This page is intended to provide guidance for planning your foreign
travel from a health perspective. It is relevant to students taking
extended travel breaks, and going to remote areas, and those taking
package holidays. The information contained within these pages and
the link sites mentioned should be regarded as a guideline rather than
a definitive statement, as the area of travel medicine is constantly
changing. With careful planning before you travel and vigilance during
and afterwards, you should be able to deal with most medical needs
with minimal disruption. Above all else your travel experience should
be a fulfilling and enjoyable experience so that you return home with
positive memories and nothing you wish you'd left behind!
BEFORE YOU LEAVE
IMMUNISATIONS
Make sure you plan your travel vaccinations well in advance; you will
generally need to start receiving immunisations at least 8 weeks before
you depart.
We are a registered Yellow Fever Vaccination Centre, go straight to Step
5D if you only need Yellow Fever
HOW TO PLAN YOUR TRAVEL IMMUNISATIONS
STEP 1 – OBTAIN A FREE MASTA TRAVEL BRIEF
To obtain any travel related vaccinations from Leeds Student Medical
Practice you must obtain a free MASTA (Medical Advisory Services for
Travellers Abroad) Travel Brief. This is a high quality medical travel guide
containing a personal travel schedule for every country on your trip. It will
advise you about: recommended vaccinations, give alerts and warnings
for each country including any disease outbreaks, and provide tailored
travel advice for your trip. You will receive an e-mail copy of the Brief,
and if connected to a printer you can print it immediately. You can obtain
a free MASTA Travel Brief using this link: http://www.masta-travelhealth.com/health-brief/create/
STEP 2 – DECIDE ON YOUR VACCINES
Your MASTA Travel Brief will tell you which vaccinations are mandatory,
which ones are strongly recommended, and which ones you may wish to
consider. It is up to you to decide which vaccinations you would like to
have
STEP 3 – PLAN YOUR VACCINATION SCHEDULE
3A – FREE NHS VACCINATIONS
Diphtheria, Tetanus, Polio, Typhoid (Spring 2013 - national shortage of
Typhoid vaccine, not currently possible to guarantee vaccination),
Hepatitis A and Cholera can all be obtained free of charge from your GP
surgery. If you are a registered patient of South Milford Surgery and wish
to book an appointment for any of these vaccines see step 5
3B – PRIVATE VACCINATIONS
All other vaccinations on your MASTA Travel Brief are treated as private
for travel purposes. At South Milford Surgery the only private vaccine we
supply is Yellow Fever for a fee of £80 including certificate. If your MASTA
Travel Brief recommends other vaccinations that we do not provide, you
can obtain them from private providers such as:
MASTA – Leeds, Moorfield Road, Yeadon, Leeds, LS19 7BN. Tel: 0330
100 4207
MASTA – Boots
York, 43 Coney Street, York, North Yorkshire, YO1 9QR.
MASTA – York Travel Clinic, Priory Medical Centre, Cornlands Road
York, YO24 3WX. Tel: 0330 100 4325
City Doc at Superdrug - 31-35 Merrion Centre, Leeds, LS2 8NG. Tel:
0845 0260 830
Leeds Travel Health and Immunisation Service at Meanwood Health
Centre - 548 Meanwood Road, Leeds LS6 4JN. Tel:0113 843 3375 STEP 4 – ANTIMALARIAL MEDICINES
Decide whether you need to take antimalarial medicine. Your MASTA
Travel Brief will tell you what type of antimalarial medicine you need. If
you are recommended to take Doxycycline, Malarone or Mefloquine these
are only available from a private travel clinic (as detailed in Step 3B), or
by getting a private prescription from a GP. If you are a registered patient
of South Milford Surgery and want to book an appointment for an
antimalarial prescription see Step 5C
STEP 5 – BOOKING APPOINTMENTS FOR TRAVEL VACCINES AND
ANTIMALARIALS AT SMS (REGISTERED PATIENTS ONLY UNLESS IT
IS FOR YELLOW FEVER VACCINE)
5A – MASTA TRAVEL BRIEF
You must have a MASTA Travel Brief in your possession in order for
us to give you travel vaccinations or an antimalarial private prescription
and you must bring it with you to the appointment
5B – APPOINTMENTS FOR FREE NHS TRAVEL VACCINES
If you require vaccination with: Diphtheria, Tetanus, Polio, Typhoid,
Hepatitis A or Cholera, book a 10-minute travel immunisation appointment
with a nurse. Bring the MASTA Travel Brief with you to the appointment if you don't bring it we will not see you, and you will have to book another
appointment to attend with the MASTA Travel Brief
Download and print our
Travel Handout to help organise your
vaccinations and save time
5C – APPOINTMENTS FOR PRESCRIPTION ONLY
ANTIMALARIAL MEDICINES
View our Malaria Prophylaxis page which contains prices and sources
for all antimalarial medicines. You can get prescription only antimalarial
medicines from a private travel clinic (as listed in Step 3B), which may be
the best option if you are attending there anyway for private vaccinations.
