Before traveling abroad, a vaccination schedule should be drawn up based on two criteria:
- Administrative obligation: the measures adopted by the country to protect against an infectious risk from another country, rather than the actual risks for the traveler.
- The actual risks for the traveler: these vary depending on the health situation of the country they are going to, the conditions and length of their stay and the traveler's own situation, especially their age and previous vaccinations. Those traveling abroad should therefore find out about the vaccinations they need one or two months before setting off, to make sure they leave themselves enough time.
Malaria is a severe, potentially fatal disease transmitted by mosquitoes that is widespread in tropical areas. Several parasite species cause malaria: Plasmodium falciparum is the most dangerous, since it is responsible for the most deadly forms. It is also the most common (especially in tropical Africa, but also in America and forest regions of Asia). Preventive measures are mainly targeted at this species.
These measures vary depending on the destination, the conditions and length of stay, the season, etc.
No single preventive measure provides travelers with comprehensive protection against malaria. They should combine the following:
- Chemoprophylaxis (taking antimalarial medication on a preventive basis);
- Measures to protect against mosquito bites.
1. Preventive malaria treatments
Depending on the country visited, the length of stay and the individual situation of each traveler, four drugs can be used to prevent malaria:
- chloroquine (Nivaquine® 100)
One tablet a day for adults weighing 50kg or more. For adults weighing less than 50kg and children, the recommended dose is 1.5mg/kg/day.
Travelers should start taking the medication on the day they arrive in the malaria endemic region and continue for four weeks after they leave the region.
- atovaquone (250mg) with proguanil (100mg) (Malarone®)
One tablet a day during mealtimes for people weighing more than 40kg.
Malarone® is available in tablets for children (Malarone® child tablets – atovaquone: 62.5mg, proguanil: 25mg), which can be given to children weighing 11 to 40kg. Malarone® may be prescribed to pregnant women, but insufficient monitoring of pregnancies exposed to the atovaquone/proguanil combination makes it impossible to rule out any risk of adverse effects.
Travelers should start taking the medication on the day they arrive in the malaria endemic region and continue for one week after they leave the region.
Atovaquone/proguanil should not be used for periods longer than three months, since there is currently not enough evidence of the effects of long-term prophylaxis.
- mefloquine (Lariam® 250)
One tablet once a week for people weighing more than 45kg.
The principles governing chemoprophylaxis in children are the same as in adults, namely a dose of 5mg/kg/week. But the product only exists as a double-scored tablet (250mg), meaning that it is only suitable for people weighing more than 15kg (roughly those aged 3 or over).
Mefloquine can be prescribed to pregnant women – an analysis of a high number of pregnancies exposed to the medication taken as malaria prophylaxis revealed no malformations or fetotoxic effects.
Travelers should start taking the medication at least 10 days before setting off to see whether they develop any side effects. Where possible, unless the drug has been well tolerated in the past, it is recommended that they take three doses before leaving so that they can detect any delayed side effects.
Travelers should stop taking this medication immediately if they suffer from any neuropsychiatric effects such as acute anxiety, depression, agitation, mental confusion, suicidal tendencies or even mild symptoms such as sadness, headaches, dizziness or difficulties sleeping.
Mefloquine should continue to be taken for three weeks after leaving the malaria endemic region.
- doxycycline monohydrate or doxycycline hyclate:
Doxypalu® (monohydrate) 50 or 100mg tablets, Granudoxy® Gé (monohydrate) 100mg scored tablets, Doxy® 100 Gé and Doxy® 50 Gé (hyclate): 100mg/day for those weighing more than 40kg, 50mg/day for those weighing less than 40kg.
Doxycycline is contraindicated for children under the age of 8, not recommended during the first trimester of pregnancy and contraindicated from the second trimester (because of the risk of discoloration of the unborn child's milk teeth). It can cause a phototoxic reaction, leading to photodermatitis. To reduce this risk, it should be taken in the evening with food, at least an hour before going to bed.
