What is it?

Malaria, aka paludism, is a parasitic infection transmitted by certain mosquito bites. Early symptoms include fever, chills, pain, headaches, and fatigue. Left untreated, malaria can lead to serious complications and even prove fatal.

What to do?

The only ways of protecting yourself against malaria are by avoiding contact with the infected mosquitos and taking medication that will prevent you from developing malaria. Prior to leaving, see your pharmacist or a travel health professional about the incidence of malaria where you will be travelling. If the area is at risk, preventive medication may be warranted and prescribed depending on certain conditions.

Upon reaching your destination, follow these basic rules for avoiding mosquito bites:

• Avoid outings between sunset and sunrise as this is peak mosquito biting time.
• Wear long, light-coloured clothing to limit your exposure to mosquito bites.
• Apply insect repellent with DEET or icaridin on exposed skin.
• Sleep under a mosquito net treated with insect repellent to prevent getting bitten while sleeping.

Your pharmacist can help

They will be able to determine your needs, and subject to certain conditions, prescribe medication you will have to start taking before departure and continue taking a few days or weeks following your return.

What is it?

Traveller’s diarrhea is the most common health problem encountered by travellers. It is usually contracted through water or food contaminated with pathogens (bacteria, viruses, parasites). Symptoms include the urgent need to have a bowel movement, abdominal cramps, diarrhea, nausea and vomiting sometimes accompanied by fever. Dehydration is the most likely complication of traveller’s diarrhea.

What to do?

Prevention is the best way to avoid contracting traveller's diarrhea.

• Be especially mindful of what you eat and drink.
• Wash your hands frequently with soap and water or sanitize them with an alcohol-based gel.
• Always carry rehydration solution packets and medication to relieve gastrointestinal symptoms. They’ll come in handy for mild symptoms. We always recommend seeing a local health professional if symptoms persist for more than 36 hours, if high fever is present, there is blood in the stools or there are signs of dehydration (excessive thirst, dark yellow urine and decreased urine production, intense fatigue, confusion). Antibiotics may be required to treat more severe symptoms.

Your pharmacist can help

They may prescribe an antibiotic for treating traveller’s diarrhea, subject to certain conditions.

What is it?

Acute mountain sickness occurs in travellers vacationing at high altitude. The higher you are, the more the atmospheric pressure and oxygen levels drop. Travellers who climb too high too fast to altitudes where there is less oxygen have to breathe faster, and the heart also has to beat faster, to compensate for the oxygen shortfall to the brain and the body’s organs. Sometimes, this is not enough to restore blood oxygen levels, which can lead to headaches, nausea, vomiting, fatigue, loss of appetite, and respiratory difficulties. These symptoms, although often benign, should not be ignored, and they can start manifesting themselves at 2,000 m. Left unattended or untreated, acute mountain sickness can progress to cerebral or pulmonary oedema (buildup of liquid in the brain or lungs), and result in death. It is therefore imperative that you plan thoroughly for trips at high altitude.

What to do?

Talk to your pharmacist or a travel health professional about altitude related risks. The onset of acute mountain sickness may be prevented by pacing your climb and ascending gradually. Mild symptoms generally go away after a few days at the same altitude. Predetermining the location and length of your stay according to the altitude, and considering extending your stay at certain heights, will enable your body to acclimatize to the lower oxygen levels and limit acute mountain sickness symptoms. Be prepared to move to a lower altitude if the symptoms persist.

Your pharmacist can help

See them to learn more about precautions recommended for trips at high altitude and medication options for preventing or relieving acute mountain sickness symptoms. They will be able to determine your needs, and subject to certain conditions, prescribe medication tailored to your health and personal characteristics.

What are they?

Vaccines help prevent certain bacterial or viral infections. The process consists of introducing a harmless version of a virus or bacterium into the body to stimulate the production of antibodies that will fight said virus or bacterium the next time the body comes in contact with it. Quebec’s Immunization Program’s vaccination schedule provides protection against the diseases most commonly found in Quebec (e.g. measles, rubella, diphtheria and tetanus). Travel may expose you to serious diseases absent in Quebec. Most of these diseases are preventable through vaccination.

What to do?

