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Sheffield
S3 7QP
Tel: 0114 2222100
Results & Advice Line: 0114 2222111
Term Time: 1-2pm Results of Tests, 2-3pm Advice
Vacation Time: 2-3pm Results & Advice
STUDENT
TRAVEL
INFORMATION
AND
ADVICE
CONTENTS
British vaccination schedule
International Schedules for travel vaccines
General side effects of vaccines
Malaria
Sun safety
Accident prevention
Medical advice on diving problems
Winter sports injuries
First Aid Kits
Culture shock
Advice for travelling in remote areas
Insurance cover
Food and water advice
Swimming
Diarrhoea
Hepatitis B and HIV infection
Insect bites
Animal bites
Advice for women travellers
Contraception advice for travellers
Advice on air travel: dehydration, circulation problems, jet lag
Airline flight restrictions
Fear of flying, air rage
Altitude sickness, mountain sickness
Ear care and air travel
Appendices – diseases that can be vaccinated against in the
traveller
List of travel clinics in the UK
Travel Health books – general reading list
References
British Vaccination Schedule
Recommended age
Which vaccine is given
of vaccination
2 months old
Diphtheria, tetanus, pertussis (whooping cough)
polio and Hib
Meningitis C
3 months old
Diphtheria, tetanus, pertussis (whooping cough)
polio and Hib
Meningitis C
4 months old
Diphtheria, tetanus, pertussis (whooping cough)
polio and Hib
Meningitis C
13 months old
MMR (measles, mumps, rubella)
4-5 years old (pre-
Diphtheria, tetanus, pertussis and polio
school)
MMR booster
13-18 years old
Tetanus, diphtheria and polio
Ref: 1
NB:
 It’s particularly important to check that your MMR (measles, mumps
and rubella) immunisation is up to date because some teenagers have
not had two doses of MMR. MMR was introduced into the UK vaccine
schedule in 1988 with a second dose being introduced in 1996. So, if
you were born before 1992, you have probably only had one dose of
MMR. So, if you think this applies to you, you should book an
appointment for the second dose now. If you have never had the
MMR vaccine, you should have one dose now and another three
months later.
 Meningitis C vaccine was introduced into the UK vaccine schedule in
1999. It is recommended that if you did not receive 3 doses as a small
baby within the above schedule, that you have received 1 dose to
protect you against this disease. It is still very important to be aware
of the signs and symptoms of meningitis, as the vaccine does not
protect against other strains.
 Hib (Haemophilus influenzae) was introduced into the UK vaccine
schedule in 1993. Hib vaccine is only recommended for the age group
2mths – 10yrs.
 BCG (Tuberculosis) vaccine recommendations changed in the UK in
July 2005. You may well have already received a BCG vaccine between
the ages of 10yrs-14yrs. Only one vaccine is recommended. The new
UK government guidelines are:

all babies living in areas where the incidence of TB is
40/100,000 or greater

babies whose parents or grandparents have lived in a country
with a TB prevalence of 40/100,000 or higher

unvaccinated new immigrants from countries with a high TB
prevalence
Ref: 1
Why do we need immunisation?
The UK national immunisation programme has meant that
dangerous diseases such as tetanus, diphtheria and polio have
effectively disappeared in the UK. But these diseases could come
back – they are still around in many countries throughout the
world. That’s why it’s so important for you to protect yourself.
I don’t remember what vaccines I’ve previously had, how do I
find out?
Your parents may remember. Your family GP may have records.
Your medical records may have the information. Your school may
have records of vaccines given at school. It is always worth you
having your own personal record of what immunisations you have
had, in case records aren’t available.
International Schedules for travel vaccines
NB: If you have had all 5 childhood doses of: Diphtheria, Tetanus
and Polio, then you are protected from these diseases for life in
countries where the diseases have effectively disappeared. But
when travelling to countries where the diseases are still endemic,
it may be recommended that you receive a booster within the last
10years.
Ref: 2
International Schedules for travel vaccines
Vaccine
Dose 1
Dose 2
Dose 3
Dose 4
Booster
Doses
Hepatitis A
Day 0
6months –
10-20 years
(Should be given at
12months
(dependent on
least 2weeks
manufacturer)
before departure)
Typhoid
Day 0
3 yearly if still
(Should be given at
at risk
least 2weeks
before departure)
Hepatitis B –
Day 0
1 month
6 months
Day 0
1 month
2 months
5 years
(preferable
schedule)
Hepatitis B –
(accelerated
Day 0
Day 7
Day 21
(very rapid
12
5 years
months
schedule)
Combined
5 years
months
schedule)
Hepatitis B –
12
Day 0
1 month
6 months
Hepatitis A at
Hepatitis A &
least 10
B
years.
(Twinrix)
Hepatitis B
(preferable
5 years
schedule)
NB Twinrix does
NOT have an
accelerated
schedule like
Hepatitis B.
Combined
Day 0
Day 7
Hepatitis A &
Day 21
12
Hepatitis A at
months
least 10
B
years.
(Twinrix)
Hepatitis B
(very rapid
5 years
schedule)
Yellow Fever
Day 0
(must be
given at least 10
days before
10 years (if
still at risk)
entering country &
a certificate issued)
Men ACWY
Day 0
5 years. (Haj
(should be given at
pilgrims may
least 2-3 weeks
need after 3 years
before departure)
– please get up to
date advice)
Rabies
Day 0
Day 7
Day 21-28
2-5 years (if
still at risk)
Japenese B
Day 0
Day 7-14
Day 28
12
Encephalitis
months
(Green Cross)
(if still at
Tick Borne
risk)
Day 0
Preferably 1-
9-12 months
3 years
Encephalitis
3 months
after 2nd dose
at risk)
(FSME)
after 1st dose
(if still
(but if travelling
immediately day
14)
Please Note: Children’s Vaccine doses and schedules are very different,
so please ask your nurse specifically about these.
WHAT GENERAL SIDE EFFECTS OF VACCINES CAN YOU EXPECT
TO EXPERIENCE?
Some people will develop slight tenderness, redness and
sometimes swelling at the site of the injection and a small number
may experience slight fever, headache, general aching and malaise
approximately 24 hours after the vaccination, lasting for up to 24
hours. You are advised to take regular analgaesia to reduce your
temperature (e.g paracetamol) and to drink plenty of non
alcoholic fluids. A cold compress applied to the site of the
injection may relieve the discomfort.
WE DO REQUEST YOU WAIT IN THE WAITING ROOM OF THE
SURGERY FOR APPROXIMATELY 20-30 MINUTES AFTER
RECEIVING ANY VACCINES.
This is merely a precaution, because in extremely rare
circumstances, a person can have an immediate and sometimes
severe allergic reaction which would require medical attention.
