If you have Crohn’s Disease or Ulcerative Colitis (the two main forms of Inflammatory Bowel Disease or IBD) you may find the thought of travelling daunting. A change of climate, water, or food can upset anyone’s bowels. Yet many people with IBD travel widely, both in the UK and abroad. They may go for a short break or a long holiday lasting several weeks or months. With careful planning ahead it should be possible for you to travel to most places. This series of articlces sets out to answer some of the questions that you may have when thinking about going on holiday or on a business trip.
Insurance
If you need medical treatment when abroad, there are many countries where you would have to pay for it, so it is usually a good idea to arrange travel insurance to cover healthcare costs. This is particularly the case if you are travelling to countries which do not have healthcare agreements with the UK. For example, costs are very high in the USA. For further information, see the NHS website
For travel to most parts of Europe you can get a free European Health Insurance Card (EHIC). This card entitles you to reduced-cost or free treatment in most European countries. However, you may not wish to rely on this alone, because it does not help you get home, or cover your family’s expenses. You can apply for an EHIC online at www.ehic.org.uk or by telephone on 0845 606 2030
It may not occur to you to mention your IBD to the insurance company when you are arranging your insurance. However, if you do not, you may find that your insurance is invalid or that you have problems should you need to make a claim. You may have to confirm that you are not travelling against your doctor’s advice.
It may be more difficult to obtain insurance if you have recently had or are awaiting surgery, have been admitted into hospital within the last year, or are waiting for the results of tests. Some insurance companies may not even cover a preexisting condition such as IBD. You may find it helpful to look at our information sheet IBD and Insurance, which gives more details about travel insurance and includes a list of insurance companies suggested by Crohn’s and Colitis UK members. It is available on our website or from our Information Line (0845 130 2233).
If you do become ill during your travels and you wish to claim on your insurance, you will need to keep receipts for everything, such as taxi fares to hospital.
Vaccination
Try to find out several months in advance whether vaccinations are needed or recommended for your destination. Some vaccinations need to be taken two or three months before travel. You could check with your travel agent, GP surgery or the NHS website: www.fitfortravel.nhs.uk. Some countries will not let in people who have not had the correct vaccinations.
If you are on certain drugs for your IBD, you may find that you cannot have some vaccinations. Some of the drugs prescribed for IBD can weaken the immune system. These include steroids, immunosuppressants (such as azathioprine, 6-mercaptopurine and methotrexate) and biologics (such as infliximab and adalimumab). If you are on any of these medications, you should avoid live vaccinations, such as polio or yellow fever. You may find it helpful when travelling to have a medical exemption letter from your doctor stating why you cannot have the vaccination. However, some countries may not admit you without a yellow fever vaccination even with such a letter. Also, if you are travelling from a country where there is a yellow fever risk and you have not had the vaccination, immigration officials are legally entitled to quarantine you.
If you have stopped taking immunosuppressants you may be able to have a live vaccination after waiting 2-3 months. Standard vaccines, such as Tetanus, Hepatitis A or B, and ‘inactivated’ polio vaccine are considered safe, but they may not be as effective when taking immunosuppressant drugs.
Malaria
If you are travelling to an area with malarial mosquitoes, you are advised to take an anti-malaria medication. Most tablets have to be started a week before travel and continued for four weeks after return. Like any medication, there may be side-effects when taking anti-malarials, and these may affect your IBD. There can also be adverse interactions between some anti-malarials and some immunosuppressant drugs for IBD. You may wish to discuss with your specialist which preparation is suitable for you.
Preventing mosquito bites is just as important as taking the medication. Mosquitoes bite particularly between dusk and dawn. You can help to protect yourself by wearing light coloured, loose clothing to cover your arms and legs, and using an effective insect repellent, such as one containing DEET (diethyltoluamide).
For further information see the National Travel Health Network and Centre website: www.nathnac.org.
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