Travel health and vaccinations, and how to plan them before you go

What a travel health consultation is

A travel health consultation is an appointment with a doctor to plan the protection you need for a particular trip. The doctor looks at where you are going, for how long, what you will be doing and where you will stay, alongside your age, your health, your medicines and the vaccines you have already had, and turns them into a plan.

UK advice is to arrange it ideally at least four to six weeks before travel, because some vaccines need courses that take a few weeks to complete [1]. Even when time is short an appointment is worthwhile, because some vaccines and malaria tablets can be given at the last minute [1].

Why it is done and who it is for

It suits anyone travelling to a country where the risks differ from home, and especially people with a long-term condition, a weakened immune system, a pregnancy or young children. It also suits people who travel often for work and want their vaccines kept in one up to date record, and families moving abroad for a posting.

Planning vaccinations

Travel vaccines fall into two groups, the routine vaccines everyone should have up to date and the vaccines recommended for a destination or a kind of trip. The doctor checks your record and plans each dose and its timing, so the record you carry is complete.

Yellow fever is the vaccine people ask about most, because some countries require proof of it under the International Health Regulations, recorded in an International Certificate of Vaccination or Prophylaxis [2]. A single dose gives lifelong protection, and immunity develops in 80% to 100% of people within 10 days [3]. Since 11 July 2016 the certificate has been valid for the life of the person vaccinated [2]. The vaccine is given at registered yellow fever vaccination centres [4].

The yellow fever vaccine is unsuitable for some people, including those with a weakened immune system or a thymus disorder, and people aged 60 or over need a careful look at their risk first [2]. Where you cannot have it, a doctor can sign an exemption certificate [5].

Malaria and insect bites

Every year about 1,500 cases of malaria are diagnosed in travellers arriving in the UK [6]. Prevention follows the ABCD of awareness of the risk, bite prevention, the right tablets where they are recommended, and prompt diagnosis if you become unwell. Tablets do not give complete protection, and used together with bite prevention they greatly reduce the risk [6].

Symptoms can appear during the trip or after you return, sometimes up to a year later [6]. If you develop a fever after visiting a malaria area, see a doctor the same day and say where you have been.

Travelling with your medicines

Carry medicines in their original packaging in your hand luggage, with a copy of the prescription and a letter from your doctor that lists them by their generic names [7]. A medicine that is legal in the UK may be controlled elsewhere, so check with the embassy of each country you will enter or pass through [7].

Controlled drugs need more planning. Taking 3 months or more of some controlled medicines in or out of the UK needs a Home Office licence, applied for at least 10 days before travel [7]. If you are visiting the UK, you can bring up to 3 months of your medicine with a prescription or a letter from your doctor [8].

Fit to fly certificates and letters

Airlines set their own rules, and some ask for a doctor’s certificate after an illness or an operation, during pregnancy or with some long-term conditions. The Royal College of Obstetricians and Gynaecologists explains that after 28 weeks of pregnancy an airline may ask for a letter confirming your due date and that the pregnancy is uncomplicated, and that most airlines do not allow flying after 37 weeks [9].

Our doctors sign fit to fly certificates, travel with medication letters, vaccine exemption certificates and visa medical certificates, and send them the same day by email and text [5]. Check what your airline or embassy asks for before you request one.

Who it is not for

A travel consultation plans ahead for a trip, so it is the wrong route if you feel unwell now. If you become ill after travel with a high fever, breathlessness, confusion or severe pain, call 999 in the UK or the local emergency number elsewhere, and tell them where you have been [10].

Benefits and risks

The benefit is a trip planned around your health, with protection matched to where you are going and the paperwork ready before you reach the airport. Vaccines can cause side effects, usually mild, and very rarely the yellow fever vaccine causes a serious reaction, which is why the doctor reviews your health and medicines before each one [2].

What to bring to the appointment

A few documents let the doctor plan everything in one visit.

• Your itinerary, with dates, countries, cities and the kind of places you will stay
• Your vaccination record, including doses given abroad
• A list of your medicines, with doses and generic names
• Any letters or forms your airline, employer, insurer or embassy has asked for
• The dates of any pregnancy, recent operation, illness or hospital stay

How The Wellness can help

A GP appointment gives you time with a GMC registered doctor to plan vaccines, malaria tablets, the medicines you carry and any letters you need, with a prescription where it is appropriate [11]. Travel medicine and vaccinations are among the areas our GPs cover, and the doctor tells you where any vaccine that must be given at a registered centre can be had.

Certificates are requested on our fit to fly page, assessed by a GMC registered doctor and sent the same day [5]. Our clinics are on Baker Street in Marylebone and Eccleston Street in Belgravia, open 7am to 9pm every day, and a doctor can come to your home or hotel in London.