SPECIFIC INFORMATION ABOUT YELLOW FEVER VACCINE
The symptoms described above under general side effects can
sometimes occur in yellow fever vaccine 5-10 days after
vaccination.
If you are concerned about your condition, you can telephone the
University Health Service Advice Line (details front cover) and ask
to speak to a nurse or doctor.
If the surgery has closed, you can also phone NHS Direct on: 0845
4647 for 24 hr help and advice from a nurse or doctor.
MALARIA
Malaria infects over 500 million people worldwide, causes over one million
deaths each year and threatens the lives of about 40% of the world’s
population. All it takes is one bite from an infected mosquito for this to
happen to you.
Many people do not realise how dangerous malaria can be, or that in some
cases it can lead to kidney failure, seizures, coma or even death. Find out
about the real dangers of malaria and speak to your doctor about malaria
prevention before you travel. There are different options available and one
will suit you.
The Dangers:
 Malaria is preventable and treatable and yet it remains one of the
major causes of death worldwide
 Malaria is an infectious disease caused by the Plasmodium parasite
 It is carried from person to person by infected female Anopheles
mosquitoes
How Malaria Spreads:
 Infected mosquito bites a human
 Parasite rapidly goes to liver within 30 minutes
 The parasite starts reproducing rapidly in liver. Some parasites lie
dormant in the liver and become activated years after initial infections.
 Gets into the blood stream, attaches and enters red blood cells.
Further reproduction occurs.
 Infected red blood cells burst, infecting other blood cells.
 This repeating cycle depletes the body of oxygen and also causes
fever. The cycle coincides with malaria’s fever and chills.
 After release, a dormant version of malaria travels through the host’s
blood stream, waiting to be ingested by another mosquito to carry it
to a new host.
Protecting Yourself From Malaria
ABCD
A – BE AWARE OF THE RISK OF MALARIA
All travellers to malarious areas must be aware of the risk of malaria in the
places they visit
B – PREVENT OR AVOID BITES FROM THE INFECTED
MOSQUITO
Use mosquito repellent with DEET (diethyltoluamide) on both your skin and
clothes. Keep arms, legs and feet covered and, if possible, with light
coloured clothing
C – COMPLY WITH THE APPROPRIATE CHEMOPROPHYLACTIC
DRUGS (PREVENTATIVE MEDICATION)
There are different antimalarial options and one will suit you, so speak to
your healthcare professional about the best protection for you
D – PROMPT DIAGNOSIS FOLLOWING ANY SYMPTOMS OF
MALARIA (EG FLU-LIKE SYMPTOMS) AND OBTAIN
TREATMENT IMMEDIATELY
The main initial symptoms are often mistaken for flu and include headache,
vomiting, fatigue, nausea, muscular pains, mild diarrhoea and fever.
Did you know that……………
 the most lethal form of malaria is on the increase
 the signs of malaria can often be confused with flu
 malaria can live inside you for years and can be a long-term disease
 malaria is not a seasonal disease and you are at risk of it throughout
the year
 it is not only in dirty swampy areas that you can contract malaria
 you are not necessarily safe from malaria if you stay in big cities or
four star hotels
 you are at risk by travelling to malarious areas without taking
antimalarials
 it is important to complete the antimalarial course after returning
from holiday
 you should ideally seek advice on malarial eight weeks before you
travel but can still seek advice even at the last minute
 there are antimalarial medications available to suit your individual
needs
(Ref: Malaria Hotspots. GSK. 05/04)
Visit www.malariahotspots.co.uk to find out more………
DIFFERENT TYPES OF MALARIA
There are 4 different species of human parasite:
 Plasmodium falciparum (most serious) in sub-Sarahan Africa, Papua
New Guinea and Amazon rain forests of South America – death can
occur within days
 Plasmodium vivax in Indian sub-continent
 P.Ovale mostly in Africa
 P.Malariae mostly in Africa
Signs and Symptoms
 Illness usually begins within 2-4 weeks of the infected bite. But
sometimes up to 35 days
 Malaise, headache and muscle pains but the first major symptom is
usually fever. At this stage symptoms are similar to flu. Rigors
followed by profuse sweating occur.
 A wide range of other symptoms can occur including diarrhoea,
abdominal pain and a dry cough.
Anti-malarial medication
Your nurse/doctor will advise which tablets you should
take.
Medication How long
Whilst in the How long after
before
malarious
departing
entering
area
malarious area?
malarious
area?
Chloroquine
Commence 1 week
Every week whilst
4 weeks after departing
(Adults) 300mg
before entering
in malarious area
malarious area
to be taken
malarious area
weekly
Proguanil
Commence 1wk
Every day whilst in
4 weeks after departing
(Adults) 200mg
before entering
malarious area
malarious area
to be taken daily
malarious area
Mefloquine
Commence 2-3 weeks
Every week whilst
4 weeks after departing
(Adults) 250mg
before entering
in malarious area
malarious area
to be taken
malarious area
Every day whilst in
7 days after departing
malarious area
malarious area
weekly
Malarone
Commence 1-2 days
(Adults) x1 tablet before entering
to be taken daily
malarious area
Doxycycline
Commence 1-2 days
Every day whilst in
4 weeks after departing
(Adults) 100mg
before entering
malarious area
malarious area
to be taken daily
malarious area
SUN SAFETY
Sun damage to the skin
Although sunbathing may be enjoyable, it must be remembered that
excessive sun exposure is a health hazard due to the effect of ultraviolet
radiation on the skin. Ultraviolet A (UVA) and Ultraviolet B (UVB) radiation
are known to cause premature cancers. UVB also causes sunburn. This is
more likely when the light is also ‘reflected’ from water (swimming pools
or the sea), white sand or snow.
Vulnerable groups
These groups may be more likely to get sun burn problems than others
• Babies and children.
• Fair skinned people who often also have red hair or blue eyes.
• Those with certain medical conditions such as albinism or previous skin
cancer.
• Those on certain medications such as tetracyclines or diuretics.
General Precautions
• Babies under 9 months should be kept out of direct sunlight.
• Children should wear long sleeved, loose fitting shirts, hats and highfactor waterproof sunscreen.
• Everyone should avoid the midday sun, usually from noon until 14.00
hours (15.00 in tropical regions).
• Adults should wear a broad brimmed hat, long sleeved shirts and
sunglasses.
Sunscreens
• These absorb ultraviolet B (UVB) and to a lesser extent ultraviolet A
(UVA).
• The Sun Protection Factor (SPF) refers to the protection against UVB. (e.g.
‘SPF 8’ allows approximately 8 times longer sun exposure without
burning than with no protection).
