Well on Your Way - A Canadian’s Guide to Healthy Travel Abroad

Contents

• Introduction
• Before you go
• Obtain travel health insurance
• While you travel
• If things go wrong
• When you return
• Travel health tips
• For more information
• Publication information

Other format

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Introduction

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.

Know before you go

Standards of safety, hygiene and medical care in other countries may differ from those 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, consider delaying your departure. Health, security and avoiding injury are your responsibilities and should be considered before, during and after travelling abroad.

Protecting the health of Canadian travellers

Travel.gc.ca, the Government of Canada’s website for Canadians travelling and living abroad, provides information to help you stay healthy in other countries, including:

• Travel Health Notices;
• information on specific diseases and health conditions; and
• country-specific health recommendations.

Before you go

Individual pre-travel health assessment

Your risk of becoming sick or injured while abroad depends on a number of factors, including:

• age;
• sex;
• immunization status;
• current state of health and pre-existing medical conditions;
• destination;
• 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 needs and help you prevent illness and injury by providing:

• vaccination against illnesses such as hepatitis, typhoid, meningococcal disease, yellow fever and Japanese encephalitis;
• preventive medication against malaria, gastrointestinal illnesses and other conditions; and
• information about general precautions you can take.

Where to get travel health advice

Consult with a health care provider or visit a travel health clinic for an individual pre-travel health assessment, preferably six weeks before travelling abroad. Some vaccines require more than one dose and some can’t be given at the same time as others. When booking your appointment, allow for delays, as 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 vaccinations you’ve received) to your appointment. For more information, see Immunization and malaria prevention.

Invest in your health

It’s always wise to invest in protecting your health before venturing abroad. Individual pre-travel health assessments and travel vaccinations 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 before your departure, especially if you have a fever, consult a health care provider to discuss whether you should postpone your trip. Doing so could help you avoid a possible health emergency abroad or spreading disease to others. Trip cancellation insurance is widely available and should be purchased when booking your trip in case unexpected circumstances prevent you from travelling.

Obtain travel health insurance

Don’t rely on your provincial or territorial health plan to cover costs if you get sick or are injured while abroad. Provincial and territorial health plans don’t always cover out-of-country travel. They may cover only part of the bill, and will not pay up front. A medical evacuation could cost more than $50,000, so it’s best to make sure you have travel health insurance to cover unexpected expenses. For more information, contact your provincial/territorial health authority.

Purchase the best private travel health insurance you can afford, even if you’re taking a day trip to the United States. 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 medical bills.

Always carry proof of your insurance coverage when travelling. Also, tell your travel agent, a friend or relative at home or your travel 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, as it may be difficult 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, particularly if you plan to stay abroad long enough to become ineligible for a provincial or territorial plan;
• offers coverage renewal 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 hospitalization for illness or injury and related medical costs outside Canada (treatment for some injuries may exceed $250,000);
• provides coverage for health care provider 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 (health care provider) 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 abroad, you may be at risk for a number of illnesses that can be prevented by vaccination. As you age, the protection you received against many illnesses through vaccination 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 immunization program and assess your needs based on your individual health, where you plan to travel and what you plan to do. Additional vaccines may be recommended depending on your age, expected travel activities and local conditions. Remember that preventing disease through vaccination is a lifelong process.

Required vaccinations

Before entering some countries, you may be required to have an International Certificate of Vaccination, or Prophylaxis, showing that you’ve received a yellow fever vaccination in the past 10 years. Other countries may require 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. In Canada, yellow fever vaccination is only given at designated yellow fever vaccination centres. A list of these centres is available.

Other countries may require additional vaccinations. Before you leave Canada, it’s best to consult with the embassy or consulate of your destination country for up-to-date information on entry and exit requirements.

Immunization records

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 prevention

Malaria is a common and serious infection in many tropical and subtropical countries, and it can be fatal. There is no vaccine available against malaria. When travelling to an area where malaria occurs, you should always protect yourself against mosquito bites and take anti-malarial medication, if recommended by a health care professional.

