The Healthy Traveller

Immunisations
Air travel
Diarrhoea and vomiting
Accidents and hazards
Children and travelling
Sun
Sex, drugs and other HIV risks
Malaria
The pregnant traveller
Useful travel medications

Air travel exercises

[For general worries about flying, try www.airfraid.com}

IMMUNISATIONS

For the most comprehensive up-to-date information we recommend a visit to www.fitfortravel.scot.nhs.uk 

Our Travel Immunisations Form is available on-line by clicking here. Also see the travel vaccines information guide in our reception area for the immunisations required for your specific destination.

The table below lists immunisations, together with details of when you should have them, how many treatments are required and how long the immunisations are effective. There are also details of whether the vaccine is live or killed (see below for further details) and whether a charge is made for a vaccination. Basic courses of tetanus and polio are given to all children as part of the routine child immunization programme.

Exceptions

Live vaccines are not advised for people in certain groups. If you are in one of the groups below you should discuss your immunization requirements with your GP.

• Any patient on immunosuppressives, i.e. long term oral steroids, cytotoxic drugs or radium treatment.

• Patients who are HIV positive.

• Pregnant women.
  

Cholera

Immunisations against cholera are no longer recommended by the World Health Organisation. For countries which request a certificate of immunization, travellers are advised to carry a signed statement on official notepaper that cholera vaccine is not indicated.

* A charge is made for these vaccinations

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AIR TRAVEL

During the flight

The following steps will help avoid problems caused by sitting still on flights:

• Stimulate circulation with a brisk walk before flying. Whilst travelling try and move frequently or follow an exercise programme. Pay extra attention to moving your legs and deep breathing exercises.
  

• Ankle swelling on long flights can be helped by exercises or wearing special support stockings. (For exercises, click here).
  

• Carry regular medication in hand baggage. Don't stop taking any medication before flying. On long flights take regular medication by calculating the number of hours between doses.
  

• Relax and try to sleep if travelling at night.
  

• Take an aspirin, unless previously advised not to, or unless you suffer from side effects.

For information and advice about Deep Vein Thrombosis click here.

Cabin pressure

Cabin air pressure is equal to being at an altitude of between 5,000 - 7,000 ft. The air is very dry and this causes a degree of dehydration which increases sensitivity to alcohol, caffeine and spicy food. To help avoid problems:

• Drink extra water and soft drinks.
  

• Use good moisturisers on skin and lips.
  

• To avoid problems with painful ears, suck sweets on take-off and landing, when suffering from a cold.
  

Jet lag

Jet lag is the physical experience of the body not acclimatising to a different time zone. To help avoid the worst effects of jet lag:

• Follow the tips above for a restful flight
  

• If travelling to a different time zone and staying there for less than 48 hours, consider trying to stay on your own time zone.
  

• When adjusting to a new time zone, reset your watch and think in destination time from the start of the flight.
  

• On arrival expose yourself to natural light as soon as possible.
  

SPECIAL CASES

The following conditions may cause problems with flying, so consult your doctor if you suffer from:

• severe asthmatic attacks

• an unresolved collapsed lung· 

• heart failure

• severe anaemia (haemoglobin less than 7)

• severe respiratory disease

• sickle cell disease

or have had

• recent middle ear disease, surgery or sinusitis

• recent chest surgery (within 3 weeks)

• recent abdominal surgery (within 10 days)

• a recent heart attack (within 3-6 weeks)

• a recent stroke (within 3-6 weeks).

Aqualung divers should not fly within 12 hours of diving, or 24 hours if diving involved depths of more than 100 feet, or decompression stops.

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DIARRHOEA AND VOMITING

Diarrhoea and vomiting is common when travelling abroad. It is usually of short duration and requires no treatment. The change in food and natural bacteria in your stomach is the commonest cause and for this taking extra fluids should suffice. Preventative medications are not usually recommended, as they have a limited duration of effectiveness and have side effects including further diarrhoea. If, however, having diarrhoea would be devastating for your trip (e.g. for athletes and some businessmen), discuss the option of preventative medication with your GP. Lots of bugs are involved in causing diarrhoea and vomiting and these are mostly found in food and drink. If symptoms persist on your return see your GP.

Prevention

There is no guaranteed way of avoiding problems but the following should help:

Water

• Drink only brand-name bottled water.

• Boil non-bottled water. Boiling kills all infectious agents.

• Use commercially available water filters.

• Consider using chemical disinfection: 

• Avoid ice and ice creams.
  

Food

• Fruit and vegetables - 'cook it, peel it, boil it or forget it. Avoid salads if they are prepared by someone else.