• There is a voluntary star system denoting UVA protection; more stars
indicating greater protection. Also check for any expiry dates
Sunburn and heat-stroke cause serious problems in travellers. Both are
preventable - to avoid, use the following PRECAUTIONARY GUIDELINES
• Increase sun exposure gradually, 20 minutes limit initially.
• Use sun blocks of appropriate adequate ‘SPF’ strength. Re-apply often
and always after swimming and washing. Read manufacturer instructions.
HOW TO BE SUNSMART
Sunscreen does not offer total protection from the suns rays and
using it is only one way to reduce your risk of skin cancer.
Be SunSmart
* Stay in the shade between 11am and 3pm
The sun is most dangerous in the middle of the day – find shade
under umbrellas, trees, canopies or indoors.
* Make sure you never burn
Sunburn can double your risk of skin cancer
* Always cover up
Sunscreen is not enough – wear a t-shirt, a wide brimmed hat and
wraparound sunglasses (eyes get sun damaged too)
* Remember to take extra care with children
Young skin is delicate, keep babies out of the sun completely
* Then use factor 15 sunscreen or higher
Apply sunscreen generously 15-30 minutes before you go outside
(it doesn’t work immediately), and re-apply often
Also….
 report mole changes or unusual skin growths promptly to
your doctor
 avoid using sun beds or tanning lamps
Ref: 3
ACCIDENT PREVENTION
All travellers should have health insurance to cover accidents as well as
other illness and check that repatriation in an emergency is also covered.
General advice
• Be aware of the possible risks and avoiding predictable injury should
always be the first priority.
• Foot injuries on the beach, for example, are common in those not
wearing shoes.
• Unfamiliar sea creatures (e.g. fish or molluscs) and caterpillars may be
unexpectedly venomous.
• Dogs in many countries run wild and will respond aggressively when
approached.
• Skin injuries can lead to tetanus and 10 yearly boosters of tetanus toxoid
are advised when post-exposure tetanus hyperimmune immunoglobulin
may not be available.
• Serious injuries that may need blood transfusion can be of concern where
HIV screening of blood products is not universal.
• To reduce any risk of mugging travel in groups, avoid remote areas after
dark, use a torch, keep on the move, carry an alarm or an anti-personnel
spray (may be illegal in some countries), wear modest clothing – do not
display wealth.
Road accidents
• When crossing the road remember the traffic may come from the
opposite direction to the one in your home country.
• Drivers in some countries may not observe pedestrian crossings or traffic
signals.
• Strictly observe speed limits, traffic lights and signs.
• Never drink and drive.
• Consider locking your doors at stopping points. e.g. at night in isolated
areas.
• Be very careful on potholed and non-tarmacadamed ‘dust’ roads
which can become corrugated from continual exposure to the wind.
• Think twice about taking an overloaded up-country bus.
• Scooters and motor bicycles are frequently unstable on poorly
maintained roads and those riding have very little protection in the event
of an accident.
• Check hire vehicles very carefully for mechanical defects.
Swimming and diving
• Alcohol and swimming do not mix.
• Do not swim immediately after a big meal – cramp may be more
common.
• Low water temperature can induce hypothermia. This can be rapidly fatal
– within minutes. Both the sea and inland deep water lakes may be very
cold even during hot summer months.
• Sunburn is common and may be unexpected since the swimmer is kept
cool by being in the water.
• Beware of fast moving tides and currents, especially the undertow from
waves and in deep water – even strong swimmers may find it difficult to
get back to the shore.
• Avoid swimming alone.
• Swim in approved places when there is a beach patrol or lifeguard
service.
• Avoid using airbeds or inflatable dinghies in the sea. If there is an
offshore wind they can easily been blown a long distance off shore. If this
happens the scenario is often panic, jumping off, exhaustion and
hypothermia. Invariably it is better to stay ‘aboard’, try to attract
attention and await rescue.
Medical Advice on Diving Problems
The Royal Navy provides a 24 hour emergency advice service. This gives
information on the location of your nearest medical diving problem
treatment facility (recompression chamber) and the emergency
management of diving related illness. Tel:- 07831 151 523 (cell phone) or
0831 151 523 (non cellphone) and ask for the Royal Navy Duty Diving
Medical Officer. State clearly that there is a diving problem. In case of
difficulty an alternative contact is Royal Hospital, Haslar. Tel:- 023 92
584255
Winter Sports Injuries
• Do not be over ambitious – make sure you are fully trained for the degree
of skill required.
• Avoid excessive fatigue – accidents often occur before lunch and on the
way back to the resort in the evening.
• Keep up your carbohydrate and fluid intake.
• Become familiar with the terrain and the hazards involved, including
avalanche potential.
• Watch out for other skiers and snowboarders. It is your responsibility to
avoid skiers in front of you.
• Observe adverse weather warnings.
• Do not ‘economise’ on protective clothing, boots and safety
equipment.
• Consider helmets for younger skiers and snowboarders.
• Learn to fall correctly and to release your ski stick before it damages your
thumb (skiers thumb)!
FIRST AID KITS
o Back packers in particular, should consider including something for
simple diarrhoea, sufficient anti-malarial tablets, possibly an antibiotic
(discuss this with the nurse), and emergency malarial treatment if
going to areas remote from medical facilities.
o The University Health Service sells Merlin Medical Packs (for use by
qualified medical staff in an emergency). This pack should be carried
in countries where sterile emergency equipment may not be readily
available.
CULTURE SHOCK
o This can be very real. Family or social difficulties at home and
psychological problems, including alcoholism, make adapting difficult.
Time differences between continents might increase isolation when it
is difficult to maintain contact with friends and relatives. A situation
that is exciting and welcome to one person can be daunting to
another.
o Problems may include adjusting to a different climate and language,
unfamiliar social amenities, coming to terms with poverty, begging
and movement restrictions for safety or political reasons. The extent
of difficulties will vary between individuals, but being open to new and
different cultures and being patient, rather than critical, will help you
adapt to new and challenging adventures.
ADVICE FOR TRAVELLING IN REMOTE AREAS
If you intend to take part in an expedition, or if you will be travelling in
areas where help is difficult to obtain in an emergency, you may find it
useful to consider the issues discussed below.
You should be aware that travel in areas which are remote from medical
facilities involves an additional element of risk. In the event of a serious
injury or illness it could be many hours or even days before evacuation is
possible. You should consider the characteristics of the environment you
will be in, such as altitude, extremes of temperature and weather, distance
from outside help, and how these factors may affect the ease of rescue in
the event of an emergency.
