Travel health: just the ticket

UK holidays are no longer a thing of the past and pharmacy teams are likely to experience a spike in travel-related queries as Covid-19 restrictions continue to lift. There’s an important role to play in helping customers plan for all kinds of eventualities and stay healthy while away from home

With the UK unlocking and the summer in sight, many people will be looking to expand their horizons and venture a little further away from their local area. They may not need to worry about jet lag or malaria risk, but there are other travel health considerations that are important when holidaying at home, not to mention that all important sun safety – it may be Britain but the sun shines some of the time at least and UV rays are pesky whatever the weather.

Travel sickness

The repeated movements experienced while travelling in cars, boats, trains and planes can sometimes result in confused signals being sent to the brain. The eyes might tell the brain that the body is stationary – particularly if the individual is concentrating on something such as a phone or map – but the balance mechanisms in the inner ear indicate the opposite. This is why travel sickness is often worse when going over bumps, in choppy seas or during turbulence.

It can affect anyone, but is more common in women and children, although many children will grow out of it as they get older. The main symptom is feeling sick (nausea), but some people may also experience sweating, increased saliva production, headaches and feeling cold and/or weak.

There are certain steps that can be taken to help avoid and manage travel sickness. These include:

• Not eating a heavy or spicy meal and avoiding alcohol before travelling
• Breaking up long journeys to get some fresh air, having a drink of water and taking a short walk
• Sitting in the front of a car, over the wing of a plane or in the centre of a boat to minimise motion
• Looking straight ahead at a fixed point, such as the horizon, rather than looking at moving objects, or keeping the eyes closed
• Breathing fresh air by opening a window, where possible
• Focusing on breathing and taking slow, deep breaths
• Finding some distractions such as talking, singing or listening to music or an audiobook
• Avoiding activities such as reading, watching films or using electronic devices
• Avoiding strong smells such as petrol fumes
• Trying to sleep, if possible.

Products to help prevent motion sickness are available, such as tablets containing cinnarizine or hyoscine hydrobromide, most of which are pharmacy-only. These are usually taken before a journey and work by interfering with the position and balance signals sent to the brain during travel. Suitability and dosage instructions differ depending on age and medical history so these should be considered by pharmacy staff before selling the product and the instructions read carefully by the customer before taking it.

Acupressure bands are also available, although these don’t work for everyone, and some people find that ginger – in the form of biscuits, sweets, drinks or capsules – helps.

Bites and stings

Creepy crawlies are everywhere and it may only take one tiny bite or sting to cause a lot of discomfort. They might not be completely avoidable, but there are steps for minimising risk and treating symptoms.

• Insects

Britain is home to more than 30 types of native mosquito species, up to 40 species of midge and many other biting insects such as horseflies. This means there’s lots of unwelcome potential for bites, especially in hotspots such as the Lake District and the Scottish Highlands and Islands. Midge season starts in May, peaks in August and runs until September when conditions are damp, warm and humid. 

Simple steps can be taken to avoid midge and mosquito bites. Remaining inside during the early mornings and late evenings when these flying insects come out to play is a good idea, or covering up exposed skin when out and about and sticking to sunny areas where there’s a breeze. Wearing brightly coloured clothes and avoiding strongly smelling soaps, shampoos, deodorants and perfumes can also help. 

Insect repellent can be applied to exposed skin and there are several types available in different formats such as roll-ons and sprays. Repellents containing 50% diethyltoluamide (DEET) are considered most effective by the NHS.

When it comes to bees, wasps and hornets, remaining calm and resisting the temptation to swat them will mean that they’re less likely to sting. If a sting does occur, carefully and quickly removing the sting from the skin is important.

Insect bites and stings can cause irritation to the skin, resulting in red and itchy lumps forming on the surface. These will usually improve in a few days without treatment. Some people can have a mild allergic reaction where a patch of skin around the bite or sting becomes swollen, red and painful, but this usually subsides within a week.

