Author: TravelHealth-UK

Going on a Gap Year? Whether you are planning to travel the world for fun, or intending to work as a volunteer as part of an Aid Agency, you will need to take careful precautions to ensure your continuing health and safety.

Vaccinations

Check your vaccination requirements at least 6 months prior to your trip. Make sure routine vaccinations are up to date, and check with your doctor or TravelHealth advisor on specific vaccination recommendations for the places you are visiting. If your trip is last minute, you should still visit your doctor, pharmacist or TravelHealth advisor as soon as possible.

Medical Check-ups

Visit your health care professional for a medical check up before leaving for your Gap Year. Some organisations will require this for acceptance onto their programme. Ensure that you are in good health before you go, and also get a dental check-up. This will reduce the possibility of having to receive emergency treatment abroad.

Insurance

Organise adequate insurance that will cover medical expenses AND the cost of repatriation back to the UK if necessary. Know your blood group. The Blood Care Foundation can organise emergency blood if the situation should arise that you require a blood transfusion.

Plan your Itinerary

Plan ahead and always let someone know your intended travel plans. Familiarise yourself with the customs and religious practices of the countries you are intending to visit. This can help to avoid offending the local inhabitants, in addition to making your stay much more enjoyable. Always check the political situation in each of the areas you are intending to visit — before you go.

Staying Healthy

Take heed of local and reliable advice concerning which food is safe to eat and which places are safe to visit. Wash your hands frequently with soap and clean water. Drink only bottled or boiled water, or carbonated drinks in cans or bottles. Avoid tap water, fountain drinks and ice cubes. Eat only thoroughly cooked food or fruits and vegetables you have peeled yourself. Remember: boil it, cook it, peel it or leave it. Do not eat food purchased from street vendors. Do not eat dairy products, unless you know they have been pasteurised.

To prevent fungal and parasitic infections, keep feet clean and dry, and do not go barefoot. Also keep groin areas clean and dry, as this area is also prone to fungal infections in hot climates. Always use condoms to reduce the risk of HIV and other STD’s. Consider all sexual partners as a potential risk of the HIV virus.

Malaria

If you will be visiting an area where there is a risk for malaria, take your malaria prevention medication before, during and after travel, as directed. Protect yourself from insects by remaining in well-screened areas, using repellents (applied sparingly at 4 hourly minimum intervals) and insect repellent impregnated mosquito nets, and wearing long-sleeved shirts and long trousers from dusk to dawn.

On Return Home

If you have visited an area where there is the risk of malaria, you must continue taking your malaria medication for the time suggested by your doctor — this varies with different types of medication. If you become ill with a fever — anything up to 1 year after your return — you must tell your health care professional that you have travelled to a malarious country.

Vaccinations

Check your vaccination requirements at least 6 months prior to your trip. Make sure routine vaccinations are up to date, and check with your doctor or TravelHealth advisor on specific vaccination recommendations for the places you are visiting. If your trip is last minute, you should still visit your doctor or TravelHealth advisor as soon as possible.

General Health

Ensure that you are in good health before you leave. Get a dentist check up – this will lessen the risk of needing emergency treatment abroad. Keep a record of your blood group, and consider joining the Blood Care Foundation, should you require emergency blood while away.

Travel Supplies

Take a well-stocked first aid kit with you and, if required, enough prescription medication for the trip. Check out our pre-travel shopping list and note the essential items needed for your trip.

Prevention of Accidents

Accidents can happen anywhere and are the top reason for medical repatriation among travellers. Think ahead – always wear seat bets when travelling in cars, never drink and drive, take special care when swimming in unknown water and never swim alone.

Safety standards of balconies and electrical appliances might not be the same standards as at home. Accidents can increases the risk of HIV or Hepatitis B & C if you require a blood transfusion in a high-risk destination.

Malaria Risk

Check out your malaria risk prior to leaving for your trip. Get good advice from your doctor or travel health advisor. Make sure you understand about malaria, so you understand why you need to take precautions.

In the year 2000 – the United Kingdom saw 1,400 cases of malaria. No medication will offer 100% protection so it is vitally important that you also don’t get bitten in the first place – with good methods of bite prevention.