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. Consult a health care provider or travel health clinic for an individual health assessment, preferably six weeks before you travel, to determine your need for anti-malarial medication. See Insect- and tick-borne diseases for recommendations on how to protect yourself from insect 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 the prescription, with both the generic and brand names of the medication.

You’ll also need this information if your medication is lost or stolen.

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. Pack an extra supply of medication in case you’re away longer than expected. Don’t stop taking medication (for blood pressure, depression, etc.) or decrease the dosage during a trip 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 or consulate 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.

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 carrying needles and syringes without an adequate explanation could face arrest, detention or other consequences. Since security screening regulations change frequently without warning and differ from country to country, it’s best to contact the embassy or consulate of your destination country in Canada before travelling to check regulations and to allow enough time to get the proper documentation. A list of foreign embassies and consulates accredited to Canada is available.

Needles and syringes may be difficult to purchase abroad, so take enough to last your entire trip. Before packing needles and syringes in carry-on luggage, check your airline’s regulations and consult What you can bring on a plane.

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 there are health care providers who speak your language in the area you’ll be visiting. Canadian consular officials can provide an up-to-date list of local registered physicians and health care facilities in your destination country.

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 a 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 People’s International website for information about accessibility in the country you’ll be visiting. For more information on international travel for disabled persons, see Travelling with disabilities.

Older travellers

Many travellers over the age of 60 are in excellent health and are at little increased health risk when travelling. However, some may have pre-existing health conditions that could worsen during travel.

Changes in environmental conditions (e.g. heat, altitude, humidity), activity levels, living conditions, diet and time zones, and jet lag may be harder on you as you age, particularly if you have a chronic illness. You may also 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 a pharmacist or health care provider whether your activities, travel-related vaccinations or preventive drugs will interact with any of your regular medications and create a problem.

Falls are the leading cause of injury among older travellers. If you have limited mobility or impaired balance, you might consider using a walking aid (e.g. a cane or walker) to prevent falls.

Older 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, make sure you’re physically prepared for the effort. A suitable exercise program to prepare your body should be discussed with your health care provider and practised at least a few weeks before leaving.

If you’re an older traveller, you should discuss the details of your trip – 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 flu (influenza) and pneumococcal vaccines, especially for trips where you’ll be in large crowds (e.g. if you’re going on a cruise or an organized trip). We strongly recommend that you purchase adequate travel health insurance.

For more information, see Older travellers.

Travelling while pregnant

If you’re pregnant, visit your health care provider or travel health clinic, preferably six weeks before going abroad, especially if travelling by air. You may be at higher risk of certain conditions or suffer added complications from disease. 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, most airlines will allow you to fly up to the 36th week of pregnancy, provided you’re healthy and have no history of premature labour. Different rules may apply in other countries, and you could be asked to supply a letter from your health care provider confirming the stage of your pregnancy. Also, be sure to review your travel health insurance policy and the coverage it provides. Most policies don’t automatically cover pregnancy-related conditions or hospital care for premature infants.

For more information, see Travelling while pregnant and the booklet Her own way: a woman’s safe-travel guide.

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 another 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 (e.g. antimalarial medications have an unpleasant taste) and children can quickly become seriously ill if infected.

Make sure you arrange a pre-travel health assessment for the children travelling with you, preferably six weeks before departure, to ensure that their specific needs are addressed.

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
• prescription medications and permission letters for controlled drugs and needles
• a copy of your children’s immunization records
• 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, consult Tips for healthy travel with children.

Travelling to your country of origin

Many foreign-born Canadians make trips to their country of origin to visit friends and relatives. 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.

If you and your family plan to travel to your country of origin, remember these facts:

• Any immunity to local diseases that you may have built up in your country of origin is considerably diminished once you move away.
• The health conditions you were familiar with in your home country may have changed.

Just because you once lived in your country of origin and are familiar with the culture and customs, don’t assume that 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 Individual pre-travel health assessment.

Travelling abroad to seek medical care and alternative therapies

More Canadians are travelling abroad for health care and treatment, ranging from therapeutic baths to cosmetic surgery to organ transplants. 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 may not be subject to the same rules and regulations. For instance, therapies considered “natural” are not necessarily safe; mineral and “holy” waters may also be sources of infectious diseases. Hospital and health care services may not meet Canadian standards.