The affected area should be cleaned with soap and water and a cool compress can be applied for around 10 minutes, or the area raised or elevated, to help any swelling. Customers should be advised to avoid scratching the area to reduce the risk of infection. For troublesome symptoms, painkillers can be taken to ease pain and discomfort and creams containing crotamiton or hydrocortisone can help with any itching. Antihistamine tablets may be suitable to help reduce swelling and itchiness. See page 20 for more.

• Ticks

In the UK, ticks – blood sucking members of the spider family – are becoming more common and are most prevalent during the spring and summer months. They particularly like moist air and grassy or wooded areas and can attach to both humans and animals. The bite is usually painless, but the tick can feed for as many as seven days before dropping off, during which time it can pass on infection.

Not all ticks are infectious, but they can carry diseases such as Lyme disease and tick-borne encephalitis (TBE). In the UK, tick infection rates vary from zero to 20 per cent. “Recently, in areas of the UK, ticks carrying the virus that causes TBE have been detected,” says Shirley Nickson, patient services project developer at Numark. “Incidents of TBE in the UK are very rare, but visitors to these areas may be at risk when walking, camping or working in woodland.”

High risk areas include the Scottish Highlands, southwest England and parts of East Anglia. Much of southern Scotland and central England are considered medium-high risk. Even in lower-risk areas, the risk of tick bites is increased when walking in grassy or heathland areas and/or where wildlife roams.

When walking through such areas, it is advisable to keep to the middle of the path and avoid overhanging vegetation as this is where ticks lie in wait for a host to brush past as they cannot jump or fly. While out and about, checking regularly for ticks and brushing them off is important, as is doing one final check once out of the high-risk area. “A vaccination for TBE is available and could be a consideration for individuals who may be visiting an at-risk location,” Shirley adds.

If a tick is discovered on the skin, it should be removed promptly using tweezers or a tick removal tool, being careful not to squash it. The area should then be cleaned and an antiseptic cream applied around the bite.

Deep vein thrombosis

While deep vein thrombosis (DVT) is commonly associated with plane travel, any journey over three hours by train, bus or car can also increase the risk of DVT developing. 

When sitting for long periods, particularly in cramped environments, pain, stiffness and swelling of the limbs can occur. Furthermore, in such conditions blood flows more slowly, which increases the risk of a blood clot forming in a vein – usually in one leg. People at higher risk of DVT include those who are over 60 years of age, overweight, smoke, have a past history of the condition, take the contraceptive pill or hormone replacement therapy (HRT), or have varicose veins, cancer or heart failure. Dehydration also increases the risk. Steps that can be taken to help prevent DVT include:

• Wearing loose, comfortable clothes
• Moving around as much as possible
• Avoiding crossing the legs while sat down
• Doing calf muscle exercises at least every half an hour by flexing and extending the ankles to encourage blood flow
• Avoiding excessive alcohol consumption
• Keeping well hydrated.

Compression stockings are available to help prevent DVT and these come in a range of sizes and levels of compression. However, it’s important to note that if these are incorrectly fitting, they can increase the risk of DVT so customers should receive advice on size and proper fitting from a healthcare professional.

Symptoms of DVT include throbbing or cramping in one leg, swelling in one leg, warm, red or darkened skin around the painful area, swollen veins that are hard or sore when touched. If any of these are experienced, customers should be advised to get an urgent GP appointment or call NHS 111. If breathlessness or chest pain accompany the symptoms, it could indicate a pulmonary embolism where the blood clot breaks loose and gets stuck in the lungs. This is a medical emergency and medical attention should be sought by calling 999 or going to A&E.

Heat stroke and heat exhaustion

Being out in the sun for long periods of time, particularly when exercising, can cause symptoms such as a headache, dizziness and confusion, loss of appetite, increased thirst, feeling sick, excessively sweating, pale and clammy skin, fast breathing, increased pulse and a temperature of 38°C or above. These all point to heat exhaustion.

The NHS lists four steps to help the individual cool down:

1. Move them to a cool place
2. Get them to lie down and raise their feet slightly
3. Get them to drink plenty of water – sports or rehydration drinks may be consumed
4. Cool their skin – spray or sponge them with cool water and fan them. Cold packs around the armpits or neck can also help.

