Well on Your Way - A Canadian’s Guide to Healthy Travel Abroad
- Before you go
- While you travel
- When things go wrong
- When you return
- Consular Services
- Publication Information
- Travel health tips
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The Government of Canada has developed this booklet to help you protect your health while travelling or living abroad. It includes essential information on understanding travel health risks; taking preventive measures before, during and after your travel; coping with a health emergency abroad; and accessing consular services in a health emergency.
We encourage you to take steps to reduce your risk of illness and accidents while abroad. With a little knowledge and preparation, you can protect yourself against many common and preventable travel-related illnesses.
Be Prepared. Expect the Unexpected!
Connect with the world and access travel advice for more than 200 destinations. Wherever you go, wherever you are, visit the Consular Services website, or consult with us by telephone (1-800-267-6788 or 613-944-6788), TTY (1-800-394-3472) or e-mail (firstname.lastname@example.org).
Know before you go!
Standards of safety, hygiene and medical care in foreign countries may not be the same as in Canada. These differences can seriously affect your health and your ability to access medical help while abroad.
Before departure, you should learn about the health risks in the country or countries you plan to visit, your own risk of disease and the steps you can take to prevent illness and injury. If you feel ill, delay your departure in order to avoid travelling on planes and ships. Health, security and accident avoidance are your responsibility and should be considered before, during and after travel abroad.
SIGN UP FOR THE REGISTRATION OF CANADIANS ABROAD SERVICE
Who should register?
All Canadians travelling or living abroad.
To allow us to contact and assist you in an emergency abroad, such as a natural disaster or civil unrest, or inform you about a family emergency at home.
Will my information be shared with other parties?
Personal information obtained through registration is confidential and is used in accordance with the provisions of the Privacy Act.
Where can I find out more?
Call 1-800-267-6788 or 613-944-6788 (in Canada), or contact the nearest Canadian government office abroad.
Protecting the health of Canadian travellers
The Public Health Agency of Canada provides information to help you stay healthy while abroad. Visit the Agency’s website for:
- travel health notices;
- information on specific diseases and health conditions; and
- recommendations about preventing illness and reducing risk while abroad.
Before You Go
Individual health assessment
Your risk of becoming sick or injured while abroad depends on a number of factors, including:
- immunization status;
- current state of health and pre-existing medical conditions;
- length of stay;
- climate and season;
- type of accommodation;
- itinerary and activities; and
- local conditions.
Based on these factors, a health care provider can assess your health needs and help you to prevent illness and injuries by providing:
- immunization against illnesses such as hepatitis, typhoid, meningitis, yellow fever or Japanese encephalitis;
- preventive medication against malaria, gastrointestinal illnesses and other potential conditions; and
- information about general precautions you can take.
Where to get travel health advice
The Public Health Agency of Canada strongly recommends that you consult your health care provider or visit a travel health clinic for an individual health assessment at least six weeks before departure, as certain vaccines and preventive medications take time to work. When booking your appointment, allow for delays ¯ busy travel health clinics may not be able to see you right away. Also, if available, bring along a copy of your immunization record (history of the immunizations you’ve received) when you visit a travel health clinic or your health care provider. For more information, consult the Immunization records section.
Invest in your health
It’s always wise to invest in protecting your health before venturing abroad. Pre-travel individual health assessments and travel immunizations may not be covered by provincial health plans. Fees for these services should be part of your travel budget.
If you’re not feeling well, especially if you have a fever, consult your health care provider to discuss postponing your trip. Doing so could help you avoid a potential health emergency and also shows respect for others. Trip cancellation insurance is widely available.
Obtain travel health insurance
Don’t rely on your provincial health plan to cover costs if you get sick or are injured while abroad. Provincial health plans don’t always cover out-of-country travel. For example, a medical evacuation could run more than $50,000. Your health plan will cover only part of the bill and will not pay up front. For more information, contact your provincial/territorial health authority. Even if you’re taking a day trip to the United States, purchase the best private travel health insurance you can afford.
It’s your responsibility to obtain and understand the terms of your travel health insurance policy. Your credit card company may offer health and travel insurance, but don’t assume that coverage is automatically included or that the card alone provides adequate coverage. Some companies charge an additional premium for travel coverage. Others require that you use their card to pay for your travel arrangements. Verify the conditions, limitations and requirements before departure.
Ask your health care provider to fill in the portion of the insurance questionnaire on pre-existing conditions to avoid future problems. For example, you may have a pre-existing condition, such as borderline diabetes or high blood pressure, that doesn’t require you to take medication at this time. If you fail to indicate all pre-existing conditions on the form and then need the coverage while abroad, the insurance company may refuse to pay your hospital bills.
Always carry proof of your insurance coverage when travelling. Also, tell your travel agent, a friend or relative at home or your travelling companion how to contact your insurer.
If you receive medical care while travelling, get a detailed invoice from the health care provider or hospital before you leave the country. Nothing is more frustrating than trying to get the proper paperwork from thousands of kilometres away. Most insurance companies won’t accept copies or faxes of receipts, but you should keep copies for your own files.
What to look for…
When assessing a travel health insurance plan, ask if it:
- provides continuous coverage before departure and after return;
- offers coverage renewable from abroad and for the maximum period of stay;
- has an in-house, worldwide, 24-hour/7-day emergency contact number in English or French and/or translation services for health care providers in your destination country;
- pays for foreign hospitalization for illness or injury and related medical costs (treatment for some injuries may exceed $250,000);
- provides coverage for doctor’s visits and prescription medicines;
- provides direct payment of bills and cash advances abroad so you don’t have to pay out of your own pocket;
- covers pre-existing conditions (get an agreement in writing that you’re covered);
- provides for medical evacuation to Canada or the nearest location with appropriate medical care;
- pays for a medical escort (doctor or nurse) to accompany you during evacuation;
- covers premature births and related neonatal care, as needed;
- clearly explains deductible costs (plans with 100 percent coverage are more expensive but may save money in the long run);
- covers preparation and return of your remains to Canada if you die abroad (in most cases, costs will exceed plan coverage);
- covers emergency dental care;
- covers emergency transportation, such as ambulance services; and
- doesn’t exclude or significantly limit coverage for certain regions or countries you may visit.