It’s your responsibility to research the standards of the health care facility and the licensing of the health care provider in your destination country. Find out how the medical services and facilities are accredited and how they are regulated. Verify the licensing of the facility or health care professional and review any complaints, comments, reports and evaluations. Even if you research the facility and staff thoroughly, there’s no guarantee that your experience will match your expectations.

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 doesn’t meet 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. These businesses pay people from developing countries for donating their organs. Organs may also be harvested from vulnerable people (e.g. prisoners) without their consent, and concerns about the exploitation of donors are growing. For these reasons, “transplant tourism” and selling organs are illegal in many countries. 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. Discuss a plan with your health care provider in Canada to make sure appropriate care is available when you return home. You may need help for any complications, side effects or post-operative care. Bring back copies of your medical records for your Canadian health care provider, including information about medications you received, results of medical tests and a description of the procedure(s) you underwent. 
• If anything goes wrong, you may not have any legal recourse.
• Be prepared to pay cash.
• Provincial health plans and some private insurance policies may not cover non-emergency medical procedures overseas.
• The medical services in some countries may not test blood for infections like HIV or hepatitis B. There’s also a risk of contracting malaria from local blood banks in certain areas. Avoid injections or blood transfusions except in an emergency.
• Be aware that multi-drug resistant bacteria are present in hospitals and other health care facilities around the world. Resulting bacterial infections can be very difficult to treat.

For more information, see Receiving medical care in other countries or consult the “Health” section of the Travel Advice and Advisories for country-specific information on medical services and facilities.

Cruises

Cruise ships are among the safest forms of transportation and usually offer the services of an on-board health care provider.

However, health risks can increase depending on the activities you engage in at the ship’s ports of call. Once ashore, take 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 infectious diseases, such as the flu or gastrointestinal illnesses with diarrhea and vomiting, can occur on cruise ships due to the close contact among passengers. Vaccination is the best form of protection against the flu. Another important way to protect yourself from getting sick or spreading germs, whether aboard ship or ashore, is to wash your hands well and frequently.

Business travel

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 check-ups and a pre-travel health assessment before your next assignment. If you intend to take a side trip, make sure that your pre-travel health 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. Unpleasant or frightening experiences can also 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. 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.

Long-term travel

If you’re travelling over a long period, your health risks will be 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-travel health assessment will document all issues that might affect the health of each family member. This assessment could include check-ups with the optometrist and dentist, as well as a psychological assessment to help you prepare for a new culture or job.

You’ll need adequate medical coverage that includes health and dental care for the length of your stay abroad and that provides full coverage if you’re away from Canada long enough to become ineligible for a provincial or territorial plan. 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 doctor, of your upcoming absence from Canada to ensure your family will still be registered with them upon your return.

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 colder 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 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 (8,200 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 gradual ascent, taking your time to acclimatize at various altitudes. If you have to make a quick ascent, some medications may help with altitude sickness, but they aren’t suitable for everyone. Moreover, some pre-existing health conditions can make travel to high altitudes more risky. If you have heart or lung disease or diabetes, be sure to discuss this subject with a health care provider before departure.

While you travel

Avoiding disease

While some diseases can be prevented through immunization, 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.

When it comes to eating and drinking while abroad, remember:

• Boil it, cook it, peel it or leave it! Eat only food that’s been well cooked and is still hot when served. Avoid uncooked foods (like shellfish and salads) and food from street vendors. Fruits and vegetables that can be peeled are usually safe to eat.
• Avoid unpasteurized dairy products and ice cream.
• Only drink and use ice made with purified water or commercially bottled water in sealed containers. Carbonated drinks are usually safe.
• Brush your teeth with bottled water.
• Wash your hands with soap under warm running water for at least 20 seconds, as often as possible, before eating or drinking. This is one of the best and easiest ways to prevent illness while travelling.
• Use alcohol-based hand sanitizers if you’re not able to wash your hands. It’s a good idea to always have some with you when you travel.
• Avoid swimming, wading, bathing or washing clothes in polluted or contaminated water.