Depending on whether you are with a commercial trek, a youth expedition,
travelling independently or in some other group, the provision for medical
support can vary enormously. Some groups always have a doctor with
them, others may have a nurse, paramedic or first-aider. You should ensure
in any case that someone has thought about medical issues and that an
appropriate first aid kit is carried. Preferably everyone on the trip should
have a basic knowledge of what to do in an emergency. It would be
advisable to get training in first aid before departure; courses are available
which are aimed specifically at those travelling in remote areas. It is worth
taking a small personal first aid kit in addition to the main expedition kit.
Before departure
The best way to deal with medical problems is to prevent them happening
in the first place. This is even more important if you are going somewhere
where medical support is hard to obtain. It would be a good idea to have a
medical check-up before going, and remember to take supplies of any
medications which you commonly need.
A dental check-up is especially important, and should be done at least three
months before departure to give time for any necessary work. Tell your
dentist that you will be going on expedition and for how long, and he may
elect to fix small problems earlier rather than later in order to avoid
potential complications in the middle of the jungle.
If you usually wear contact lenses, consider whether you will be able to
keep them in a sterile condition when away. Often in an expedition
environment this is not possible, and it may be wise to use spectacles
instead. Contact lenses can also be a problem if the environment is dusty,
such as a desert.
Physical and mental fitness
Most expeditions are likely to involve a considerable amount of physical
exertion. It is very much worth preparing for this with a regular aerobic
exercise programme, for several weeks or months before departure. This
will certainly increase your enjoyment of the trip and improve the chances
of achieving your objectives.
Some people may find it difficult adapting mentally to an expedition
environment, due to factors such as a lack of privacy and being cut off from
family and friends. If you have a history of any psychological problems,
including alcoholism or drug dependency, it is important to make sure that
these are well under control before putting yourself into an unfamiliar
environment. It may be worth seeking counselling before your plans are
finalised. The extent of difficulties will vary between individuals, but being
open to new and different cultures and being patient, rather than critical,
will help you adapt to new and challenging adventures.
Camp hygiene
Depending on whether food is provided by your own expedition, or bought
locally, the risks of infection will vary. If local cooks are employed, check
that they use hygienic methods to avoid contamination. You will usually
need to treat drinking water by chemical means and/or filtration. Sterilised
water should also be used for cleaning teeth and for washing dishes and
cutlery. All expeditions should have an environmentally aware policy about
the disposal of kitchen and human waste, which should be kept totally
separate from cooking areas and water sources. Wash your hands, with
water containing a disinfectant, before eating or handling food and always
after using the toilet.
INSURANCE COVER
 Take out adequate insurance cover for your trip. This should possibly
include medical repatriation and this 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 an E111 form before you travel (including a photocopy of
the original form). The E111 form is in the T6 leaflet, and after
completion, should be stamped at the Post Office.
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)
1. Boiled water
2. Bottled water or canned drinks
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 ICE-CREAM 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 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 of 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 re-hydration solution is extremely useful.
This can be bought in tablet or sachet form at a chemist shop. There is now
a new formula containing rice powder which also helps to relieve the
diarrhoea, particularly useful in children. Prepare the re-hydration solutions
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. A wide range of products are available over the counter
at chemist shops.
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 may also be a risk)
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 (containing DEET or eucalyptus oil base) on
exposed skin, 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 an 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.
ANIMAL BITES
Rabies is present in many parts of the world. If rabies is not treated, 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 condition
• Use reliable taxi firms, know where emergency facilities are.
ADVICE FOR WOMEN TRAVELLERS
Contrary to popular opinion, world travel and exploration have never been
the sole prerogative of man. However, women have additional problems to
overcome as a result of their physiology and gender.
Menstruation
Emotional upset, exhaustion and travelling through different time zones can
all contribute to an upset in the menstrual pattern. Irregular menstruation is
a very common problem affecting women travellers, excessive exercise and
the stress of travel may cause infrequent periods, if this is the case it may
lead to confusion over the timing of oral contraception and great anxiety of
unplanned pregnancy. Dysmenorrhoea may also be aggravated by travel.
Oral contraception can be used to suppress menstruation
This is achieved by taking the pill continuously, without the usual seven-day
break in between packets. A reminder to take extra packets to allow for this
should be stressed. However, this method is not advisable for women
taking biphasic or triphasic pills because the dose in the first seven pills is
too low to prevent possible breakthrough bleeding.( See Nurse/Dr for
further advice if necessary or ring advice line.).
Menstruation can also be suppressed using Norethisterone tablets (a
progesterone drug). An appointment with a Doctor is required to receive
advice on this drug.
Sanitary hygiene
Tampons and sanitary towels are unobtainable in parts of Africa, Asia and
South America, and they are scarce luxuries in many of the former eastern
block countries. Locally made menstrual supplies are usually available
although the standard varies.
Travelling women should be sensitive to the cultural and religious attitudes
towards menstruation. In some countries it is forbidden to enter places of
worship while menstruating and some cultures will not allow women to
touch or even walk near food. To avoid such situations discreet use of and
disposal of sanitary towels and tampons would be advisable.
Personal safety and security
When travelling, particularly alone, leave an itinerary of your trip with a
responsible person contacting them at pre-arranged times and dates.
Ostentatious displays of money, jewellery, luggage and dress can
encourage the wrong type of attention. When travelling be aware of where
your luggage, particularly hand bags, are at all times. Do not leave them
unattended or hanging on the back of chairs in restaurants.
Choose your accommodation carefully:• try and pick accommodation which is in a safe area
i.e. not bang in the middle of the local red light district,
• request a room near the lift or stair well,
• not on the ground floor,
• inspect the door locks and window fasteners,
• never open the door to your room until you have identified the caller,
• do not identify yourself on the telephone until the caller has done so,
• keep your money and valuables close by you at night.
Be alert, listen to the advice of locals and fellow travellers, develop a street
sense, try not to be in the wrong place at the wrong time.
In a confrontational situation a woman traveller is rarely a physical
match for a man.
The following rules can help:
• Don’t turn a scary situation into a dangerous one if you can help it (e.g.
it would be unwise to launch into a physical attack if the man confronting
you is just after your money – hand it over and avoid finding out what he
may do if provoked).
• Don’t panic or show fear or let the person confronting you get the
upper hand, try to gain psychological advantage throwing him off his
balance i.e. compliance.
• If you do find yourself in physical dangers try to anticipate the
aggressor’s next move and plan ahead for it. As the innocent party in
the confrontation you have the advantage of surprise, if you are forced to
strike back physically, make sure it is a crippling blow that gives you a
chance to escape.
• If you are worried about your ability to gauge dangerous situations and
to defend yourself then consider joining a women’s self defence course
before travelling.
Personal safety when travelling alone
Insist on inspecting your accommodation before agreeing to stay. If
unhappy with the room request a change or where possible move to
different accommodation.