Immunization and malaria prevention
When travelling, you may be at risk for a number of illnesses that can be prevented by immunization. As you age, your vaccine-acquired protection against many illnesses may decrease or your risk for getting certain diseases may increase. Your pre-travel health assessment provides an opportunity to review your immunization history, get you
up-to-date according to your provincial/territorial vaccination program and assess your needs based on where you plan to travel, what you plan to do and your own individual health concerns. Additional shots may be recommended depending on your age, anticipated travel activities and local conditions. Remember that prevention of infection through immunization is a lifelong process.
The following is an alphabetical list of diseases against which immunization may be recommended prior to travel:
- chicken pox
- European tick-borne encephalitis
- Haemophilus influenzae type b disease
- hepatitis A
- hepatitis B
- human papillomavirus (HPV)
- Japanese encephalitis
- meningococcal disease
- pertussis (whooping cough)
- pneumococcal disease
- rubella (German measles);
- yellow fever
Yellow fever immunization within the past 10 years and an International Certificate of Vaccination or Prophylaxis are requirements for entry into some countries. Many countries require this proof of yellow fever vaccination if you’ve passed through an area where yellow fever may occur. Without such proof, you may be refused entry, quarantined or vaccinated. Yellow fever vaccination is only given at designated yellow fever vaccination centres; a list of these centres is available on the Public Health Agency of Canada’s Travel Health Clinics page.
As another example of destination-specific requirements, Saudi Arabia requires proof of meningococcal immunization for all pilgrims and proof of polio immunization for all children going to Mecca during the Hajj.
Keep your family’s immunization records in a safe and accessible place and carry copies when you travel. However, if your destination country requires proof of yellow fever vaccination, you must carry the original International Certificate of Vaccination or Prophylaxis. Keep a copy of this certificate at home.
Malaria is a common and serious infection in many tropical and subtropical countries, and it can be fatal. At this time, an anti-malarial vaccine that provides effective protection for travellers is not available. Therefore, when travelling to an area where malaria occurs, you need to follow two measures to reduce your risk of infection: (1) protect yourself against mosquito bites and (2) take anti-malarial medication.
Anti-malarial medication decreases your risk but doesn’t provide 100 percent protection against the disease. The medication must be taken before, during and after travel. As with all drugs, this medication can have side effects and contraindications (conditions for which its use is inadvisable). Through an individual health assessment, your health care provider can give you a prescription for the appropriate anti-malarial medication for your needs. See the section entitled Insect- and tick-borne diseases for advice on measures you can take to prevent mosquito bites.
Travelling with prescription drugs
When travelling outside Canada with prescription drugs, you should carry a note of explanation from your health care provider to avoid problems with customs officials. Requirements vary from country to country and may also include:
- a clear hospital or pharmacy label on the original drug container that identifies your full name as it appears on your passport, the name of the pharmacy, the name of the medication and the dosage; and
- a copy of your prescription.
You’ll also need this information if your medication is lost or stolen. Along with copies of your prescriptions, keep a record of each drug’s generic and trade names.
If you wear glasses or contact lenses, having the prescription with you will make it easier to replace them if needed.
Essential medication should be carried in two different pieces of hand luggage, in case one gets lost or stolen. Bring enough medication for more than the duration of your trip. Don’t give in to the temptation to stop taking medication (for blood pressure, depression, etc.) or to decrease the dosage during a trip just because you suddenly feel better.
Some over-the-counter medications, dietary supplements, and herbal and homeopathic products used in Canada are illegal for import and use in other countries or may require a prescription. Contact the embassy of your destination country before departure to make sure both your prescribed drugs and any over-the-counter medication you intend to bring into the country are allowed. Visit the Consular Services website or contact Consular Services for a list of foreign government offices accredited to Canada.
If your medication requires needles and syringes, carry an explanation from your health care provider or a medical certificate with you. In some countries, a traveller found with needles and syringes and without an adequate explanation could be in serious trouble. Since security screening regulations change frequently without warning, and differ from country to country, check regulations before you travel to allow enough time to get the proper documentation.
Needles and syringes may be difficult to purchase abroad, so take enough to last your entire trip. Before departure, check your airline’s regulations regarding needles and syringes in carry-on luggage.
Over-the-counter drugs for sale in Canada aren’t always easy to find in other countries. Just in case, take some preventive medication along, such as medication against diarrhea or allergic reactions. Some medications available in foreign countries may cause allergic reactions or may be counterfeit and not contain any actual medication. It is also possible that medication in foreign countries may have been removed from the market in Canada because of toxicity or other concerns about its safety or effectiveness.
Travelling with a pre-existing medical condition
If you have a chronic medical condition, carry a letter from your health care provider outlining your situation and required medications. Find out if English- or French-speaking doctors are available in the area you’ll be visiting. The International Association for Medical Assistance to Travellers (IAMAT) can help with your research.
Elizabeth had been living with heart disease for decades. Before she went south in January, she booked two appointments. The first was with a travel health clinic to find out what she’d need to carry with her in case she became ill while travelling. She was advised to take a copy of her latest electrocardiogram (EKG) as well as a list of all her medications, and to carry these items in her hand luggage. She was also reminded to purchase comprehensive travel health insurance. Then she booked an appointment with her family doctor to get copies of all the relevant medical information.
If you have medical needs that will require attention abroad, call each hotel or resort you’ll be visiting to discuss arrangements in advance. Be sure to bring any medical supplies you may need. Discuss all your travel plans in advance with your health care provider or travel health clinic.
