This paper considers the hazards of getting to and from one's destination; the subject of accidents occurring as part of a holiday is too broad for present consideration.

The symposium is mainh concerned with travel abroad but, since one has to reach the definitive means of travel, the epidemiology of road traffic accidents is first considered. An unusually optimistic view is taken of the current position as regards fatalities. Emphasis is placed on the importance of recent legislation in the prevention of injury. Overall, the chances of being killed on the roads are now not much greater than those of suffering an accidental death in the home. The effect of alcohol and common drugs on the holiday motorist are discussed and mention is made of the hazards of carbon monoxide poisoning.

Death and injury due to travel by boat or train is so unusual as to eliminate them from useful discussion and most interest probably centres on the accidental hazards of air travel.

The major anomaly here is that, on a passenger-mile basis, the worldwide chances of being killed in an accident involving a scheduled air carrier are about the same as for travelling on British Rail. The relationship of aircraft accidents to fatalities is discussed and reasons advanced for the remarkable improvement in both. Potentially survivable accidents are commonest at take off and landing. It is in such accidents that the hazard of fire is of maximal importance though adequate restraint is also highly significant. Suggestions are made for increased safety.

The wholly fatal accident is commonly associated with a catastrope in flight and some of the dangers of exposure to high altitude are considered. There is considerable public interest in sabotage as a cause of aircraft accident and its incidence is briefly considered. The overall message is that air travel is quite remarkably safe and that the unduly widespread fear of flying is related, in the main, to the publicity which inevitably surrounds the occasional disaster.

A number of factors increase the stress on both driver and vehicle when going on holiday or unaccustomed journeys. Greater distances than normal are attempted in short periods of time without rest and the economics of motoring often mean that small family cars are expected to carry heavy loads for long distances. Drivers become easily exhausted under these conditions and due care should be taken in preparation for long journeys to reduce the strain on both car and driver to a minimum.

Environmental hazards present themselves in different parts of the world. Hurricanes plague the Caribbean, typhoons sweep the China Seas and cyclones rage in the Bay of Bengal. Volcanoes erupt and the earth quivers in a circumpacific belt, in northern India, Soviet Central Asia, Turkey, Italy, etc. Extremes of heat and cold promote adverse reactions in the skin. Diseases of insanitation (enteric fevers, dysentery, cholera, etc.) are prevalent in tropical countries with low standards of hygiene; insect-borne diseases (malaria, yellow fever, filariasis, etc.) are common in certain warm countries. Prior warning of these dangers and appropriate health safeguards (vaccination, inoculation) should be obligatory.

During the 7 year period between 1975–81, a total of 2081 cases of infection were reported to the Communicable Diseases (Scotland) Unit, concerning persons with a history of recent overseas travel. The most frequently reported diseases were salmonellosis (829 cases), bacillary dysentery (345), malaria (236), campylobacter enteritis (219), giardiasis (125), enteric fever (82) and viral hepatitis (74).

Holidaymakers, particularly those who had visited the Mediterranean area, were most frequently affected, comprising more than two-thirds (67·8%) of the total, followed by business travellers and immigrants. Nearly three-quarters (72·7%) of infections were reported between June and November. Young adults, particularly males between 15 and 34 years, were responsible for almost one-half (48·l%) of cases.

Secondary spread of infection after arrival in Scotland was uncommon, occurring in less than 3% of cases. One unusual episode occurred in the North of Scotland when an imported rare salmonella serotype (S. zanzibar) subsequently contaminated milk at a dairy farm and later caused disease among young calves on another farm with seagulls being the apparent vehicle of secondary infection.

Being a healthy traveller involves communication in more than one sense of the word.

Health administrations have a responsibility to prevent illness associated with international travel and trade without undue interference to these inevitable activities. Past experience of travel-associated disease transmission should determine epidemiologically justified and cost-effective preventive measures.

The aeroplane transmits disease faster but should not become the scapegoat for travel-associated ill health. Viral influenza can spread rapidly because of air travel but the latter's role in transmission of diseases such as cholera and smallpox in the past or viral haemorrhagic fevers in the future may not be clear cut.