The lone woman traveller will often be flouting convention simply by her
presence. Unfortunately women in the developing world don’t have the
independence that their western counterparts take for granted. For this
reason, their presence, especially unaccompanied, will generate interest
within local people of both genders. Male dominated Muslim countries
such as the Middle East, North Africa, Pakistan and parts of India and South
America are frequently seen as difficult places for women to visit.
How you dress is an easy method of self-preservation and the most
immediate symbol of respect. Dress codes differ greatly from country to
country and to get them wrong would put you at an immediate
disadvantage. A culture’s standard of dress has a lot to do with what parts
of the body are considered to be sensuous or provocative. As a general rule
tight and skimpy clothes are inappropriate for most countries outside of
Europe and North America. Clothing should be conservative and
presentable, loose fitting and comfortable. Arms and legs should be
covered, especially when visiting places of worship and national
monuments. Throughout the Arab world and in other Muslim countries,
hair should be covered by a head scarf.
When travelling try to be inconspicuous yet confident avoiding
confrontational challenging situations with men by adopting an assertive,
dismissive manner.
Remember many men can see eye contact as a ‘come-on’. The use of
dark sunglasses will limit this problem. Be prepared to answer questions
about yourself particularly if single and travelling alone. The often-asked
questions of your marital status and family, are ones of genuine interest. To
avoid the unwanted attentions of some men the use of a few white lies
about ‘your husband’ and a fake wedding ring are a useful pretence.
(Adapted from ‘Travel Medicine and Migrant Health’ – chapter on
Women and Children by Marlene Simpson.)
CONTRACEPTION ADVICE FOR TRAVELLERS
Women travelling or living for prolonged periods abroad should be advised
to find out what contraceptive services are available to them in the
country/countries they are visiting. The International Planned Parenthood
Federation (IPPF) and the Family Planning Association of Britain can provide
extra information.
The Combined Oral Contraceptive Pill
Stomach upsets and severe diarrhoea reduce absorption and may leave
inadequate protection. If vomiting occurs within three hours of taking the
Pill a barrier method should be used as well, throughout the stomach upset
and for seven days after it has ended i.e. ‘the seven day rule’.
Some broad-spectrum antibiotics, e.g. doxycycline, may reduce their
efficacy. (This normally only occurs for the first 3 weeks of taking
doxycycline.) The Family Planning Association advice is that additional
contraceptive precautions should be taken whilst on a short course of
broad-spectrum antibiotics and for 7 days after stopping.
The Progestogen only Pill (POP)
For women taking the progestrogen only Pill the same rules apply as with
the combined Pill. It is slightly less effective, 96–98%, and must be taken at
the same time each day – this can pose problems when crossing time
zones. However, it does have the advantage of not being affected by
antibiotics.
Injectable methods of contraception (Parenteral progestogen–
only contraceptives)
Injectable contraception is not affected by time zones, gastrointestinal
upsets and antibiotics.
Condoms
Reliable condoms are often hard to find in the poorer parts of the world.
If the condoms carry the British Kite Mark or the new European CE mark it
means that they have been tested to a strict safety standard. Rubber
perishes with age, and heat, and should be discarded if it displays any signs
of being brittle, sticky or discoloured.
Diaphragms/caps
They should be stored in a cool dry place in an airtight container, severe
heat can perish rubber. Spermicides may loose their efficacy if not stored in
cool, dry containers. Creams may melt and be difficult to apply and
pessaries, which are designed to melt at body temperature, impossible to
use.
(Adapted from ‘Travel Medicine and Migrant Health’ – chapter on
Women and Children by Marlene Simpson.)
Advice on air travel (health issues)
Dehydration
The circulating air in aircraft cabins is kept dry to protect equipment and
this can mean passengers may become significantly dehydrated. Alcohol
can make this problem worse. Drinking adequate fluids (sufficient to keep
the urine pale) is necessary and skin moisturisers can help dry skin.
Circulation problems
Sitting still for long periods in the inevitably cramped positions in aircraft
frequently leads to swollen ankles and sometimes muscle cramps. Venous
thrombosis in the legs and occasionally serious pulmonary emboli can
occur – some authorities suggest that the anti-adhesive effect of a small
dose of aspirin on blood platelets may be helpful in those predisposed such
as the elderly, the overweight, those with heart problems and those on oral
contraceptives. Regular stretching and mobility exercises should be
encouraged and walking around the cabin whenever practicable. Use of
surgical support stockings may be beneficial. It is however, important that
they are correctly fitted.
Jet lag
Changes to circadian rhythms
These regulate our sleep patterns, need time to adjust to changes in local
time (usually about one day per time zone crossed). Westward travel may
be better tolerated than eastward travel but problems occur when travelling
in both directions. The effects of jet lag include – sleep disturbance, loss of
appetite, nausea and sometimes vomiting, bowel changes (e.g.
constipation), general malaise, tiredness and poor concentration.
• A relaxed flight is important.
• Avoid travelling when you are already tired and take rest before
departure.
• Remember the actual home to destination travelling time will usually be
at least twice the actual time spent in the air since it will include waiting
in airports and often unexpected delays.
• Breaking very long journeys halfway with a stopover can be helpful.
• On the flight get maximum sleep aided by a mild hypnotic if necessary.
• Stretch and exercise as much as possible to aid circulation and prevent
swollen ankles.
• Drink plenty of water or soft drinks to counteract the dry cabin
atmosphere and remember alcohol in spirits and wine and also caffeine
increase dehydration (caffeine is present in coffee, tea, chocolate and
cola).
Jet lag is made worse by a hangover!
• Avoid heavy commitments on the first day. Be prepared for tiredness in
the evenings and early waking which can last up to 5 or more days.
• Hypnotics (sleeping tablets) have been shown to help sleep and
correspondingly alertness during the following day. They do not speed
up adjustment the new time zone and therefore may need to be used
for several nights.
• Some travellers find taking regular melatonin helpful. It may help the
body to adjust its circadian rhythms but its effect is scientifically
unproven. It is not readily available in Britain but can be purchased in
some other countries such as USA and Hong Kong.
Infections on air flight
Respiratory tract infections
There is no convincing evidence that re-circulation of air in aircraft cabins
increases the risk of transmitting infections since very effective filters are
used to remove bacteria and viruses. However sitting in close proximity for
long periods next to passengers who are suffering, for example, from
common colds or influenza clearly may increase the chances of a passenger
becoming infected. This is why airlines discourage passengers from
travelling while unwell with infectious conditions.
Tuberculosis
The World Health Organization (WHO) advises that, with tuberculosis
increasing worldwide, there is a small but real risk of catching the disease
during air flights. Transmission has only been recorded in flights lasting
over eight hours. The risk is clearly greater when many of those on board
are from countries with a high incidence of the disease.