Over the counter anti-malarial medicines can be obtained from
pharmacies and usually private travel clinics. If you want us to give you a
private prescription for Doxycycline, Malarone or Mefloquine, make a 10minute appointment with a doctor at South Milford Surgery for this
prescription. Bring the MASTA Travel Brief with you to the appointment - if
you don't bring it we will not see you, and you will have to book another
appointment to attend with the MASTA Travel Brief
Download and print our
Travel Handout to help organise your
vaccinations and save time
5D – APPOINTMENTS FOR YELLOW FEVER VACCINE
South Milford Surgery is a registered Yellow Fever centre. This means
that you can book an appointment for this private vaccine even if you are
not a registered patient. Please contact the practice and ask for an
appointment for a Yellow Fever Vaccination. Our fee for giving the
vaccine and providing a certificate is £80.
INSURANCE
Make sure you have full medical insurance covering all activities you are
likely to take part in, and make sure it is a repatriation policy. The biggest
risks to travellers abroad are theft and road accidents. Make copies of
your travel insurance documents, take one with you and leave a copy with
a contact in the UK. If you can, scan them and e-mail them back to
yourself. Do the same with your passport and tickets etc. Keep a copy of
your travel insurance company telephone number and your insurance
document number with you at all times
If you are a UK resident, you can obtain a European Health Insurance
Card, this entitles you to medical treatment that becomes necessary, at
reduced cost or sometimes free, when temporarily visiting a European
Union (EU) country, Iceland, Liechtenstein, Norway or Switzerland. You
can apply on-line (at least 6 weeks before departure)
LOCAL KNOWLEDGE
Look up information, medical and otherwise on the area you will be
travelling to and draw up a list of items you need to take (including
medical kit). Be aware of the medical conditions you are likely to
encounter and read up on them
PERSONAL HEALTH
Make sure you have adequate supplies of any regular or intermittent
medications you take. Have a full dental check up a couple of months
before you go.
FIRST AID KIT
Put together a medical kit appropriate to the nature of your trip. See our
Medical Kit for Travellers page
MEDICAL INDEMNITY
Medical Students need to contact MPS or MDU and arrange an elective
study indemnity policy
Back to top
KEEPING HEALTHY WHEN ABROAD
AIR TRAVEL
To reduce the risk of Deep Vein Thrombosis it is sensible on any long
haul flight to:
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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 dehydration
DRINKING 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:
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Boiled water
Bottled water or canned drinks (and drink them from the original
container)
Water treated by a sterilising agent (you can buy water purification
tablets from a pharmacy)
This advice applies to ice cubes in drinks and water for cleaning your
teeth
SWIMMING
If swimming in fresh water lakes and rivers in Africa, Latin America and
South-East Asia you are at risk of contracting Schistosomiasis. The best
advice is to avoid swimming in freshwater lakes or rivers, or if you do, you
need a blood test 12 weeks after returning from your trip. (In 2011 we had
15 cases in 6 months)
FOOD SAFETY
Contaminated food is the commonest source of many diseases abroad.
You can help prevent it by following these guidelines:
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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 unless it is
thoroughly cooked in front of you
Alcohol! If you drink to excess, alcohol could lead you to become
carefree and ignore these precautions
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
DIARRHOEA AND VOMITING
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 or
drinking food and liquids contaminated by bacteria, viruses or parasites.
Risk of illness is higher in some countries than others:
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High risk areas include North Africa, sub-Saharan Africa, the
Indian Subcontinent, South East 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 to 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 re-hydration. 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 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 short term relief for
adults (e.g. for a bus or train journey or flight) 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 seek medical help if the affected person has:
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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)
SUN SENSE
Sunburn and heat-stroke cause serious problems in travellers. Both are
preventable - to avoid, use the following precautionary guidelines:
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Increase sun exposure gradually, 20 minutes limit initially
Use sun blocks of adequate Sun Protection Factor strength (SPF
15 minimum). Reapply often and always after swimming and
washing. Read manufacturer's instructions
Wear protective clothing - sun hats 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
Why factor 15?