Insect- and tick-borne diseases

Many travel-related diseases, like dengue fever, malaria or tick-borne encephalitis, are transmitted by infected insects such as mosquitoes, ticks, fleas or flies. Be aware of peak biting times (e.g. daytime vs. night-time biting mosquitoes) and areas (e.g. indoor vs. outdoor, rural vs. urban) in which certain insects may appear. Scorpions and biting spiders can also pose a risk in hot climates.

Your first line of protection against any insect- or tick-borne disease is to practise protective measures to avoid insect bites:

• Wear light-coloured, long-sleeved, loose-fitting shirts that are tucked in at the waist, long pants, shoes (not sandals) and a hat to cover exposed skin. In tick-infested areas, you can also tuck the cuffs of your pants into your socks, shoes or boots and tape them in place. Use insect repellent on exposed skin. Insect repellents containing DEET or Icaridin (also called Picaridin) are the most effective; use as directed by the manufacturer. Apply sunscreen first, if needed, followed by the repellent.
• Stay in well-screened or completely enclosed air-conditioned rooms or sleep under an insecticide-treated bed net.
• 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 to your clothing and other travel gear for greater protection. Use only products manufactured for clothing and gear and don’t use them directly on skin. Permethrin-treated clothing is effective through several washes. Although permethrin-treated products aren’t readily available in Canada, a travel health clinic can advise you how to purchase permethrin and pre-treated gear before or during your trip.

For more information, consult Insect bite prevention.

If you’re going to areas where malaria exists, consult your health care provider or travel health clinic for an individual travel health assessment. 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.

If you become sick with fever within a year of returning to Canada, even if you took an anti-malarial medication while travelling, see a health care provider immediately and explain that you’ve travelled to or lived in an area where there is a risk of malaria. Infection with malaria is considered a medical emergency.

Animal-borne diseases

You can become ill from animal bites, from contact with animal fluids or feces or by eating food made with or from contaminated animals, including meat, fish 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 or handling animals.

Influenza (flu) viruses

Influenza viruses can spread easily among humans, birds and pigs. A few simple steps can help protect you and others from the flu:

• Get vaccinated.
• Wash your hands with soap under warm running water for at least 20 seconds, as often as possible.
• Practise proper cough and sneeze etiquette. Cover your mouth and nose with your arm to reduce the spread of germs. If you use a tissue, dispose of it as soon as possible and wash your hands afterwards.
• Try to avoid close contact with people who are sick.
• Keep shared surfaces clean.

You may be at risk not only of seasonal flu but also of several other strains of influenza. Travellers 65 years of age and older, those with chronic medical conditions (e.g. diabetes, heart disease, kidney disease, respiratory disease), young children (six months to five years of age) and pregnant women are more likely to become seriously ill from all types of flu and may wish to take extra protective measures, such as avoiding large gatherings and crowds.

Avian influenza subtypes normally circulate among birds but can infect humans and cause severe illness. If you’re travelling to a destination where avian influenza is a concern, avoid high-risk areas such as poultry farms and live animal markets; contact with birds, including chickens, ducks and wild birds; surfaces that may be contaminated with bird droppings or secretions; and make sure that all poultry dishes and eggs are well cooked.

Additional information is available at Flu (influenza): Symptoms and treatment.

Person-to-person infections

Diseases transmitted through blood, such as hepatitis B, hepatitis C and HIV infection, are spread from person to person by direct contact with infected blood or other bodily fluids. Reduce your risk of infection by avoiding unprotected sex, sharing needles and other equipment for drug use, any medical or cosmetic procedure that penetrates the skin (including acupuncture, piercing and tattooing) and, except in an emergency, blood transfusions and organ transplants. In some countries, the blood or organ supply might not be adequately screened, increasing the risk of virus transmission.

Certain diseases can be spread from person to person without direct physical contact. Tiny infected droplets that spread through the air when someone coughs or sneezes can cause the flu, meningococcal disease and tuberculosis. Close contact with people in buses, planes and other crowded and enclosed places may increase your risk, so wash your hands frequently.