Travelers should start taking the medication on the day they arrive in the malaria endemic region and continue for four weeks after they leave the region.
To find out whether there is a risk of malaria in the country you are traveling to and what group the country is classified in, please see our world map.
2. Protection against mosquito bites
It is also very important to take protective measures against mosquito bites, as this can help prevent other infections that are transmitted in the same way – especially dengue, which is widespread in tropical areas. Anopheles mosquitoes (which carry malaria) usually bite between sunset and sunrise. The following measures are recommended:
- Wear long clothes treated with insecticide in the evening: clothes and tent canvas can be sprayed with insecticide or soaked (in this case the insecticide used should be permethrin). Permethrin can be bought at pharmacies in spray bottles. You should spray the outer parts of your clothes.
- Apply an insect repellent to any exposed areas of the body: the product should be applied as soon as the sun sets to any exposed areas of the body, including your face, and also to any areas that may become exposed as you move.
- Insect repellents provide protection for 2 to 5 hours: this depends on the concentration of the product and the outside temperature. Perspiration or taking showers or baths will mean that you need to reapply the product more often. These products can be toxic if ingested: avoid all contact with the mouth or eyes. Insect repellent can be sprayed on clothes but it does not remain effective for long (2 hours) because it is volatile.
- Sleep under an insecticide-treated bed net (treated with deltamethrin or permethrin): insecticide-treated nets provide the best protection against mosquito bites during the night. They should be in good condition (no tears) and used correctly (either tucked under the mattress or touching the ground). Pre-treated bed nets can be bought in pharmacies or travel supplies stores, or you can treat the net yourself with special kits available in pharmacies. Insecticide-treated bed nets are effective for 6 to 8 months. Even in air-conditioned rooms, use an electric insecticide diffuser (make sure you take plug adapters), as although air conditioning makes mosquitoes less aggressive it does not stop them from biting. Outside, you can burn mosquito coils.
|Age||Max no. applications per day||DEET*||Picaridin||PMDRBO**||IR3535***|
|6 months to walking age||1||10%-30%||-||20%-30%||20%|
|Walking age to 24 months||2||10%-30%||20%-30%||20%|
|24 months to 12 years old||2||20%-30%||20%-30%||20%-30%||20%-35%|
|> 12 years old||3||20%-50%||20%-30%||20%-30%||20%-35%|
In the event of exposure to Anopheles mosquitoes, vectors of the malaria parasite Plasmodium, the minimum effective concentration of DEET is 30%.
* DEET (N,N-Diethyl-m-toluamide) was assessed at EU level under the Biocidal Products Directive 98/8/EC. There are restrictions on usage in children under 2. However, if there is a high risk of transmission of a vector-borne disease, it can be used for short periods if special care is taken not to exceed the maximum number of applications and to comply with guidelines for use in children.
** PMDRBO, para-menthane-3,8-diol Rich Botanical Oil, a mixture of cis- and trans-p-menthane-3,8 diol.
*** IR3535, picaridin and PMDRBO are currently being assessed at EU level.
Relative efficacy of available methods to prevent against mosquito bites
Anopheles and Culex
Bite during the day
|Paludisme, Filarioses, West Nile...||Dengue, Chikungunya...|
|Insecticide-treated bed net||++++||+|
|Bed net (treated or untreated) for cots and pushchairs for children under walking age||++++||++++|
|Indoor residual spraying (IRS) – spraying a residual insecticide within the home (method only applicable by malaria professionals, not available for travelers)||+++||++|
|Indoor spraying of commercially available insecticides||++||++|
|Electric insecticide diffuser (inside)||++||++|
|Mosquito screens for doors and windows||++||++|
|Clothes treated with insecticide||++||++|
|Mosquito coil (outside)||+||+|
Sources: IRD, InVS
++++: most effective
+: least effective
Even if you have received appropriate chemoprophylaxis and applied all possible protection measures, if you develop a fever after returning from a tropical area it may be an outbreak of malaria and you should seek medical attention immediately. The first symptoms may seem mild but malaria can be fatal if treatment is delayed. If you develop even a mild fever, nausea, headaches, aches or fatigue during your time abroad or in the months following your return, you should see a doctor immediately. A blood test will be performed to confirm the diagnosis. Fever in travelers returning from tropical areas should be considered as a potential case of malaria until proven otherwise.
