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southmilfordsurgery

27/06/2017 - There is a national shortage of vaccinations for Hepatitis A and Typhoid. We do not currently have any stock of these and will not be able to vaccinate. Stock is not likely to be available until September. If you require these vaccinations local travel clinics may have stock and might be able to assist.

Local clinics

Superdrug - leeds

Masta - York

Boots - Leeds

For further information on specific countries and travel vaccinations visit Travel Health Pro or Fit for Travel. These will also give you lots of advice for reducing your risk of contracting any of these diseases when abroad.

PLEASE MAKE SURE YOU READ ALL OF THE INFORMATION BELOW BEFORE ATTENDING FOR AN APPOINTMENT

*please be aware that we are no longer a registered Yellow Fever vaccination centre. Please visit www.nathnac.org to find an alternative clinic.*

This page is intended to provide guidance for planning your foreign travel from a health perspective. It is relevant to students taking extended travel breaks, and going to remote areas, and 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 and 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!


BEFORE YOU LEAVE

IMMUNISATIONS Make sure you plan your travel vaccinations well in advance; you will generally need to start receiving immunisations at least 8 weeks before you depart.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

We are no longer a registered Yellow Fever Vaccination Centre,

HOW TO PLAN YOUR TRAVEL IMMUNISATIONS

STEP 1 – OBTAIN A FREE FIT FOR TRAVEL TRAVEL INFORMATION

To obtain any travel related vaccinations from South Milford Surgery you must obtain fit for travel information relating to the country you are visiting. It will advise you about: recommended vaccinations, give alerts and warnings for each country including any disease outbreaks. Click on the following link then on browse country information. Select the appropriate country and print out the sections. http://www.fitfortravel.nhs.uk/home.aspx

 

 

STEP 2 – DECIDE ON YOUR VACCINES

Your fit for travel information will tell you which vaccinations are mandatory, which ones are strongly recommended, and which ones you may wish to consider. IT IS UP TO YOU TO DECIDE WHICH VACCINES YOU WOULD LIKE TO HAVE

STEP 3 – PLAN YOUR VACCINATION SCHEDULE

3A – FREE NHS VACCINATIONS

Diphtheria, Tetanus, Polio, Typhoid (Spring 2013 - national shortage of Typhoid vaccine, it is not currently possible to guarantee vaccination), Hepatitis A and Cholera can all be obtained free of charge from your GP surgery. If you are a registered patient of South Milford Surgery and wish to book an appointment for any of these vaccines see step 5

3B – PRIVATE VACCINATIONS

All other vaccinations on your Fit for travel information are treated as private for travel purposes. If your fit for travel information recommends other vaccinations that we do not provide, you can obtain them from private providers such as:

MASTA   – Leeds, Moorfield Road, Yeadon, Leeds, LS19 7BN. Tel: 0330 100 4207 – Boots York, 43 Coney Street, York, North Yorkshire, YO1 9QR.    – York Travel Clinic, Priory Medical Centre, Cornlands Road, York, YO24 3WX. Tel: 0330 100 4325

City Doc at Superdrug - 31-35 Merrion Centre, Leeds, LS2 8NG. Tel: 0845 0260 830

Leeds Travel Health and Immunisation Service at Meanwood Health Centre - 548 Meanwood Road, Leeds LS6 4JN. Tel:0113 843 3375 -

STEP 4 – ANTIMALARIAL MEDICINES

Decide whether you need to take antimalarial medicine. Your fit for travel information will tell you what type of antimalarial medicine you need. If you are recommended to take Doxycycline, Malarone or Mefloquine these are only available from a private travel clinic (as detailed in Step 3B), a private website https://knowmalaria.com/ or by getting a private prescription from a GP. If you are a registered patient of South Milford Surgery and want to book an appointment for an antimalarial prescription see Step 5C. Anti-malarial treatment are always chargeable regardless of whether you normally get free prescriptions. Please note there is a charge of £11 for a private prescription

STEP 5 – BOOKING APPOINTMENTS FOR TRAVEL VACCINES AND ANTIMALARIALS AT SOUTH MILFORD SURGERY (REGISTERED PATIENTS ONLY )

5A – Fit for travel information

You must have a FIT FOR TRAVEL information in your possession in order for us to give you travel vaccinations or an antimalarial private prescription and you must bring it with you to the appointment

5B – APPOINTMENTS FOR FREE NHS TRAVEL VACCINES

If you require vaccination with: Diphtheria, Tetanus, Polio, Typhoid, Hepatitis A or Cholera, book a 10-minute travel immunisation appointment with a nurse. Bring the Fit for Travel information with you to the appointment - if you don't bring it we will not see you, and you will have to book another appointment to attend with the travel information.