Surveillance activities are essential to enable the earliest possible detection of disease because measures taken with the intention of keeping a disease out of a country cannot be foolproof. Frank and rapid exchange of information between national epidemiological services is essential for effective control of international spread of diseases.

National health administrations have an obligation to provide travellers with reliable information. A specific programme co-opting the medical profession, travel agencies of every form and the media is necessary.

The World Health Organisation should collaborate with national health administrations in the prevention of disease associated with travel.

Member airlines of the International Air Transport Association in general accept very seriously the responsibilities regarding health problems due to travel. They lay down standards in a practical manner which they try and maintain, the principle being to combine maximum safety regulations with minimum restrictive practices to fit in with a successful commercial operation. These standards cover the prevention of spread by not carrying contact passengers who are in a stage of incubation; the prevention of food- and water-borne disease which covers satisfactory food preparation and food handling and also satisfactory water supplies on the aircraft; the prevention of insect-borne disease by adequate aircraft spraying; the prevention of animal-borne disease and the avoidance of, and, if necessary, the adequate treatment of, any animal vermin on the aircraft, and the avoidance of zoonoses carried by animals transported as air freight. In addition to these standards, British Airways run an immunisation centre which provides various pamphlets and booklets which give medical advice. Finally, they make an announcement of the need to take an antimalarial when entering a malarious area.

From the organisations other than the airlines the situation is mainly advisory —the World Health Organisation, the Department of Health and Social Security, the Health Educational Council; all issue booklets and pamphlets to a greater or lesser extent. The medical profession and the pharmacists regrettably tend, on the whole, to be ill-informed and uninterested. The media are often inaccurate and tend to put the stress on less important issues. The travel agents and the inclusive tour operators vary greatly in their attitudes. Some are responsible and some are irresponsible.

All of these points are covered in the article and it is suggested that more post-graduate centres should encourage lectures on the subject of the prevention of imported disease and it should be included in the medical school curriculum along with the lectures on tropical diseases.

The intending traveller should plan a detailed itinerary well in advance of his departure from the United Kingdom if he is to take full advantage of the health precautions and advice that are available. The present mechanism of delivering health care advice is inefficient and many travellers remain ignorant of how they should protect themselves against illness acquired overseas. Passport offices, travel agents, shipping and airline authorities and health insurance firms are in a unique position to share the responsibility with the community health services and general practitioners of ensuring that intending travellers are appropriately briefed and visit their family doctor and dentist in plenty of time. Chemoprophylaxis against malaria and inoculation against many tropical diseases are available and sensible advice can be given about how to keep healthy abroad. Adults and children should also be immune to infections such as poliomyelitis, diphtheria, tetanus and, if visiting the developing world, tuberculosis as well. Sensible clothing, equipment and adequate supplies of any regular medicaments must be taken. Some form of health insurance and, in addition for E.E.C. countries, a certificate of entitlement to free health care are wise additional precautions to take.

World-wide travel leads to disturbances of the sleep and circadian rhythmicity of man, and after transmeridian flights ability to carry out work may be impaired. The initial approach to the problem is to avoid overnight flights, arrive in the new country during the early evening and to rest for an appropriate period of time. However, this is often difficult to achieve, and in this context the use of hypnotics during the flight and the adaptation phase is discussed.

Distress often reveals itself as physical symptoms. The relationship between disease and symptomatology is a complicated interaction where the influence of psychological and social factors in the aetiology of distress should always be considered.

Travel can bring frustration whether it be in the air or on the ground. Disabled people are entitled to equality of opportunity but their opportunity for travel is often very restricted. The needs of psychotic patients and those in the rehabilitative phase of illness also need to be considered.

Many factors contribute to fatigue and insomnia in travel. Some of these are discussed including psychological and social factors, state of mood, fear and circadian rhythms. It is suggested that the solution to some of the problems of hazards of travel will come more from knowledge already acquired than from highly technical consideration.