Six to eight weeks before leaving, consult your pharmacist or travel health professional to ascertain your vaccine status and the risk of contagious diseases where you will be travelling. The country and type of trip may warrant optimizing your immunization coverage (e.g. to prevent Hepatitis A and B, typhoid fever, yellow fever or Japanese encephalitis). Some countries actually require a vaccination certificate for specific diseases. Determining your vaccination needs prior to leaving will make sure you won’t be refused entry into the country you are visiting.

Your pharmacist can help

See them to learn more about the vaccines you need before leaving. They can evaluate your vaccine status. If certain vaccines are warranted and the pharmacy administers vaccines, the nurse on site will be able to vaccinate you immediately, subject to certain conditions.

What is it?

Being motionless inside a moving vehicle sends conflicting signals to the brain. Motion is seen but not felt. The resulting confusion translates into feeling faint, sweating, nausea, and vomiting.

What to do?

• Where you sit can influence your symptoms. On airplanes or boats, pick middle seats or cabins. In cars or on buses, sit at the front.
• Avoid travelling on an empty stomach by snacking frequently.
• Make sure your view is unobstructed and limit activities requiring you to focus your eyes on one thing (reading, watching movies, playing games on a tablet or cellphone).
• Over-the-counter nausea medication available in pill and patch form can help prevent and relieve nausea and vomiting triggered by motion sickness. Be sure to take the pill at least one hour before departure, or to sitck the patch on the skin at least 12 hours before departure.

What are they?

Changes in ambient pressure, e.g. during an airplane’s take-off or descent, or a car or train ride in mountainous territory, can cause ear and facial discomfort. The discomfort manifests itself as ear, sinus or tooth aches, loss of hearing or ringing in the ears. These symptoms can intensify if you’re travelling with an upper respiratory tract infection (e.g. sinusitis, otitis). Fortunately, these are generally temporary symptoms that eventually wane as the ambient pressure stabilizes.

What to do?

• Chewing gum, swallowing frequently, yawning or blowing your nose regularly may help alleviate the discomforts.
• Some over-the-counter decongestants may be taken minimum one hour before departure to prevent the onset of symptoms triggered by changes in ambient pressure.

What are they?

Sitting motionless for long intervals and changes in atmospheric pressure can cause discomfort, swelling in the legs, and potentially blood clots. Certain factors may influence the risk of experiencing discomfort due to sluggish blood flow, such as smoking, obesity, vein diseases, pregnancy, a recent surgery or travelling for more than eight hours.

What to do?

• Be sure to stay well hydrated during travel. Drink plenty of water, but avoid alcohol and coffee as they tend to dehydrate you.
• Get up and move around for a few minutes every two to three hours to promote good blood flow. Once every hour, move your legs and feet for a few minutes (e.g. rotate your ankles, stretch your legs, or raise and lower your thighs several times.)
• Compression stockings are specifically designed to improve blood flow in the legs. To be effective, they must be properly fitted to your leg. We recommend wearing them when travelling for more than six hours.

What is it?

Travelling by plane or boat, or the journey itself, can cause anxiety. Anxiety is an unpleasant feeling that can trigger physical symptoms (e.g. difficulty breathing, faster heart rate, sweating, shaking/trembling or muscle tension). Anxiety is often accompanied by anxious thoughts like worrying, dwelling or obsessing over a situation, doubts or fears.

What to do?

• Learn to identify anxiety-inducing situations.
• Share them with your travelling companions so they may help you cope with and guide you through these situations.
• Avoid caffeine and other stimulants that can serve to amplify anxiety symptoms.
• Controlling your breathing can help calm the initial symptoms. You do this by inhaling for four seconds, holding your breath for four seconds, slowly exhaling for four seconds and waiting four seconds before repeating the procedure.
• There exists medication that can be used to reduce or control travel-related anxiety symptoms.

What are they?

The excitement of a trip and time spent travelling can often cause sleep disorders, like trouble falling asleep or frequently interrupted sleep.

What to do?

• Carry earplugs and an eye mask. They will help reduce distractions stemming from noise and light, and foster sleep-inducing conditions.
• While in transit, use a Do Not Disturb card or sign. The crew will know not to wake you for meals.
• A light blanket and neck pillow can improve your comfort during overnight travel.
• There is over-the-counter sleep medication you can use for travel.

What is it?