Print our Travel Checklist to help organise your vaccinations and save time

5C – APPOINTMENTS FOR PRESCRIPTION ONLY ANTIMALARIAL MEDICINES

View our Malaria Prophylaxis page which contains prices and sources for all antimalarial medicines. You can get prescription only antimalarial medicines from a private travel clinic (as listed in Step 3B), which may be the best option if you are attending there anyway for private vaccinations or the know malaria website https://knowmalaria.com/. Over the counter anti-malarial medicines can be obtained from pharmacies and usually private travel clinics. If you want us to give you a private prescription for Doxycycline, Malarone or Mefloquine, make a 10-minute appointment with a doctor at South Milford Surgery for this prescription. Bring the FIt for Travel information with you to the appointment - if you don't bring it we will not be able to see you, and you will have to book another appointment to attend with the Fit for Travel information.

Download and print our Travel Handout to help organise your vaccinations and save time

5D – APPOINTMENTS FOR YELLOW FEVER VACCINE

South Milford Surgery is no longer a registered Yellow Fever centre. Please visit http://www.nathnac.org/yellowfevercentres.aspx?comingfrom=travel for details of the nearest clinics.

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 least 6 weeks before departure)

 

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

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.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

FIRST AID KIT

 

Put together a medical kit appropriate to the nature of your trip. See our Medical Kit for Travellers page

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

KEEPING HEALTHY WHEN ABROAD

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

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

SWIMMING

If swimming in fresh water lakes and rivers in Africa, Latin America and South-East Asia you are at risk of contracting Schistosomiasis. The best advice is to avoid swimming in freshwater lakes or rivers, or if you do, you need a blood test 12 weeks after returning from your trip. (In 2011 we had 15 cases in 6 months)

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

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

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

  • High risk areas include North Africa, sub-Saharan Africa, the Indian Subcontinent, South East 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 to 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 re-hydration. In severe cases and particularly in young children and the elderly, commercially prepared re-hydration solution is 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 short term relief for adults (e.g. for a bus or train journey or flight) 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 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

In very special circumstances, antibiotics are used for diarrhoea, but this decision should only be made by a doctor (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)

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

Why factor 15?

The reason experts recommend factor 15, is that this represents the best balance between protection and price. You will get over 90 per cent protection from UVB rays with SPF 15. But no sunscreen, no matter how high the factor, can offer 100 per cent protection

When Buying sunscreen:

  • Choose one with an SPF of 15 or above - this will give you over 90% protection
  • Make sure it is labelled 'broad spectrum' - to protect against UVA and UVB
  • Choose water resistant - it is less likely to wash or be sweated off
  • Check the 'use by' date - most sunscreens have a shelf life of 2-3 years
  • You don't have to pay for expensive brands. All types are tested and the cheaper brands are just as effective if used properly - just remember factor 15+

Tips for using sunscreen properly:

  • Try to apply it 15-30 minutes before going out in the sun
  • Apply to clean, dry skin and rub in only lightly
  • Use generous amounts
  • Re-apply once outside to ensure even coverage
  • Then re-apply every 2 hours or more frequently if washed, rubbed or sweated off
  • Put on before make-up, moisturiser, insect repellent, and so on
  • Never use it to spend longer in the sun - this will put you at risk of sun damage that could lead to skin cancer
  • In hotter climates and hotter days in the UK avoid direct sun exposure between 11am and 3pm
  • Take special care of children and those with pale skin / red hair
  • Use SPF 60 on any areas of recent scarring / skin damage
  • You can get severe sunburn in the UK
  • Do not store sunscreens in very hot places as extreme heat can ruin their protective chemicals