Sex Files

Sexually transmitted diseases such as gonorrhoea, chlamydia, Hepatitis B and HIV are easily contracted if precautions are not taken. Casual sexual behaviour abroad can increase the risk of contracting HIV by 300-fold.

If you do engage in sexual contact, always use a condom. Use the web to find local sexual health clinics at the first sign of any problems.

Travellers Diarrhoea

The more care you take with what you eat and drink, the lower your risk of getting travellers diarrhoea.

Take some anti-diarrhoeal medication with you. If you also develop a fever, have blood in your stool, or are unable to drink fluids, you should see a doctor as soon as possible.

Sun Care

As the Australians say – Slip, Slap, Slop – Slip on a shirt, Slap on a hat, and Slop on some sun cream.

The sun is strongest between 10.00 – 15.00hrs. During this time make the most of the shade. Reapply sun cream every 2 hours and always put insect repellents on top of sun cream.

Be Informed

Get yourself an e-mail box that can be picked up from a remote server such as hotmail account. Make use of the account to store essential health information, and keep in touch with those at home.

Take time to get acquainted with local customs, religious holidays and laws and the political situation before going – it might save you a lot of trouble in the long run! Always let others know of your itinerary and plan ahead. If you change course, write or e-mail home, so others are aware of your schedule.

 

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Note: This information is designed to complement and not replace the relationship that exists with your existing family doctor or travel health professional.  Please discuss your travel health requirements with your regular family doctor or practice nurse.

The only sexually transmitted disease that is preventable by vaccination is Hepatitis B – see your Doctor or Nurse 3-6 months before you intend to travel for advice.

Abstinence or sex with a trustworthy, lifelong partner is a highly effective way of preventing sexually transmitted disease.

Extra strong condoms should always be used when having casual sex, they should be bought at home, before travelling, as in many countries local condoms can be destroyed by heat and are often of a poorer quality.

Couples who do not have any sexually transmitted diseases and no other sexual partners can not contract sexually transmitted diseases while on holiday.

If you have any unusual rash, discharge or soreness on return from your time abroad you should stop having sex and see your Doctor or local Genital Urinary Medicine (GUM) clinic Nurse immediately.

  

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Note: This information is designed to complement and not replace the relationship that exists with your existing family doctor or travel health professional.  Please discuss your travel health requirements with your regular family doctor or practice nurse.

What is Traveller’s Diarrhoea?

Any food or water from an infected source can cause traveller’s diarrhoea. Symptoms of traveller’s diarrhoea usually begin about three to four days after arrival. It can continue for up to ten days after return. The risk of traveller’s diarrhoea is very much related to the destination, level of accommodation and travel habits of the traveller.

Those who only go to 5* hotels will be at a lower risk of traveller’s diarrhoea than those eating and living in local accommodation and restaurants. There is some evidence to suggest that those who travel frequently (at least every six months) to developing countries – do build up a limited defense against Traveller’s Diarrhoea. However, this is not a life long immunity.

How to Avoid Traveller’s Diarrhoea

While in some destinations traveller’s diarrhoea will be inevitable to the traveller, some steps can be taken towards prevention and it is important to understand how traveller’s diarrhoea is transmitted.

Make sure that meat eaten is well cooked. Avoid seafood and abide by the “cook it, boil it or peel it” rule when eating in local restaurants. Wash salads with a good source of clean water – in fact when eating out avoid salads at all costs in high-risk locations! Avoid any food that has been re-heated and left at room temperature.

Apply strict hygiene while away especially after using the bathroom and before you eat food – never use communal, damp towels in public conveniences! Use disposable paper towels, antibacterial wipes or hot air.

Care with water is essential and this includes ice in drinks at the bar. As well as drinking soft drinks from cans it is good practice in developing countries to use sealed, bottled water, not only for drinking, but also for cleaning teeth and washing fruit.

When swimming avoid swallowing water in swimming pools, lakes or the sea.