Once you enter the departure screening area at an airport, tell the screening officers about any medical implants, artificial limbs or mobility aids you have that may be affected by the metal detection equipment.
If you’re disabled and will be travelling outside North America, visit the Disabled Peoples’ International website for information about accessibility in the country you’ll be visiting. More information on international travel for disabled persons can be found under Frequently Asked Questions on the Consular Services website.
Always carry with you a list of your medications, including the dosage and your reason for taking them, any allergies you have, your blood type and the name of a contact person. Also include contact information for your regular health care provider (e.g., family physician). If you end up in hospital while travelling, this information will be the first thing doctors will need. You may want to consider using MedicAlert®.
Medications should be listed under their generic names to ensure they’re recognizable to doctors in other countries where the drugs may be sold under different trade names. Depending on the nature of your pre-existing condition, your health care provider may recommend that you carry additional documentation ¯ such as copies of your latest EKG or of your lab, X-ray or ultrasound reports ¯ to assist foreign doctors in the event you experience a health problem abroad.
The senior traveller
Many seniors are in excellent health and are at little increased health risk when travelling, but others have one or more pre-existing health conditions that may worsen during travel.
Changes in environmental conditions (heat, altitude, humidity), activity levels, living conditions, diet and time zones — as well as jet lag — may be harder on you as a mature traveller, particularly if you have a chronic illness. In addition, you may be at greater risk for such problems as dehydration, infectious diseases and injuries. How well you respond to vaccinations may depend on your age and medical history. It’s important to discuss with your pharmacist or health care provider whether your activities, travel-related immunizations or preventive drugs will interact with any of your regular medications and create a problem.
Kuldeep and Jasmine were making their first trip to their homeland in 25 years. At the airport, thrilled to be “home”, Kuldeep felt his pulse racing. Jasmine hurried him into a taxi and headed to their hotel. At the hotel pharmacy Jasmine saw an over-the-counter medication with the same name as the prescription drug Kuldeep had taken in Canada ¯ and she made an almost fatal purchase. Jasmine didn’t know that the medication in her homeland was twice as strong as the Canadian product. Luckily, she had asked to see the hotel doctor, who directed her to the right drug for Kuldeep.
Falls are the leading cause of injury among seniors. Older travellers can minimize falls by staying fit, eating well and using an aid (e.g., cane, walker, sturdy shoes with non-skid soles). These will help ensure a safer trip.
Senior travellers should be especially mindful of the effects of heat. Be sure to drink plenty of water during hot weather. If you’re planning a holiday involving hiking or walking, ensure you’re physically prepared for the effort. Take up a suitable exercise program at least one month before leaving to prepare your body.
If you’re a senior traveller, you should discuss the details of your trip ¯ your destination, length of stay and planned activities ¯ with your health care provider or a travel health clinic well before departure. Ask about your need for influenza and pneumococcal vaccines, especially if you’re going on a cruise. Always carry adequate travel health insurance.
Travelling while pregnant
If you are pregnant, visit your health care provider or travel health clinic before going abroad, especially if travelling by air. You may be more susceptible to certain conditions or suffer added complications from diseases. For instance, pregnant women have an increased risk of blood clots. When flying, request an aisle seat and try to stand up, walk around or stretch your legs regularly.
You should check the airline’s rules for pregnant passengers before booking your ticket. In Canada, airlines will allow you to fly up to the 35th week of pregnancy, provided you’re healthy and have no history of premature labour. The rules in other countries may be different, and you could be asked to supply a letter from your health care provider verifying the stage of your pregnancy. Also, make sure that your travel health insurance policy provides coverage for all eventualities. Most policies don’t automatically cover pregnancy-related conditions or hospital care for premature infants.
For more information, see the Consular Services booklet Her Own Way: A Woman’s Guide to Safe and Successful Travel.
Travelling with infants and children
Travelling with infants and children can be fun and rewarding. Whether heading south for a week, visiting friends or relatives in a developing country or embarking on an adventure tour, be aware that children can become ill very quickly and may be a challenge to care for while travelling.
You must consider specific and sometimes complex issues when planning a trip for your family. For instance:
- Certain travel vaccines and preventive medications recommended for adults may not be suitable for infants and children.
- Infants may require an accelerated childhood immunization schedule before travel.
- Children are at increased risk for conditions such as diarrhea and vomiting and can develop more severe symptoms.
- Children are at greater risk of exposure to certain health hazards, such as rabies. They may be more inclined than adults to approach stray, and possibly rabid, animals.
- Children are at special risk of contracting malaria since preventive measures for them can be difficult to implement and they can quickly become seriously ill if infected.
Make sure you arrange a pre-travel health assessment for the children travelling with you to ensure that their specific needs are addressed.
Lena was wondering how to provide food for her baby Sarah while travelling. It took her some time to decide whether to continue breastfeeding Sarah, which would mean finding the time and privacy to do so, or switch to formula, which would mean sterilizing bottles and making sure the water was safe for the formula.
Be prepared to deal with your children’s minor health problems yourself, and know what to do and where to go in case of a more serious illness. Remember to bring the following:
- an adequate supply of baby products, such as formula and snacks;
- over-the-counter medications, such as acetaminophen and packets of oral rehydration salts for mixing with safe water;
- any prescription medications and permission letters for controlled drugs and needles;
- a copy of your children’s vaccination records; and
- a health care provider’s letter outlining any chronic conditions.
When travelling by air or by car, use an approved child safety seat. Carry a bottle or pacifier to make a young child more comfortable and to equalize ear pressure when flying. For more information on travelling with children, visit Consular Services’ Children and Travel page.
Travelling to your country of origin
Many foreign-born Canadians make regular trips to their birth countries to visit friends and relatives. In developing countries, these travellers ¯ and especially their children ¯ may be more vulnerable to preventable diseases than tourists because they tend to expose themselves to the same health risks as the local population.