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

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

PSYCHOLOGICAL SUPPORT

Medical Students - On your elective you may have many new and sometimes distressing experiences including helplessness and frustration witnessing preventable deaths. You may experience significant culture shock and have difficulty adjusting on your return to the UK. It is important to prepare for this and also to ask for help from peers, colleagues, counselling services or doctor if needed

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 from some pharmacies. In addition we suggest that you also consider taking the items detailed on our Medical Kit For Travellers page

 

 


INSECTS, MALARIA, & ALTITUDE

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

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.  There are four species of malaria parasite, of which Plasmodium falciparum is the most dangerous and can lead to cerebral malaria and death

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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

View the Malaria Prophylaxis page which contains prices and sources for all anti-malarial medicines

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

Extreme altitude sickness can be fatal. It is advised that climbers should acclimatise if climbing to high altitude:

  • If above 10,000 feet, no more than 1000 feet should be climbed per 24 hour period
  • If a climber develops symptoms of mild altitude sickness then he/she should rest for 24 hours at that altitude
  • If a climber has more severe symptoms then he/she must descend to the last altitude at which they felt well. This should occur whether or not they are using medication prescribed to help cope with high altitude

The following preventative measures should be utilised:

  • Slow ascent e.g. once over 8000ft (2500m) avoid sleeping more than1000ft (300m) higher than previous day
  • Keep warm
  • Keep well hydrated and avoid alcohol
  • High carbohydrate diet
  • Modest exercise on acclimatising days

Download Travel At High Altitude 4MB PDF booklet by Medex

 

 


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

CHOLERA

 

A serious bacterial disease, mainly water-borne, with a high mortality rate if untreated.  It causes profuse watery diarrhoea and death can occur rapidly due to dehydration.  Cholera epidemics are most common in refugee camps or disaster zones.  Relief or disaster aid workers should consider requesting the vaccine

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

DIPHTHERIA

 

A bacterial disease spread by droplets and contact with articles from infected people.  It causes a disease affecting your respiratory system.  Check you have had your childhood vaccinations, and if it is more than 10 years since your last vaccination, you can have a combined polio, diphtheria and tetanus vaccine booster

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

HEPATITIS A

 

A viral infection spread through contaminated food or water.  It is highly contagious and is the most common vaccine-preventable disease in travellers.  Symptoms include fever, nausea, vomiting, dark-coloured urine and jaundice.  A single dose of vaccine followed by a booster 6 to 12 months later will give you an estimated 25 years protection. You can reduce your risk by following the advice in the drinking water and food sections above

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

HEPATITIS B, C AND HIV INFECTION

These diseases can be transmitted by:

  • Blood transfusion
  • Medical procedures with non sterile equipment
  • Sharing of needles (e.g. tattooing, body piercing, acupuncture and drug abuse)
  • Sexual contact (this will also put you at risk of other sexually transmitted diseases)

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

Hepatitis B is one hundred times more infectious than HIV, and is a leading cause of liver cancer.  Even if you are vaccinated, take precautions to avoid exposure to the virus.  Consider taking a sterile medical pack with you in case of emergencies

JAPANESE B ENCEPHALITIS

A mosquito-borne viral disease found in rural areas of South-East Asia and the Far East; especially where rice growing and pig farming co-exist.  The risk of infection is greatest during and just after the rainy season.  Most cases of the disease go unnoticed but about 1 in 250 cases becomes clinically apparent and in these individuals the disease can lead to severe encephalitis with permanent brain damage or even death. The Japanese B encephalitis vaccine is a course of 2 injections given over 1 month (with an optional booster after 3 years)

MENINGITIS

 

Meningitis ACWY is a vaccine against 4 strains of the meningococcal bacterium found in Africa and some parts of Asia, especially India.  Meningococcal infection can affect your brain (meningitis) or your blood (septicaemia) or both.  The vaccine is particularly recommended for those travelling on public transport or living in crowded conditions or working closely with the local population.  A vaccination certificate is required for all travellers to the Hajj or for the Umrah.  A single dose of vaccine provides 3-5 years protection

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

POLIO

 

