Microsoft word - travel advice pack april 2012.rtf
RG25 3DU Tel 01256 770212 Fax 01256 771581
TRAVEL HEALTH SERVICE FOR PATIENTS Travel Clinics are available at Overton Surgery only: These clinics offer:-
• Travel Health Advice • Immunisations • Private prescriptions for anti-malarial medication
Please read this travel advice pack before you travel.
If you would like to use our service please complete and return the Travel
Risk Assessment Form to us at least 6 weeks before you travel.
• Travel advice for some destinations may be complex; you may need several
• Appointments are limited, so we ask you to be as flexible as possible when
• If you are not able to return your risk assessment form 6 weeks before you
travel, we cannot guarantee that we will be able to give you an appointment in time for your holiday. Our travel nurse will advise you of any immunisations you require.
• Not all vaccinations are provided by the NHS. You may have to pay a fee for
your vaccination or for a private prescription for malaria drugs or antibiotics. This travel advice pack contains a list of charges.
• If you are travelling to Western Europe, the USA, Canada, Australia or New
Zealand, you do not need travel vaccinations. If you are stopping over in Thailand or Singapore, however, you may need travel vaccinations. Please ensure that your Tetanus, Diphtheria and Polio vaccinations are up to date.
Travel Charges Not all vaccines are available on the NHS. If you require any of these items you will be charged at the current rate. Payment will be accepted by cash or cheque only. We do not accept credit or debit cards. Please note that our charge for a private prescription for anti-malarial drugs, or antibiotics, is for the prescription only. The pharmacy will charge you for the actual cost of the drugs.
Charges at the 1st April 2012 Vaccination:
Private Clinics Some times we recommend a traveller to visit private clinics for specialist vaccines, or because it may be quicker for you to be seen. Information about these clinics can be found at:-
MASTA travel clinics around the UK Location Line: 01276 685040 or www.masta.org/travel_clinic/index.html Private Travel Clinics in London The Hospital for Tropical Diseases Travel Clinic Mortimer Market Capper Street Off Tottenham Court Road London WC1E 6AU
The Royal Free Travel Health Centre Pond Street London NW3 2QG
The following information will help you to stay healthy on your trip: PLEASE READ IT!
WATER Diseases can be caught from drinking contaminated water, or swimming in it. Unless you KNOW the water supply is safe where you are staying, ONLY USE (in order of preference)
3. Water treated by a sterilising agent.
This includes ICE CUBES in drinks and water for CLEANING YOUR TEETH. SWIMMING It is safer to swim in water that is well chlorinated. If you are travelling to Africa, South America or some parts of the Caribbean, AVOID SWIMMING in fresh water LAKES and STREAMS. You can catch a parasitic disease called SCHISTOSOMIASIS from such places. This disease is also known as BILHARZIA. It is wise NEVER TO GO BAREFOOT, but to wear protective footwear when out, even on the beach. Other diseases can be caught from sand and soil, particularly wet soil. FOOD Contaminated food is the commonest source of many diseases abroad. You can help prevent it by following these guidelines: • ONLY EAT WELL COOKED FRESH FOOD • AVOID LEFTOVERS and REHEATED FOODS • ENSURE MEAT IS THOROUGHLY COOKED • EAT COOKED VEGETABLES, AVOID SALADS • ONLY EAT FRUIT YOU CAN PEEL • NEVER DRINK UNPASTEURISED MILK • AVOID ICECREAM and SHELLFISH • AVOID BUYING FOOD FROM STREET VENDOR’S STALLS Another source of calories is ALCOHOL! If you drink to excess, alcohol could lead you to become carefree and ignore these precautions. Two phrases to help you remember 1. COOK IT, PEEL IT, OR LEAVE IT! 2. WHEN IN DOUBT, LEAVE IT OUT! PERSONAL HYGIENE Many diseases are transmitted by what is known as the ‘faecal-oral’ route. To help prevent this, always wash your hands with soap and clean water after going to the toilet, before eating and before handling food. TRAVELLERS’ DIARRHOEA This is the MOST COMMON ILLNESS that you will be exposed to abroad and there is NO VACCINE AGAINST IT! Travellers’ diarrhoea is caused by eating and/or drinking food and water contaminated by bacteria, viruses or parasites. Risk of illness is higher in some countries than others. High risk areas include North Africa, sub-Saharan Africa, the Indian Subcontinent, S.E. Asia, South America, Mexico and the Middle East. Medium risk areas include the northern Mediterranean, Canary Islands and the Caribbean Islands. Low risk areas include North America, Western Europe and Australia You can certainly help PREVENT travellers’ diarrhoea in the way you BEHAVE - make sure you follow the food, water and personal hygiene guidelines already given.