The reason experts recommend factor 15, is that this represents the best
balance between protection and price. You will get over 90 per cent
protection from UVB rays with SPF 15. But no sunscreen, no matter how
high the factor, can offer 100 per cent protection
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Factor 15 sunscreen offers about 93% protection
Factor 30 sunscreen offers about 96% protection
Factor 60 sunscreen offers about 98% protection
www.cancerresearchuk.org/sunsmart/staysafe/sunscreen/
When Buying sunscreen:
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Choose one with an SPF of 15 or above - this will give you over
90% protection
Make sure it is labelled 'broad spectrum' - to protect against UVA
and UVB
Choose water resistant - it is less likely to wash or be sweated off
Check the 'use by' date - most sunscreens have a shelf life of 2-3
years
You don't have to pay for expensive brands. All types are tested
and the cheaper brands are just as effective if used properly - just
remember factor 15+
Tips for using sunscreen properly:
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Try to apply it 15-30 minutes before going out in the sun
Apply to clean, dry skin and rub in only lightly
Use generous amounts
Re-apply once outside to ensure even coverage
Then re-apply every 2 hours or more frequently if washed, rubbed
or sweated off
Put on before make-up, moisturiser, insect repellent, and so on
Never use it to spend longer in the sun - this will put you at risk of
sun damage that could lead to skin cancer
In hotter climates and hotter days in the UK avoid direct sun
exposure between 11am and 3pm
Take special care of children and those with pale skin / red hair
Use SPF 60 on any areas of recent scarring / skin damage
You can get severe sunburn in the UK
Do not store sunscreens in very hot places as extreme heat can
ruin their protective chemicals
PERSONAL SAFETY
Leading causes of death in travellers are due to drowning and traffic
accidents. You can help prevent them by following these precautionary
guidelines:
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Avoid alcohol and food 1 hour 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
SEXUAL HEALTH
Remember that unprotected sex can result in anything from Chlamydia to
HIV. The Sun newspaper reported in July 2005 that a Syphilis outbreak in
Manchester was quickly replicated in Amsterdam, Dublin, and Paris as a
result of people jetting from place to place and having unprotected sex everyone going on holiday should take condoms, don't leave it to chance,
it's not worth the risk
PSYCHOLOGICAL SUPPORT
Medical Students - On your elective you may have many new and
sometimes distressing experiences including helplessness and frustration
witnessing preventable deaths. You may experience significant culture
shock and have difficulty adjusting on your return to the UK. It is important
to prepare for this and also to ask for help from peers, colleagues,
counselling services or doctor if needed
FIRST AID KIT
If you are travelling to remote areas where access to medical care is
limited we strongly advise you to carry a medical kit appropriate to the
nature of your trip. Sterile medical kits containing syringes, needles, IV
giving set, sutures and dressings are available to purchase from some
pharmacies. In addition we suggest that you also consider taking the
items detailed on our Medical Kit For Travellers page
INSECTS, MALARIA, & ALTITUDE
INSECT BITES
Mosquitoes, certain types of flies, ticks and bugs can transmit many
different diseases. E.g. malaria, dengue fever, yellow fever. Some bite at
night, but some during daytime. The main way to avoid illness is to avoid
being bitten, where possible:
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If your 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
not effective
Cover 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
Report any unexplained illness with symptoms such as fever,
headache, malaise, muscle aches and fatigue
MALARIA
Malaria is probably the most common and most serious disease you will
be exposed to when travelling. Malaria is caused by a microscopic
parasite transmitted by female mosquitoes when they take a blood meal
at your expense. There are four species of malaria parasite, of which
Plasmodium falciparum is the most dangerous and can lead to cerebral
malaria and death
Malaria usually starts as a fever and you will feel very unwell. Other
symptoms may include diarrhoea, headache or a cough. In a malarious
area, all illnesses with fever should be considered to be malaria until
proved otherwise. Seek medical help as soon as you can if you become
ill
Check carefully the areas you plan to travel to and take anti-malarial
tablets (prophylaxis) if advised by the travel-health nurse or doctor. Some
tablets can be bought over the counter in a chemist but others are only
available on prescription. Do not take over-the-counter tablets if
prescription-only prophylaxis has been advised
You can get malaria even when taking prophylaxis, but this happens more
commonly in individuals who forget to take one or more tablets. It is
essential that you take the tablets you are prescribed regularly and on
time and for the whole of the recommended time after leaving a malarious
area (sometimes for 4 weeks after)
Mosquitoes that transmit malaria bite mainly at night, but this can be any
time from dusk onwards and even just after dawn. Use insect repellent
