Multiple Sclerosis and Travel
Multiple Sclerosis (MS) is an autoimmune disorder that affects the brain and spinal cord. The exact cause of MS is unknown but there may be a genetic and environmental element to the development of the illness. At present there is no cure although there are many treatment therapies available to manage the condition. In the UK around 100,000 people are affected.
General Travel Health Advice
Travellers with MS are a diverse group, ranging from those who are well with no disability to those with symptoms and significant disability. UK MS support websites offer advice for travellers with MS, for example the Multiple Sclerosis Trust or the MS Society
Prior to travel the following should be considered.
Pre travel Medical Check Up
Travellers should ensure they have had a recent specialist review and have discussed their intention to travel.
Travelling with Medication
All medication should be requested from the GP well in advance of the trip.
- Twice as much medication required for the trip should be taken to cover unexpected delays, damages or losses.
- Medication should be kept in its original packaging and carried in hand luggage to avoid loss or damage in the hold.
- Many medications must be stored within a particular temperature range, this will be detailed in the product information leaflet.
- Gabapentin, used for neuropathic pain, is classed as a Class C controlled drug since April 2019 – see additional advice for travelling with controlled drugs under ‘Home Office Requirements’.
- For those using injectable treatment, a doctors’ letter is necessary for passing through security or customs and can facilitate seeking medical attention abroad.
Travel Health Insurance
MS is considered a pre-existing medical condition and must be declared to the insurer before travel. The European Health Insurance Card (EHIC) is available online and allows UK residents to access reciprocal health care within Europe.
- Medical insurance is still recommended to cover non-refundable costs and pay for repatriation, which is not covered by the EHIC.
- MS websites offer advice on appropriate insurance companies, for example the Multiple Sclerosis Trust or the MS Society
Accessing Healthcare Abroad
Find out about the location of local health facilities prior to travel – this information can be found in travel guides and online resources.
Reducing Risk of Travel Related Illness
Serious infection may impact on the course of MS. The majority of travel-related infections are not vaccine preventable but can be avoided through taking other precautions.
Gastrointestinal Infections and Travellers Diarrhoea
- Taking food and water precautions will reduce the risk of infections that cause travellers’ diarrhoea.
- The risk of respiratory infections can be reduced by practising good respiratory hygiene.
- Most MS patients will have been offered the annual inactivated influenza vaccine under UK immunisation guidelines.
- Vaccines do not exist against the majority of insect-borne infections. Practical measures should be taken on insect bite avoidance.
Travellers with MS are not at a higher risk of acquiring malaria but severe infections may worsen MS symptoms.
- Be aware of malaria risk.
- Take good mosquito bite prevention measures.
- Take antimalarial medications when indicated.
- Seek prompt medical attention if you become unwell of develop a fever after being in a malaria area.
- Travellers should be advised to take appropriate steps to minimise sun exposure.
- Some immunosupressive medication may make sunburn more likely as a side effect.
Accidents and Injury
- Accidental injury is more common during travel than infectious disease. Accidental injury may be even more likely if symptoms of MS affect mobility.
- MS itself does not result in increased risk of infection, except in advanced disease.
- Having an infection may provoke a relapse of MS, therefore preventing infection through vaccination is protective.
- There is no evidence of an increased risk of side effects from vaccination in those with MS.
- Vaccination should be avoided during serious relapse and until 4 to 6 weeks after full recovery.
- Vaccination may be less effective in those on immunosuppressive medication.
- Live vaccines (including yellow fever) are contraindicated in travellers with MS taking immunosuppressive medication.
Yellow Fever Vaccine
In travellers with MS, who are not on immunosuppressive medication, the possible risk of relapse versus the actual risk of yellow fever infection during travel must be discussed.