Jet lag is a series of symptoms occurring when our internal body clock is disrupted. These symptoms generally appear when travelling through at least three time zones. Travellers experiencing jet lag feel overly tired, have trouble sleeping and concentrating, suffer a loss of appetite and mood swings. The extent of the symptoms varies depending on the individual and the number of time zones crossed.

What to do?

• Upon arriving at your destination, do your activities according to the local time.
• Expose yourself to daylight as much as possible and synchronize your meal times to local time.
• Avoid napping in the day or limit naps to 20 to 30 minutes.
• At bedtime, create a sleep-inducing environment. Use earplugs and an eye mask if needed.
• Avoid stimulant substances (e.g. coffee, tea, chocolate, etc.) at least six hours before bedtime.
• If you use medication taken at fluctuating times, see your pharmacist before leaving to discuss when to take them while travelling.

Food can harbour contaminants that cause diarrhea and intestinal discomfort. Follow these recommendations to protect yourself from exposure to these contaminants:

• Always check where the food is from.
• Opt for food that is boiled, cooked, peeled or washed with clean drinking water.
• Eat cold food cold and hot food hot.
• Avoid raw meats or fish as well as wild meat.
• Always wash your hands before eating as they too may be contaminated. Use an alcohol-based hand sanitizer if soap and water are not available.

Water may contain contaminants that can lead to intestinal discomfort or the onset of an illness. Follow these recommendations to protect yourself from exposure to these contaminants:

• Be sure to always drink water that has been boiled or purified or bottled water from sealed bottles. Follow this same precaution when brushing your teeth.
• Confirm the ice cubes in your drink are from boiled or purified water. When in doubt, avoid adding ice cubes.
• When swimming, keep your head above water and avoid ingesting water through your mouth or nose, even if the water looks clean.

Plantlife and wildlife are often the main attraction of a trip. They can also trigger diseases, or be poisonous or toxic. Follow these tips to make sure you bring back fond memories of your encounters with nature:

• Avoid contact with local plants and animals.
• Ask local inhabitants about animal and plant species you need to be especially wary of.
• Always carry products used to treat the main reactions that can result from unexpected contact. For a list of the main products you should pack, see the section titled "My Travel Health Kit" in this booklet.

Although the sun is a travel favourite for many, it can play nasty tricks on vacationers. Be sure to protect skin exposed to sunrays with a generous amount of sunscreen with an SPF of 30 or more. Reapply every two hours or after swimming or excessive sweating. Sunburns can occur even on cold or cloudy days. The sun’s rays bounce off surfaces like water or snow, making them even stronger. Be extra careful in those situations. If you still get a sunburn despite having followed all of these precautions, we recommend:

• Avoiding re-exposing sunburnt skin to the sun’s rays.
• Covering sunburnt skin next time you go out.
• Applying cool compresses to soothe the burning sensation and also applying a moisturizing cream over the affected area.
• Checking with your pharmacist, prior to leaving for vacation, if you’re taking any sun-sensitizing medication.

Prolonged exposure to the sun combined with intense heat can lead to heat stroke. Heat stroke makes you feel dizzy, tired, nauseous and feverish. Follow these tips to treat heat stroke:

• Make sure you’re well hydrated and wear light clothing that is also light-coloured.
• Protect yourself against the effects of heat by wearing a hat, sunglasses and seeking shade during peak sun periods.
• If feeling discomfort, hydrate and move to a shaded area.
• Help lower your body temperature by applying cold water compresses on your skin or moving near a ventilator blowing cool air.
• If the symptoms persist, see a local health professional.

Here are some tips to keep in mind if you take medication regularly:

• Before leaving, make sure you have enough medication to last you the entire trip.
• Factor in medication for a few extra days to cover any unexpected situations.
• Bring along a list of all your medication you will be able to share with local health professionals if needed.
• During travel, pack your medication in your handbag or carry on, and be sure to leave them in their original duly-labeled container.
• Clearly label your medication. Although prescription drugs are exempted from the liquid restrictions, you still need to show them to the customs officer, and labelling them facilitates the customs screening process!

Your pharmacist is your go-to for advice on labelling, storing and regulations pertaining to your medication. Talk to your pharmacist before you travel!

