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Travel Health & Vaccinations

global air travel

If you require any vaccinations relating to foreign travel please simply phone the surgery and book an appointment with one of our specialist travel nurses.   When you arrive for your appointment you will be given a form to complete outlining your travel plans, any current medication and your previous vaccination history.  Our nurse will check this with you at the appointment.

It is important to make this initial appointment as early as possible  - at least 6 weeks before you travel - as some vaccines need to be ordered as they are not a stock item. 

Some travel vaccines are ordered on a private prescription and these incur a charge over and above the normal prescription charge.  This is because not all travel vaccinations are included in the services provided by the NHS.

You can find detailed information on the countries you are visiting and vaccinations on the links below.

Europe Europe & Russia North America North America
Central America Central America South America South America
Caribbean Caribbean Africa Africa
Middle East Middle East Central Asia Central Asia
East Asia East Asia Australasia Australasia and Pacific

 


 

Travelling in Europe

If you are travelling to Europe a very useful booklet has been published with advice and guidance to help you get the most out of your holiday.  To visit please click:- http://ec.europa.eu/publications/booklets/eu_glance/86/en.pdf (this is a large document and may take a minute or two to view)


 TRAVEL HEALTH TIPS

Health considerations are usually well down the list when you’re making travel plans. However a few simple precautions can dramatically reduce your risk of illness abroad.

 

1.       Think about travel health as a real issue. Knowledge is key. Many travellers do not give it due consideration until it’s too late. If you travel for any length of time, especially to the developing world, you are almost certain to run into health problems at some point.

 

2.       Check what immunizations you’ll need and give yourself plenty of time to have them before departure.

 

3.       If you’re planning on a long trip or visiting a developing country, assemble some kind of medical kit prior to departure and consider buying a decent book on travel health.

 

4.       Ensure that you have adequate travel insurance and that it includes a repatriation (air evacuation) clause.

 

5.       Remember that taking measures to protect your health during travelling are simply risk limitation; there are no guarantees!

 

6.       In developing countries the vast majority of travel health problems are caused by drinking contaminated water, eating contaminated food, insect-borne disease or accidents. Observation of simple, common sense measures against these risks will greatly reduce the likelihood of travel health problems.

 

·         Drink bottled or boiled water. Failing this, sterilise with iodine tablets or use a water filter.

·         Avoid ice in drinks, salads, uncooked food, street food, “chefs specials” (often yesterdays leftovers), seafood (especially if you’re a long way from the sea). Be aware of the local water when teeth cleaning, showering, utensil cleaning and as an ingredient in less obvious foods (eg ice  cream, sorbets, locally brewed alcoholic drinks)

·         Use effective anti-insect measures. Cover up between dusk and dawn, wear an insect repellent which contains DEET, impregnate clothing/mosquito nets with permethrim, avoid wearing perfume, use mosquito coils and nets, etc

·         Accidents can be difficult to avoid but remember that safety standards are generally likely to be poor in under-developed countries. Don’t take unnecessary risks.

7.       Consider other potentially dangerous but perhaps less obvious health risks such as environmental factors (sunlight, altitude, heat, cold, etc), animal bites, sexually transmitted diseases, violence, snake bites, swimming (many diseases are contracted from fresh water, currents, specific hazards such as crocodiles, etc), walking barefoot (stings, bites, worm infections).

 

8.       If you’re travelling to countries where you’re unsure of adequately sterile medical equipment, you should consider carrying a needle/syringe pack. Consider also taking out insurance for blood transfusions (Blood Care Foundation).

 

9.       If you do become ill when travelling, stop (do not attempt to continue your journey), rest, drink plenty of fluids and have a low threshold for seeking medical advice.

 

10.   Never let travel health concerns stop you visiting a country but always be alert to the dangers and ready to react should the worst happen. Only a relatively very small number of people come to any serious harm whilst travelling.

  


 USEFUL TRAVEL HEALTH WEBSITES

 General

 

q       http://www.cdc.gov/

q       http://www.tripprep.com/

q       http://www.nathnac.gov/

q       www.who.int/en

 

http://www.bloodcare.org.uk/

http://www.fitfortravel.nhs.uk/

 

Disease outbreaks/safety advice

q       http://www.fco.gov.uk/

q       http://www.travel.state.gov/

q       www.who.int/csr/don/en

 

Medical Kits, etc

q       http://www.nomadtravel.co.uk/

 

 

Insurance

q       http://www.bloodcare.org.uk/

q       http://www.uk-travel-insurance-directory.co.uk/

 

 

Altitude

q       http://www.ciwec-clinic.com/

q       http://www.thebmc.co.uk/

 

 

http://travel.roughguides.com/health/index.html

 

Useful email addresses

BSCCG.st-chads@nhs.net  

 

 


MALARIA AND ANTIMALARIALS

 

Please research your proposed destination on http://www.fitfortravel.nhs.uk/.

