Information and risk assessment For patients travelling abroad
If you have planned or are planning a trip abroad it is advisable to make an appointment in the Travel Clinic, so the nurse can discuss any risks associated with your travel and advise you of any vaccines or Malaria prophylaxis you may require. Ideally vaccines should be administered at least 6 weeks prior to travel; this will ensure your vaccine has had time to become effective and for you to recover from any reactions or side effects that may occur. This will also ensure you have all that is needed in the way of medications, lotions, insurance, malaria tablets etc. Please read and if required print off the information sheets regarding the risks associated with travel and your health. You are requested to complete a travel health record sheet. Once completed please print off and hand this to reception so the nurse can identify what vaccines may be needed. It would be helpful to write down all countries you are planning to visit for those going on a cruise or backpacking and how long you will be staying in each country. This will help us to provide the best possible care.
Travel leaflet to be read before attending Travel clinic appointment 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
• Avoid alcohol and food before swimming • Never dive into water where the depth is uncertain • Only swim in safe water, check for currents, sharks, jellyfish etc. • Avoid alcohol when driving, especially at night • Avoid hiring motorcycles and mopeds, if hiring then wear appropriate
• If hiring a car, rent a large one if possible, ensure the tyres, brakes and
• Use reliable taxi firms; know where emergency facilities are located.
• Take out adequate insurance to cover 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 card is found at hhtp://www.nhs.uk/NHSEngland/Healthcareabroad/EHIC/Pages/introduction.aspx
https://www.ehic.org.uk/Internet/home.do Additional travel insurance will still be required.
AIR TRAVEL It is sensible on any long haul flights 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
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.
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 cats and dogs. 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 Saliva coming into contact with your eyes or inside your mouth (essentially any mucous membranes)
3. Seek medical advice IMMEDIATELY, even if you have been
previously immunized, this is essential, as you may need further vaccinations.
FOOD Contaminated food is the most 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 • ENSURE MEAT IS COOKED THOROUGHLY • EAT COOKED VEGETABLES AND AVOID SALADS • ONLY EAT FRUIT YOU CAN PEEL • NEVER DRINK UNPASTEURISED MILK • AVOID ICE-CREAM and SHELLFISH • IN GENERAL, AVOID BUYING FOOD FROM STREET
1. COOK IT, PEEL IT OR LEAVE IT!! 2. WHEN IN DOUBT LEAVE IT OUT!!
Also remember if you drink to excess, alcohol could lead you to become carefree and ignore these precautions.
INSECT BITES Mosquitoes, certain types of flies, ticks and bugs can cause 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 during dusk and dawn). Wear loose fitting clothes, long sleeves, trousers or long skirts and socks
• Use insect repellants on exposed skin. (DEET containing products are
the most effective and the higher content of DEET the longer it will last. A content of up to 50% DEET is recommended for tropical destinations.) Clothes can be sprayed with repellants too or clothing specific sprays. Check suitability for children on the individual products. If using sunscreen always apply this first followed by an insect repellant spray on top.
• If room is not air conditioned, but screened, close shutters early
evening and spray room with knockdown insecticide spray. Check suitability children on the individual products. 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 vaporizers are very effective as long as there are
• There is no scientific evidence that electric buzzers, savoury yeast
extract, teat tree oil, bath oils, garlic and vitamin B are effective.
MALARIA 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 and also mention where you’ve been abroad, this is vital don’t delay.
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. 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 not 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. TRAVELLERS’ DIARRHOEA This is 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 other. High risk areas include North Africa, Sub-Sahara 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 stalls 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 ELECTOLADE. (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 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 of age. Commonly used tablets are Immodium, 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 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). 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)
1. Boiled water 2. Bottled water with seal intact or canned drinks 3. Water treated by a sterilizing agent. This includes ice cubes in drinks and water for cleaning your teeth.
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
• 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
• Avoid casual sex, especially without condoms Remember – excessive alcohol can make you carefree and lead you to take risks you otherwise would not consider,
SUN AND HEAT Sunburn and heat-stroke cause’s 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 block 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 manufacturers instructions.
• Always apply sunscreen first followed by an insect repellant spray on
• Wear protective clothing – sunhats, T-shirts and sunglasses etc. • Avoid going out between 11am-3pm, when the sun’s rays are
• 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.
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
HNS Choices www.hs.ul – go to the ‘Live Well’ menu select ‘travel health’
Foreign and Commonwealth Office – www.fca.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 locator’ www.istm.org
1. “Flying without fear” from Virgin Atlantic (£2.99). Possibly not for
those with severe phobia, but worth knowing about.
2. Fit for Travel (Free). This German version is viewable in both
German and English. It has vaccine specific information (remember that standby treatments is preferred to chemoprophylaxis for malaria so differs from UK and American guidance) and a guide with useful travel health advice.
3. SOS 4 LIFE (£2.99). Is a mobile health record that stores vital
information securely which can then be translated to Spanish, German, French, Italian, Dutch or Portuguese at the touch of a button?
Information in this leaflet taken from www.janechiodini.co.uk 2011.
Portslade Health Centre Travel Health Clinic record Date of birth: Sex: Male Female Patient’s address: Address:
Postcode: Postcode: Medical history: Have you recently undergone: Do you have any history of Mental illness? Radiotherapy Yes No Chemotherapy Do you or any close family have epilepsy? Steroid treatment Yes No Current health problems: Current medication: Allergies: Women only: Are you pregnant Yes No Travel details Type of trip: Tick all that apply Date of Departure:--------------------- Package holiday---- Backpacking How long for:--------------------------- Cruise---------------- Visiting family/friends
Where going to------------------------- Business<3months Voluntary/Charity Do you have Medical insurance? Business>3months Aid worker Immigration Self organised Organised adventure holiday Type of Accommodation: Areas to be visited: Hotel Camping Youth Hostel n Altitude>3000m Poor Basic Unknown Rural Beach
Please sign your name below to show that you have read the information supplied and understand the risks associated with travel as discussed with your nurse. Date and Signature of patient travelling:-----------------------------------------
Travel clinic record of vaccines required and administered Please bring to your appointment Name of Vaccines Vaccines Vaccines Please tick if vaccines recommended for administered patient travelling for purpose of (If known)
1st/2nd/3rd Not available at PHC FREE Hepatitis B
1st/2nd/3rd Booster Private £30 each injection cash only Hepatitis A and Typhoid
1st/2nd NOT AVAILABLE (Private) at PHC Rabies NOT AVAILABLE
1st/2nd/3rd at PHC (Private) Yellow fever Private £50 cash only Malaria Prohylaxis advised 1.Chloroquine 2.Proguinal 3.Doxycycline 4.Mefloquine 5.Malarone Quantity Required:
The patient(s) named below can be given Yellow fever vaccination by Subcutaneous or intramuscular injection of: YELLOW FEVER VACCINE – STAMARIL 0.5ML By…………………………………….(Practice Nurse) who is competent and up to date with giving yellow fever vaccinations
No contraindications apparent according to pt. records, Vaccine Authorised by……………………………………….(Doctor) Dated……………………………. Please use space below for practice stamp if not registered at PHC.
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