PREVENTION OF DISEASES TRANSMITTED BY BITES AND STINGS FROM OTHER ARTHROPODS (MOSQUITOES, TICKS, BUGS, FLIES, ETC.)
Many infections that cannot be treated by vaccination or medication are transmitted by arthropods. Protection methods are the same as those used to protect against mosquitoes that carry malaria (see previous section), but the time of day may vary: the mosquitoes that transmit dengue and chikungunya bite in the daytime or early evening.
Envenomation is the process by which venom from snake, spider, scorpion or ant bites or from contact with marine animals (jellyfish, fish and shellfish) enters the body.
A few guidelines:
- Wear closed ankle boots and long trousers, tap the ground with a stick or make noise while walking.
- Shake out clothes, shoes, bags, sleeping bags and sheets before use.
- Never go barefoot.
- Never touch animals or sea creatures.
- In the event of a bite, keep the victim calm, call the nearest emergency service and describe the animal responsible if possible (a photo can help). Don't apply a tourniquet, make it bleed, cauterize, make an incision or suck the wound.
BITES FROM DOGS AND OTHER MAMMALS
It is mainly transmitted by dogs, but all mammals (cats, monkeys, bats, foxes, raccoons, etc.) can spread the virus responsible.
This virus is found in the saliva of the infected animal and can be transmitted through a bite or scratch but also a lick to a wound (even very light) or contact between the animal's saliva and mucous membranes (such as the eyes or mouth). Animals can transmit the virus without displaying symptoms themselves, in other words they may be contagious even if they do not seem to be ill.
The general rule should therefore be not to approach animals – even pets, docile and baby animals or dead animals – and not to stroke them. Extra care needs to be taken with children.
In the event of a bite, scratch or licked wound, you should:
- Wash the wound or licked area with soap and water for 15 minutes, rinse thoroughly and apply an antiseptic.
- Then contact the local healthcare facilities (or the medical assistance company), which will judge whether post-exposure prophylactic measures need to be taken. These involve several vaccine doses and sometimes immunoglobulin (often unavailable in developing countries).
A pre-exposure vaccination can be administered before traveling abroad. This does not remove the need for prophylaxis if bitten but makes it simpler to administer (only two vaccine doses are needed and no immunoglobulin). (See the section on the vaccines available at the Medical Center.)
It is strictly prohibited to bring domestic animals (especially dogs) or wild animals into France from a foreign country without an official health and vaccination certificate. Anyone who does not comply with this ban puts their family and friends in danger and runs the risk of criminal proceedings or a heavy fine.
See the website of the French Ministry of Agriculture. (This page is only available in French)
PREVENTION OF OTHER RISKS
Trauma care and other medical treatment: accidents (including road accidents) represent 30% of cases of repatriation for medical reasons.
Those traveling abroad should take extra care, bearing in mind that roads may be in poor condition and that in some countries there is widespread non-compliance with traffic rules. Helmets should always be worn when driving two-wheeled vehicles. Before traveling abroad you should always take out insurance that includes medical assistance. Blood transfusions, medical treatment involving injections, incisions or endoscopies, and dental care represent a major risk in most countries with insufficient healthcare facilities (hepatitis B, hepatitis C, HIV) thus:
- You should refuse any treatment without new, single-use equipment (needles, syringes);
- You should also avoid tattoos, piercings and acupuncture.
Before setting off:
- If necessary, take basic emergency medical supplies with you (see first aid kit);
- It is also a good idea to go for a dental check-up.