This an excellent website with a particularly useful and detailed “malaria map” function for individual countries. The choice of antimalarial is rarely clear cut and the final decision rests with you.

 

Malaria kills one million people world-wide each year. Annually nearly 2000 cases are imported back to the UK resulting in a handful of fatalities. If you are travelling to an area where malaria risk exists we would strongly recommend that you take some form of drug prophylaxis. However none of the anti-malarial alternatives confer complete protection and it is very important that you use appropriate measures to reduce the risk of being bitten by insects in the first place. Always seek medical advice if you develop a fever within 3 months of returning from a malarial area.

 

Remember that all drugs can cause side effects and these are largely unpredictable before you take them. The cautions, contra-indications and side effects quoted below are adapted from the British National Formulary (BNF) and are for guidance only.

 

Chloroquine

For many years the mainstay of anti-malarial prophylaxis, frequently used in conjunction with proguanil. It is available over-the-counter without prescription. There is widespread parasitic resistance to chloroquine in most of Africa and in parts of India, South America and Southeast Asia. Needs to be taken weekly, commencing one week before departure and continuing for four weeks after return

Cautions: liver or kidney impairment, pregnancy (relative contra-indication), psoriasis, previous epilepsy, myasthenia gravis, severe gastro-intestinal disorders, G6PD deficiency, retinal problems with long-term use. Avoid taking other drugs which may adversely affect the liver concurrently. Dangerous in overdosage.

Side-effects: gastro-intestinal disturbances, headaches, fits, hair loss, rashes. Rarely: depresses bone marrow affecting blood.

 

Proguanil

Almost always used in conjunction with chloroquine. It is available over-the-counter without prescription. Needs to be taken daily, commencing one week before departure and continuing for four weeks after return.

Cautions: kidney impairment, pregnancy (folate supplements advised)

Side-effects: Mild gastric intolerance and diarrhoea. Mouth ulcers, rashes, hair loss.

 

Doxycycline

An antibiotic useful as an anti-malarial option where chloroquine resistance exists. Interacts with other drugs including the oral-contraceptive pill (potentially reduces the efficacy as a contraceptive), warfarin and anti-epileptic drugs. May pre-dispose to vaginal thrush.  Available on private prescription only. Needs to be taken daily, commencing one or two days before departure and continuing for four weeks after return.

Cautions: pregnancy (absolute contra-indication), breast feeding, sun-sensitive skin reactions in roughly 3%, avoid in porphyria. Avoid in children under 12.

Side effects: nausea, vomiting, diarrhoea, difficulties swallowing, gullet irritation, hypersensitivity reactions, headache, visual disturbances, liver toxicity, skin discolouration, blood abnormalities, anti-biotic-associated bowel problems.

 

Mefloquine (Larium)

Useful alternative where chloroquine resistance exists. Has attracted much media publicity and a bad reputation in terms of its side-effects. Scientific reviews have indicated that the risk of serious side effects from mefloquine lies somewhere between 1 in 10,000 to 1 in 20,0000. Available only on private prescription. Needs to be taken weekly, commencing two or three weeks before departure and continuing for four weeks after return.

Cautions: manufacturer advises avoid in pregnancy and for 3 months after. Avoid if breast feeding and for children under 3 months of age. Avoid in liver impairment, cardiac conduction problems. Absolutely contra-indicated if history of epilepsy, fits, neuropsychiatric disorders (including depression) and previous hypersensitivity to quinine.

Side effects: nausea, vomiting, diarrhoea, sleep disturbance, abdominal pain, loss of balance, dizziness, headache, neurological reactions (eg, tremor, anxiety, fits, depression, hallucinations, psychosis, etc), tinnitus, visual disturbances, circulatory disorders, heart disorders, muscle pain and weakness, joint pains, rash, itching, disturbances in liver function, fatigue, fever, loss of appetite, blood disorders, hypersensitivity reactions, encephalopathy.

 

Proguanil with atovaquone (Malarone)

Licensed in the UK for malaria prophylaxis in 2001 and therefore the newest option. Popular because of the dose regime and general rarity of side effects but expensive. Available on private prescription only. Needs to be taken daily, commencing one or two days before departure and continuing for one week after return.

Cautions:Manufacturer advises avoid in pregnancy and when breast feeding unless there is no suitable alternative. Avoid with kidney disease; diarrhoea and vomiting may reduce absorption.

Side effects: nausea, vomiting, mouth ulcers, diarrhoea, abdominal pain, loss of appetite, headache, dizziness, abnormal dreams, insomnia, cough, visual disturbances, itching, occasional deranged liver function.

 

Updated February 2012 – Dr N Jones

 

 



 
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