Serena enjoyed the events held by family and friends to celebrate her first visit back to her homeland. Even though nine years had passed since she had moved to Canada, she didn’t feel like a tourist at all. She re-entered her old world, reconnecting with her roots. Because she’d been born and raised there, she considered herself immune to common local infections, such as malaria. In fact, her natural immunity had weakened. When she became ill with fever back in Canada, she saw her doctor and mentioned her recent travel. She was tested and treated successfully for malaria, but it made a difficult end to what was intended to be the trip of a lifetime.
If you and your family plan to travel to your country of origin, remember these facts:
- Any immunity to local diseases that you acquired while living in your country of origin may have greatly diminished.
- The disease situation you were familiar with in your home country may have changed.
Just because you once lived there and are familiar with the culture and customs, don’t assume you’re safe from health risks. For instance, extended stays in rural locations may carry greater risks. While staying with family or friends, you may be exposed to untreated water and undercooked food or you may stay in accommodations without air conditioning, window screens or bed nets. Therefore, you must take precautions to protect yourself and your family. For recommendations, see the section entitled Individual health assessment.
Travelling to seek medical care abroad
The hip replacement surgery Brian had overseas was available sooner than what he could get at home. He had planned well, both financially and personally, and took his sister with him for support. The procedure was a success, but he didn’t heal as fast as expected. His immune system was weakened and infection took hold. After an extra week in hospital, Brian wanted to go home despite being too weak to fly as a regular passenger. His sister had to arrange for medical evacuation back to Canada, where Brian spent another two weeks in recovery.
These days, more Canadians are travelling abroad, often to developing countries, for health care and treatment ranging from bathing in healing waters to organ transplants to cosmetic surgery. No matter the reason, if you’re a “medical tourist” you should understand that health systems outside Canada may operate very differently from what you’re accustomed to, and are not subject to Canadian rules and regulations. For instance, therapies considered “natural” are not necessarily safe. Mineral and “holy” waters may be sources of infectious diseases. Hospital and health care services may not be up to Canadian standards.
Before making a commitment to undergo medical treatment outside Canada, consult your health care provider or a travel health clinic. In addition to discussing your travel health-related risks, your health care provider will know your history and the procedure you’re travelling to obtain and can advise you accordingly.
Be aware of potential problems and risks. For instance:
- In some settings where medical care is not up to Canadian standards, you may be at greater risk of acquiring an infection ¯ such as hepatitis B or C or HIV ¯ as a result of procedures you undergo.
- Following surgery, you may be more vulnerable to local health risks, as your immune system may be compromised.
- As demand increases for donated organs, businesses dealing in international transplant services have been formed, which pay people from developing countries for donating their organs. Organs may also be harvested from prisoners without their consent. Such practices are legal in only a few countries, and concerns about the exploitation of donors are growing. In addition, the safety of these organs or the surgical procedures used to transplant them may not meet Canadian standards.
- Follow-up care is usually not included. You’ll have to seek help for any complications, side effects or post-operative care with your health care providers in Canada. However, many useful details about the care you obtained abroad may be lacking in Canada.
- If anything goes wrong, you may not have any legal recourse.
- Be prepared to pay cash. Provincial health plans, and some private insurance policies, don’t cover medical procedures overseas.
Cruise ships are among the safest forms of transportation and usually offer the services of an on-board doctor. However, health risks can increase depending on the activities you engage in at the ship’s ports of call. Once ashore, you have to follow precautions about what you eat and drink. The safest option is to take the land excursions offered by your ship. Otherwise, if problems occur and you end up in hospital, the cruise ship won’t necessarily take care of you and may even leave without you.
Seasickness or motion sickness affects some cruise passengers. Your health care provider or travel health clinic can discuss options to reduce the symptoms.
Outbreaks of communicable diseases, such as influenza or viral gastrointestinal illness (diarrhea and vomiting), have occurred on cruise ships due to the close contact among passengers. Vaccination is the best form of protection against influenza. Another important thing you can do to protect yourself from communicable disease, whether aboard ship or ashore, is to wash your hands well and frequently.
Working in a foreign environment, often under time constraints, can make for a stress-filled stay, putting you at greater risk for illness. If you travel frequently, it’s wise to arrange for regular medical checkups and a pre-travel health assessment before your next assignment. If you intend to take a side trip, ensure that your pre-travel assessment takes this into consideration.
Mental health and travel
International travel can suddenly uproot you from familiar surroundings, which can lead to mental and physical stress. Travel can also intensify pre-existing psychiatric conditions or provoke psychological crises because of feelings of uncertainty or anxiety about unfamiliar places. As well, unpleasant or frightening experiences can be more difficult to cope with while travelling because you’re removed from your usual support systems.
Many international travellers experience some degree of culture shock, the psychological stress experienced when adapting to a new culture or when re-entering your own culture after a prolonged absence. Travellers who are dealing with mental health issues before departure may be more prone to this type of stress, so learning to recognize its signs is important.
Changes in diet, activities, sleep and climate can have an impact on psychiatric symptoms and medications. In addition, some medications can be affected by foods you consume in foreign countries. For instance, aged and preserved foods containing high levels of tyramine ¯ such as soy sauce, wine, cheeses, smoked meats and nuts ¯ can cause severe side effects when taken with some anti-depressants.
Eating well, getting adequate sleep and exercise, and avoiding alcohol and recreational drugs can help prevent problems. If you have pre-existing psychiatric issues or disorders, see your health care provider or a travel health clinic to learn about precautionary steps you can take.
Most foreigners living overseas experience a degree of culture shock. This form of psychological stress affects even experienced long-term travellers and occurs when familiar cues and patterns are no longer present. It is important to recognize the symptoms of culture shock, which may be fleeting or last several months. Some of the symptoms are irritability, sleepiness, apathy, depression, compulsive eating, excessive drinking, negative stereotyping of the local people and recurring minor illnesses. For suggestions on how to ease the adjustment process, consult the Consular Services publication Working Abroad or the Coping with Culture Shock page on the Consular Services website.