Sexually transmitted infections (STIs – hepatitis B, HIV, gonorrhea, syphilis, chlamydia, etc.):
Excluding abstention, appropriate use of condoms is the only effective means of prevention from infection via sexual contact. Take some with you.
Depending on the conditions and length of your trip, you may also face environmental risks:
- Swimming in sea water or fresh water, soil, heat and humidity;
- Insects and other creatures that bite or sting;
- Food and drink – traveler's diarrhea.
HYGIENE MEASURES (ESPECIALLY BUT NOT ONLY IN TROPICAL AREAS)
Food hygiene (prevention of travelers' diarrhea, hepatitis A, amebiasis, etc.).
Wash your hands frequently with soap (just water is not enough), especially:
- Before meals;
- Before touching food;
- After going to the toilet.
- Only drink sealed bottled water (opened in front of you) or water that has been made safe (with a portable filter or disinfectant or by boiling for 5 minutes);
- Peel all fruit;
- Only consume milk that has been pasteurized or boiled.
You should not consume food or drink that may represent a risk, such as:
- Raw vegetables or cooked food eaten cold, even if it has been kept in the refrigerator;
- Local, non-bottled water;
- Shellfish, reheated meals, ice cubes and ice cream.
In some regions, try to find out locally about the risk of toxicity of sea fish, regardless of whether it is well cooked (ciguatera).
Diarrhea is a frequent health problem for travelers. It is caused by infections contracted when eating contaminated food or water, and is generally not serious. The symptoms usually disappear on their own after 1 to 3 days.
Travelers from industrialized countries are most at risk of diarrhea when they travel in countries with low hygiene levels or stay in basic conditions. You should take care and observe recommended food hygiene measures. There is no vaccination available. The most common approach is self-treatment – it is a good idea to take medication with you.
General and personal hygiene
You should take care to protect yourself against bacteria and parasites in the ground or in water (to prevent cutaneous larva migrans, strongyloidiasis, ancylostomiasis, schistosomiasis and skin infections).
- Avoid leaving laundry to dry outside or on the ground;
- Don't go barefoot on beaches;
- Don't lie directly on sand;
- Wear closed shoes on muddy or wet ground;
- Don't walk or swim in fresh water;
- Don't stroke animals.
Pregnant women are at greater risk of contracting serious diseases. They are advised to avoid traveling to regions with high malaria transmission or multidrug resistance (countries in group 3). If the trip cannot be avoided, treatment should be adapted.
Yellow fever vaccination should be avoided at all stages of pregnancy. However, given the severity of the disease, if the trip cannot be postponed, the vaccine should nevertheless be administered.
Warning! Traveling with newborn babies to tropical countries in poor conditions is not recommended and should be postponed if at all possible.
Anyone intending to travel to a developing country, especially with a newborn baby, should consult a medical practitioner before they leave.
Make sure you are up to date with the vaccinations on the vaccination schedule.
Specific vaccinations for the destination country:
- The yellow fever vaccine can be administered from the age of 6 months but is only compulsory for babies from age 1;
- Typhoid fever vaccination is particularly recommended for children of immigrant families going on holiday to their home country, especially in North Africa;
- The hepatitis A vaccine can be administered from the age of 1. Although the disease is usually harmless or even asymptomatic at this age, children can be infected and pass the virus on to those traveling with them;
- Vaccination against meningococcal meningitis is recommended for children aged 2 or over in high-risk regions during the dry season.
This vaccination can be administered from the age of 6 months in the event of an epidemic outbreak. In this case a second dose should be given a few months later.
For those who have to leave without warning, vaccinations can be combined.
Travelers should avoid taking young children to malaria endemic areas as they are at greater risk of contracting severe malaria.
Mosquito control measures are vital. The safety of insect repellents for children under 2 has not yet been confirmed. Travelers should take particular care to avoid the risk of mosquito bites after sunset, especially by putting children's beds and cots under insecticide-treated bed nets at night.
Your family physician should prescribe an anti-malaria prophylaxis based on the child's weight.