A viral disease caused by on of three serotypes of polio virus.  If infected, meningitis or paralysis may occur.  Some countries, especially in West Africa, now have outbreaks of polio following a cessation of the vaccination programme in Nigeria.  Check you have had your childhood vaccinations, and if it is more than 10 years since your last vaccination, you can have a combined polio, diphtheria and tetanus vaccine booster

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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 getting vaccinated against rabies 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 South Milford Surgery 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

SWINE FLU

There are still cases of Swine Flu (Influenza A) being reported in the Southern Hemisphere. If you are travelling to this area we recommend you receive vaccination against Swine Flu

TETANUS

A disease caused by the toxin of a bacterium present in soil or manure which may enter the body through a wound, burn or scratch.  The disease leads to muscle stiffness which usually involves the jaw (lockjaw) and can cause death.  If it is more than 10 years since your last tetanus vaccination, you can have a combined polio, diphtheria and tetanus vaccine booster

TICK-BORNE ENCEPHALITIS

As the name suggests, is spread by ticks.  However, it can also be acquired by consuming unpasteurised dairy products from infected animals, especially goats.  It is a viral disease which occurs mostly in the summer months in forested areas of Central and Eastern Europe and Scandinavia.  In most cases, the infection has no symptoms.  In the 10% of people where symptoms develop they usually have a flu-like illness with severe headache, joint stiffness and confusion.  These symptoms usually resolve, but in 10% of these cases a second phase of fever occurs which leads to encephalitis and may result in paralysis, seizures or death

Avoid contact with ticks by wearing long trousers, avoid long grass and undergrowth if possible and use insect repellent containing at least 50% DEET.  Only 1-2% of ticks are likely to be carrying the virus, but if you find any ticks attached to your skin (check armpits, groin and navel regularly) remove them by grasping with tweezers or fingers, holding as close to your skin as possible, and pull gently and consistently until the tick comes away. If the mouthparts remain stuck in your skin, remove them as soon as possible

Vaccination is recommended if you will be spending long periods in infected areas or if you will be camping or working in forests, especially during the summer.  The tick-borne encephalitis vaccine is a course of 3 injections given over 3 weeks

TUBERCULOSIS (TB)

 

A bacterial disease spread through cough and sneeze droplets.  Although it may affect any part of the body, most commonly it affects the lungs.  It occurs in many parts of the world and you can acquire the disease through close contact with an infected person, such as living in the same household.  The BCG vaccine is not believed to give very good protection against TB so if you have a persistent cough when you return (or during your trip if you are travelling for some time) seek medical attention.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

TYPHOID FEVER

 

A bacterial disease spread through contaminated food and water and can cause serious disease, the symptoms of which start with diarrhoea and vomiting.  The fatality rate is as high as 20% in untreated cases (1% with prompt antibiotic therapy).  In endemic areas, take care with your food and water even if you have been vaccinated.  A single dose of vaccine lasts for 3 years. You can reduce your risk by following the advice in the drinking water and food sections above

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

YELLOW FEVER A virus carried by the Aedes mosquito, which bite during the day.  It is a serious and sometimes fatal disease which occurs in many parts of sub-Saharan Africa and Central and South America.  Some countries will not let you enter without a valid International Certificate of Vaccination.  You must be vaccinated at least 10 days before travel

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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 some of these diseases and how they can be avoided

DENGUE FEVER

 

Prevalence: Common in many parts of the tropics

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Dengue fever is caused by one of four virus serotypes which are spread by Aedes species of mosquito.  These mosquitoes bite during the day.  The epidemics of dengue fever are often seasonal, during or just after rainy seasons.  Check the NATHNAC link for current outbreaks

Symptoms come on very suddenly, with fever, severe headache, and muscle and joint pains, with a rash typically developing after 3-5 days.  Nausea, vomiting and diarrhoea are also common.  The acute phase usually lasts a week, and although serious complications are uncommon, post-viral fatigue syndrome is common, so take it easy for a few weeks if you can. Rarely, dengue fever can develop into a more serious form, called dengue haemorrhagic fever, which in turn can lead to dengue shock syndrome, which can be fatal.  The haemorrhagic form occurs more commonly in subsequent attacks with a different serotype of dengue virus

Treatment is symptomatic: keep your fluid intake up (not alcohol!) so that you don’t dehydrate, and pain should be relieved with paracetamol, not aspirin or ibuprofen.  Hospital care is indicated in severe illness or if complications occur