Self Treatment of Traveller’s Diarrhoea

The first rule when traveller’s diarrhoea attacks is to try to get some rest and drink plenty of clear fluids. It is important, especially in hot climates, that you do not become dehydrated.

If you feel like eating, good foods are bananas, salted crisps, rice or clear soups. Avoid alcohol at all costs. In most cases, traveller’s diarrhoea is self-limiting and with a little rest and rehydration you can be on your way again.

Taking an over-the-counter anti-diarrhoeal medication such as Loperamide will stop the diarrhoea, especially if you have an important meeting or flight to catch. While it is important not to take more than the recommended dose, some people can feel constipated after taking this medication.

The reason people may believe they are constipated is that Loperamide works by slowing down the movements of the gut and restoring natural balance. Therefore people may then not need to go to the toilet for a while afterwards until the gut movements have been restored to ‘normal’. It can take a while for food to reach the gut again (as most or all of the existing gut contents have been rapidly removed as diarrhoea).

This medication should not be taken if you are passing blood or have a history of bowel problems; in this instance you should discuss an alternative treatment with your doctor before you leave for your trip.

Antibiotics (such as Ciprofloxacin), as advised by your doctor, should be taken if the condition does not improve or worsens. Diarrhoea treatment packs can be purchased at most travel clinics and contain a single dose of antibiotic, which can be taken if a fever accompanies the problem.

For women taking the pill it is important to recognise that absorption of the pill can be affected by traveller’s diarrhoea. If this occurs always use alternative protection, such as condoms, as well as continuing with your normal oral contraceptive pill.

When to Get Medical Help

If after 24-48 hours the diarrhoea does not improve or worsens it is good to seek medical attention, as the diarrhoea could indicate other conditions. This should also be done if you suffer from a preexisting condition of the bowel or immune system, if you are passing blood or have a persistent temperature.

Traveller’s Diarrhoea in the Returning Traveller

The returning traveller can also suffer from diarrhoea and it is important that you seek medical attention if you suffer on return, as this could also indicate other diseases that would need to be investigated by your doctor.

  

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Note: This information is designed to complement and not replace the relationship that exists with your existing family doctor or travel health professional.  Please discuss your travel health requirements with your regular family doctor or practice nurse.

• Boil any drinking water you are unsure about – or drink bottled water – but always ask to open the bottle yourself in restaurants, checking the seal is in place – if in doubt stick to carbonated water – and make sure it fizzes!
• Use bottled or boiled water for cleaning your teeth, don’t open your mouth and drink water in the shower.
• In developing countries order drinks without ice, avoid roadside food vendors selling ice cream and unwashed fruit.
• Eat early if you have a buffet that has been sitting out for long periods during the day — food kept warm under food lamps can be a source of infection.
• Avoid – unpasturized milk, shellfish, soft cheeses, lukewarm food and empty restaurants!
• Boil it, cook it, peel it or forget it….
• Apply strict hygiene while away especially after using the bathroom and before you eat food – never use communal, damp towels in public conveniences! Use disposable paper towels or hot air.
• If you get diarrhoea – drink plenty of clear, clean fluids. It might be helpful to take diarrhoea medication along with you with some rehydrating fluid.
• If it continues for more than 48 hours and you are unable to drink, or are passing blood – SEEK IMMEDIATE MEDICAL ATTENTION 

• Discuss with your Doctor or Nurse the need for rabies vaccination if travelling in areas more than 24 hours from medical help in risk areas.
• Know what to do if you get bitten – wash the wound for 5 minutes under running water with soap. Rinse and pour an iodine preparation or 60-70% alcohol on the wound and get to medical help IMMEDIATELY.
• Do not have the wound stitched for at least 48 hours.
• If you are bitten by an animal abroad it is important to see your Doctor on return
• Always wear long trousers and boots when walking through undergrowth or long grass
• When sleeping outside always have the bed raised off the ground
• If you meet a snake do not panic keep very still until it goes away!
• Carry a torch and spare batteries when walking at night

 

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Note: This information is designed to complement and not replace the relationship that exists with your existing family doctor or travel health professional.  Please discuss your travel health requirements with your regular family doctor or practice nurse.