Mefloquine is only available as double-scored tablets and is not recommended for children under 15kg (age 3). Malarone® is now available in tablets for children and can be administered to children weighing between 11 and 40kg, but doxycycline is contraindicated for children under the age of 8. You should seek medical advice immediately if the child develops a fever. In the case of newborns, you should consult a doctor if they display any symptoms, even in the absence of fever. Anti-malaria medication should be kept out of the reach of children.
Preventive measures are vital and are based on good hygiene:
- Use mineral water or boiled filtered water for baby bottles;
- Sterilize baby bottles;
- Make sure those looking after the baby observe strict hygiene standards;
- Breast feeding is recommended if possible.
In the event of diarrhea, you should learn how to react appropriately (ask your doctor for advice before leaving), especially:
- Knowing how to use oral rehydration sachets such as those recommended by WHO or similar;
- Being able to recognize severe symptoms;
- Knowing the anti-diarrhea diet depending on age.
If the child develops a fever: seek medical advice as soon as possible.
- Never expose children to sunlight and make sure they are protected (hat, clothes, sunscreen if necessary);
- Avoid heat exhaustion when making long journeys in very hot countries, especially car journeys, by giving children baby bottles filled with water or preferably rehydration solutions;
- Make sure they wear light, loose, cool clothing (cotton and non-synthetic fabrics).
Make sure children don't:
- Go barefoot, especially on sand or damp ground where there may be animal droppings (parasites);
- Swim in ponds or rivers (schistosomiasis);
- Play with animals (rabies).
Age should not stop you from traveling, but you should be aware of the implications of any medical conditions and get a medical check-up before you leave.
People with a chronic condition
- Keep a medical report with you at all times (if possible written in English or in the language of the country you are traveling to) mentioning your ongoing treatments with their international nonproprietary names (INNs), as well as the details of a specialist physician that can be contacted;
- Take the relevant form – provided by the CPAM (French health insurance office) – that entitles you to coverage under international agreements (the European Health Insurance Card, which has now replaced the E111 form for European Union nationals);
- Take out international medical assistance insurance.
Time differences should be taken into account when taking some medication (the contraceptive pill, insulin, etc.) and also in terms of fatigue and sleeping difficulties. If you will be going on any trips at high altitude (above 3,000m) you should consult a medical specialist before leaving.
For anyone with:
- A pacemaker;
- A hearing aid;
- Ear, nose and throat problems;
- Vein disorders (support stockings are recommended for long flights);
- Sickle-cell disease.
It is vital to see a doctor before traveling so that you can determine:
- Whether the trip is feasible;
- Whether the travel conditions need to be adapted;
- If you need any vaccinations;
- What medication you should take with you.
FIRST AID KIT
There is no standard first aid kit. It will vary depending on the nature of your trip abroad (ask your doctor for advice). Medication should be kept in its original packaging to avoid any risk of error.
We would recommend the following as a starting point:
- A preventive anti-malarial medication and mosquito repellent;
- Medication to treat pain and fever (paracetamol keeps better than acetylsalicylic acid (aspirin) in hot conditions);
- Anti-diarrheal medication;
- Travel sickness medication.
- An unbreakable thermometer;
- A cream for burns;
- A skin disinfectant;
- Eye drops (in single-use vials);
- Sterile dressings and adhesive strips;
- A compression bandage;
- Safety pins;
- Drinking water disinfectant;
- Sun cream;
- Single-use syringes.
For babies and young children:
- Sterilizing tablets for baby bottles (cold sterilization);
- WHO-type rehydration sachets;
- Medication for pain and fever;
- Medication in pediatric form.
The Weekly Epidemiological Bulletin (BEH – mostly in French), published by Santé publique France (the French National Public Health Agency), is the communication outlet for the French Ministry of Health and General Directorate of Health with its partners and all healthcare professionals. The Institut Pasteur website is regularly updated with the latest recommendations for travelers and the vaccination schedule as published each year in the BEH.