Parasitic infections
Occasionally head lice and other skin parasites have been passed through
contact with aircraft seats when a previous passenger has been infested.
Itching and a papularrash, for example, around the neck and occiput can
result.
Airline flight restrictions
Airlines may discourage or not allow passengers with the
following conditions to fly.
• Pregnancy beyond 36 weeks.
• Neonates during the first few days after birth (longer after premature
births).
• Recent or current middle ear infections or sinusitis.
• Unstable psychiatric illness.
• Unstable epilepsy.
• Previously documented air rage or a record of previously causing
disruption during flights (some airlines use a ‘yellow card’ warning
system).
• Recent myocardial infarction.
• Moderate/severe heart failure.
• Moderate/severe hypoxic pulmonary disease.
• Recent chest, intracranial or abdominal surgery.
• Recent pneumothorax.
• The presence of a communicable disease.
Airlines’ regulations may vary so if in doubt advice should be sought from
the medical department of the airline concerned.
Fear of flying
In Britain an estimated nine million people suffer anxiety about flying and
may miss out on professional and personal opportunities. There is no single
personality-type prone to fear of flying and there may be a link with
problems at work or home.
Fear may develop from a bad experience – a rough flight, or after a news
report of a highjacking or crash. Panic attacks are common (sudden, intense
anxiety, sweating and trembling). The sensation is often so frightening that
the sufferer may from then on refuse to fly.
Advice for the traveller who is afraid of flying.
• Explain that fear of flying is common and emphasize that flying is safer
than road or rail travel in most developed countries.
• Try distraction by talking with other passengers, watching in-flight films,
eating or reading.
• Tell the cabin crew. Reassurance about strange sounds can help.
• A visit to the doctor prior to travel can provide reassurance about general
fitness for air travel.
• Consider a tranquillizer before departure. It should be stressed that these
drugs do not mix well with alcohol.
Cognitive Behaviour Therapy.
Recent research has indicated that “cognitive behaviour therapy” can be
helpful for more severe cases. The person identifies what they actually fear,
and then learns different ways of overcoming it.
Courses and counselling on fear of flying:
Aviatours provide courses at Heathrow and Manchester airports (Tel: 01252
793 250).
Air rage
This term has recently been introduced to describe psychological or
physical violence occurring within aircraft. It is of particular concern because
of the cramped conditions inside an aircraft and the inevitable involvement
of not only the cabin crew but also other passengers. There have been
instances where aircraft have had to land prematurely to offload disruptive
passengers and legal action taken against those involved.
What is air rage?
There is often a developing cycle of events, which may include delays,
exhaustion due to lack of sleep, excessive use of alcohol sometimes to
compensate fear of flying, minor irritations due to behaviour of fellow
passengers which elsewhere would largely go unnoticed and sometimes
anoxia causing irritability in those with pre-existing hypoxic illnesses.
Smoking and alcohol: It has recently been recognised that a common cause
of air rage is nicotine withdrawal in heavy smokers on long-distance ‘no
smoking’ flights. This has now been introduced by many airlines. Alcohol
intoxication can also contribute.
Prevention
Nicotine gum or a mild tranquilliser may be useful ‘prophylaxis’.
Passengers should avoid excessive alcohol consumption and discouraging
heavy drinking by their travelling companions. Airlines have the right to
refuse to carry those who have previously caused disruption on a flight –
warnings may be issued (the equivalent of ‘yellow/red’ card system as
used at football matches)
Altitude Sickness on arrival
Healthy people may travel rapidly to 3500 m above sea level but develop
symptoms of acute mountain sickness after arrival (headache, nausea,
breathing difficulty, mental confusion). Those with respiratory or cardiac
problems may experience symptoms on arrival at even lower levels. A few
airports are sited above this level, for example, in the Andes and Himalayas,
which can mean symptoms, may present after disembarking.
An awareness of the symptoms can be helpful and care to avoid
dehydration, aggravated by the dry aircraft cabin atmosphere, is important.
Dehydration may worsen symptoms. Rest after arrival with only light activity
is recommended because strenuous activity will worsen symptoms. Those
with serious pre-existing hypoxic respiratory disease can seek advice prior
to departure when an estimate of the degree of hypoxia occurring on
exercise may be able to predict whether they will have problems.
Advice on mountain sickness
High altitude holidays are increasingly popular. In South America they
include crossing Andean passes often above 4000 metres. Trekkers in the
Himalayas, especially in Nepal, often reach similar heights. Kilimanjaro in
Tanzania and Mount Kenya are both more than 5000 metres.
Only those healthy and trained should attempt such expeditions, and if in
doubt medical advice should be taken.
All including the physically fit can get acute mountain sickness during rapid
ascent if staying for more than 12 hours above 2500 metres. It affects all
ages including children when the symptoms may be more difficult to
recognise.
The altitude difference undergone in 24 hours is the determining factor.
From 3000 metres and higher, the risk increases when the altitude
difference between encampments exceeds 300 metres.
Signs of mountain sickness
Early signs of acute mountain sickness include headache, nausea, anorexia
and insomnia. If vertigo, vomiting, apathy, staggering and dyspnoea occur,
immediate accompanied descent is essential. Failing to descend may be
fatal.
Prevention
Avoid ascents of greater than 300 metres per day if starting from above
3000 metres. If early signs of mountain sickness appear, rest for a day at the
same altitude. If they persist or increase, descend at least 500 metres.
Acetazolamide can be used as prophylaxis for mountain sickness when a
gradual ascent cannot be guaranteed. It should NOT be used as an
alternative to a gradual ascent. It acts on acid-base balance and stimulates
respiration. It should be combined with a good fluid intake. It should not
normally be used in young children except under close medical supervision.
Dose: 250mg bd. for adults. A smaller dose (125mg bd) is probably just as
effective and gives less side effects.
Treatment
Initially simple analgesics (e.g. paracetamol) for headaches. Sleeping pills
should be avoided if possible.
Acute mountain sickness with cerebral oedema.
Immediate evacuation or descent at least 1000 metres; oxygen if available.
Dexamethasone (12–20 mg daily) or prednisolone (40 mg daily).
High altitude pulmonary oedema
Immediate evacuation or descent. If symptoms are acute and/or descent is
impossible or delayed consider nifedipine (20 mg tds).
A useful address
For information sheets available to Doctors/Climbers/Trekkers contact the
British Mountaineering Council, 177–179 Burton Road, Manchester, M20
2BB.
Tel: 0870 0104 878, Fax: 0161 445 4500, web-site address:
www.thebmc.co.uk
(Ref: The Rose Cottage Surgery. Jane Chiodoni 02/2002)
Greater detail for Travel at altitude
Definitions
High Altitude
Between 2400 m and 3658 m.
