travel advice

TRAVEL ADVICE
ALPHABETIC QUICKLINKS: AIR TRAVEL // D&V // DRINKING WATER // FIRST AID KIT // FOOD SAFETY // HYGIENE // IMMUNISATIONS // INSECT BITES // INSURANCE // LINKS // LOCAL KNOWLEDGE // MALARIA // PARASITES // PERSONAL HEALTH // PERSONAL SAFETY // RABIES // SEXUAL HEALTH // SUN SENSE // TRAVEL CLINICS // TRAVELLERS TO HIGH ALTITUDE // VACCINE PREVENTABLE DISEASES // WHEN YOU RETURN

This page is intended to provide guidance for planning your foreign travel from a health perspective. It is more relevant to students taking extended travel breaks, and going to remote areas, than those taking package holidays. The information contained within these pages and the link sites mentioned should be regarded as a guideline rather than a definitive statement, as the area of travel medicine is constantly changing. With careful planning before you travel, vigilance during and afterwards, you should be able to deal with most medical needs with minimal disruption. Above all else your travel experience should be a fulfilling and enjoyable experience so that you return home with positive memories and nothing you wish you'd left behind!

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BRADFORD STUDENT HEALTH SERVICE TRAVEL CLINICS
Our nurses run weekly comprehensive travel advice and immunisation clinics. Please remember to plan well in advance of your travels (at least 6 to 8 weeks if possible), so that you have time to receive any necessary immunisations - it is never too early to come and discuss your travel plans with the nurse!

You can download a Travel Form which you will need to return to us before you book your first appointment

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INSURANCE
Make sure you have full medical insurance covering all activities you are likely to take part in, and make sure it is a repatriation policy. The biggest risks to travellers abroad are theft and road accidents. Make copies of your travel insurance documents, take one with you and leave a copy with a contact in the UK.  If you can, scan them and e-mail them back to yourself.  Do the same with your passport and tickets etc. Keep a copy of your travel insurance company telephone number and your insurance document number with you at all times

If you are a UK resident, you can obtain a European Health Insurance Card, this entitles you to medical treatment that becomes necessary, at reduced cost or sometimes free, when temporarily visiting a European Union (EU) country, Iceland, Liechtenstein, Norway or Switzerland. You can apply on-line at https://www.ehic.org.uk/Internet/home.do (at least 6 weeks before departure)

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LOCAL KNOWLEDGE
Look up information, medical and otherwise on the area you will be travelling to and draw up a list of items you need to take (including medical kit). Be aware of the medical conditions you are likely to encounter and read up on them

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IMMUNISATIONS
Make sure you plan these well in advance, please make your first travel clinic appointment at least 8 weeks before you leave. Our Travel Form must be completed before you can book a Travel Clinic appointment. You can open the form using the link above or collect a copy from Reception

You may wish to contact MASTA (Medical Advisory Services for Travellers Abroad). For £3.99 you can obtain a personal travel schedule for every country on your trip, which will advise you about: recommended vaccinations, up to date alerts and warnings for each country including any disease outbreaks, and tailored travel advice for your trip. Bringing this report to your first travel consultation here will save a lot of time

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PERSONAL HEALTH
Make sure you have adequate supplies of any regular or intermittent medications you take. Have a full dental check up a couple of months before you go

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FIRST AID KIT
If you are travelling to remote areas where access to medical care is limited we strongly advise you to carry a medical kit appropriate to the nature of your trip. Sterile medical kits containing syringes, needles, IV giving set, sutures and dressings are available to purchase on the Internet and from some pharmacies

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AIR TRAVEL
To reduce the risk of Deep Vein Thrombosis 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

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DRINKING 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:

• Boiled water
  
• Bottled water or canned drinks (and drink them from the original container)
• Water treated by a sterilising agent (you can buy water purification tablets from a pharmacy)

This advice applies to ice cubes in drinks and water for cleaning your teeth

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FOOD SAFETY
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's stalls unless it is thoroughly cooked in front of you
• Alcohol! If you drink to excess, alcohol could lead you to become carefree and ignore these precautions

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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

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DIARRHOEA AND VOMITING
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 or drinking food and liquids contaminated by bacteria, viruses or parasites. Risk of illness is higher in some countries than others:

SUN SENSE
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 adequate Sun Protection Factor strength (SPF 15 minimum). Reapply often and always after swimming and washing. Read manufacturer's instructions
• Wear protective clothing - sun hats 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

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PERSONAL SAFETY
Leading causes of death in travellers are due to drowning and traffic accidents. You can help prevent them by following these precautionary guidelines:

• Avoid alcohol and food 1 hour 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

