International travel is one of the primary ways in which antibiotic resistance is spread by humans. Travel to resistance “hotspots” such as India and Southeast Asian countries has been linked to the emergence of resistant bacteria in areas deemed low risk. The 2003 SARS outbreak that began in China is an illustrative case of just how quickly infections can spread due to global travel; within weeks new cases were spread to Canada, Hong Kong, Taiwan, Singapore, Thailand, and the United Kingdom (WHO). A 2014 report found that in Swiss tourists travelling to India the risk of returning with ESBL producing E. coli. was 87% (Kuenzli et al. 2014).
Advice on protecting yourself against AMR will be dependent on which country you visit and the health and safety legislation already implemented there. That said, please find some general tips to avoid contracting resistant infections while abroad.
- Make sure all vaccinations are up to date
- Ask your health care professional if you could benefit from any vaccines specific to your destination country
- Always use safe sexual practices
- Maintain good hygiene; wash your hands often and especially prior to eating
- Learn about ways to treat and prevent common travel associated illnesses such as travelers’ diarrhea
- Drink only bottled water
- Avoid eating street food, particularly meat; use your judgement, if a restaurant or food vendor looks unclean your safest option is to eat packaged foods or stick to restaurants that have clear health and safety standards
- Avoid eating meat in countries where antibiotics are still used incorrectly in animal husbandry
- If you become sick while on vacation or after returning home, make sure you seek medical attention and let your healthcare provider know what countries you have been travelling in
AMR Travel Tool
EPI-Net (Epidemiology Network) engages in developing a consensus program and homogenous approach on epidemiological surveillance strategies for AMR and HAI (health-care associated infection) in Europe and addressing research needs to support antibacterial drug development. It has made available an easy-to-use, annually updated, freely accessible AMR travel tool. For healthcare professionals, it can provide a valuable resource for teaching and a repository that facilitates a stepwise assessment of the risk of AMR spread and strengthen implementation of optimized infection control measures. Similarly, for travelers the tool has the potential to raise awareness of AMR and outlines preventive measures that reduce the risk of AMR acquisition and spread. The tool is available here.
Students travelling for holidays or study abroad programs should particularly pay attention to the travel advisory warnings in their destination countries. A survey of travelers found that roughly 47% of all age groups experience health problems during their travels, while younger travelers had higher incidence rates overall. Of the students surveyed, 35% had been colonised by Extended-Spectrum Beta-Lactamase Producing Enterobacteriaceae (ESBL-PE) following study abroad; within that group, 70% of those who had traveled to India had been colonised (Angelin, 2015).
The Indian peninsula is associated with higher risks of illness compared with other popular travel destinations; visitors to the region should seek health information prior to their trip. On of the most common travel associated infections is Travelers’ diarrhea (TD); nearly a third of travelers to developing countries will be stricken by this illness caused most often by the bacteria Enterotoxic Escherichia coli (ETEC). Because of the relatively routine nature of this infection, travelers are often given an antibiotic regimen prior to travel to self-treat should they be afflicted by symptoms. This practice that has become standard in many countries should be reserved only for patients with underlying medical conditions that may be worsened by TD such as type 1 diabetes and IBD. Unnecessary use of antibiotics to treat or prevent TD is rapidly accelerating the development of resistance in bacteria. TD cases typically subside in under a week and often do not require an antibiotic treatment.
In 2013/2014 there was an outbreak of Hepatitis A among European tourists in Egypt. In total, there were 107 cases and, of the 43 survey respondents, not a single one received the preventative vaccine prior to their travels (Angelin, 2015). This outbreak highlights the importance of checking with a medical professional before you travel to ensure you are fully vaccinated and informed of the health risks in your destination country. The WHO provides a list of vaccination requirements and travel considerations organised by country, we recommend checking their information to see what may be applicable for your trip.