Cochabamba, Bolivia = 2550 m
Bogota, Colombia = 2645 m
Quito, Ecuador = 2879 m
Cuzco, Peru = 3225 m
Very High Altitude
Between 3658 m and 5500 m.
La Paz, Bolivia = 3658 m
Lhasa, Tibet, China = 3685 m
Base Camps of Everest = 5500 m
Extreme Altitude
Between 5500 m and 8848 m (the summit of Mount Everest).
Most people feel at least a little unwell if they drive, fly or travel by train
from sea level to 3500 m. Headache, fatigue, flu-like symptoms, undue
breathlessness on exertion, the sensation of the heart beating forcibly, loss
of appetite, nausea, vomiting, minor swelling of the face, feet and hands,
dizziness, difficulty sleeping, frequent awakenings and irregular breathing
during sleep are all common complaints.
These are symptoms of Acute Mountain Sickness (AMS) which usually
develop during the first 36 hours at altitude but not immediately upon
arrival. AMS is common and well over 50% of travellers develop it in some
form at 3500 m – almost all do so if they ascend rapidly at 5000 m. There is
a wide variation in both the rate of onset and severity of symptoms and
also at the height at which they occur. The problems are caused by lack of
oxygen which leads to hypoxia.
Ears and Air Travel
Ear problems are the most common medical complaint of air travellers. It is
the middle ear which causes discomfort during air travel. Normally you
swallow 5 times every minute and air passes up the back of the nose when
you swallow and sometimes enters the Eustachian tube which leads into the
middle ear space. The air in the middle ear is constantly being absorbed by
its lining so air keeps being replaced via the Eustachian tube. In this way,
the air is kept at equal pressure either side of the ear drum allowing it to
vibrate when sound enters your ear. If the air pressure on each side of the
drum is not equal then your ears will feel blocked.
What Causes the Air Pressure to Not Be Equal?
The back of the nose can be blocked with wet mucus. The lining at the
back of the nose is the same as that in the mouth so if you have a common
‘cold’ lots of stuffy wet secretions collect at the back of the nose and
block off the entrance to the Eustachian tube. When you swallow, air
cannot get to the opening of the tube and so no air is passed into the
middle ear. The air already in the middle ear is absorbed and as no more
air can get up the tube a vacuum occurs, sucking the drum inwards. This
drum can then not vibrate effectively and sounds become muffled, also
because the body does not like a vacuum it draws fluid from the lining of
the middle ear in an attempt to overcome the vacuum this causes you to
have ‘fluid in the ear’ and feel more blocked. The most common cause
of blocking this tube is the common ‘cold’ but another frequent problem
is hay fever or nasal allergies. Children up to the age of 8 or 9 years have
very small undeveloped Eustachian tubes and consequently when they have
stuffy noses they find difficulty getting enough air into their middle ear and
this is the reason why many children have middle ear fluid and infections.
How Air Travel Causes Problems
When there is a change in air pressure outside the ear, the entrance to the
Eustachian tube has to be clear so that you are able to get air up the tube
when you swallow to equalise the air both sides of the ear drum. Every
time the air pressure outside the ear changes you must swallow or yawn
again to open the tube and let air in at a similar pressure. The greatest air
pressure changes are noticed when an aircraft is coming down for landing.
The air pressure is lower while the aircraft is in flight and the air pressure is
higher nearer the earth. The changes as the plane descends cause a
vacuum to form in the middle ear even faster than normal and there is
more need to swallow more frequently and let air enter the middle ear.
Some pressure changes are unavoidable especially if there is a sudden
descent through hitting an air turbulence. You may have experienced
similar problems when travelling by train through a tunnel or when diving
or when driving in hilly country.
What Will Help?
Clearing the back of your nose is the main priority so that when you
swallow, air can pass more easily into the Eustachian tube. There are nasal
sprays on the market which help clear the nose and these are useful for use
an hour or so before descent but beware of making the use of these sprays
a habit because after a few days use they may cause the nose to become
more congested than before. Use them just to clear the nose prior to
descent.
When your nose is clear of congestion just keep swallowing during descent,
this is helped by chewing mints or gum. Yawning is a stronger activator of
the tube opening and will help. Do not sleep during descent as you may
not swallow enough to keep up with the pressure changes. Another way to
unblock your ears is to force air into the Eustachian tube by pinching your
nostrils shut and then swallowing until you feel your ears ‘pop’. Do not
use force from your stomach or chest to do this, it is sufficient to use
pressure created only by your cheek and throat muscles.
Ear plugs – These will protect the outer ear from the sudden pressure
changes which in turn means that swallowing frequently is not so much
required. These may be helpful for smaller children. Pressure on the outer
part of the ear at the front will close off the outer ear canal for a short while
which may also help in the short term.
Reversed Problem – It is important that the outer ear canal is not
completely blocked if there is NO problem with your nose or Eustachian
tubes. This will cause a negative pressure in the ear canal and a positive
pressure in the middle ear, which again could cause pain and discomfort eg
if your ear canal is full or wax or the ear plug fits tightly.
If Your Ears Will Not Unblock
If these exercises and nasal drops do not help and pain persists you will
need to seek medical advice.
Ref: 4
APPENDIX – Illnesses that can be vaccinated against in the
traveller.
Hepatitis A
Spread by faecal-oral route, either through contaminated water and food,
especially shellfish, or through person to person contact when personal
hygiene is poor. Travellers from countries with good hygiene are at risk
because few are immune from previous (mostly sub-clinical) infection.
Typhoid
Mainly by food and drink that has been contaminated with excreta of a
human case or carrier (faeces or urine).
Hepatitis B
This is through infected blood and blood products, sexual intercourse with
an infected partner and very importantly from an infected mother to her
new born child. It is also spread through 'blood to blood' contacts such as
through injuries in playgrounds, contaminated instruments during medical,
dental, acupuncture, other body piercing procedures, sharing used intravenous needles and face of head shaving when razors are reused. It is
highly infectious when viral replication is present (detected by the presence
of viral DNA or more crudely by the presence of e-antigen) - this applies to
about 10% of carriers.
Rabies
Rabies can infect many animals but the dog, fox and vampire bat are those
most likely to come in contact with humans. Infection usually occurs as the
result of a bite by an infected animal; the virus is transmitted in the animals'
saliva, usually by inoculation but occasionally by inhalation.
Yellow Fever
Jungle yellow fever is transmitted among non-human hosts (mainly
monkeys) via forest mosquitoes. Spread to an urban area occurs when an
infected monkey carries the virus to an area adjacent to the forest and is
then bitten by a species of mosquito living in close association with man,
usually Aedes aegypti. Both jungle and urban cases occur in Africa
(especially west Africa). Urban cases are rare in the Americas.