containing at least 35% DEET, wear long, loose clothing when possible
and consider taking a mosquito net impregnated with permethrin to sleep
and rest under. These can be bought in outdoor/camping shops which
stock a full range of products. Do not rely on insect repellent and
mosquito nets alone if you have been advised to take prophylaxis as well;
all forms of protection are important
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Take adequate supplies of the antimalarial agent suited to your
area of travel and remember to take it. People die every year from
malaria in the UK
Even with the best prophylaxis you may still catch malaria so have
a high index of suspicion
Report any unexplained illness with symptoms such as fever,
headache, malaise, muscle aches and fatigue
Malaria can occur up to two years after being bitten by an infected
mosquito
If you become unwell with fever up to a year after returning from a
malarious area, see your GP and tell them you have travelled
abroad
View the Malaria Prophylaxis page which contains prices and sources
for all anti-malarial medicines
TRAVELLERS TO HIGH ALTITUDE
Acute altitude sickness occurs when an individual who is accustomed to
low altitudes rapidly climbs to high altitude (above 8,000 feet). Clinical
features of mild altitude sickness are:
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Headache
Loss of appetite
Nausea
Fatigue
Dizziness
Insomnia
Extremity oedema
Dyspnoea
Palpitations
The treatment for acute altitude sickness ranges from rest and analgesia,
to oxygen therapy and descent
Extreme altitude sickness can be fatal. It is advised that climbers should
acclimatise if climbing to high altitude:
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If above 10,000 feet, no more than 1000 feet should be climbed
per 24 hour period
If a climber develops symptoms of mild altitude sickness then
he/she should rest for 24 hours at that altitude
If a climber has more severe symptoms then he/she must
descend to the last altitude at which they felt well. This should
occur whether or not they are using medication prescribed to help
cope with high altitude
The following preventative measures should be utilised:
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Slow ascent e.g. once over 8000ft (2500m) avoid sleeping more
than1000ft (300m) higher than previous day
Keep warm
Keep well hydrated and avoid alcohol
High carbohydrate diet
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Modest exercise on acclimatising days
Download Travel At High Altitude 4MB PDF booklet by Medex
Back to top
VACCINE PREVENTABLE DISEASES
First of all, it is important to remember that no vaccine is 100% effective in
everyone. For this reason you need to take other precautions to avoid
exposure to disease, such as taking care with food and water, avoiding
animals and not using un-sterile medical equipment
CHOLERA
A serious bacterial disease, mainly water-borne, with a high mortality rate
if untreated. It causes profuse watery diarrhoea and death can occur
rapidly due to dehydration. Cholera epidemics are most common in
refugee camps or disaster zones. Relief or disaster aid workers should
consider requesting the vaccine
DIPHTHERIA
A bacterial disease spread by droplets and contact with articles from
infected people. It causes a disease affecting your respiratory system.
Check you have had your childhood vaccinations, and if it is more than 10
years since your last vaccination, you can have a combined polio,
diphtheria and tetanus vaccine booster
HEPATITIS A
A viral infection spread through contaminated food or water. It is highly
contagious and is the most common vaccine-preventable disease in
travellers. Symptoms include fever, nausea, vomiting, dark-coloured
urine and jaundice. A single dose of vaccine followed by a booster 6 to
12 months later will give you an estimated 25 years protection. You can
reduce your risk by following the advice in the drinking water and food
sections above
HEPATITIS B, C AND HIV INFECTION
These diseases can be transmitted by:
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Blood transfusion
Medical procedures with non sterile equipment
Sharing of needles (e.g. tattooing, body piercing, acupuncture and
drug abuse)
Sexual contact (this will also put you at risk of other sexually
transmitted diseases)
Ways to protect yourself:
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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
Hepatitis B is one hundred times more infectious than HIV, and is a
leading cause of liver cancer. Even if you are vaccinated, take
precautions to avoid exposure to the virus. Consider taking a sterile
medical pack with you in case of emergencies
JAPANESE B ENCEPHALITIS
A mosquito-borne viral disease found in rural areas of South-East Asia
and the Far East; especially where rice growing and pig farming co-exist.
The risk of infection is greatest during and just after the rainy season.
Most cases of the disease go unnoticed but about 1 in 250 cases
becomes clinically apparent and in these individuals the disease can lead
to severe encephalitis with permanent brain damage or even death. The
Japanese B encephalitis vaccine is a course of 2 injections given over 1
month (with an optional booster after 3 years)
MENINGITIS
Meningitis ACWY is a vaccine against 4 strains of the meningococcal
bacterium found in Africa and some parts of Asia, especially India.