If you’re travelling over a long period, your health concerns will be a bit different from those of the short-term traveller. You’ll be more exposed to potential disease risks and you may have to take preventive medication, such as anti-malarial drugs, for a longer time. You’ll need to learn how to shop for and prepare food safely in your new location, and you may need access to health care services for yourself and other family members.
A pre-departure health assessment will document all issues that might affect the health of each family member. This assessment could include checkups with the optometrist and dentist, as well as a psychological assessment to help you prepare for a new culture or a new job.
You’ll need adequate medical coverage that includes health and dental care for the length of your foreign stay. You may also want to consider getting enhanced life and disability insurance. Before you leave home, it’s wise to inform your health care providers, including your children’s pediatrician, of your upcoming absence from Canada to ensure your family will still be registered with them upon your return.
Chloe knew that living and working overseas would be the chance of a lifetime. While her posting afforded her good accommodations, there were few high-quality medical services available in the country if she needed them. She was concerned that the hospitals might have limited equipment, questionable blood supplies or poor infection control practices. Chloe chose to protect her health by investigating a number of travel health insurance options and selected the one that provided both medical services and medical evacuation coverage.
Be prepared to acclimatize!
Almost every traveller has experienced jet lag, the physical and psychological symptoms you feel when you travel over multiple time zones. Symptoms include fatigue, difficulty sleeping, poor concentration, altered moods and gastrointestinal problems. The effects are generally worse for eastward travel and with increasing age. It’s best to avoid caffeine, alcohol and heavy meals while you’re in the air. If you’re travelling on business, try not to schedule any work until 24 to 48 hours after you arrive. If you’re staying at your destination for more than three days, adjust your cycle of sleeping, eating and activity to your new location as soon as you arrive.
When you travel from a cold to a warmer climate, your body will need time to adjust to the heat. Take it easy if you exercise at the start of your trip and drink plenty of fluids. For protection from the tropical sun, wear sunglasses, a hat and other protective clothing. Use sunblock (SPF 15 or higher) regularly, especially if you’re taking medications (such as tetracycline) that increase the skin’s sensitivity to the sun.
Travel to areas of high altitude poses special risks. Oxygen decreases as you climb higher above sea level, and rapid ascents to altitudes greater than 2,500 metres (8,000 feet) can cause altitude sickness, even if you’re in excellent health. Symptoms include light-headedness, headache, fatigue, altered perceptions and sleep disorders. The safest method for climbing is a graded ascent, taking your time to acclimatize at various altitudes. Some drugs can help with altitude sickness, but they aren’t suitable for everyone. Moreover, some pre-existing health conditions can make travel to high altitudes (even some popular tourist destinations) more risky. If you have heart or lung disease or diabetes, be sure to discuss this subject with your health care provider and your travel health provider.
While You Travel
While some diseases can be prevented by vaccination, others require extra precautions on your part to safeguard your health. You may need to take preventive medications and adjust your behaviour to reduce your risk. It’s wise to follow the precautions below even if you’ve been vaccinated or are taking medications to prevent disease.
Food- and water-borne diseases
Diseases such as hepatitis A and typhoid fever are transmitted when you consume contaminated food or water. Schistosomiasis, a parasitic illness, can be transmitted by skin contact in some tropical freshwater lakes, rivers or streams. Other infections can sometimes be transmitted in public bathing facilities, including water parks.
To protect yourself from contaminated food and water:
- “Boil it, cook it, peel it or leave it!”
- Always wash your hands before eating or drinking.
- Eat only food that’s been well cooked and is still hot when served. Avoid uncooked foods—especially shellfish—and salads. Fruits and vegetables that can be peeled are usually a good choice.
- Drink only purified water that’s been boiled or disinfected with chlorine or iodine, or commercially bottled water in sealed containers. Drinking carbonated drinks, including beer, is usually safe.
- Avoid ice, unless it’s been made with purified water.
- Avoid unpasteurized dairy products and ice cream.
- Avoid food from street vendors.
- Avoid swimming in polluted or contaminated water.
- Brush your teeth with bottled water.
Hand washing with soap under running water is one of the most important practices in preventing illness while travelling. Alcohol-based hand gel can be used if soap and water are not readily available, so keep some in your pocket or purse.
Insect- and tick-borne diseases
Insects and ticks transmit a variety of serious infections. Mosquitoes can carry malaria, yellow fever and dengue fever; sand flies can transmit leishmaniasis; ticks can cause tick-borne encephalitis and Lyme disease; and beetles can transmit Chagas disease. Some diseases (e.g., dengue) are caused by daytime-biting mosquitoes; others (e.g., malaria) by night time-biting mosquitoes; and still others (e.g., West Nile fever) by both. Scorpions and biting spiders can also pose a risk to travellers in hot climates.
David and Barbara had never heard of dengue fever, an acute viral illness that’s spread by infected mosquito bites. So they hadn’t considered the need to take precautions while on holiday in the Caribbean. They only learned about the risk of dengue when they visited a travel health clinic for individual health assessments. Dengue is a common disease in many tropical and subtropical countries that are popular destinations for Canadian travellers.
Your first line of protection against any insect- or tick-borne disease is to not get bitten. To reduce your exposure to insects:
- Stay in well-screened or completely enclosed air-conditioned rooms and sleep under an insecticide-treated bed net.
- Wear light-coloured, long-sleeved, tucked-in shirts, long pants, shoes (not sandals) and a hat to cover exposed skin.
- Use insect repellent on exposed skin. Of the insect repellents registered in Canada, those containing DEET are the most effective. Use as directed by the manufacturer. When using sunscreen, apply the sunscreen first and then the repellent. Repellent should be washed off at the end of the day, before going to bed.
- Inspect your body and clothing for ticks during outdoor activity and at the end of the day. Wear light-coloured or white clothing so that ticks can be more easily seen.