Travellers’ diarrhoea is 4 or more loose stools in a 24 hour period often accompanied by stomach pain, cramps and vomiting. It usually lasts 2-4 days and whilst it is not a life threatening illness, it can disrupt your trip for several days. The main danger if the illness is DEHYDRATION, and this, if very severe, can kill if it is not treated. TREATMENT is therefore REHYDRATION. In severe cases and particularly in young children and the elderly, commercially prepared rehydration solution is extremely useful. This can be bought in tablet or sachet form at a chemist shop e.g. DIORALYTE or ELECTROLADE. (Dioralyte Relief is a new formula containing rice powder which also helps to relieve the diarrhoea, particularly useful in children). Prepare according to instructions. ANTI DIARRHOEAL TABLETS can be used for adults but should NEVER be USED in children under 4 years of age, and only on prescription for children aged 4 to 12 years. Commonly used tablets are IMODIUM and LOMOTIL. None of these tablets should ever be used if the person has a temperature or blood in the stool. DO CONTACT MEDICAL HELP IF THE AFFECTED PERSON HAS:- • A temperature • Blood in the diarrhoea • Diarrhoea for more than 48 hours (or 24 hours in children) • Becomes confused In very special circumstances, antibiotics are used for diarrhoea, but this decision should only be made by a doctor. (A woman taking the oral contraceptive pill may not have full contraceptive protection if she has had diarrhoea and vomiting. Extra precautions must be used - refer to your ‘pill’ information leaflet. If using condoms, use products with the British Kite Mark.) HEPATITIS B and HIV INFECTION These diseases can be transmitted by 1. Blood transfusion 2. Medical procedures with non sterile equipment 3. Sharing of needles (e.g. tattooing, body piercing, acupuncture and drug abuse) 4. Sexual contact. Sexually transmitted diseases are also transmitted by no. 4) WAYS TO PROTECT YOURSELF • Only accept a blood transfusion when essential • If travelling to a developing country, take a sterile medical kit • Avoid procedures e.g. ear, body piercing, tattooing and acupuncture • Avoid casual sex, especially without using condoms REMEMBER - excessive alcohol can make you carefree and lead you to take risks you otherwise would not consider. INSECT BITES Mosquitoes, certain types of flies, ticks and bugs can cause many different diseases. e.g. malaria, dengue fever, yellow fever. Some bite at night, but some during daytime. AVOID BEING BITTEN BY: • Covering up skin as much as possible if going out at night, (mosquitoes that transmit malaria
bite from dusk until dawn). Wear light coloured clothes, long sleeves, trousers or long skirts.
• Use insect repellents on exposed skin. (Choose those containing DEET or eucalyptus oil base.
A content of approximately 35% DEET is recommended for tropical destinations.) Clothes can be sprayed with repellents too. Impregnated wrist and ankle bands are also available. Check suitability for children on the individual products.
• If room is not air conditioned, but screened, close shutters early evening and spray room with
knockdown insecticide spray. In malarious regions, if camping, or sleeping in unprotected accommodation, always sleep under a mosquito net (impregnated with permethrin). Avoid camping near areas of stagnant water; these are common breeding areas for mosquitoes etc.
• Electric insecticide vaporisers are very effective as long as there are no power failures! • Electric buzzers, garlic and vitamin B are ineffective.
MALARIA If you are travelling to a malarious country, the travel nurse will have given you a separate leaflet with more details, please read it. REMEMBER, malaria is a serious and sometimes fatal disease. ANIMAL BITES Rabies is present in many parts of the world. If a person develops rabies, death is 100% certain. There are 3 RULES REGARDING RABIES 1. Do not touch any animal, even dogs and cats 2. If you are licked on broken skin or bitten in a country which has rabies, wash the wound
thoroughly with soap and running water for 5 minutes.
