Travel Health Advice
At Adur Health Partnership we are here to offer you information regarding your planned holiday abroad. The practice nurses Jan, Amanda, and Ali have received training to give you advice, risk assessment for your trip and vaccine and disease information for your country of destination. Our aim is that you have a safe trip.
Some vaccines are not available on the NHS but there are a large number of vaccines that are. Some of these vaccines are more than one dose to give the full protection and so it is never too early to book a travel appointment at the surgery. We suggest a minimum of 6 weeks before travel. Late travellers may not have time to be vaccinated for full protection.
There is also lots of advice regarding prevention of diseases and your practice nurse will often provide you with this. Some vaccines may need to be administered at a private travel clinic, for instance Rabies vaccine and Japanese encephalitis vaccine. The list below also offers you some safety information during your holiday.
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)
- Boiled water
- Bottled water or canned drinks
- Water treated by a sterilising agent
This includes water used to make ice cubes in drinks and water for cleaning your teeth.
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 also 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.
Contaminated food is the commonest source of many diseases abroad. You can help prevent it by following these guidelines:
ONLY EAT WELL COOKED FRESH FOOD
AVOID LEFTOVERS and REHEATED FOODS
Two phrases to help you remember
COOK IT, PEEL IT, OR LEAVE IT!
WHEN IN DOUBT, LEAVE IT OUT!
ENSURE MEAT IS THOROUGHLY COOKED
EAT COOKED VEGETABLES, AVOID SALADS
ONLY EAT FRUIT YOU CAN PEEL
NEVER DRINK UNPASTEURISED MILK
SHELLFISH IS A HIGH RISK FOOD
AVOID BUYING FOOD FROM STREET VENDORS’ STALLS AS A GENERAL RULE
Another source of calories is alcohol! If you drink to excess, alcohol could lead you to become carefree and ignore these precautions.
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 hand gel is another sensible option.
This the most common illness that you will be exposed to abroad and there is NO vaccine against it. Diarrhoea is caused by eating and/or drinking food and water contaminated by bacteria, viruses or parasites. Risk of illness is higher in some countries than others.
High risk areas include North Africa, sub-Saharan Africa, the Indian Subcontinent, S.E. Asia, South America, Mexico and the Middle East.
Medium risk areas include the northern Mediterranean, Canary Islands and the Caribbean Islands.
Low risk areas include North America, Western Europe and Australia.
You can certainly help prevent travellers’ diarrhoea in the way you behave – make sure you follow the food, water and personal hygiene guidelines already given.
What is travellers’ diarrhoea?
Travellers’ diarrhoea is 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 of the illness is dehydration, and this, if very severe, can kill if it is not treated. Treatment is therefore rehydration. In severe cases and particularly in young children and the elderly, commercially prepared rehydration solution is extremely useful.
Travel well prepared
A good tip is to take oral rehydration solutions with you. These can be bought over the counter in a chemist shop, available in tablet or sachet form — for example:
DIORALYTE or ELECTROLADE or DIORALYTE RELIEF (the latter is a formula containing rice powder which also helps to relieve the diarrhoea, particularly useful in children). Prepare according to instructions. Take care regarding their use in very small children and seek medical advice where necessary.
Anti-diarrhoea 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® and LOMOTIL® or NORMALOE®.
None of these tablets should ever be used if the person has a temperature or blood in the stool.
Do contact medical help if the affected person has:-
Blood in the diarrhoea
Diarrhoea for more than 48 hours (or 24 hours in children)
In some circumstances, antibiotics are used as a standby treatment for travellers’ diarrhoea. Such medication is not usually available on the NHS in anticipation of you being ill when away and needs to be prescribed. 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, take a supply of good quality ones with you which are CE approved.
Hepatitis B and HIV Infection
These diseases can be transmitted by:
Medical procedures with non sterile equipment
Sharing of needles (e.g. tattooing, body piercing, acupuncture and drug abuse)
Sexual contact — sexually transmitted infections or STIs are also transmitted this way
Ways to protect yourself
Only accept a blood transfusion when essential
If travelling to a resource poor country, take a sterile medical kit
Avoid procedures e.g. ear and body piercing, tattooing & 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.
Mosquitoes, certain types of flies, ticks and bugs can cause many different diseases e.g. malaria, dengue fever and 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.
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 e.g. permethrin. 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 is 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.