Prescription narcotics, controlled and targeted substances

Certain drugs used to treat pain, attention deficit disorder or sleep disorders are subject to different monitoring regulations than other medication. Generally, you are permitted to travel with a 30-day supply of prescription narcotics and controlled substances, and a 90-day supply of targeted substances (e.g. benzodiazepines). Some drugs that are readily used in Canada may be considered illegal in other countries. We strongly recommend contacting the foreign government office in Canada of the country you plan to visit to confirm the status of your medication as well as importation and exportation regulations to avoid surprises at customs.

Refrigerated medication

Some drugs require cold storage to ensure their stability and effectiveness. Prior to leaving, talk to your pharmacist about the stability requirements of your refrigerated medication. Room temperature may influence the stability of some of your medication without necessarily compromising their suitability for travel purposes. But should your medication require cold storage, get a cooler bag or cooling devices. Ask your carrier about the conditions onboard. Several carriers may provide cooling equipment or allow you to store your medication in a refrigerated environment during transit.

Rescue medication

Serious allergies, respiratory issues, cardiac symptoms and hypoglycemia are all conditions that can be managed with rescue medication. Be sure to always have your rescue medication with you. Tell your travelling companions and your carrier’s crewmembers where you keep it and how to use it. Be prepared and pack extra medication.

Sharp objects

If travelling with medication requiring auto-injectors, syringes or needles, be sure to carry a copy of the original prescription and a medical certificate outlining the reason for the use of these products. Contact your carrier to confirm their policies and procedures regarding the presence of these products onboard. Remember to pack a biomedical waste container for the safe disposal of your needles and syringes.

Medical devices

Mobility aids, ostomy supplies, insulin pumps and other medical devices are not subject to baggage allowance restrictions. Always carry documents that support your medical condition.

Travelling and pregnancy

Travelling while pregnant requires having to consider some extra factors. Pregnant women are at an increased risk of contracting infections or developing complications that could affect the baby.

• Before travelling, consult your doctor to ascertain the risks associated with your destination or the type of trip you’re planning.
• If flying, check with your airline, as most airlines restrict travel in late pregnancy. Pregnant women have a higher risk of experiencing poor blood flow or developing blood clots during a flight. The use of compression stockings is recommended to limit the effects of altitude on blood flow.
• Also, contact your personal insurance provider about your medical coverage abroad in the event of obstetric complications or a premature delivery.

Talk to your pharmacist about the medication you need to pack. They will make sure the medication is compatible with your pregnancy and personal characteristics.

Travelling while pregnant requires having to consider some extra factors. Pregnant women are at an increased risk of contracting infections or developing complications that could affect the baby.

• Before travelling, consult your doctor to ascertain the risks associated with your destination or the type of trip you’re planning.
• If flying, check with your airline, as most airlines restrict travel in late pregnancy. Pregnant women have a higher risk of experiencing poor blood flow or developing blood clots during a flight. The use of compression stockings is recommended to limit the effects of altitude on blood flow.
• Also, contact your personal insurance provider about your medical coverage abroad in the event of obstetric complications or a premature delivery.

Talk to your pharmacist about the medication you need to pack. They will make sure the medication is compatible with your pregnancy and personal characteristics.

Travelling with children requires thinking a little more about preventive healthcare.

Children are at a higher risk of developing the severe forms and complications of the main infections encountered abroad. They are also more sensitive to the various travel-related discomforts covered in this booklet.

Six to eight weeks before leaving, consult your pharmacist or a travel health professional to go over your child’s vaccine status and determine the need for any supplementary vaccines that will ensure your child is fully covered in the country you are visiting.

See your pharmacist to learn more about the different factors to consider when travelling with children. They will suggest products tailored to children (e.g. syrups, chewable tablets) and determine the appropriate dosage based on your child’s weight.

Humanitarian travel poses additional health risks.

Do not bring personal medication for the purposes of donation. Although tempting, it is a practice that often results in donations being destroyed as the local organizations are unable to identify the medication or its use. They become burdened with the extra cost of destroying the medication.

Healthcare resources may be scarce faraway, so you may need more vaccines, preventive medication and first aid products. See your pharmacist to properly ascertain your needs.

Despite Canada legalizing cannabis in October 2018, Canada’s border rules remain unchanged.

Entering or leaving Canada with cannabis or any product containing cannabis is illegal and can result in serious criminal penalties in Canada and abroad. This also applies if visiting countries that have legalized or decriminalized cannabis.

Transporting cannabis used for medicinal purposes is also illegal. Consult your pharmacist to determine other possible options for your trip.