Malta classified a ‘medium risk’ destination for traveller's diarrhoea

With only 41 cases of laboratory-confirmed out of 477,450 visits by residents of England, Wales and Northern in 2008, Malta is classified in the ‘medium risk’ category – with a rate of 8.59 cases per 100,000 visits.

The report, titled Foreign travel-associated illness - a focus on travellers' diarrhoea, found that the top countries where travellers from England, Wales and Northern Ireland are most likely to acquire gastrointestinal infection following their visit are Egypt, India, Thailand, Pakistan, and Morocco.

The safest country was found to be the Netherlands, with a rate of 0.22 cases per 100,000 visits, followed by Ireland, with a 0.25 rate. Germany also scored a rate of 0.33 cases per 100,00 visits.

With 47 cases in 2008, Gambia was classified as just below Malta’s 41, while Bangladesh inched ahead of Malta with 38 cases.

The report also revealed that half of the 24,322 laboratory confirmed cases of gastrointestinal infection reported in those who had recently travelled abroad between 2004 and 2008 were caused by salmonella. Other bacteria such as campylobacter and shigella and organisms such as giardia and cryptosporidium were also reported. 

Dr Jane Jones, a travel health expert with the HPA said: "There are measures people can take to protect themselves while they are away and it is also important that travel health specialists and the travel industry work together to increase awareness of travellers' diarrhoea and to actively promote prevention strategies in high risk destinations. 

We know from studies that travellers may not follow health advice consistently while abroad. Personal hygiene and precautionary measures against food and water borne illness are important at all times anywhere, but particularly when travelling to countries with less robust sanitary infrastructure than the UK. Taking sensible precautions such as avoiding tap water and ensuring food is properly cooked will help to keep a holiday at any time of the year both enjoyable and healthy."

The report concludes that there are several factors which can affect a person's risk of acquiring travellers' diarrhoea while abroad:

 - Destination of visit. Although gastrointestinal infections occur worldwide, some are more common in countries or areas where there is a lack of sanitation and access to clean water. The world can be divided into three different risk zones for risk of travellers’ diarrhoea:

- Low risk: western Europe, USA, Canada, Japan, Australia and New Zealand.
- Medium risk: southern Europe, Israel, South Africa, some Caribbean islands and the Pacific.

- High risk: Africa, Latin America, the Middle East and most parts of Asia.

 - Hygiene standards at accommodation (including swimming pools)

 - Hygiene standards at eating establishments

 - The personal hygiene of the traveller and the individual's health or susceptibility to infection - underlying ill health or certain illnesses may increase the risk of infection and make illness more severe.