- Apply a permethrin insecticide (similar to the natural pyrethrins) to your outerwear and shoes, and to tents and bed nets for greater protection. Use only products manufactured for clothing and gear, and don’t use them directly on skin. Permethrin-treated clothing is effective for up to two weeks or six washings. Although permethrin isn’t available in Canada, travel health clinics can advise you how to purchase permethrin and pre-treated gear before or during your trip.
Comprehensive information on protective measures against insects can be found on the Travel Health website.
As she crawled into bed after a long day, Carla thought, “I’ve got the bed net tucked in and the air conditioning on. I’ve closed the windows, so I’m safe from mosquitoes. No malaria bites tonight!” But the doors and windows had been open throughout the day. By evening, mosquitoes had collected around her room and were even under the bed net. To be safe, Carla should have checked the room thoroughly and shaken out her bed net before retiring for the night.
If you’re going to travel to areas where malaria exists, consult your health care provider or travel health clinic for individualized advice. Be sure to take anti-malarial medication as prescribed, and don’t stop taking it until you finish the full course. If you have a reaction or illness when taking the medication, see a health care provider immediately to get another method of malaria prevention.
Even if you took an anti-malarial medication while travelling, if you become sick with fever within a year of returning to Canada, inform your health care provider that you have been to a malaria-risk area. Infection with malaria is considered a medical emergency and you should see a health care provider immediately.
You can become ill from animal bites, from simple contact with animal fluids or feces, or by eating food made from contaminated animals (particularly meat and dairy products). Rabies, brucellosis, leptospirosis and certain viral hemorrhagic fevers are all spread through contact with animals or animal products. Reduce your risk of infection by avoiding close contact with wild, captive or domestic animals in any area where infection is being reported or is likely. Be particularly careful to prevent children from approaching and handling animals.
PROTECT YOURSELF FROM RABIES!
- Avoid direct contact with wild or domestic animals, especially dogs and monkeys in developing countries.
- Don’t handle, feed or attract wild animals with open garbage cans or litter.
- Instruct children to avoid wild or domestic animals, even if they appear friendly.
- Prevent bats from entering living quarters.
If you’re bitten by a potentially rabid animal:
- Wash the wound thoroughly with soap and water.
- Get medical attention immediately.
If you have difficulty getting treatment for rabies (obtaining rabies vaccine and rabies immunoglobulin after an incident), contact the nearest Canadian embassy or consulate.
Avian influenza (bird flu)
Avian influenza is a viral infection that can spread easily and quickly among birds. A particularly strong subtype called H5N1 has been circulating among birds in parts of Asia, Europe, the Middle East and Africa. In rare instances, H5N1 has infected people. Most human cases have been traced to direct contact with live infected birds or their droppings.
Your health care provider or travel health clinic can discuss the best way to protect yourself from avian influenza. In general, travellers should avoid contact with domestic poultry and wild birds at farms and markets. Make sure that all fowl to be eaten is thoroughly cooked. Wash your hands and all cooking equipment after contact with eggs or raw fowl and avoid cross-contamination with other food products. Additional information on avian influenza is available on the Governement of Canada’s Pandemic Influenza website.
Blood-borne diseases such as hepatitis B and C and HIV infection are transmitted from person to person by direct contact with infected blood or other bodily fluids. Reduce your risk of infection by avoiding any medical or cosmetic procedure that penetrates the skin (including acupuncture, piercing and tattooing), unprotected sex (not using condoms), transfusions with unsafe blood and sharing needles to inject intravenous drugs.
Certain diseases can be transmitted from person to person without direct physical contact. Infected microscopic droplets expelled when someone sneezes or coughs can cause meningococcal disease, tuberculosis and influenza. Close contact with people in aircraft, buses and other crowded and enclosed places may increase your risk, so use alcohol-based hand sanitizer and wash your hands frequently.
Diseases transmitted from sand and soil
Bacteria naturally residing in sand and soil can cause infection if they come into contact with broken skin. Wear shoes to prevent penetrating wounds and avoid direct contact with soil in locations where infections such as tetanus and anthrax are reported or likely to occur. Some parasites, such as intestinal worms, also live in soil and can infect you if you eat soil-contaminated vegetables.
Avoiding accidents and injuries
Traffic accidents are the most common cause of death among travellers under 50 years of age. You can reduce your risk by taking the same precautions you would at home and by being aware of ¯ and attentively following ¯ local traffic laws.
- Make sure you have travel health insurance coverage both for illness and for injuries sustained in accidents.
- Obtain information about traffic regulations, vehicle maintenance practices and the road system of the countries you’ll be visiting.
- Before renting a car at your destination, check the tires, seat belts, spare wheels, lights and brakes. Know the informal rules of the road ¯ in some countries, drivers will sound their horn or flash their headlights before overtaking another vehicle.
- Be particularly vigilant in a country where the traffic drives on the left side of the road.
Max was looking forward to being on his own for a few hours. He rented a motorbike from a local vendor, who assured him that the law didn’t require a helmet. Max took to the road, enjoying the breeze. Suddenly a truck sideswiped him. With no helmet, Max suffered a serious head injury, requiring care well beyond what the hotel doctor could offer. Luckily for Max, he had bought comprehensive travel health insurance, which covered his medical evacuation back to Canada.
Accidents and injuries in recreational waters
Recreational waters ¯ including seaside beaches, freshwater lakes and rivers, swimming pools and spas ¯ can pose health and safety risks. Use common sense in or near the water. Avoid alcohol, wear a life jacket aboard any watercraft, and take the following precautions:
- Watch for signs of dangerous waters like rip currents (discoloured or unusually choppy, foamy water with debris) while swimming. If a strong current carries you from shore, swim parallel to the beach until the current stops, then turn toward shore.
- Avoid waters where shark attacks are known to occur.
- Avoid electrical outlets in spas and near swimming pools.
