All travel has associated health risks that need to be recognized not only by travellers, but also by tour operators and governments. In this context, the author considers some of the infections that have been contracted by package holiday tourists from the UK. With 15 million package holidays sold in the UK each year and increasing consumer concern about health risks, health is now a major factor in customer satisfaction. Media exposure and possible legal action when expectations are not met mean that the need to reduce the health risks associated with travel is crucial for the tourism industry as well as for travellers themselves. This paper sets out the main hazards and risks and examines what actions can and should be taken by tour operators, destination countries, and tourists. The author stresses the importance of ensuring a proper health infrastructure in the development of tourist areas; the need for operators to stipulate minimum hotel standards, backed up by regular auditing; the responsibility of tourists to ensure that they do not expose themselves to unnecessary risks; and the significance of surveillance systems in the control of travel-related diseases.
Travellers' diarrhoea is the commonest health affliction for visitors to developing countries and to resorts with an inadequate water supply and sewage disposal systems. Attack rates may exceed 50% and although rarely a severe health hazard may be the cause of an economic deprivation to a community if it discourages tourism. Enterotoxigenic Escherichia coli (ETEC) is the predominant causative organism. It is spread from man to man through water and food. The fundamental preventative strategy must be an improvement in drinking water supplies, safe sewage collection and disposal, and the achievement of high levels of hygiene at all stages of the food chain. Travellers visiting under-developed areas can take simple dietary and beverage precautions. Prophylactic antimicrobial agents will reduce the risk to an individual but may be detrimental to the community by encouraging the emergence of resistant bacterial strains. Vaccines are being developed against ETEC. The corner stone of treatment is fluid replacement. Symptomatic relief can be provided by antimotility drugs and the disease shortened by antibiotics. There is a need for a greater understanding of the faecal-oral pathways, for ongoing epidemiological studies and for cost benefit analysis studies of prophylactic and treatment schedules.
BackgroundInternational travellers are at a risk of infectious diseases not seen in their home country. Stomach upsets are common in travellers, including on cruise ships. This study compares the incidence of stomach upsets on land- and cruise-based holidays.MethodsA major British tour operator has administered a Customer Satisfaction Questionnaire (CSQ) to UK resident travellers aged 16 or more on return flights from their holiday abroad over many years. Data extracted from the CSQ was used to measure self-reported stomach upset in returning travellers.ResultsFrom summer 2000 through winter 2008, 6,863,092 questionnaires were completed; 6.6% were from cruise passengers. A higher percentage of land-based holiday-makers (7.2%) reported stomach upset in comparison to 4.8% of cruise passengers (RR = 1.5, p<0.0005). Reported stomach upset on cruises declined over the study period (7.1% in 2000 to 3.1% in 2008, p<0.0005). Over 25% of travellers on land-based holidays to Egypt and the Dominican Republic reported stomach upset. In comparison, the highest proportion of stomach upset in cruise ship travellers were reported following cruises departing from Egypt (14.8%) and Turkey (8.8%).ConclusionsIn this large study of self-reported illness both demographic and holiday choice factors were shown to play a part in determining the likelihood of developing stomach upset while abroad. There is a lower cumulative incidence and declining rates of stomach upset in cruise passengers which suggest that the cruise industry has adopted operations (e.g. hygiene standards) that have reduced illness over recent years.
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