2018. 

2-4 May 2018
Clarion Hotel
Stockholm, Sweden

CISTM16

5-9 June 2019
Washington DC, USA