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SEXUAL HEALTH
Remember that unprotected sex can result in anything from Chlamydia to HIV. The Sun newspaper reported in July 2005 that a Syphilis outbreak in Manchester was quickly replicated in Amsterdam, Dublin, and Paris as a result of people jetting from place to place and having unprotected sex - everyone going on holiday should take condoms, don't leave it to chance, it's not worth the risk

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INSECT BITES
Mosquitoes, certain types of flies, ticks and bugs can transmit many different diseases. e.g. malaria, dengue fever, yellow fever. Some bite at night, but some during daytime. The main way to avoid illness is to avoid being bitten, where possible:

• If your 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 not effective
• Cover 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
• Report any unexplained illness with symptoms such as fever, headache, malaise, muscle aches and fatigue

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MALARIA
Malaria is probably the most common and most serious disease you will be exposed to when travelling.  Malaria is caused by a microscopic parasite transmitted by female mosquitoes when they take a blood meal at your expense.  Malaria usually starts as a fever and you will feel very unwell.  Other symptoms may include diarrhoea, headache or a cough.  In a malarious area, all illnesses with fever should be considered to be malaria until proved otherwise.  Seek medical help as soon as you can if you become ill

Check carefully the areas you plan to travel to and take anti-malarial tablets (prophylaxis) if advised by the travel-health nurse or doctor.  Some tablets can be bought over the counter in a chemist but others are only available on prescription.  Do not take over-the-counter tablets if prescription-only prophylaxis has been advised

You can get malaria even when taking prophylaxis, but this happens more commonly in individuals who forget to take one or more tablets.  It is essential that you take the tablets you are prescribed regularly and on time and for the whole of the recommended time after leaving a malarious area (sometimes for 4 weeks after)

Mosquitoes that transmit malaria bite mainly at night, but this can be any time from dusk onwards and even just after dawn.  Use insect repellent containing at least 35% DEET, wear long, loose clothing when possible and consider taking a mosquito net impregnated with permethrin to sleep and rest under.  These can be bought in outdoor/camping shops which stock a full range of products.  Do not rely on insect repellent and mosquito nets alone if you have been advised to take prophylaxis as well; all forms of protection are important

• Take adequate supplies of the antimalarial agent suited to your area of travel and remember to take it. People die every year from malaria in the UK
• Even with the best prophylaxis you may still catch malaria so have a high index of suspicion
• Report any unexplained illness with symptoms such as fever, headache, malaise, muscle aches and fatigue
• Malaria can occur up to two years after being bitten by an infected mosquito
• If you become unwell with fever up to a year after returning from a malarious area, see your GP and tell them you have travelled abroad

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TRAVELLERS TO HIGH ALTITUDE
Acute altitude sickness occurs when an individual who is accustomed to low altitudes rapidly climbs to high altitude (above 8,000 feet). Clinical features of mild altitude sickness are: headache, loss of appetite, nausea, fatigue, dizziness, insomnia, extremity oedema, dyspnoea, palpitations

The treatment for acute altitude sickness ranges from rest and analgesia, to oxygen therapy and descent. This booklet from Medex contains a great amount of useful information: Travel At High Altitude 4MB PDF booklet

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RABIES
Rabies is present in many parts of the world. If a person develops rabies death is 100% certain. There are 40,000 deaths worldwide every year from Rabies. Do not be complacent - do not touch any animal, particularly; dogs, cats, monkeys, bats. If you are travelling to remote areas, it is particularly important that you consider having the rabies vaccine before you travel

WHAT TO DO IF YOU ARE SCRATCHED OR BITTEN BY A MAMMAL IN A COUNTRY WHERE RABIES IS PRESENT

1. Vigorously clean wound with soap and running water for 10 minutes
2. Encourage the wound to bleed a little
3. Apply tincture of aqueous iodine solution if you have any, or 40% alcohol or stronger (e.g. whisky)
4. Obtain information about the animal concerned
5. SEEK MEDICAL HELP IMMEDIATELY (AT THE LATEST WITHIN 24 HOURS OF INJURY). If you have not been vaccinated you will probably require 5 injections plus an injection of rabies immunoglobulin. If you have been vaccinated you may still require 2 further injections within 48 hours
6. Do not allow the wound to be stitched unless absolutely necessary
7. It is vital that you complete the appropriate course of post-exposure treatment offered
8. Please report the incident back to Bradford Student Health Service on your return to the UK

An article in the British Medical Journal in September 2005 reported the case of a British woman who travelled to India. Whilst there she was bitten by a puppy, leaving a slight graze. She had not been vaccinated against Rabies, but thought nothing more about it and did not seek medical help. Three and a half months after returning to the UK she was admitted to hospital with severe shooting pains in her lower back and left leg. She was diagnosed with rabies and died after eighteen days in hospital

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VACCINE PREVENTABLE DISEASES