- Never scuba dive alone or without training. Stay well hydrated and rested before diving, only dive within the limits of your training, and follow local diving guidelines. When snorkelling, watch out for jellyfish, biting and stinging fish, and coral.
- Watch your children! Use appropriately sized and certified life jackets. Lack of adult supervision is the most common factor in children’s deaths by drowning.
Violence while travelling
Violence is a risk in many countries. Criminals often target tourists and business travellers, particularly in countries where crime levels are high. Refer to the Travel Reports and Warnings section for country-specific advice and precautions you can take to reduce this risk.
Common health concerns
By far, the most common traveller’s complaint is diarrhea, or “turista.” Turista is caused by bacteria, viruses or parasites found in local water supplies used for drinking, washing and preparing food. To protect yourself, follow the food- and water-borne disease precautions.
Diane had been in the ocean all day and had worked up a good appetite. She ordered a meal at the bar on the beach. “I’ll avoid foods I’m not familiar with and ask for bottled water or pop.” What she forgot was that she had put on her sandals, picked up her wallet from the sand and carried the money in her hand when she bought her food. That night when she became ill with a gastrointestinal bug, she regretted not packing a small bottle of alcohol-based hand gel in her beach bag so she could have cleaned her hands before eating.
The most important treatment for diarrhea is to get water back into your body. So drink plenty of safe fluids (bottled water and juices) as soon as the problem starts. Bring along an oral rehydration solution, especially if you’re travelling with children; several brands are available in drug stores in Canada. Ask your health care provider or travel health clinic for more information on self-treatment of diarrheal illness. Most cases of traveller’s diarrhea will clear up in a few days. If your symptoms persist for more than two days during travel or after you come home, or if you have bloody diarrhea or fever, you should see a health care provider.
Recreational drug and alcohol use
Although recreational drugs may be readily available in some countries, their purchase, consumption, import and export are prohibited virtually everywhere. If you break the law in another country, you are subject to that country’s judicial system. So don’t agree to transport, hold, buy or use illegal drugs under any circumstances.
The Government of Canada does not, and cannot, authorize Canadians to use marijuana for medical purposes in other countries. Canadians are subject to the laws and judicial systems of the country in which they are travelling.
Recreational drug use can also lead to serious safety risks, as well as physical and mental health problems. Drug dealers may not know (or reveal) exactly what they are selling; drugs laced with other substances or chemicals or contaminated by fungi or moulds can be harmful, resulting in bad drug reactions, including fatal overdoses.
Martin knows his limit when it comes to drinking alcohol at home, but he didn’t realize the temptation he’d feel to “party” on holiday. One evening at a riverside bar in a small town, Martin had one too many rum punches and was asked to leave. Drunk and disoriented, he stumbled down to the pier in the dark — and walked off the edge into two metres of water. If it hadn’t been for the passerby who pulled him out that night, Martin’s holiday could have ended with his funeral.
Alcohol strengths vary, and the alcohol available on your travels might be stronger than what you’re used to. Don't accept drinks from strangers — drugs may be present in the beverages and put you at risk of sexual assault and robbery. Also be mindful that local laws may not tolerate drinking, especially binge drinking. In Saudi Arabia, for example, the importation, possession and use of alcohol is strictly forbidden. To find out if alcohol is permitted at your destination, contact the country’s embassy or consulate in Canada before you travel.
If you have unprotected sex with a new partner, you could acquire a variety of sexually transmitted infections. Many sexually transmitted infections have periods with no symptoms when the infection can still be spread to others, so an infected individual may not even know he or she is at risk of transmitting disease. Having sex with commercial sex workers can put you at a much greater risk for sexually transmitted infections.
If you’re sexually active, follow these precautions to prevent illness:
- Don’t have sex (vaginal, oral or anal) with strangers or commercial sex workers, and avoid casual sexual contact.
- Before departure, pack your own supply of high-quality condoms. If you’re going to have sex with a new partner, use latex condoms (or polyurethane condoms, if you’re allergic to latex) consistently and correctly for every sexual contact.
- Discuss vaccinations for hepatitis B and human papillomavirus (HPV) with your physician. No vaccines exist for many sexually transmitted infections, including HIV.
When Things Go Wrong
Many Canadians become ill and require medical assistance abroad. Be aware that standards of medical care vary from country to country and even within countries, although general health care is usually available anywhere. As a rule of thumb, more choices are available in urban than in rural or remote areas. However, options for specialized treatment may be nonexistent or inadequate at some destinations.
Major tourist hotels, including those in developing countries, have in-house physicians who provide medical assistance to both resident and non-resident guests. Hotels can also arrange appointments with local physicians. Most doctors have a fixed fee and will agree to make “house calls” to a hotel room on a priority basis.
If you need urgent care, the best option is often the nearest hospital. Mobile emergency services are rare in many countries, especially in the developing world, so use whatever form of transport you have. Canadian consular services include limited medical assistance abroad.
Consular services for travellers
Foreign Affairs and International Trade Canada has more than 260 offices worldwide, where consular officials can assist Canadians travelling, working or living abroad.
For a complete list of Canadian consular services and more information on planning a safe and problem-free trip:
- check the publication Bon Voyage, But… ;
- visit the Consular Services website;
- call 1-800-267-6788 (in Canada and the U.S.) or 613-944-6788;
- contact us via TTY by calling 1-800-394-3472 (in Canada and the U.S.); or
- you can consult travel information by country online, including health advice offered by the Public Health Agency of Canada.
Not only did Richard lose his wallet, valuables and passport when a burglar broke into his vacation villa, he was also stabbed in the chest while attempting to fight off the intruder. Fortunately, he was able to get medical attention and report the incident to the police, with assistance from the Consulate of Canada. He needed specialized medical treatment and had to return to Canada at once. Consular officials helped arrange for Richard’s medical evacuation and the transfer of funds from his family, since he had no health or travel insurance. Several days later, he was recovering from emergency surgery in a Canadian hospital.