3. Seek medical advice IMMEDIATELY, even if you have been previously immunised. ACCIDENTS Major leading causes of death in travellers are due to swimming and traffic accidents. You can help prevent them by taking the following PRECAUTIONARY GUIDELINES • Avoid alcohol and food before swimming • Never dive into water where the depth is uncertain • Only swim in safe water, check currents, sharks, jellyfish etc. • Avoid alcohol when driving, especially at night • Avoid hiring motorcycles and mopeds • If hiring a car, rent a large one if possible, ensure the tyres, brakes and seat belts are in good
• Use reliable taxi firms, know where emergency facilities are. INSURANCE COVER • Take out adequate insurance cover for your trip. This should possibly include medical
repatriation as without it, this service if needed is extremely expensive.
• If you have any pre existing medical conditions, make sure you inform the insurance company
of these details and check the small print of the policy thoroughly.
• If you travel to a European Union country, make sure you have obtained a European Health
Insurance card before you travel .You can apply for one by:
• Completing the online form https://ehic.org.uk (your card will be delivered in 7 days)
• Calling 0845 606 2030 (your card will be delivered in 10 days)
• Completing a form available at your post office (your card will be delivered in 21 days)
It is sensible on any long haul flight to • Be comfortable in your seat • Exercise your legs, feet and toes while sitting every half an hour or so and take short walks
whenever feasible. Upper body and breathing exercises can further improve circulation
• Drink plenty of water and be sensible about alcohol intake which in excess leads to
Further information can be obtained from the Department of Health website detailed below with more specific advice and information on travel-related deep vein thrombosis.
SUN AND HEAT Sunburn and heat-stroke cause serious problems in travellers, but in the long term can be a serious cause of skin cancer. Long term damage to the skin due to sun exposure can lead to skin cancer. There is no such thing as a safe suntan but the following advice should be taken PRECAUTIONARY GUIDELINES. • Increase sun exposure gradually, 20 minutes limit initially. • Use sun blocks of appropriate adequate ‘SPF’ strength but a minimum of SPF 15. Children
under 3 years should have a minimum SPF 25 and babies under 6 months should be kept out of the sun at all times. Reapply often and always after swimming and washing. Read manufacturer instructions
• Wear protective clothing – sunhats, T shirts and sunglasses etc. • Avoid going out between 11am - 3pm, when the sun’s rays are strongest. • TAKE SPECIAL CARE of CHILDREN and those with pale skin/red hair. • Drink extra fluids in a hot climate. • Be aware that alcohol can make you dehydrated
Boots the Chemist have a useful sun factor calculator where individual details can be entered and
http://www.cancerresearchuk.org/sunsmart/ is also very good
With increased use of the internet, travel health information is available in abundance. It’s always wise to use well validated sites that keep their information updated regularly. Certain recommendations for appropriate vaccines are specific to the country of the origin, therefore for this information; it is wise to use UK based sites. Have fun! Travel-related internet sites
• Fit for Travel – an NHS site written at the Scottish Centre for Infection and
Environmental Health www.fitfortravel.scot.nhs.uk
• Foreign and Commonwealth Office www.fco.gov.uk/travel/
• National Travel Health Network and Centre www.nathnac.org
• Medical Advice Services for Travellers Abroad www.masta.org
• UK travel health site developed by a nurse - www.travelhealth.co.uk
• British Airways for information pre and during flights; fear of flying courses, fitness to
fly regulations etc. http://www.britishairways.com/travel/travelwise/public/en_gb?source=RH_travelwise_en_gb
• Centre for Disease Control in Atlanta - www.cdc.gov
AVIAN INFLUENZA ADVICE FOR TRAVELLERS (last updated 25/09/07)
To reduce the risk of infection, travellers to areas affected by avian influenza outbreaks in birds and humans (Afghanistan, Albania, Austria, Azerbaijan, Bangladesh, Bosnia/Herzegovina, Bulgaria, Burkina Faso, Cambodia, Cameroon, China, Cote d'Ivoire, Croatia, Czech Republic, Denmark, Djibouti, Egypt, France, Georgia, Germany, Ghana, Greece, Hong Kong, Hungary, India, Indonesia, Iran, Iraq, Israel, Italy, Japan, Jordan, Kazakhstan, Korea (Rep), Kuwait, Laos, Malaysia (peninsular), Mongolia, Montenegro, Myanmar, Niger, Nigeria, Pakistan, Palestinian Auton Territories, Philippines, Poland, Romania, Russia, Saudi Arabia, Serbia, Slovakia, Slovenia, South Africa, Spain, Sudan, Sweden, Switzerland, Thailand, Togo, Turkey, UK, Ukraine, Vietnam and Zimbabwe
Learn more about it - Avian influenza, or "bird flu", is a contagious disease of animals caused by viruses that normally infect only birds and less commonly, pigs and other mammals. It can spread rapidly between birds, especially in poultry farms or live bird markets where birds are kept close together. Humans are usually infected through close contact with live infected birds as influenza virus is shed in bird droppings, saliva and nasal secretions, spreading it to their feathers. For further information on avian influenza infection visit the Department of Health website.