First of all, it is important to remember that no vaccine is 100% effective in everyone.  For this reason you need to take other precautions to avoid exposure to disease, such as taking care with food and water, avoiding animals and not using un-sterile medical equipment

You may wish to contact MASTA (Medical Advisory Services for Travellers Abroad). For £3.99 you can obtain a personal travel schedule for every country on your trip, which will advise you about: recommended vaccinations, up to date alerts and warnings for each country including any disease outbreaks, and tailored travel advice for your trip. Bringing this report to your first travel consultation here will save a lot of time

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PARASITES & OTHER DISEASES
Parasitic diseases are common in the local population in many travel destinations and although you should not worry, it is advisable to be aware of parasitic diseases and how they can be avoided

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WHEN YOU RETURN

Have you been travelling to tropical or sub-tropical countries over the summer? If so we strongly advise you to make an appointment with a Practice Nurse to arrange for a screening stool culture and a full blood count. This is to check that you haven't picked up any diseases or travelling companions. If you have been travelling and have returned feeling unwell, especially with an unexplained fever or prolonged diarrhoea you should make an appointment with a doctor

If you have been to Africa, South America or some parts of the Caribbean, and have been swimming in fresh water lakes and steams, you will need screening for Schistosomiasis. Make an appointment with a Practice Nurse 12 weeks after after your return

Maintain a high degree of suspicion of Malaria if you develop any flu-like illness (characterised by fever, headache, joint aches etc)

Travel occasionally brings some negative experiences. Please seek support for any unresolved issues from whomever you feel most comfortable with: friends / family / doctor or counselling services

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WEB SITE LINKS

TRAVEL HEALTH LINKS Aviation Health Institute www.aviation-health.org Centre for Infectious diseases - Travellers' Health www.cdc.gov/travel/ International Society of Travel Medicine www.istm.org/ Malaria Foundation International www.malaria.org/ Malaria Hotspots www.malariahotspots.co.uk/ MASTA Medical Advice Centres for Travellers Abroad www.masta-travel-health.com NOMAD Online travel shop including sterile medical kits Travel Health On-Line www.tripprep.com/ Travel Medicine www.travmed.com/ TravelTurtle www.travelturtle.co.uk/TravelHealthAdvice.aspx Tropical Medicine Bureau www.tmb.ie/

GOVERNMENT LINKS CIA World factbook www.odci.gov/cia/publications/factbook/index.html Department of Health Advice for Travellers www.doh.gov.uk/PolicyAndGuidance/healthadviceForTravellers Fit for Travel www.fitfortravel.scot.nhs.uk/ Foreign Office www.fco.gov.uk/ Health Protection Agency www.phls.co.uk/ NATHNAC (National Travel Health Network and Centre) www.nathnac.org/ The Meteorological Office www.met-office.gov.uk/ United Nations Web Site www.un.org/ WHO (World Health Organisation) www.who.int/ WHO Immunisation Schedules Country by Country www-nt.who.int/vaccines/globalsummary/pgs2000.cfm WHO Tropical Diseases Images & information www.who.int/tdr/media/image.html

HIGH ALTITUDE LINKS High Altitude Medicine www.high-altitude-medicine.com Himalayan Trekking Information http://trekinfo.com/index.html Oral contraceptives & high altitude www.thebmc.co.uk/world/mm/mm11.htm The British Mountaineering Council www.thebmc.co.uk/

DIVING LINKS Diving Diseases Research Centre www.ddrc.org/ Diving Medicine On Line www.scuba-doc.com/ PADI www.padi.com The Marine Conservation Society www.mcsuk.mcmail.com/ The Travel Doctor - Scuba page www.traveldoctor.co.uk/scuba.htm

GENERAL INTEREST LINKS Adventure Travel Information http://activetravel.about.com/travel/activetravel/?once=true& Insurance (cheap travel insurance policies for under 40s, can be done Via Internet & e-mail, as late as 24hrs before departure) www.leadedge.co.uk Lonely Planet On Line www.lonelyplanet.com/ National Geographic www.nationalgeographic.com/ Objective Travel Safety Ltd www.objectivegapsafety.com Travelmag - magazine www.travelmag.co.uk/ Wanderlust - magazine www.wanderlust.co.uk World Outdoor Web www.w-o-w.com/

MALARIA LINKS Malaria Prevention guidelines www.hpa.org.uk/cdph/issues/CDPHvol6/No3/6(3)p180-99.pdf Prophylaxis - long term traveller www.hpa.org.uk/cdph/issues/CDPHvol6/No3/6(3)p200-208.pdf Health Protection Agency www.hpa.org.uk/infections/topics_az/malaria/menu.htm

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Source: www.leedsstudentmedicalpractice.co.uk

NHS Direct 0845 46 47 www.nhsdirect.nhs.uk