General Travel Advice

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 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.

WALKING

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:

• only eat well cooked fresh food
• avoid leftovers and reheated foods
• ensure meat is thoroughly cooked
• eat cooked vegetables, avoid salads
• only eat fruit you can peel
• never drink unpasteurised milk
• avoid ice-cream and shellfish
• avoid buying food from street vendor stalls

Another source if contamination 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.

TRAVELLERS' DIARRHOEA

This is the most common illness that you will be exposed to abroad and there is no vaccine against it! Travellers' 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.

Travellers' diarrhoea is 4 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 if 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 solutions are extremely useful. This can be bought in tablet or sachet form at a chemist shop e.g. DIORALYTE or ELECTROLADE. (Dioralyte Relief is a new formula containing rice powder, which also helps to relieve the diarrhoea, particularly useful in children). Prepare according to instructions.

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 and LOMOTIL.

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: -

• A temperature
• Blood in the diarrhoea
• Diarrhoea for more than 48 hours (or 24 hours in children)
• Becomes confused

In very special circumstances, antibiotics are used for diarrhoea, but a doctor should only make this decision.

(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 with the British Kite Mark.)

HEPATITIS B and HIV INFECTION

1. These diseases can be transmitted by
2. Blood transfusion
3. Medical procedures with non-sterile equipment
4. Sharing of needles (e.g. tattooing, body piercing, acupuncture and drug abuse)
5. Sexual contact. Sexually transmitted diseases may also be transmitted this way

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, 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 many different diseases. E.g. malaria, dengue fever, yellow fever. Some bite at night, but some during daytime.

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 light coloured clothes, long sleeves, trousers or long skirts.
• Use insect repellents on exposed skin. (Choose those containing DEET or eucalyptus oil base. A content of approximately 35% DEET is recommended for tropical destinations.) Clothes can be sprayed with repellents too. Impregnated wrist and ankle bands are also available. Check suitability for children on the individual products.
• 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!
• Electric buzzers, garlic and vitamin B are ineffective.

MALARIA

If you are travelling to a malarious country, the travel nurse will have given you a separate leaflet with more details, please read it.

REMEMBER, malaria is a serious and sometimes fatal disease.

ANIMAL BITES

Rabies is present in many parts of the world. If a person develops full-blown rabies, death is 100% certain.

There are 4 RULES REGARDING RABIES

1. Do not touch any animal, even dogs and cats
2. If you are licked on broken skin or bitten in a country, which has rabies, wash the wound thoroughly with soap and running water for 5 minutes.
3. Cleanse the wound with antiseptic e.g povidone iodine or alternatively alcohol (40-70%). Whisky or gin would do if necessary
4. Seek medical advice IMMEDIATELY

Remember, even if you have had rabies vaccine prior to travel, if you are exposed to risk of the disease you still need to obtain post exposure treatment as soon as possible.

ACCIDENTS

Major leading causes of death in travellers are due to swimming and traffic accidents. You can help prevent them by taking 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 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.

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 E111 form before you travel (including a photocopy of the original form). The E111 form is in the T6 leaflet, and after completion, should be stamped at the Post Office. Additional travel insurance is still advised.

AIR TRAVEL

It is sensible on any long haul flight to;

• Be comfortable in your seat
• Drink plenty of water
• Be sensible about alcohol, as excess leads to dehydration and immobility
• Bend and straighten the legs, feet and toes every half-hour while seated
• Press the balls of feet down hard on the floor or foot-rest to increase the blood flow in the legs and reduce the chance of clotting in the vessels
• Use upper body and breathing exercises to further improve circulation
• Take occasional short walks (when in-flight advice suggests this is safe)
• At stopovers, where possible, get off the plane and walk about
• Avoid taking sleeping pills, which will increase immobility

SUN AND HEAT

• Sunburn and heat-stroke cause serious problems in travellers. Both are preventable - to avoid, use the following PRECAUTIONARY GUIDELINES
• Increase sun exposure gradually, 20 minutes limit initially.
• Use sun blocks of appropriate adequate'SPF' strength (see table below). Reapply often and always after swimming and washing. Read manufacturer instructions.

Suggested minimum and maximum protection factors for different skin types and destinations.

• Wear protective clothing - sunhats 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

Further information

Scottish NHS public travel site - www.fitfortravel.scot.nhs.uk
Department of Health - http://www.dh.gov.uk/PolicyAndGuidance/HealthAdviceToTravellers/fs/en
Foreign and Commonwealth Office www.fco.gov.uk
www.masta.org

HAVE A VERY HAPPY AND HEALTHY TRIP!

Last reviewed 5/07/2010