Albany House Medical Centre 3 Queen Street, Wellingborough, NN8 4RW 01933 234 900 PATIENT INFORMATION LEAFLET Overseas travel – general information for travellers
This leaflet provides for sensible, simple advice to help you stay healthy when travelling abroad. Please read it – it might just help prevent a ruined holiday!
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)
2. Bottled water with the seal intact 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 : •
In general, 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. Using a hand gel is another sensible option. Travellers’ diarrhoea This the most common illness that you will be exposed to abroad and there is no vaccine against it at present. Travellers’ diarrhoea is caused by eating and/or drinking food and water contaminated by bacteria, viruses or parasites. The 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 said to occur when you pass 3 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 is if dehydration occurs during the illness, and this, if very severe, can be life threatening if it is not treated. Treatment is therefore REHYDRATION. In severe cases and particularly in young children and the elderly, commercially prepared rehydration solution is extremely useful. This can be bought in tablet or sachet form from a chemist shop e.g. Dioralyte or electroladE. (Dioralyte Relief is a formula containing rice powder which also helps to relieve the diarrhoea, particularly useful in children). Prepare all products according to instructions, taking care regarding their use in very small children and seeking medical advice where necessary). Anti diarrhoeal tablets can be used for adults but should never be used in children under 4 years of age, and only on prescription for children aged 4 to 12 years. Commonly used tablets are Imodium, Lomotil or Normaloe. 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: •
A temperature Blood in the diarrhoea Diarrhoea for more than 48 hours (or 24 hours in children) Becomes confused
(Please note, 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 which are CE approved.) 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. Unprotected sexual contact 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 or 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 different diseases. e.g. malaria, dengue fever, yellow fever. Some bite at night, but some during daytime, so protection is needed at all times. 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 loose fitting clothes, long sleeves, trousers or long skirts and socks.
Use insect repellents on exposed skin. (DEET containing products are the most effective. A content of up to 50% DEET is recommended for tropical destinations.) Clothes can be sprayed with repellents too or clothing specific sprays. Check suitability for children on the individual products. If using sunscreen always apply first followed by an insect repellent spray on top
If room is not air conditioned, but screened, close shutters early evening and spray room with knockdown insecticide spray. In malarious regions, if camping, or sleeping in unprotected accommodation, always sleep under a mosquito net (impregnated with permethrin). Avoid camping near areas of stagnant water, these are common breeding areas for mosquitoes etc.
Electric insecticide vaporisers are very effective as long as there are no power failures!
There is no scientific evidence that electric buzzers, savoury yeast extract, tea tree oil, bath oils, garlic and vitamin B are effective.
If you are travelling to a malarious country, the travel health adviser will have given you a separate leaflet with more details, please read it. REMEMBER, malaria is a serious and sometimes fatal disease. If you develop flu like symptoms, including fever, sweats and chills, feeling unwell, headaches, muscle pains, cough, diarrhoea, then seek medical advice immediately for advice and also mention where you’ve been abroad, this is vital, don’t delay. Animal bites Rabies is present in many parts of the world. If a person develops rabies, death is 100% certain. There are 3 rules regarding rabies 1. Do not touch any animal, even dogs and cats 2. If you are licked on broken skin, scratched or bitten in a country which has rabies, wash the wound or area thoroughly
with soap and running water for a minimum of 5 minutes then apply an antiseptic solution if possible e.g. iodine or alcohol. Such precautions also apply if you are licked by an animal with their saliva coming into contact with your eyes or inside of your mouth (essentially any mucous membranes)
3. Seek medical advice immediately, even if you have been previously immunised, this is essential Accidents Major leading causes of death in travellers are due to swimming and traffic accidents. You can help prevent them by taking notice of the following Precautionary guidelines •
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
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.
Insurance cover •
Take out adequate insurance cover for your trip. This should possibly include medical repatriation as without it, this service if needed is extremely expensive.
If you have any pre existing medical conditions, make sure you inform the insurance company of these details and check the small print of the policy thoroughly.
If you travel to a European Union country, make sure you have obtained an EHIC card before you travel which takes some time to obtain. Further information about the EHIC is found at http://www.nhs.uk/NHSEngland/Healthcareabroad/EHIC/Pages/Introduction.aspx and to make an application go to https://www.ehic.org.uk/Internet/home.do Please note additional travel insurance is still advised.
Air travel It is sensible on any long haul flight to •
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
Further information can be obtained from the websites detailed at the end of this leaflet with more specific advice and information on travel-related deep vein thrombosis. SUN AND HEAT Sunburn and heat-stroke cause serious problems in travellers, but in the long term can be a serious cause of skin cancer. Long term damage to the skin due to sun exposure can lead to skin cancer. There is no such thing as a safe suntan but the following advice should be taken Precautionary guidelines. •
Increase sun exposure gradually, 20 minutes limit initially.
Use sun blocks which contains both UVA and UVB protection and sufficient sun protection factor (SPF) and a minimum of SPF 15. Children under 3 years should have a minimum SPF 25 and babies under 6 months should be kept out of the sun at all times. Reapply often and always after swimming and washing. Read manufacturer instructions
Always apply sunscreen first followed by an insect repellent spray on top
Wear protective clothing – sunhats, T shirts and sunglasses etc.
Avoid going out between 11am - 3pm, when the sun’s rays are strongest.
Take special care of children and those with pale skin/red hair.
Be aware that alcohol can make you dehydrated
Interesting web site addresses and further information:
Scottish NHS public travel health site - www.fitfortravel.nhs.uk
National Travel Health Network and Centre – www.nathnac.org
NHS Choices www.nhs.uk – go the ‘Live Well’ menu and select ‘travel health’
Foreign and Commonwealth Office – www.fco.gov.uk/travel
Malaria for the general public – www.malariahotspots.co.uk
International websites for travel health
World Health Organisation www.who.int/ith
Centers for Disease Control and Prevention www.cdc.gov
International Society of Travel Medicine ‘global travel clinic locator’ www.istm.org
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