Homeopathic and herbal medications should NEVER be used as an alternative to conventional measures for malaria prevention.
Malaria is a disease spread by mosquitoes and to date there is no vaccine available. If you are travelling to a malarious country, the travel 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, chills, feeling unwell, headaches, muscle pains, cough, diarrhoea – then seek medical help immediately for advice and say you’ve been abroad. This is VITAL, don’t delay.
Remember the ABCD of malaria prevention advice:
Awareness of the risk
Chemoprophylaxis (taking the correct tablets)
Diagnosis (knowing the symptoms and acting quickly)
Rabies is present in many parts of the world. If a person develops rabies, death is 100% certain.
There are 3 rules regarding rabies
Do not touch any animal, even dogs and cats.
If you are licked on broken skin, scratched or bitten by an animal in a country which has rabies, wash the wound thoroughly with soap and running water for 10 – 15 minutes, then apply an antiseptic solution if possible e.g. iodine or alcohol. Such precautions also apply if you are licked by the animal with their saliva coming into contact with your eyes or inside your mouth (essentially any mucous membranes).
Seek medical advice IMMEDIATELY, even if you have been previously immunised, this is absolutely essential.
Major leading causes of death in travelers abroad are due to accidents, predominantly road traffic accidents and swimming/water accidents. You can help prevent them by following sensible precautions:
- Avoid alcohol and food before swimming
- Never dive into water where the depth is uncertain
- Only swim in safe water, check currents, sharks, jellyfish etc.
- Avoid alcohol when driving, especially at night
- Avoid hiring motorcycles and mopeds
- If hiring a car, rent a large one if possible, ensure the tyres, brakes and seat belts are in good condition
- Use reliable taxi firms, know where emergency facilities are
Personal Safety and Security
The Foreign and Commonwealth Office (FCO) provide excellent information about this. They have information for many different types of travel and also advise on travel to specific destinations in times of political unrest and natural disasters. Please go to their website for more information at:
Take out adequate insurance cover for your trip. This should possibly include medical repatriation as without it, this service is extremely expensive if needed.
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/Applyingandrenewing.aspx
Please note, additional travel insurance is still advised even if you have an EHIC card.
It is sensible on any long haul flight to 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. Further information can be obtained from the websites detailed at the end of this article 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. There is no such thing as a safe suntan, but the following advice should be taken:
Increase sun exposure gradually, with a 20 minute limit initially.
Use sun blocks which contain 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 of 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.
Drink extra fluids in a hot climate.
Be aware that alcohol can make you dehydrated.
Fear Of Flying
Fear of flying – why Doctors do not recommend taking diazepam or similar drugs during a flight.
Patients come to us, asking us to prescribe diazepam for fear of flying. There are a number of very good reasons why prescribing this drug is not recommended.
1) Diazepam is a sedative, which means it makes you sleepy and more relaxed. If there is an emergency during the flight it may impair your ability to concentrate, follow instructions and react to the situation. This could have serious safety consequences for you and those around you.
2) Sedative drugs can make you fall asleep, however when you do sleep it is an unnatural non-REM sleep. This means you won’t move around as much as during natural sleep. This can cause you to be at increased risk of developing a blood clot (DVT) in the leg or even the lung. Blood clots are very dangerous and can even prove fatal. This risk is even greater if your flight is greater than 4 hours.
3) Whilst most people find benzodiazepines like diazepam sedating, a small number have paradoxical agitation and increased aggression. They can also cause disinhibition and lead you to behave in a way that you would not normally. This could impact on your safety as well as that of other passengers and could also get you into trouble with the law.
4) According to the prescribing guidelines doctors follow (BNF) Benzodiazepines are contraindicated (not allowed) in treating phobia. Your doctor would be taking a significant legal risk by prescribing against these guidelines. They are only licensed short term for a crisis in generalised anxiety. If this is the case, you should be getting proper care and support for your mental health and not going on a flight.
5) Diazepam and similar drugs are illegal in a number of countries. They may be confiscated or you may find yourself in trouble with the police.
6) Diazepam stays in your system for quite a while. If your job requires you to submit to random drug testing you may fail this having taken diazepam.
We appreciate that fear of flying is very real and very frightening. A much better approach is to tackle this properly with a Fear of Flying course run by the airlines. We have listed a number of these below.
British Airways https://www.flyingwithconfidence.com/venues/london-gatwick