Tamiflu ®- The European Centre for Disease Prevention and Control has advised that "It is not recommended that travellers take Oseltamivir (Tamiflu ®) with them".
Be prepared - Before you travel seek advice from your General Practitioner or Practice Nurse to ensure that any necessary vaccinations and anti-malarial tablets (if required) can be arranged. Do this well in advance if possible (at least 4 weeks) as courses of vaccines may take time. There is no vaccine available at present for protection against avian influenza. This is also a good opportunity to discuss other travel health issues.
Always ensure you have health insurance cover - Travel insurance is essential and must cover medical evacuation in the event that you become unwell and have to be transported home.
Consider taking a first aid kit - This should include a small, basic first aid kit, including some means of checking a persons temperature, either a thermometer or strips to place on the forehead and alcohol-based rub for hand hygiene.
Travel - There are currently no restrictions on travelling to affected areas.
Avoid contact with poultry (chickens, ducks, geese, pigeons, and quail) or any wild birds and the settings where they are present e.g. commercial poultry farms, backyard poultry farms and live poultry markets. Also avoid contact with sick or dead poultry and birds.
One of the most important ways of preventing the spread of infection is careful and frequent hand washing. If soap, clean water and towels are not available, alcohol hand rub can be used.
Do not eat uncooked or undercooked poultry or poultry products including food with uncooked poultry blood. All poultry, including eggs must be thoroughly cooked.
If you become unwell with a fever (temperature of 38° C or more), cough, difficulty with breathing, headache, sore throat, sore eyes or muscle aches, promptly seek out medical attention. The British Embassy can assist with contacting medical aid and relatives. Postpone any further travel until you are well again. The Foreign and Commonwealth Office provide information on what to do when ill abroad.
Do not attempt to live bring poultry or poultry products back into the country.
Pay attention to your health on return home, particularly over the first 10 days.
If you develop symptoms such as those mentioned above or any other "Flu like" or respiratory illness during this period, seek immediate medical attention. Contact your General Practitioner or NHS Direct (England) Tel: 0845 4647or NHS 24 (Scotland) Tel: 08454 24 24 24. Before you visit a health-care setting (e.g. your health centre or a hospital), describe your symptoms and tell the provider that you may have been exposed to avian influenza, giving details of recent travel history.
Do not travel while you are unwell and limit your contact with others as much as possible to prevent the spread of any infectious illness until you can be seen by a Doctor.
Follow good hygiene practices: cover your nose and mouth when coughing or sneezing, use tissues only once, disposing of them promptly and carefully, wash hands frequently.
CLINICIAN’S CORNER Management of Urinary Incontinence in Women Scientific Review Context Urinary incontinence is a common health problem among women that nega- tively impacts quality of life. Therefore, it is important that primary care physicians havean understanding of how to manage urinary incontinence effectively. Objective To review the most recent, high-quality evidence regard
Das Kopieren der Leseproben ist nicht gestattet. Tel. +49 7626 9749 700Fax +49 7626 9749 709und englischen Homöopathie Bücher vorgestellt. SINUSITIS & RHINITIS o Sinusitis has blocked nose with frontal headache, and there may be yellow or o Rhinitis has watery coryza', frontal pain; sneezing; may have blocked nose; o Catarrh refers to a thick or purulent mucous discharge