First line protection for the traveller against any insect borne disease is not getting bitten in the first place.

Risk of contracting certain diseases varies with location of your accommodation and for those travelling to rural areas certain risks increase.

Mosquitoes

While malaria mosquitoes feed between dusk and dawn, other types of mosquitoes carrying different diseases bite at other times of day. It is important to discuss with your Travel Health advisor

1. when you are at risk of mosquito borne disease and
2. what time of day carries the greatest risk.

Mosquitoes tend to respond to light in their feeding habits, some preferring daylight, others darkness.

Malaria mosquitoes usually prefer low light hours after dusk until dawn. Dengue mosquitoes’ peak biting times are the few hours before dusk and the few hours after dawn and are present during the day light hours.

Avoid being bitten by mosquitoes by applying a good mosquito repellent to exposed areas every 6 hours. Clothes can also be impregnated with repellent for further protection. If wearing sunscreen, apply your repellent on top.

Keep your legs and arms covered with clothing to lower risk of bites on the skin. Avoid wearing dark colours, as they can attract mosquitoes. While mosquitoes are able to bite through many materials, canvas mosquito boots and thick denim jeans will make it more difficult in rural areas, where the risks are always the greatest.

Use a ‘knock-down’ spray in the evening to get rid of mosquitoes before going to sleep. Avoid strong perfumes, hair sprays or after-shaves as they can attract mosquitoes!

Use air-conditioning if it is available. Because air conditioning helps keep the mosquitoes away due to the lower temperature, it is important that it is left on all day and that the windows or shutters are not left open at night!

Try to avoid evening walks beside rivers and ponds as this is where mosquitoes breed.

Use this information along with any medication advice your doctor has given you.

Other biting insects include the small sand fly, which is capable of spreading Leishmaniasis in certain locations; ticks, which are responsible for diseases such as Lymes disease; and mites which can cause scabies; as well as many other different species.

In a risk area, it is wise to use a bed net, which is impregnated with permethrin. For a net to be effective, it needs to be impregnated with permethrin at least every six months or whenever it is washed. While sand flies will be able to get through the holes, by landing on a net that is impregnated, they will be killed.

Use a repellent that has DEET or contains a natural repellent such as lemon and eucalyptus; try to avoid using products that are connected to homemade concoctions!

Clothing that has been impregnated with permethrin will also help repel insects if you will be working in a rural area. This clothing, along with impregnated wrist and ankle bands, lower the risk of being bitten. If you are reluctant to impregnate everyday clothing, impregnated netting worn over the clothing will prevent chemical contact with the skin. It is important that fellow travellers are protected in a similar way, as repelled mosquitoes will go to another person who is not protected!

  

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Note: This information is designed to complement and not replace the relationship that exists with your existing family doctor or travel health professional.  Please discuss your travel health requirements with your regular family doctor or practice nurse.

The tourist on holiday or away from home is relaxed, and in an uninhibited environment away from social restrictions that they might live by at home – being off guard means a higher risk of having an accident!

Beware of the risks on roads – driving ‘on the other side’, new signs, unfamiliar winding roads, badly maintained roads and different standards in car and moped safety.

Always check a vehicle before renting – especially the brakes, seatbelts, insurance and emergency numbers.

NEVER DRINK AND DRIVE

NEVER DRINK AND SWIM

Always swim with others, keep check on tides, currents and strong winds

Allow at least one hour after eating before swimming and never fall asleep on an airbed in the sea!

Check swimming pool depths before diving

Always look for emergency exits and check balconies and first aid arrangements on arriving at your chosen accommodation.

If you try a new sport check that there is adequate instruction, well kept equipment and you are at a good level of personal fitness.

  

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Note: This information is designed to complement and not replace the relationship that exists with your existing family doctor or travel health professional.  Please discuss your travel health requirements with your regular family doctor or practice nurse.

