Category Archives: Travel Health Tips

Travel Health Tips – Update

Travel Health Tips – Update

Insect repellents

The optimal concentration of D.E.E.T. (N,N-diethyl – 3 – methylbenzamide) is 20 to 50%. It must be freshly applied every 6 hours. CAUTION: children and pregnant women should not use concentrations higher than 20 or 25%. Especially with children there have been seen serious side effects ( convulsions). Experts advise to wash off any D.E.E.T. when there is no longer need for protection. Your best option for protection during the night is a mosquito net: and little children are best kept under the net from sunset till the sun come up again.

Travel Health Tips Sun blocks

Studies show that D.E.E.T. reduces the effects of sun protecting crèmes. The protecting crèmes however do not influence the insect repellent working of D.E.E.T. So the repellent can be administered together with the sun block, but it is advised to take a sun product with a higher level of protection.

The application of sun block is best done 15 to 30 minutes before getting into the sun en has to be repeated every two hours or after swimming or excessive sweating. The mentioned protection is only assured if enough of the product is applied. Once you have been burned by the sun there is no proven treatment that will speed up recovery!

Travel Health Tips Heat stroke

Some medication can actually worsen the effect of a very hot period. These medications are typically the ones that influence thermoregulation and sweating. Patients taking this kind of medication are advised to consult with their physician in the event of an announced heat wave. Alcohol and drugs like cocaine or ecstasy are known to aggravate the heat stroke symptoms.

Travel Health Tips Animals

Some useful info on snakebites, spider bites scorpion bites can be found on Bites 

Some other useful sites: 

World Health Organisation : International Travel and Health document by the World Health Organisation 

Federation of American Scientists : Website of the Federation of American Scientists with recent info on epidemics (‘outbrake news’ ) and emerging diseases ( ‘emerging diseases’) 

US Department of State section ‘Travel Publications’ Website of the US Department of State 

Notice

The editors of this work have checked with reliable sources in their efforts to provide information that is complete and generally in accord with the standards accepted at the time of publication. In the view of possible human error or changes in the medical sciences, neither the editor nor the publisher nor any another party who has been involved in the preparation or publication of this work warrants that the information contained herein is in every respect accurate or complete. They are not responsible for any errors or omissions or the results obtained from such information.

Travel Health: Vaccinations

Preferably start 6 weeks before departure

Keep a photocopy of your official “yellow vaccination booklet” at home !!

1. YELLOW FEVER

This deadly viral infection – transmitted by mosquitoes that bite during day time – occurs only in some countries of South-America and Africa. There is no medication against yellow fever, but there is a very effective vaccine that is well tolerated.

One injection in the arm – (price € 12.00) offers a protection for 100% during ten years. In 2 to 5 p.c. of the cases a slight influenza-like reaction may occur after a few days or up to a week after vaccination (take paracetamol if this happens).

Allergic reactions are very rare. However, during the last years life-threatening side effects have been reported very exceptionally and only at the first vaccination and in persons older than 65 years.

The extremely low risk, linked to the vaccine, never outweighs the risk of acquiring yellow fever in these endemic areas. It is the only disease for which a certificate (“yellow booklet”) is required of the traveller going to or coming from areas in which yellow fever occurs. 

A vaccination can only be obtained in centres that are recognised by the National Administration of Public Health. Children are vaccinated from the age of one, in exceptional cases from the age of 6 months.

The vaccine is usually not administered to pregnant women neither to immunosuppressive people; for them it is not recommended to travel to countries endemic to yellow fever.

2. TETANUS AND DIPHTERIA

Travel preparations are an ideal time to update your tetanus and diphtheria vaccinations. For most people and certainly for young people, a booster every ten years is sufficient (Tedivax pro Adulto. € 5.32).

If the last injection dates back to over 20 years, two injections with an interval of 6 months are recommended. If there are any doubts as to the completeness of the earlier inoculation, the schedule consists of two injections with a 1-month interval, followed by a third injection after one year.