Diagnosis is usually made clinically.  Self-diagnosis of dengue in a malarious area could be very dangerous – All illnesses with fever should be considered to be malaria until proven otherwise. In places with good medical facilities a blood test can be done at 8 days after the onset of fever to confirm the diagnosis.  It can be useful if you are a long-term or recurrent traveller to know if you have had dengue as subsequent episodes should be monitored more closely for complications

Prevention, as with all insect-borne diseases, is by using insect repellent (containing DEET), covering up with clothing where possible and sleeping/resting under a mosquito net impregnated with permethrin

AFRICAN TRYPANOSOMIASIS (sleeping sickness)

Prevalence: Patchy distribution in sub-Saharan Africa

African trypanosomiasis is a potentially lethal disease caused by a microscopic parasite spread by tsetse flies.  These flies are large, brown and give a painful bite, often resulting in a boil on the skin if the fly is carrying the parasite.  In different parts of Africa the flies favour either shady riverside habitats or the bases of tree trunks in the savannah regions.  An important feature of the disease is swollen glands, especially on the neck, accompanied by fever, headaches and joint pain.  Use insect repellent (50% DEET) and wear long, loose clothing to prevent being bitten by tsetse flies

SOUTH AMERICAN TRYPANOSOMIASIS (Chagas’ disease)

Prevalence: Mexico, Central and South America

South American trypanosomiasis is transmitted by ‘kissing bugs’ that feed by sucking blood when you are asleep, often from your face.  Parasites are passed out of the bug not in saliva but in faeces, and you become infected if you scratch the bite and rub the faeces into the wound.  The bite is surprisingly painless even though the bug may feed for more than 10 minutes.  The bugs typically live in the cracks of mud huts or in thatched roofs, but they also live behind furniture and pictures on the wall.  The disease is serious in that, if undiagnosed or untreated in the acute phase (the first few weeks), damage to the heart and digestive system is irreversible and can lead to health problems in the future.  It is strongly advised that you do not sleep in rural dwellings in Latin America without an insecticide-treated bed net, and make sure you tuck it under your mattress!

LEISHMANIASIS

Prevalence: Patchy distribution worldwide

Leishmaniasis embraces a range of diseases caused by different types of microscopic parasites and they occur in many countries of the world.  All are spread by sandflies, which are smaller than mosquitoes and are quite hairy

  • The most serious is visceral leishmaniasis, which can be lethal if untreated.  Symptoms include fever, anaemia, weight loss, and enlarged liver and spleen
  • Less serious is mucocutaneous leishmaniasis, only present in Central and South America, which causes a skin ulcer and spreads to disfigure the nose and throat
  • Least serious is cutaneous leishmaniasis which causes self-healing ulcers, often leaving a scar

Sandflies bite from dusk throughout the night and insect repellent should be used.  If you are going to a known endemic area, consider buying a sandfly net, which is a finer mesh than a mosquito net and will keep out sandflies.  Make sure it is insecticide-impregnated every 6 months with permethrin.  If you develop a skin ulcer that persists, or the symptoms of visceral leishmaniasis, seek medical attention

ONCHOCERCIASIS (River Blindness)

Prevalence: Patchy distribution in equatorial Africa and equatorial Latin America

Onchocerciasis is a chronic disease caused by small parasitic worms which are transmitted by the bite of black flies which live near rivers.  The worms take up residence in your skin, producing itchy skin and nodules.  They also show a preference for the eye but blindness only occurs after many years of infection.  If you are concerned see a doctor on your return

LYMPHATIC FILARIASIS

Prevalence: South-East Asia, India, Equatorial Africa, some parts of Latin America

Lymphatic filariasis is a parasitic infection which initially causes fever and inflammation of the skin.  When chronic the disease affects the lymphatic system which results in swelling, usually of the legs.  It occurs mainly in the least developed countries of the world and usually travellers are not at high risk.  The parasitic worms are spread by mosquitoes which bite at night, so use a good insect repellent containing DEET and an insecticide-treated mosquito net

PLAGUE

Prevalence: Isolated foci in Africa, Asia and Latin America.

