Travel health tips: what is required, what is recommended, and what to pack

Required is not recommended

A required vaccination is one the border will ask about: for most destinations the list is empty, and where it is not it is almost always yellow fever, and almost always only if you are arriving from a country where yellow fever is present. That transit rule catches people who connect through the wrong airport, so check the route as well as the destination.

A recommended vaccination is a clinic's judgement for a normal tourist trip — hepatitis A for most of the world outside Western Europe and North America, typhoid where food hygiene is uncertain, rabies for long stays or rural travel. The health card on every guide here keeps the two lists apart, because a page that mixes them makes people either skip the required one or panic about the recommended ones.

• Routine vaccinations up to date — MMR, tetanus, polio — is the recommendation for everywhere, including next door
• See a travel clinic six to eight weeks before departure; some courses need two doses spaced apart
• Carry the yellow fever certificate with the passport where it applies; a photo of it does not count at the border

Water, ice and the first three days

Whether tap water is drinkable is a fact about the city's supply, not about the country, and the guides say which. Where it is not, the rules are simple: sealed bottles, no ice you did not see made from bottled water, and fruit you peel yourself. Most "travellers' diarrhoea" is a change of bacteria rather than contamination, and it passes; oral rehydration salts in the bag make it a day rather than three.

Street food is not the enemy. A stall with a queue of locals and a hot wok is safer than a quiet restaurant buffet that has been sitting since lunch. Heat and turnover are the two things to look for.

Mosquitoes: the real regional risk

Dengue, malaria, chikungunya and Zika are carried by mosquitoes and are the health risks that genuinely differ by place. Dengue is now present in most of the tropics and increasingly in southern Europe in summer; there is no simple prevention beyond not being bitten. Malaria is more limited — many popular destinations have none — and where it exists, a clinic will prescribe tablets for the specific region, because resistance differs.

The defence is the same for all of them and it is not glamorous: repellent with DEET or picaridin on exposed skin, long sleeves at dusk, a room with screens or air conditioning, and a net where neither exists. The guides note where the risk is real and where it is a rumour.

• Dengue mosquitoes bite by day, especially early morning and late afternoon — not only at dusk
• A fever in the two weeks after a tropical trip is a doctor's visit, and you say where you have been
• Altitude is the other regional risk: above 2,500 m, arrive a day early and climb slowly

Sun, heat and the wrong week

Heat is the health risk travellers underrate most, and it needs no mosquito. The guides' monthly temperature series shows which weeks are the hot ones, and in a humid climate a day of walking at 34 °C with high humidity is a genuine medical risk, not a discomfort. Water before thirst, shade at midday, and the sightseeing done early — the way the locals do it.

Getting treated, and who pays

Within the EU and EEA, an EHIC — or a GHIC for UK travellers — gets you treated on the same terms as a resident in the public system. Everyone else, and everyone everywhere else, pays, and that is what travel insurance is for. Read the repatriation cover rather than the excess: a broken leg is a few thousand; a medical flight home is the price of a car.

Pharmacies are the underused resource. In much of the world a pharmacist can diagnose and sell what a doctor would prescribe at home, and the guides note where that is true. Bring a small kit anyway — the things that are hard to find at eleven at night in a language you do not read.

• Your usual medication for the whole trip plus a week, in its original packaging, with the prescription
• Painkillers, antihistamines, oral rehydration salts, plasters, a thermometer
• The care score on each guide says how easy and how expensive emergency help is for a visitor

The number to dial

112 reaches emergency services across Europe and in many countries beyond; the health card on each guide gives the local number where it differs, and whether the ambulance is public or a private service you will be billed for. Save it, with the address of where you are staying, on the first day.