3. POLIO

Since 1965 most citizens of developed countries have been vaccinated against polio (using an oral vaccine (Sabin®), since 2001 an injection). In most cases the inoculation ensures lifelong protection.

In contrast however, the disease is still prevalent in developing countries. Therefore, it is important that a booster should be considered before a short or long trip in less hygienically conditions.

Only one subsequent booster injection is required in case a complete vaccination cycle has been given before.

4. HEPATITIS A (JAUNDICE)

Hepatitis A is a contagious liver disease that is transmitted through food, drinks, or objects that have been contaminated either directly or indirectly with faeces.

Although hepatitis A is usually quite a mild disease, its evolution can sometimes be very slow. In the industrialised countries, the risk of infection is very low because of the high level of hygiene.

In developing countries the risk of infection is high, especially for people who go on adventure trips, or individuals undertaking a trip lasting over three weeks. Hepatitis A vaccination is recommended by the WHO for travellers to Africa, Latin America and Asia.

Individuals who have had the disease acquire a lifelong immunity and thus do not need vaccination. (This should be confirmed by a laboratory test). However, antibody screening after vaccination is absolutely not warranted.

Epaxal®, Havrix® : – after one injection there is nearly 100% protection for at least one year – after a 2° injection after 6 to 12 months, protection will be extended to at least 20 years, maybe lifelong validity – the price per dose : Epaxal® 39 € (from the age of 2 years); Havrix® € 45.66 (adults) and Havrix Junior® € 30.04 (1-15 years) (2x), these vaccines can be used together in one vaccination scheme

If vaccination against Hepatitis B is recommended (see below), a combination vaccine is used (Twinrix® : 3 injections : adults € 45.84 per dose, children up to 15 years € 30.24 per dose).

5. TYPHOID FEVER

Typhoid fever is a serious infection accompanied by high fever. Its transmission occurs through the intake of contaminated food or water.

Again, strict precautionary measures in order to prevent diarrhoea are important. The risk of infection is fairly low (and much lower than the risk of a hepatitis A infection), the risk is highest in Northern and Northwestern Africa, India and Peru.

Vaccination protects about 60-70% for three years and is recommended for all adventure journeys or those lasting for three weeks or more.

6. CHOLERA

Cholera is characterised by frequent watery stools which may cause rapid dehydration. Cholera is a disease which affects deprived people living in poor hygienic conditions and who are usually suffering from malnutrition.

However, for the healthy traveller who applies the preventive measures for diarrhoea mentioned above, the risk is as good as non-existent, even when travelling in an area where a cholera epidemic is occurring.

However, as the vaccine is not very efficient and often causes side effects, it was decided to discontinue its further use. Some African countries still require a vaccination certificate.

In order to avoid problems at frontier borders, such a certificate may be useful and can be provided by your doctor.

7. HEPATITIS B

(Engerix®B, HBVAXPRO® : € 28.98/dose, children up to 15 years € 17.42/dose , 3 injections, on day 1-30-180, or 4 injections on day 1-7-21-360) (Twinrix®: 3 injections : adults € 45.84 per dose, children up to 15 years € 30.24 per dose)

In principle a lifelong protection after a full vaccination is possible, though a check-up of antibody titre after 10 years is recommended. Vaccination is recommended :

(1) For people who frequently travel to Asia, Latin America and Africa, or stay there longer than 3-6 months, also for children who will be staying there (infection through direct or indirect contact with mucous membrane, eye membrane and skin lesions);

(2) For travellers (a) who may have sexual contacts or (b) may have to undergo medical or dental operations abroad; (c) also the adventurous traveller or the traveller who will practise dangerous sports activities, who are at risk of trauma and medical care in a hospital in poor hygienic conditions;

(3) In Europe Hepatitis B vaccination is (a) strongly recommended (if not mandatory) to people that are at risk through their profession; recently (b) it has also become part of the basic vaccination schedule for infants, children and adolescents.