Meningococcal infection can affect your brain (meningitis) or your blood
(septicaemia) or both. The vaccine is particularly recommended for those
travelling on public transport or living in crowded conditions or working
closely with the local population. A vaccination certificate is required for
all travellers to the Hajj or for the Umrah. A single dose of vaccine
provides 3-5 years protection
POLIO
A viral disease caused by on of three serotypes of polio virus. If infected,
meningitis or paralysis may occur. Some countries, especially in West
Africa, now have outbreaks of polio following a cessation of the
vaccination programme in Nigeria. Check you have had your childhood
vaccinations, and if it is more than 10 years since your last vaccination,
you can have a combined polio, diphtheria and tetanus vaccine booster
RABIES
Rabies is present in many parts of the world. If a person develops rabies
death is 100% certain. There are 40,000 deaths worldwide every year
from Rabies. Do not be complacent - do not touch any animal,
particularly; dogs, cats, monkeys, bats. If you are travelling to remote
areas, it is particularly important that you consider getting vaccinated
against rabies before you travel
WHAT TO DO IF YOU ARE SCRATCHED OR BITTEN BY A MAMMAL
IN A COUNTRY WHERE RABIES IS PRESENT
1. Vigorously clean wound with soap and running water for 10
minutes
2. Encourage the wound to bleed a little
3. Apply tincture of aqueous iodine solution if you have any, or 40%
alcohol or stronger (e.g. whisky)
4. Obtain information about the animal concerned
5. SEEK MEDICAL HELP IMMEDIATELY (AT THE LATEST WITHIN
24 HOURS OF INJURY). If you have not been vaccinated you will
probably require 5 injections plus an injection of rabies
immunoglobulin. If you have been vaccinated you may still require
2 further injections within 48 hours
6. Do not allow the wound to be stitched unless absolutely
necessary
7. It is vital that you complete the appropriate course of postexposure treatment offered
8. Please report the incident back to South Milford Surgery on your
return to the UK
An article in the British Medical Journal in September 2005 reported the
case of a British woman who travelled to India. Whilst there she was
bitten by a puppy, leaving a slight graze. She had not been vaccinated
against Rabies, but thought nothing more about it and did not seek
medical help. Three and a half months after returning to the UK she was
admitted to hospital with severe shooting pains in her lower back and left
leg. She was diagnosed with rabies and died after eighteen days in
hospital
Open the Rabies information on a separate page (suitable for printing to
take with you)
SWINE FLU
There are still cases of Swine Flu (Influenza A) being reported in the
Southern Hemisphere. If you are travelling to this area we recommend
you receive vaccination against Swine Flu
TETANUS
A disease caused by the toxin of a bacterium present in soil or manure
which may enter the body through a wound, burn or scratch. The disease
leads to muscle stiffness which usually involves the jaw (lockjaw) and can
cause death. If it is more than 10 years since your last tetanus
vaccination, you can have a combined polio, diphtheria and tetanus
vaccine booster
TICK-BORNE ENCEPHALITIS
As the name suggests, is spread by ticks. However, it can also be
acquired by consuming unpasteurised dairy products from infected
animals, especially goats. It is a viral disease which occurs mostly in the
summer months in forested areas of Central and Eastern Europe and
Scandinavia. In most cases, the infection has no symptoms. In the 10%
of people where symptoms develop they usually have a flu-like illness
with severe headache, joint stiffness and confusion. These symptoms
usually resolve, but in 10% of these cases a second phase of fever occurs
which leads to encephalitis and may result in paralysis, seizures or death
Avoid contact with ticks by wearing long trousers, avoid long grass and
undergrowth if possible and use insect repellent containing at least 50%
DEET. Only 1-2% of ticks are likely to be carrying the virus, but if you find
any ticks attached to your skin (check armpits, groin and navel regularly)
remove them by grasping with tweezers or fingers, holding as close to
your skin as possible, and pull gently and consistently until the tick comes
away. If the mouthparts remain stuck in your skin, remove them as soon
as possible
Vaccination is recommended if you will be spending long periods in
infected areas or if you will be camping or working in forests, especially
during the summer. The tick-borne encephalitis vaccine is a course of 3
injections given over 3 weeks
TUBERCULOSIS (TB)
A bacterial disease spread through cough and sneeze droplets. Although
it may affect any part of the body, most commonly it affects the lungs. It
occurs in many parts of the world and you can acquire the disease
through close contact with an infected person, such as living in the same
household. The BCG vaccine is not believed to give very good protection
against TB so if you have a persistent cough when you return (or during
your trip if you are travelling for some time) seek medical attention.