Canadian government offices abroad offer 24-hour assistance, seven days a week. Outside office hours, your telephone call will automatically be transferred to a consular officer in Ottawa or you’ll be asked to leave a message for a return call. In either case, there will be a prompt response.
- If you leave a recorded message, make it clear and leave a complete telephone number or contact address. From some countries, you can use a toll-free number to speak to a consular officer in Ottawa. Also, you can make a collect call (where available) to Foreign Affairs and International Trade Canada in Ottawa at 613-996-8885. Or contact the Emergency Operations Centre by
e-mail at email@example.com or by fax at 613-943-1054.
- In locations where Canada does not have a local office, some Australian or British government offices can provide you with emergency services and contact the nearest Canadian government office on your behalf. Before you leave Canada, check the List of Canadian Government Offices Abroad.
If you have a medical emergency while abroad, officials at the nearest Canadian government office can provide you with the following services:
- Supply names of local medical providers and facilities. (Some Canadian embassies and consulates post lists of local medical providers on their website.)
- Visit you in hospital and provide basic translation services if required.
- Assist in arranging for medical evacuation if treatment is not available locally. (You must have appropriate travel health insurance to cover the costs.)
- Help with travel health insurance issues.
- Contact your next of kin, with your authorization, if you have an accident or are hospitalized, or in the event of your death.
- Provide advice about burying a Canadian abroad or repatriating the remains to Canada.
- Assist you in obtaining financial help from family and friends.
- Make alternative travel arrangements for you, including obtaining visas and other travel documents.
However, the Canadian government does not:
- Pay medical, travel or other expenses.
- Pay for the burial, cremation or repatriation of a deceased Canadian.
Suzanne woke up, dazed and bewildered, in an unfamiliar hotel room. She had no memory of what had happened after accepting a drink from a stranger she had met while sightseeing — but she knew she had been raped. Terrified and confused, she went to the Embassy of Canada. There, consular officials provided her with emotional and professional support. They assisted Suzanne in obtaining emergency medical attention and counselling, contacting her relatives and reporting the crime to the police. They would also see that a police investigation was carried out and that charges were laid if the offender was caught.
When You Return
The rise in global travel has increased the possibility of importing diseases to Canada. A recent example occurred in 2003 when SARS (severe acute respiratory syndrome) was brought to this country from East Asia. All travelling Canadians have a responsibility to protect their own health while abroad and to guard against importing diseases that could affect the health of others.
If you’re ill with a disease that could be transmitted to others, or have been near someone with a disease that could be transmitted to others, you are required to inform a customs officer or a quarantine officer upon your return to Canada so that they can determine if you require further assessment. If you’ve been sick while travelling or become sick after your return to Canada, inform your health care provider, without being asked, that you’ve been abroad, where you’ve been and what, if any, treatment or medical care you’ve received (e.g., blood transfusions, injections, dental care, surgery).
If you’ve been taking medication to prevent malaria while travelling, you must continue to take it for the full course prescribed, even after your return to Canada. If you’ve been to an area where malaria occurs and you develop fever within a year of returning home (especially in the first three months), inform your health care provider immediately. You may need a blood test to rule out the presence of malaria in your system. Anti-malarial medication doesn’t guarantee absolute protection against malaria.
Consular Services website
Tel.: 1-800-267-6788 (in Canada and the U.S.) or 613-944-6788
TTY: 1-800-394-3472 (in Canada and the U.S.) or 613-944-1310
(call collect from abroad where available)
The Consular Affairs Bureau publishes, in both official languages, a series of safe travel brochures.
Country Travel Reports provide information on safety and security conditions, health issues and entry requirements for approximately 200 travel destinations. This information is also available by telephone: 1-800-267-6788 (in Canada and the U.S.) or 613-944-6788.
Canadian government offices abroad
Published by Foreign Affairs and International Trade Canada and the Public health Agency of Canada.
Information in this publication is readily available for personal and public non-commercial use and may be reproduced, in part or in whole and by any means, without charge or further permission from Foreign Affairs and International Trade Canada and the Public Health Agency of Canada. We ask only that:
- Users exercise due diligence in ensuring the accuracy of the materials reproduced;
- Foreign Affairs and International Trade Canada be identified as the source department; and
- the reproduction not be represented as an official version of the materials reproduced, nor as having been made in affiliation with or with the endorsement of Foreign Affairs and International Trade Canada.
All information in this publication is provided on an “as is” basis without warranty of any kind, either expressed or implied. Foreign Affairs and International Trade Canada and the Public Health Agency of Canada make all reasonable efforts to ensure that the information contained in this publication is accurate. The reader is also encouraged to supplement this information with independent research and professional advice.
This publication is available in alternative formats upon request.
To obtain more information or free copies of this publication, write to:
Foreign Affairs and International Trade Canada
125 Sussex Drive
Ottawa, ON K1A 0G2
Tel.: 1-800-267-8376 (in Canada) or 613-944-4000
We would like to receive your comments on this publication. Write to us at the address above or e-mail us at firstname.lastname@example.org.
Travel Health Tips
- Get a pre-travel individual health assessment from a travel health clinic or your health care provider.
- Make sure you have full travel health insurance coverage for both illness and injury.
- Be prepared to acclimatize to jet lag, altitude sickness, culture shock and the effects of heat.
- Carry proof of your need for any prescription drugs.
- Take precautions with food and water.
- Wash your hands often.
- Be sure to drink plenty of liquids to prevent dehydration.
- Remember your anti-malarial medication, if prescribed.
- Remember to take precautions against insects. Use a sunblock with a minimum SPF of 15.
- Always use a condom if you have sex with someone you meet while travelling.
- Never share needles to inject intravenous drugs.
- Remember that swimming in some fresh water poses risks, including exposure to parasites.
- See your health care provider immediately if you become ill with fever within a year (especially within three months) of your return to Canada from an area known to have malaria.