Plague is rare.  It is spread through the bite of infected rodent fleas.  Don’t lose any sleep about this but use insect repellent (containing DEET) if you are staying in very rough, rural housing.  If you develop a large, red, painful boil in your groin or armpit, see a doctor soon

LEPTOSPIROSIS

 

Prevalence: Worldwide distribution

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Leptospirosis is a bacterial disease spread through animal urine, usually from the rat.  It can be lethal but unless you will be working in sewers you will probably be at low risk of the disease.  However, if you are working in rural areas or shanty towns, especially in the rainy season, don’t mess about in the flood water and cover any cuts and grazes with waterproof dressings

SOIL-MEDIATED PARASITIC WORMS

Prevalence: Very common in the tropics

Be aware of washing your hands before you eat and don’t go barefoot as some worms will penetrate your skin.  See your GP if you have any intestinal symptoms that continue on your return to the UK, and let them know where you have travelled to

CUTANEOUS LARVA MIGRANS

Prevalence: Southeast Asia, Latin America, and the Caribbean basin

Cutaneous larva migrans is a characteristic itchy creeping skin eruption, usually of the foot. It is due most commonly to a dog or pig hookworm, passed in faeces. The worm can enter your skin when walking barefoot in sand or dirt in the tropics. Treatment is by medication (even though this is a self-limiting disease with the larva dying and the lesions resolving - but this can take from 4 weeks to 1 year)

MYIASIS

Prevalence: Worldwide distribution

A rather unpleasant boil with a little surprise in store. The Bot fly lays an egg under the skin and the larva feasts on your subcutaneous tissues. A reactive boil forms but the larva has formidable hooks which allow it to prevent efforts to removal by squeezing it out. The technique for removal is to coat the area in a thick layer of Vaseline and wait for it to come up for air, whereupon it can be grabbed!

RIFT VALLEY FEVER Prevalence: Kenya, Tanzania and Somalia

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Rift Valley Fever is a viral disease primarily affecting domestic animals including cattle, sheep and goats.  It can be transmitted to humans via mosquito bites or through contact with body fluids (including milk) and meat of infected animals.  The majority of cases experience a brief flu-like illness but the disease can progress and become fatal.  Avoid insect bites using insect repellent (containing DEET), long, loose clothing and consider buying a bed-net impregnated with insecticide.  Boil fresh milk, cook meat thoroughly and avoid direct contact with raw meat.

CHIKUNGUNYA VIRUS

Prevalence: India, Sri Lanka, Indian Ocean Islands, Africa

Chikungunya Virus, like Dengue Fever, is spread by day-biting Aedes mosquitoes.  The illness presents as rapid onset on joint pains, muscle pain, high fever, conjunctivitis and rash.  Avoid mosquito bites by using DEET insect repellent, long, loose clothing and consider buying a bed-net impregnated with insecticide

SCHISTOSOMIASIS (Bilharzia)

Prevalence: Africa (90% of cases), some parts of Latin America and South-East Asia

Schistosomiasis is a disease caused by blood flukes acquired when wading or swimming in infested fresh water lakes and streams.  When you are in the water, microscopic parasites burrow through your skin and migrate through your body until they come to their final destination in the veins of the bowel or bladder.  Light infections may pass unnoticed but more severe infections may cause blood in the urine or faeces, together with other symptoms. Avoid swimming in freshwater lakes or rivers, or if you do, request a blood test 12 weeks after returning from your trip. In addition It is wise never to go barefoot, but to wear protective footwear when out, even on the beach. Other diseases and parasites can be caught from sand and soil, particularly wet soil

 

 


WHEN YOU RETURN

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 South-East Asia, and have been swimming in fresh water lakes and streams, you will need screening for Schistosomiasis. Make an appointment with a practice nurse 12 weeks 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

 


LINKS TO RELEVANT WEB SITES

The following links to web sites are for your interest and assistance, however LSMP personnel may not be familiar with all the content of these sites and we may not agree with or endorse the views contained within them. When you select one of the links below you will open the new site in this existing window. You can hit the Back button in your Internet browser to return here, or select this site from the Address drop-down list

 

 

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/ (This has a travel clinic directory and has a list of most countries with names and contact details of health providers who speak English and other languages)

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

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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