Meningococcal Meningitis
Droplet spread via direct contact from nasal carriers or those in the early
stage of illness. Nasal carriage is more common in young children than in
adults.
Japenese B Encephalitis
It is transmitted to man by the bite of an infected Culicine mosquito that
normally breeds in rice paddies. Pigs and birds such as the Siberian stork
act as intermediate or 'amplifying' hosts and they can become viraemic.
There is serological evidence that other animals may also be infected but as
'dead-end' hosts - viraemia is rarely observed.
Tick-Borne Encephalitis
Tick-borne encephalitis (TBE) is a flavivirus infection spread by the bite of
the ixoxides tick (synonyms: spring-summer meningoencephalitis, central
European encephalitis, Far eastern encephalitis, Taiga encephalitis, Russian
spring-summer encephalitis). It has been recognised since the 1950's that
TBE infection can also (rarely) be transmitted via unpasteurised milk from
cows, goats and sheep that are infected with TBE.
Diptheria
Skin infection causing indolent ulcers is common on the limbs of children in
the tropics who go around barefoot - this results in 'natural' immunity.
Usually later in life respiratory droplet infection is more common and also
through contact with articles soiled by infected persons - these are the
more serious infections when toxaemia can occur.
Tetanus
Tetanus spores are present in soil from contamination with human, animal
and bird faeces and enter the body through injuries. Neonatal disease may
result from contamination of the umbilical cord or after otitis media when a
ruptured tympanic membrane allows contamination of the middle ear.
Polio
There are 3 serotypes of poliovirus (types 1,2 and 3). Infection is usually
through the faecal-oral route from contaminated food or drink, although
nasopharyngeal droplets may spread it during an acute illness. In
developing countries poliomyelitis has caused much crippling disease but
now widespread use of vaccine has virtually eradicated disease.
BCG (Tuberculosis)
Most commonly spread though infected sputum, either from those with
pneumonia or asymptomatic carriers. Can also be spread through infected
unpasteurised milk. Long air flights, when a passenger has 'open'
pulmonary tuberculosis and is coughing close to fellow passengers may
also be a risk.
Sometimes we recommend our travellers to visit private travel clinics for
specialist vaccines or because it may be quicker for you to be seen if
travelling at very short notice and we have no available appointments.
Below are a list of available travel clinics:
MASTA Travel Clinics countrywide (also in Boots the Chemist)
For details of your nearest Travel Clinic please call 01276 685040 or
www.masta.org
Travel Clinics in London
The Hospital for Tropical Diseases Travel Clinic
Mortimer Market
Caper Street
off Tottenham Court Road
London WC1E 6AU
Appointments
Tel : 0207 388 9600
Fax : 0207 383 4817
www.thehtd.org
The Royal Free Travel Health Centre
Pond Street
London
NW3 2QG
Tel: 020 7830 2885
Fax: 020 7830 2741
www.travel-health.co.uk
Trailfinders Travel Clinic
194 Kensington High Street
London
Tel: 0207 938 3999
Nomad Travellers Store Travel Clinic
Russell Square
Turnpike Lane
London
London
Tel: 0207 833 4114
Tel: 0208 889 7014
Travel Health books - General reading list
It is sometimes very useful to read around the subject of travel health
before you travel. Such work will prepare you well in advance to help
prevent illness and trauma whilst abroad and on your return home. This is
particularly recommended for those travelling for long periods e.g. back
packing.
Understanding Travel and Holiday Health by Dr Gil Lea and Bernadette
Carroll.
Family Doctor Publications Ltd. in association with the British Medical
Association,
1997 ISBN 1-898205-35-3 Price £2.49.
Travellers’ Health - How to stay healthy abroad by Dr Richard Dawood
(Ed.)
Oxford University Press, 3rd Edition 1992. ISBN 0-19-262247-1 Price £9.50
Bugs Bites and Bowels by Dr Jane Wilson Howarth. Cadogan Books, London
2nd Edition 1999. ISBN 1-86011-914-X Price £7.99
Handbook for Women Travellers by Maggie and Gemma Moss. Piatkus
Publishers 1995 ISBN 0-7499-1439-4 Price £8.99
Your Child’s Health Abroad - a manual for travelling parents by Dr Jane
Wilson-Howarth and Dr Matthew Ellis. Bradt Publications UK. 1998 ISBN 1898323-63-1 Price £8.95
The Royal Geographical Society Expedition Medicine Edited by David
Warrell and Sarah Anderson. Publishers - Profile Books (1998) ISBN 1 86197
040 4 £17.99
Stress-Free Flying by Robert Bor, Jeannette Josse and Stephen Palmer. Quay
Books,
Mark Allen Publishing Ltd. ISBN 1 85642 167 8 (2000)
The Travellers’ Good Health Guide by Ted Lankester, Interhealth. Sheldon
Press 1999 £6.99 (from supplies@interhealth.org.uk or 157 Waterloo Road,
London Se1 8US
The Rough Guide to Travel Health by Dr Nick Jones, Rough Guides Ltd.
ISBN 1-85828-570-4 Price £4.99
Everything you need to know before you go - Information and advice for
independent travel by Mark Ashton. Abroadsheet Publications 3rd Edition
1998.
ISBN 0-9525128-2-3 Price £3.50
References
Ref. 1.
Ref. 2.
www.immunisations.nhs.uk (July 2005)
www.dh.gov.uk Green Book (2004)
Ref. 3.
www.sunsmart.org.uk (June 2003)
Ref. 4.
www.earcarecentre.com (July 2005)
Other information in this advice book has been adapted from TRAVAX for
health professionals www.travax.scot.nhs.uk .
Travax database is maintained and continually updated by the Travel
Medicine Team at the Scottish Centre for Infection and Environmental
Health (SCIEH). It aims to help Health Care Professionals who are advising
travellers about health risks in overseas countries. SCIEH is part of the
Common Services Agency of the Scottish National Health Service. Travax is
copyright of the Scottish Executive, Department of Health.
Important Notice from Travax.
Every effort has been made to ensure the accuracy of the information
supplied herein, but the providers make no warranty, express or implied, as
to accuracy, completeness or usefulness of the information and all liability
is excluded save in respect of personal injury or death caused by negligence
of the suppliers. It is also important to realise that the best decisions on
preventive advice or treatment for a particular traveller can only be reached
after a careful consultation and risk assessment and with the traveller’s
informed consent.
The information from TRAVAX is frequently updated and therefore the web
site should be accessed periodically to update the information leaflets
within these guidelines as necessary.
For the public web site of TRAVAX go to: www.fitfortravel.scot.nhs.uk
Other sources used in this book are:
ACMP guidelines: www.hpa.org.uk
www.nathnac.org.uk