Diseases transmitted from sand and soil

Bacteria found naturally 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 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

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 for both illness and injuries sustained in accidents.
• Know the risks of renting motorcycles, scooters and mopeds, particularly from unregulated agencies and be sure to wear a helmet and protective clothing to minimize the risk of injury. Your travel insurance may not provide coverage for these activities.
• 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.
• Don’t drive if you’re under the influence of drugs or alcohol.
• Don't get into a vehicle if you think the driver may have been drinking or taking drugs.
• 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.

Accidents and injuries in recreational waters

Recreational waters – including oceans, lakes, 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 proper instruction or certification from a reputable training organization, such as the Professional Association of Diving Instructors (PADI). Don’t use alcohol and stay well hydrated and rested before diving, only dive within the limits of your training and follow local diving guidelines. Check that your insurance provides coverage for accidents and injuries related to scuba diving, or take out special diving insurance that covers the high cost of decompression chamber treatment. 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.

Violent crime while travelling

There is a risk of violent crime in any country. Criminals often target tourists and business travellers. See our Travel Advice and Advisories for country-specific recommendations you can follow to reduce the risk of violent crime.

Common health concerns

Gastrointestinal illness

By far, the most common traveller’s complaint is diarrhea. Travellers’ diarrhea is caused by bacteria, viruses or parasites found in local water supplies used for drinking, washing and preparing food. See Food- and water-borne diseases for precautions you can take to protect yourself.

The most important treatment for diarrhea is to get water back into your body. Drink plenty of safe fluids (bottled water, diluted juices or sports drinks) 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 travellers’ 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. For more information, see Travellers’ diarrhea.

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.

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.

Alcohol strengths vary widely, and the alcohol available on your travels might be stronger than what you’re used to. Some drinks, particularly alcoholic beverages, may contain harmful substances. The contents of any bottle, even brand-name bottles, may have been altered. Locally brewed liquors can be especially dangerous.

Don’t accept drinks from strangers – drugs may be added to beverages and put you at risk of sexual assault, robbery and other crimes. Also, be mindful that local laws may not tolerate drinking, especially binge drinking. The importation, possession and use of alcohol are strictly forbidden in some countries. To find out if alcohol is permitted in your destination country, contact that country’s embassy or consulate in Canada before travelling. For more information, see Alcohol, drugs and travel.

Sexually transmitted infections

If you have unprotected sex, you could be at risk of various 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. The risk for sexually transmitted infections is higher among travellers who engage in unprotected sex (anal, oral or vaginal), casual and/or anonymous sex and sexual activity with sex trade workers.

If you’re sexually active, follow these precautions for safer sex and to reduce the spread of infections:

• Pack a supply of high-quality latex or polyurethane male or female condoms before travelling. Use them consistently and correctly for every sexual activity.
• Be aware that other birth control methods do NOT protect you against HIV or other sexually transmitted infections.
• Discuss vaccinations for hepatitis A, hepatitis B and human papillomavirus (HPV) with a health care provider. There are no vaccines against other sexually transmitted infections, including HIV.

For further recommendations and information, consult Sexually transmitted infections.

If things go wrong

If you become ill and require medical assistance while abroad, be aware that standards of medical care vary greatly from country to country and even within countries. More choices are generally available in urban rather than rural or remote areas. However, options for specialized treatment may be nonexistent or inadequate in some countries.

Medical emergencies

Major tourist hotels, including those in developing countries, often have in-house physicians who provide medical assistance to guests. Hotels can also arrange appointments with local physicians. Many health care providers 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. Ambulance services are uncommon in many countries. Use the most readily available transport to get to the hospital.

If you have a medical emergency while abroad, consular officials at the nearest Canadian embassy or consulate can:

• provide an up-to-date list of local registered physicians and health care facilities (e.g. hospitals, dental clinics, sexual assault counsellors, mental health crisis services);
• help you to identify different options to obtain necessary medical care;
• help you in a medical emergency by offering appropriate assistance, subject to your consent to release personal information to a third party, unless there is a medical reason that makes this impossible;
• identify and contact your next of kin or another person designated by power of attorney to make decisions if you are incapacitated;
• act as an intermediary with local authorities and medical facilities abroad and provincial/territorial healthcare services and medical facilities in Canada;
• contact your health insurance company if you are unable to communicate and there is no designated family member or friend to take responsibility;
• contact your medical doctor in Canada;
• help you arrange for a medical evacuation and safe transfer, including liaison with service providers, if necessary treatment is not available locally; and
• issue a temporary loan from the Distressed Canadian Fund, subject to consular fees and strict conditions, if you are in a situation deemed life-threating by a medical professional and all other financial options are exhausted.