• Seafood, fish and meat should be well cooked. Seek local advice on safety of fish and seafood especially.

• Avoid unpasteurised milk and other dairy produce.

• Wash your hands well, before eating and clean all cutlery.

• Avoid food prepared in advance and left out unrefrigerated.
  

Treatment

Adults

• Increase intake of non-alcoholic fluids, particularly fruit juices.
  

• Add salt to the diet
  .

• Use rehydration therapy if severe and prolonged e.g. Rapolyte and Diarolyte, (available from your pharmacist) or alternatively 1 tsp. sugar plus 1/2 tsp. salt to 1 pint of boiled water.
  

• Loperamide (Arret) decreases the frequency of bowel motions and may be useful on long journeys. Use it if necessary when diarrhoea is acute and watery. Limit the use to 24 hours if the diarrhoea is severe. If symptoms include the following, seek medical advice:

                 Bloody, explosive or prolonged diarrhoea.
                 Abdominal pains
                 Fever
                 Mucus in the stools

Antibiotics. A three to five day course will shorten the duration of the illness but causes some people to become carriers of the disease.

Fasting is unnecessary except in severe attacks.

Children

An oral rehydration therapy sachet should be taken, made up using boiled or bottled water. They enhance the absorption in the gut and should be started at the onset of an attack even if vomiting is present. They will reduce the risk of dehydration.

Encourage the child to eat as soon as possible.

Breast feeding should be continued but oral rehydration therapy should be given in addition.

DO NOT GIVE LOPERAMIDE OR OTHER ANTI-DIARRHOEA AGENTS

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ACCIDENTS AND HAZARDS

Take the following points into account:

• Travel insurance check you have suitable insurance to cover all activities i.e. skiing, paragliding etc.
  

• Rent as large a car as possible, check seat belts, brakes, tyres etc. Take care if driving on the right hand side of the road, especially at roundabouts
  .

• Be wary of driving at night and when tired
  .

• Avoid using motorcycles/mopeds, but if you do, always wear a crash helmet.
  

• Avoid alcohol and food before swimming and driving. Select safe areas for swimming. Beware of currents, jellyfish, sea urchins and crocodiles!
  

• Know what local emergency medical facilities are available.
  

• Take care at country borders. Never accept packages etc. for posting elsewhere and do not accept food or drink from strangers.
  

• Don't take photographs in sensitive areas e.g. some airports, military establishments etc.
  

• Be aware of thefts, fire hazards, lifts, balconies. Ensure you are familiar with fire escape routes.
  

• Take with you an E111 form (available from DHSS and post offices) if travelling in the European Union. This will enable you to obtain free emergency treatment.
  

CHILDREN AND TRAVELLING

A few simple precautions can make travelling with children easier:

• Choose a suitable location for your holiday.
  

• Ask in advance for a sky cot for babies when flying.
  

• Take books, toys and games for the journey.
  

• Use a mild sedative e.g. Phenergan. Try in advance to test the child's reaction to it.
  

• Take baby milk, food and drinks: avoid fizzy drinks
  .

• Avoid painful ears when flying by sucking sweets on take off and landing. Take decongestants if travelling when the child has a cold.

SPECIAL PRECAUTIONS

Warn children about crossing roads. The traffic may be coming from a different direction.

Do not allow children to stroke or touch any animals.

Take care when swimming in the sea. Look out for jellyfish, currents etc. Shower afterwards.

Take any medication the child may need and a supply of Phenergan, Calpol, Rapolyte or Dioralyte sachets, mosquito spray (Jungle formula), travel sickness tablets e.g. Stugeron, Sea Legs etc.

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SUN

Sunbathing for too long too soon can cause a variety of problems and lead to the development of skin cancer. A few simple precautions can help:

• Increase exposure to the sun slowly, only 20 minutes at a time, at first.

• Use the correct factor sun protection cream, initially 10 for adults and always 15 for children, and reapply after swimming.

• Wear protective clothing (e.g. cotton T-shirt, hat, etc.). This is particularly important for children, in and out of the water.

• Avoid sunbathing when the sun's rays are strongest, i.e. in the middle of the day.

• Rapid or long exposure to the sun can result in heat-stroke, leading to dehydration and exhaustion. If this occurs, rest in a cool place and drink plenty of fluids.
  

SEX, DRUGS AND OTHER HIV RISKS

Casual sex carries a risk of contracting disease, hepatitis B, genital herpes or HIV, which can lead to AIDS.

Condoms provide good but not complete protection. It is sensible to carry a reliable make of condom.

Drug-taking behaviour puts you at risk of contracting HIV, and needle sharing is dangerous.