TYPHOID FEVER
A bacterial disease spread through contaminated food and water and can
cause serious disease, the symptoms of which start with diarrhoea and
vomiting. The fatality rate is as high as 20% in untreated cases (1% with
prompt antibiotic therapy). In endemic areas, take care with your food
and water even if you have been vaccinated. A single dose of vaccine
lasts for 3 years. You can reduce your risk by following the advice in the
drinking water and food sections above
YELLOW FEVER
A virus carried by the Aedes mosquito, which bite during the day. It is a
serious and sometimes fatal disease which occurs in many parts of subSaharan Africa and Central and South America. Some countries will not
let you enter without a valid International Certificate of Vaccination. You
must be vaccinated at least 10 days before travel
PARASITES & OTHER DISEASES
Parasitic diseases are common in the local population in many travel
destinations and although you should not worry, it is advisable to be
aware of some of these diseases and how they can be avoided
DENGUE FEVER
Prevalence: Common in many parts of the tropics
Dengue fever is caused by one of four virus serotypes which are spread
by Aedes species of mosquito. These mosquitoes bite during the day.
The epidemics of dengue fever are often seasonal, during or just after
rainy seasons. Check the NATHNAC link for current outbreaks
Symptoms come on very suddenly, with fever, severe headache, and
muscle and joint pains, with a rash typically developing after 3-5 days.
Nausea, vomiting and diarrhoea are also common. The acute phase
usually lasts a week, and although serious complications are uncommon,
post-viral fatigue syndrome is common, so take it easy for a few weeks if
you can. Rarely, dengue fever can develop into a more serious form,
called dengue haemorrhagic fever, which in turn can lead to dengue
shock syndrome, which can be fatal. The haemorrhagic form occurs
more commonly in subsequent attacks with a different serotype of dengue
virus
Treatment is symptomatic: keep your fluid intake up (not alcohol!) so that
you don’t dehydrate, and pain should be relieved with paracetamol, not
aspirin or ibuprofen. Hospital care is indicated in severe illness or if
complications occur
Diagnosis is usually made clinically. Self-diagnosis of dengue in a
malarious area could be very dangerous – All illnesses with fever should
be considered to be malaria until proven otherwise. In places with good
medical facilities a blood test can be done at 8 days after the onset of
fever to confirm the diagnosis. It can be useful if you are a long-term or
recurrent traveller to know if you have had dengue as subsequent
episodes should be monitored more closely for complications
Prevention, as with all insect-borne diseases, is by using insect repellent
(containing DEET), covering up with clothing where possible and
sleeping/resting under a mosquito net impregnated with permethrin
AFRICAN TRYPANOSOMIASIS (sleeping sickness)
Prevalence: Patchy distribution in sub-Saharan Africa
African trypanosomiasis is a potentially lethal disease caused by a
microscopic parasite spread by tsetse flies. These flies are large, brown
and give a painful bite, often resulting in a boil on the skin if the fly is
carrying the parasite. In different parts of Africa the flies favour either
shady riverside habitats or the bases of tree trunks in the savannah
regions. An important feature of the disease is swollen glands, especially
on the neck, accompanied by fever, headaches and joint pain. Use insect
repellent (50% DEET) and wear long, loose clothing to prevent being
bitten by tsetse flies
SOUTH AMERICAN TRYPANOSOMIASIS (Chagas’ disease)
Prevalence: Mexico, Central and South America
South American trypanosomiasis is transmitted by ‘kissing bugs’ that feed
by sucking blood when you are asleep, often from your face. Parasites
are passed out of the bug not in saliva but in faeces, and you become
infected if you scratch the bite and rub the faeces into the wound. The
bite is surprisingly painless even though the bug may feed for more than
10 minutes. The bugs typically live in the cracks of mud huts or in
thatched roofs, but they also live behind furniture and pictures on the
wall. The disease is serious in that, if undiagnosed or untreated in the
acute phase (the first few weeks), damage to the heart and digestive
system is irreversible and can lead to health problems in the future. It is
strongly advised that you do not sleep in rural dwellings in Latin America
without an insecticide-treated bed net, and make sure you tuck it under
your mattress!