8. MENINGITIS CAUSED BY MENINGOCOCCI A,C,W,Y (€ 27.79; 1 injection, booster every 3 years).

Vaccination is indicated for travellers to countries in the African sub-Saharan belt, who will be living in close contact with the local population (i.e. travelling by public transport, sleeping in local guesthouses, migrants who are travelling to their country of origin and who will be staying there with family members), or who will be staying there for more than 4 weeks.

Vaccination is mandatory for pilgrims to Mecca (should be administered ten days before departure).

9. RABIES (€ 19.63 X 3) 3 injections, on day 1,7,21 or 28; booster after 1 year and then every 5 years (map see further : http://www.who.int/ith/chapter05_m10_rabies.html

10. Japanese Encephalitis (Far East) (€ 53.30 X 3) 3 injections, on day 1,7,28; booster after 3 years – map : http://www.who.int/ith/chapter05_m07_japencepha.html

11. European tick-borne Encephalitis (€ 34.5; 3X); Measles-Mumps-Rubella; Influenza; Pneumococcal; TB)

CAUTION: The information provided here should not be used during any medical emergency or for the diagnosis or for the treatment of any medical condition. A licensed physician should be consulted for any and all medical conditions. Call 911 for all medical emergencies.

More Travel Health Tips

  • Make sure you leave in good health. Pay a visit to your dentist for a dental check-up before leaving. 
  • Any medication is only available on doctor’s prescription. 
  • It is essential to take out a good travel assistance insurance. Take your blood group card with you. 
  • Information concerning the safety in the country of destination: http://travel.state.gov/
  • Safety criteria in traffic should not be any different from those at home (this certainly applies to the use of alcohol) and always use the seatbelt in the car (if present). 
  • Sunburn : sunbaths should be absolutely taken with moderation. Protective clothing and head covering are recommended. On the uncovered skin parts one should put regularly and carefully suncream with a high protective factor. 
  • Problems that frequently occur with travellers in developing countries are wound infections and ulcers. Every wound, no matter how small, should be thoroughly washed and disinfected, followed by the application of a strong disinfectant cream. 
  • Other issues you may wish to discuss with your doctor are : travel sickness (car sickness, etc.), skin care, heat and sun exposure, sunburn, minor wounds and injuries, bites and stings, problems related to air-travel : aero-otitis and aero-sinusitis, jet lag, altitude, problems of altitude sickness, contraception, diving, travelling with children, travelling when pregnant, travelling with chronic illness. 
  • Dengue.

    Dengue fever, a viral infection transmitted by mosquitoes which are active in the day time, is quite common in Latin America and Asia. The disease is characterised by fever and violent muscle pains.

    Dramatic evolution with blood pressure fall and hemorrhages very seldom occur, but when treated correctly, the outcome will practically always be favourable. There is no vaccine nor effective medication available. Recovery is spontaneous, but can take very long.

    Do not take aspirins, but only paracetamol for lowering the fever.

    Rabies

  •  In many countries rabies still exists. Avoid contact with stray dogs, (tame) wild animals and road kills. When bitten by an animal, wash out the wound with water and soap, and disinfect with isobetadine.

  • Do not delay consulting a doctor to see whether or not vaccination (with gamma globulin) is necessary. See map : http://www.who.int/ 

  • Schistosomiasis (Bilharziasis) is a worm infestation that may be contracted by swimming or bathing in contaminated water. It occurs in the major part of Africa and in limited areas of South America and the Near and Far East.

    Stagnant water offers the greatest risk (especially in dams), though contamination may also occur in rivers (large or small, fast- or slow running water). There is no available vaccine, so bathing or swimming in fresh water should be avoided.

    However, if you do swim in potentially contaminated water, a check-up is necessary after 3 months (serology, eosinophily). Rarely serious complications may occur within the first months post-exposure (blood in the urine, paralysis), in which case you should immediately consult a medical doctor.

  • It may sometimes be useful to get some sterile needles from your local pharmacist in case you should need an injection on your journey. It is important to refuse injections if the medications can be taken orally.

  • It may be that your trip will require other specific vaccinations or preventive measures. Your doctor will inform you about these.