If they don’t start to feel better after 30 minutes, it could be a sign of heatstroke. Other symptoms include not sweating but feeling too hot, a temperature of 40°C or above, fast breathing or shortness of breath, confusion, loss of consciousness, being unresponsive. This is a medical emergency and 999 should be called.

To help prevent heat exhaustion and heatstroke, customers should be advised to keep well hydrated, avoid the sun between 11am and 3pm, avoid excess alcohol, take cool baths or showers and wear light-coloured, loose clothing.

Advising on staying safe in the sun

Sunlight is strongest in the UK between 11am and 3pm between March and October – this is when sunburn is most likely. Even on a cloudy day, sunburn is possible as, according to Cancer Research UK, over 90 per cent of UV can pass through light cloud cover. Underestimating the strength of the sun is common, especially when wind and water are involved too. If people are going in and out of the sea or swimming pool, for example, the water has a cooling effect so they may not realise they’re getting burnt.

Any amount of sun damage to the skin can be dangerous, with a risk of serious health problems such as skin cancer in later life. But there are immediate effects too. Obvious symptoms include reddened, warm skin, blistering and often pain in the affected areas. Skin may start to flake and peel after a few days and will usually fully heal within a week.

The best way to prevent sunburn is to use a sun cream with a sun protection factor (SPF) of at least 30 to protect against UVB and at least four-star UVA protection. Customers should be advised to check the expiry dates of their sun creams as the protection levels can deplete over time. Staying out of the sun during peak times of the day and covering up with suitable clothing, a hat and sunglasses is also important to protect the skin.

If people start to feel like they’re getting burnt they should get out of the sun as soon as possible and find a shady spot, covering the skin with loose clothing. The affected area should be protected from sunlight until the sunburn is completely healed.

A cool compress to the skin or a cool, gentle shower can help to ease any discomfort – a bath is more advisable if blisters are starting to develop. Unperfumed lotion, such as moisturiser or a special after sun products can be used to soothe the skin. Customers should also be encouraged to drink plenty of water to avoid dehydration.

Dehydration occurs when more fluid leaves the body – as urine or sweat – than is taken in. Urine colour is a good indication of hydration status. The darker the urine, the less hydrated the person is. Other symptoms of dehydration include thirst; dizziness; feeling tired; dry mouth, lips and eyes; and passing little urine or fewer than four times a day. Replacing lost fluids is vital by drinking plenty of water or using oral rehydration sachets or sports drinks. 

Sun cream: the facts 

There are two types of ultraviolet light emitted from the sun that reach the earth’s surface: 

• UVA rays are associated with skin tanning and ageing. These penetrate the skin very deeply and affect the elastin, leading to wrinkles, leathery skin, brown pigmentation. Other long-term damage from UVA rays includes all types of skin cancer 
• UVB rays don’t penetrate as deeply but are largely responsible for sunburn. These rays have strong links to the skin cancers malignant melanoma and basal cell carcinoma. 

The sun protection factor (SPF) in sun cream helps to block UVB rays and prevent the skin from burning. These range from 2 to 50+ and this number relates to how long the sun’s UVB rays would take to redden the skin when the product is liberally applied compared to how long it would take without. For example, SPF 30 means it would take 30 times longer for the skin to burn than if it was unprotected, assuming that the correct amount of sun cream was used as the amount of protection reduces if it is applied too thinly. 

UVA star ratings from 0 to 5 stars indicate the indicate the percentage of UVA radiation absorbed by the sunscreen in comparison to UVB. The higher the star rating, the better the protection against UVA rays and it is recommended that no products below a star rating of 4 are used. Sun creams that offer both UVA and UVB protection are sometimes called ‘broad spectrum’.  

As a rough guide for adults, two teaspoons of sun cream should be used for the head (including face and ears), arms and neck. A minimum of two tablespoons are necessary if the whole body is being covered. This should be applied around 30 minutes before going outside. If a long period of time is to be spent in the sun, reapplying it just before going out is advised by the NHS. 

Reapplication of sun cream is important. This should be done at least every two hours to ensure full protection. If swimming or excessively sweating, the sun cream should be reapplied more frequently, even if it is labelled “water resistant”, especially straight after getting out of the water.