LEISHMANIASIS
Prevalence: Patchy distribution worldwide
Leishmaniasis embraces a range of diseases caused by different types of
microscopic parasites and they occur in many countries of the world. All
are spread by sandflies, which are smaller than mosquitoes and are quite
hairy
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The most serious is visceral leishmaniasis, which can be lethal if
untreated. Symptoms include fever, anaemia, weight loss, and
enlarged liver and spleen
Less serious is mucocutaneous leishmaniasis, only present in
Central and South America, which causes a skin ulcer and
spreads to disfigure the nose and throat
Least serious is cutaneous leishmaniasis which causes self-
healing ulcers, often leaving a scar
Sandflies bite from dusk throughout the night and insect repellent should
be used. If you are going to a known endemic area, consider buying a
sandfly net, which is a finer mesh than a mosquito net and will keep out
sandflies. Make sure it is insecticide-impregnated every 6 months with
permethrin. If you develop a skin ulcer that persists, or the symptoms of
visceral leishmaniasis, seek medical attention
ONCHOCERCIASIS (River Blindness)
Prevalence: Patchy distribution in equatorial Africa and equatorial Latin
America
Onchocerciasis is a chronic disease caused by small parasitic worms
which are transmitted by the bite of black flies which live near rivers. The
worms take up residence in your skin, producing itchy skin and nodules.
They also show a preference for the eye but blindness only occurs after
many years of infection. If you are concerned see a doctor on your return
LYMPHATIC FILARIASIS
Prevalence: South-East Asia, India, Equatorial Africa, some parts of Latin
America
Lymphatic filariasis is a parasitic infection which initially causes fever and
inflammation of the skin. When chronic the disease affects the lymphatic
system which results in swelling, usually of the legs. It occurs mainly in
the least developed countries of the world and usually travellers are not at
high risk. The parasitic worms are spread by mosquitoes which bite at
night, so use a good insect repellent containing DEET and an insecticidetreated mosquito net
PLAGUE
Prevalence: Isolated foci in Africa, Asia and Latin America.
Plague is rare. It is spread through the bite of infected rodent fleas. Don’t
lose any sleep about this but use insect repellent (containing DEET) if you
are staying in very rough, rural housing. If you develop a large, red,
painful boil in your groin or armpit, see a doctor soon
LEPTOSPIROSIS
Prevalence: Worldwide distribution
Leptospirosis is a bacterial disease spread through animal urine, usually
from the rat. It can be lethal but unless you will be working in sewers you
will probably be at low risk of the disease. However, if you are working in
rural areas or shanty towns, especially in the rainy season, don’t mess
about in the flood water and cover any cuts and grazes with waterproof
dressings
SOIL-MEDIATED PARASITIC WORMS
Prevalence: Very common in the tropics
Be aware of washing your hands before you eat and don’t go barefoot as
some worms will penetrate your skin. See your GP if you have any
intestinal symptoms that continue on your return to the UK, and let them
know where you have travelled to
CUTANEOUS LARVA MIGRANS
Prevalence: Southeast Asia, Latin America, and the Caribbean basin
Cutaneous larva migrans is a characteristic itchy creeping skin eruption,
usually of the foot. It is due most commonly to a dog or pig hookworm,
passed in faeces. The worm can enter your skin when walking barefoot in
sand or dirt in the tropics. Treatment is by medication (even though this is
a self-limiting disease with the larva dying and the lesions resolving - but
this can take from 4 weeks to 1 year)
MYIASIS
Prevalence: Worldwide distribution
A rather unpleasant boil with a little surprise in store. The Bot fly lays an
egg under the skin and the larva feasts on your subcutaneous tissues. A
reactive boil forms but the larva has formidable hooks which allow it to
prevent efforts to removal by squeezing it out. The technique for removal
is to coat the area in a thick layer of Vaseline and wait for it to come up for
air, whereupon it can be grabbed!
RIFT VALLEY FEVER
Prevalence: Kenya, Tanzania and Somalia
Rift Valley Fever is a viral disease primarily affecting domestic animals
including cattle, sheep and goats. It can be transmitted to humans via
mosquito bites or through contact with body fluids (including milk) and
meat of infected animals. The majority of cases experience a brief flu-like
illness but the disease can progress and become fatal. Avoid insect bites
using insect repellent (containing DEET), long, loose clothing and
consider buying a bed-net impregnated with insecticide. Boil fresh milk,
cook meat thoroughly and avoid direct contact with raw meat.