Blood transfusions in developing countries carry risks and should be avoided if possible. If travelling in developing countries you should consider taking a travel kit containing sterile equipment for use in an emergency. These are available from the health centre.

MALARIA

Malaria remains one of the most common tropical diseases, causing sickness and death in 2,000 people in the UK per year. It is an infection caused by a parasite in the blood. It destroys blood cells, causing fever, headache and anaemia, and can cause either death or symptoms which may recur for many years. Malaria is transmitted by bites from a female mosquito that is carrying the parasite. The most dangerous areas are tropical Africa and coastal New Guinea, but many other areas carry a risk. Pregnant women are more susceptible to catching malaria

Protection

Avoiding being bitten:

• Bites from mosquitoes most commonly occur at night. When out, cover up legs and arms and use a repellent (such as Jungle formula) on all exposed areas.

• When inside, burn mosquito coils or heat discs of mosquito repellent on special plug-in devices. These are readily available locally and at airports.

• Kill all visible mosquitoes with insecticide before going to bed.

• If possible sleep in an air-conditioned room or inside a permethrin impregnated mosquito net.

Preventive medication

Avoiding mosquito bites is not always possible. In 'at risk' areas, tablets to prevent malaria are essential. For full information on up to date recommended treatment for your area refer to the relevant destination sheets. 

Resistance to drugs changes from time to time. Tablets must be taken for at least one week before travel and four weeks after returning home. They are not available through the NHS. Some can be purchased directly from a pharmacist (e.g. Nivaquine, Paludrine) whilst others are only available on private prescription from your GP (e.g. Mefloquine). No treatment will guarantee 100% protection. 

If you are concerned that you may have malaria or you suffer from symptoms similar to flu, with fever and headache, or episodes of vomiting and diarrhoea after returning from abroad, consult you GP, giving details of your trip. If you are ill while away seek medical attention.

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THE PREGNANT TRAVELLER

Many women travel abroad during pregnancy. To help avoid problems:

Avoid travel in first three months of pregnancy.

Consult your doctor early with regard to travel plans, vaccinations and, in particular, malaria. Some vaccinations should not be given during pregnancy.

Ensure you obtain adequate insurance. If travelling late in pregnancy this should include insurance for the baby in case of premature birth.

Avoid travel to 'at risk' countries and countries where suitable medical facilities are not readily available.

Check the acceptability of pregnant travellers with the airline. Most do not accept passengers beyond 32nd week of pregnancy, although they may allow travel up to 36 weeks if you have a doctor's certificate.

Be aware of the increased risk of complications if you are flying long distance, due to dehydration and immobility.

USEFUL TRAVEL MEDICATIONS

The following is a list of tablets, creams and other medications recommended for a variety of conditions. It is a guide from which you can select those appropriate to your needs and destination. They are all available direct from your pharmacist.

Antihistamines
For bites, prickly heat and other allergies e.g. Piriton - may make you sleepy, Triludan - will not make you sleepy.

Analgesics
Paracetamol, aspirin, ibuprofen. (Aspirin and ibuprofen should be avoided in asthmatics and those with stomach ulcers.)

Antiseptics
Savlon/Betadine
Germolene

Anti-sickness tablets
Promethazine eg Avomine
Stugeron

Creams
Calamine for bites and irritation to the skin.
Hydrocortisone - for severe inflammation or eczema.
Gyno Daktarin cream or Femeron pessary - for thrush or fungal skin infections
Witch Hazel gel for bums and bites and general skin irritations.

Others
Rapolyte or Dioralyte - for rehydration and prevention of dehydration with
diarrhoea or sunstroke.
Loperamide (Arret) - for diarrhoea.
Plasters
Micropore (paper adhesive tape)
Steri strips (paper sutures)
Crepe bandage
Insect repellent
Condoms (foreign brands may not be reliable)
Sterile wipes
Safety pins, scissors and tweezers.
Waspeze - for stings and bite

If you are susceptible to the following conditions, these are other
recommended treatments:

Urinary tract infection - Trimethoprim
Conjunctivitis - Chloramphenicol ointment or drops
Herpes Simplex - (cold sores) Acyclovir (available over the counter)
Migraines Imigran (if used already)

These will need to be obtained on a private prescription if they are for the prevention of an illness that you may develop abroad.

We also recommend that you take a wound and intravenous pack if travelling to third world countries or remote areas. These should be given to the doctors who treat you in such regions. They are sold at the practice at a price of £13.00 each and contain sterile needles, syringes, stitches and other useful items.

It is important when purchasing any of these medications that you read carefully the indications for use and other information in the pack

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© 2002 Sonning Common Health Centre