However, Canadian consular officials cannot:

• pay hospital or medical bills;
• pay for air ambulance or other aeromedical services;
• provide medical or legal advice;
• make a medical diagnosis; or
• interfere in or make decisions regarding your medical care.

Emergency services

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 Global Affairs Canada in Ottawa at 613-996-8885. Or contact the Emergency Watch and Response Centre by email at sos@international.gc.ca 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 directory of Canadian embassies and consulates abroad.

When you return

The rise in global travel has increased the possibility of bringing diseases back into Canada. Examples include SARS (severe acute respiratory syndrome) in 2003 and the H1N1 influenza virus in 2009. 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 become sick (e.g. fever, shortness of breath) or if symptoms of an existing medical condition worsen while abroad and you’re still sick when returning to Canada, tell a flight attendant, cruise staff or border services officer upon arrival.

If you develop symptoms after returning, see a health care provider. Explain where you’ve been travelling or living 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, seek medical attention immediately. Anti-malarial medication doesn’t guarantee absolute protection against malaria.

For more information

Government of Canada

The Government of Canada’s website for Canadians travelling or living abroad 

travel.gc.ca

Travel Advice and Advisories 

Travel Advice and Advisories provide vital information on safety and security, local laws and customs, health conditions and entry requirements for more than 200 travel destinations. This information is also available by phone: 1-800-267-6788 (in Canada and the U.S.) or 613-944-6788.

Travel Health Notices

The Public Health Agency of Canada releases Travel health notices that outline potential health risks to Canadian travellers and recommend measures that can be taken to help reduce those risks.

Travel Health and Safety

Essential information on understanding Travel health and safety risks and preventive measures to take before and during your trip

Alcohol, Drugs and Travel

Information and advice to help you understand and avoid risks related to alcohol, drugs and travel

Publications (free)

Access smart-travel publications on line or order them by calling 1-800-267-8376 (in Canada) or 613-944-4000.

Global Affairs Canada

Consular services

General

travel@international.gc.ca

Emergencies

613-996-8885 (call collect from abroad where available)

sos@international.gc.ca

Canadian embassies and consulates abroad

travel.gc.ca/assistance/embassies-consulates

Stay connected

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Public Health Agency of Canada

Yellow Fever Vaccination Centres in Canada 

Passports, Certificates of Identity and Travel Documents

Canadian passports

canada.ca/en/immigration-refugees-citizenship/services/canadian-passports.html

Immigration, Refugees and Citizenship Canada

Other sources of information

International Association for Medical Assistance to Travellers (IAMAT)

MedicAlert®

MedicAlert® provides Canadians with customized bracelets and necklets linked to their medical records. This information can be accessed in an emergency by health professionals anywhere.

World Health Organization (WHO)

who.int

WHO publishes International Travel and Health, offering guidance on health risks travellers may encounter at specific destinations and associated with different types of travel.

Publication information

Published by Global Affairs 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 Global Affairs Canada and the Public Health Agency of Canada. We ask only that:

• Users exercise due diligence in ensuring the accuracy of the materials reproduced;
• Global Affairs Canada and the Public Health Agency of 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 Global Affairs Canada and the Public Health Agency of Canada.

All information in this publication is provided on an “as is” basis without warranty of any kind, either expressed or implied. Global Affairs Canada and the Public Health Agency of Canada make all reasonable efforts to ensure that the information contained in this publication is accurate. The Government of Canada, as the publisher, is solely responsible for the accuracy, completeness, timeliness and reliability of any such information. The information, however, is subject to change at any time without notice.

The reader is also encouraged to supplement this information with independent research and professional advice.

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