CHIKUNGUNYA VIRUS
Prevalence: India, Sri Lanka, Indian Ocean Islands, Africa
Chikungunya Virus, like Dengue Fever, is spread by day-biting Aedes
mosquitoes. The illness presents as rapid onset on joint pains, muscle
pain, high fever, conjunctivitis and rash. Avoid mosquito bites by using
DEET insect repellent, long, loose clothing and consider buying a bed-net
impregnated with insecticide
SCHISTOSOMIASIS (Bilharzia)
Prevalence: Africa (90% of cases), some parts of Latin America and
South-East Asia
Schistosomiasis is a disease caused by blood flukes acquired when
wading or swimming in infested fresh water lakes and streams. When
you are in the water, microscopic parasites burrow through your skin and
migrate through your body until they come to their final destination in the
veins of the bowel or bladder. Light infections may pass unnoticed but
more severe infections may cause blood in the urine or faeces, together
with other symptoms. Avoid swimming in freshwater lakes or rivers, or if
you do, request a blood test 12 weeks after returning from your trip. In
addition It is wise never to go barefoot, but to wear protective footwear
when out, even on the beach. Other diseases and parasites can be
caught from sand and soil, particularly wet soil
WHEN YOU RETURN
If you have been travelling and have returned feeling unwell, especially
with an unexplained fever or prolonged diarrhoea you should make an
appointment with a doctor
If you have been to Africa, South America or South-East Asia, and have
been swimming in fresh water lakes and streams, you will need screening
for Schistosomiasis. Make an appointment with a Practice Nurse 12
weeks after your return
Maintain a high degree of suspicion of Malaria if you develop any flu-like
illness (characterised by fever, headache, joint aches etc)
Travel occasionally brings some negative experiences. Please seek
support for any unresolved issues from whomever you feel most
comfortable with: friends / family / doctor or counselling services
LINKS TO RELEVANT WEB SITES
The following links to web sites are for your interest and assistance,
however LSMP personnel may not be familiar with all the content of these
sites and we may not agree with or endorse the views contained within
them. When you select one of the links below you will open the new site in
this existing window. You can hit the Back button in your Internet browser
to return here, or select this site from the Address drop-down list
TRAVEL HEALTH LINKS
Aviation Health Institute www.aviation-health.org
Centre for Infectious diseases - Travellers' Health www.cdc.gov/travel/
International Society of Travel Medicine www.istm.org/ (This has a
travel clinic directory and has a list of most countries with names and
contact details of health providers who speak English and other
languages)
Malaria Foundation International www.malaria.org/
Malaria Hotspots www.malariahotspots.co.uk/
MASTA Medical Advice Centres for Travellers Abroad www.masta-travelhealth.com
NOMAD Online travel shop including sterile medical kits
Travel Health On-Line www.tripprep.com/
Travel Medicine www.travmed.com/
TravelTurtle www.travelturtle.co.uk/TravelHealthAdvice.aspx
Tropical Medicine Bureau www.tmb.ie/
GOVERNMENT LINKS
CIA World factbook www.odci.gov/cia/publications/factbook/index.html
Department of Health Advice for Travellers
www.doh.gov.uk/PolicyAndGuidance/healthadviceForTravellers
Fit for Travel www.fitfortravel.scot.nhs.uk/
Foreign Office www.fco.gov.uk/
Health Protection Agency www.phls.co.uk/
NATHNAC (National Travel Health Network and Centre)
www.nathnac.org/
The Meteorological Office www.met-office.gov.uk/
United Nations Web Site www.un.org/
WHO (World Health Organisation) www.who.int/
WHO Immunisation Schedules Country by Country wwwnt.who.int/vaccines/globalsummary/pgs2000.cfm
WHO Tropical Diseases Images & information
www.who.int/tdr/media/image.html
HIGH ALTITUDE LINKS
High Altitude Medicine www.high-altitude-medicine.com
Oral contraceptives & high altitude
www.thebmc.co.uk/world/mm/mm11.htm
The British Mountaineering Council www.thebmc.co.uk/
DIVING LINKS
Diving Diseases Research Centre www.ddrc.org/
Diving Medicine On Line www.scuba-doc.com/
PADI www.padi.com
The Marine Conservation Society www.mcsuk.mcmail.com/
The Travel Doctor - Scuba page www.traveldoctor.co.uk/scuba.htm
GENERAL INTEREST LINKS
Adventure Travel Information
http://activetravel.about.com/travel/activetravel/?once=true&
Insurance (cheap travel insurance policies for under 40s, can be done
Via Internet & e-mail, as late as 24hrs before departure)
www.leadedge.co.uk
Lonely Planet On Line www.lonelyplanet.com/
National Geographic www.nationalgeographic.com/
Objective Travel Safety Ltd www.objectivegapsafety.com
Travelmag - magazine www.travelmag.co.uk/
Wanderlust - magazine www.wanderlust.co.uk
World Outdoor Web www.w-o-w.com/
MALARIA LINKS
Malaria Prevention guidelines
www.hpa.org.uk/cdph/issues/CDPHvol6/No3/6(3)p180-99.pdf
Prophylaxis - long term traveller
www.hpa.org.uk/cdph/issues/CDPHvol6/No3/6(3)p200-208.pdf
Health Protection Agency
www.hpa.org.uk/infections/topics_az/malaria/menu.htm