A person can be sitting in their GP surgery shortly after arriving home with a tropical disease such as malaria, dengue fever or diarrhoea. These conditions in times gone by were incubated on board ocean going liners and never reached the shores of the United Kingdom. This problem, brought on by the speed of international travel, is often overlooked. Another problem, which faces the frequent business traveller, is the issue of adjusting to time changes and Jet Lag. Good pre-planning and thinking through the issues will help in dealing with differences in time.

Good Pre-Planning

When booking your flight, look at the travel times available and plan for a time to sleep. Get a good nights sleep the night prior to travel, ensure you are well organised and everything related to your trip is in order. If you need to be in meetings as soon as you arrive, try to fly during a time when you usually go to sleep. Choose a direct flight that cuts down on travelling time.

On Board the Flight

When you are flying try to avoid alcohol. As well as dehydrating your body, and increasing your risk of DVT, it can leave you feeling sluggish. Drink plenty of fruit juices or water. Still water is better than carbonated, as this will keep you from the inevitable bloated, gassy feeling associated with carbonated drinks. Avoid any stimulant such as caffeine until you have had a nights sleep at your destination

Try to exercise regularly on the flight, as this will help your circulation. Just a short walk around the cabin or moving your ankles around can help improve your circulation in a pressurised cabin. Using an exercise aid can be useful on a long flight

Do not change your watch during the flight, stick to your home time until you reach your destination. This is especially important if you are a Diabetic and need to continue a strict insulin regime during the flight. If your watch says it is 11pm and time for bed – close your eyes and sleep (even if it means missing the movie!). If you need to make connecting flights however, do check the local time regularly as you could end up missing a vital flight.

When you arrive

When planning your schedule try to allow for a few hours to rest when arriving at your destination to give yourself time to be at your best for meetings. A warm shower is a good way to get refreshed, but avoid hot baths as they can relax the body and you might find it hard to get going again!

On arriving at your destination change your watch to local time. Try to adjust immediately to local food and sleep patterns. Exposing yourself to bright light is believed to help your body return to normal cardiac rhythms. Some travellers have seen positive effects using melatonin, but you should discuss its suitability with your Doctor, others suggest the use of short acting sleeping tablets to help you sleep those first few days away.

There are many suggestions and discussion on this issue of jet lag and many proficient travellers will have an established routine and way of dealing with it. But despite any suggestions to the contrary, the body still needs to adjust and it is essential to rest after any flight.

 

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Note: This information is designed to complement and not replace the relationship that exists with your existing family doctor or travel health professional.  Please discuss your travel health requirements with your regular family doctor or practice nurse.

Time Zones

The earth is divided into 24 time zones, with time changing by one hour for every 150 of travel east or west of the Greenwich meridian. When travelling from London to New York you would need to turn your watch back by five hours, while travel to Japan from London means turning your watch forward by nine hours (nine time zones). Arriving in Tokyo by plane from London at bedtime your body will feel as though it is lunchtime.

It takes about one day per time zone crossed to adjust to local time.

Ways of reducing Jet Lag

In order to cope with Jet lag you should get a good deal of sleep before your journey. It is also important to rest as much as possible during your flight. Planning to arrive at your destination as near to the time when you normally go to sleep will also help with the adjustment. If you are able to plan your itinerary allow time on arrival for adjustment.

Some people advise changing their watches to destination time when they get onto the plane. While this helps many people, for those who are on regular medication, such as diabetics, watches should remain on home time until you are able to adjust your medication to local times on arrival at your destination or as suggested by your health advisor.

On arrival at your destination get active as soon as possible and adjust your meals and activities to local time as soon as you can. Exposure to light is also a good way of naturally allowing your body to adjust. If you need to take a short nap – use an alarm clock or a helpful friend to wake you up!

Medication in reducing the effects of Jet-lag

For those with important schedules and meetings it would be worth discussing with your doctor the possible benefits of a mild sleeping tablet for 2-3 days whilst you adjust.

The drug melatonin is used frequently in the USA – although research is limited. Taking the drug is advised just before bedtime. After taking the drug you should avoid driving as it can make you very drowsy.

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Note: This information is designed to complement and not replace the relationship that exists with your existing family doctor or travel health professional.  Please discuss your travel health requirements with your regular family doctor or practice nurse.