(source: Prince Leopold Institute of Tropical Medicine , Antwerp, Belgium)

 

Notice

 

The editors of this work have checked with reliable sources in their efforts to provide information that is complete and generally in accord with the standards accepted at the time of publication. In the view of possible human error or changes in the medical sciences, neither the editor nor the publisher nor any another party who has been involved in the preparation or publication of this work warrants that the information contained herein is in every respect accurate or complete. They are not responsible for any errors or omissions or the results obtained from such information.

 

Travel Health

Travel Health: Useful medical information for good health before your departure, during your trip and after your return.

The diseases most commonly seen in travellers are diarrhoea, malaria (if you travel in a malaria-infested area), accidents (when travelling by car or swimming), wound infections and sexually transmitted diseases.

– Diarrhoea is caused by contaminated food and drinking-water. You must therefore be careful if your are travelling in poor hygiene conditions.

– Malaria is transmitted by mosquitoes, so the first thing to do is to protect yourself against these mosquitoes.

– In order to prevent accidents during travelling, it is wise to apply the same precautions as those taken at home. In addition, it is very important that all wounds should be thoroughly disinfected in order to avoid infection.

  • [Travel health]TRAVELLER’S DIARRHOEA
    • Many intestinal infections are attributable to infections picked up by mouth or hands. With a little care most of these illnesses can be prevented. Hepatitis A, typhoid fever, polio and cholera still occur in countries with poor hygiene, but these diseases are easily prevented.

      However, the chance is rather large that you will still contract a light and/or nondangerous form of traveller’s diarrhoea. Traveller’s diarrhoea almost always spontaneously clears up after a few days, but can nevertheless be irritating. And a rsik to your overall and travel health.

      In the first place measures must be taken against dehydration. Likewise, treatment of the symptoms must be considered in order to reduce the number of bowel movements and relieve other symptoms such as fever, vomiting and stomach cramps.

      Sometimes a more serious form of diarrhoea occurs, for which specific treatment with antibiotics is indicated or where hospitalisation or fluid replacement appears unavoidable.

      It takes only a few basic preventive measures to make your trip a success : Total prevention of traveller’s diarrhoea is impossible and it is obvious that preventive measures can seldom be strictly followed at all times. But following preventive measures do significantly reduce the risk of contracting serious diarrhoea:

      In order to maintain good travel health wash your hands before eating and avoid (if possible) :

      – raw vegetables and fruits that you have not peeled yourself – uncooked or unpasteurized dairy products – insufficiently cooked sea foods (+ Hepatitis A !) and meat – “local meals” which do not smell fresh – ice-cream bought from street merchants (industrial ice straight from the deep-freeze is probably safe).

      Cooked meals should be served hot. The place where you eat is also important. A meal taken from a stall presents a greater risk than a meal taken in a restaurant. Avoid restaurants where there are a lot of insects.

      Avoid tap water and ice-cubes. Bottled water and soft drinks are safe. Watch out for bottle caps that have already been used.

      It is very important to disinfect drinking-water on adventure trips. Total sterilisation of drinking water is impossible.

      The following measures considerably reduce the contamination risk and safeguard your travel health: – Boiling the water is very effective. – A good alternative is chemical disinfection with chlorine drops (e.g. Hadex®, Drinkwell chloor®; available in sport shops specialized in outdoor activities) or chlorine tablets (Certisil Combina®; chloramine tablets; available at the pharmacy). Their effect can be improved by first filtering unclear water. Silver salts (Micropur®, Certisil Argento®) are not very suitable to disinfect water, but they keep disinfected water germ-free for a long time.

      For adventurous travellers conscious to travel health it is best to buy a portable water-filter. The use of antibiotics in order to prevent diarrhoea before it occurs can be dangerous + Also the use of other preventive medications is not recommended.

      [Travel health]How to treat diarrhoea? 

      It is extremely important to consume sufficient liquid and salt in order to prevent dehydration. You can do this by taking salt solutions, but tea with lemon, broth, soft drinks and fruit juice, supplemented with salt crackers are tastier.

      Commercial salt products are available on the market (ORS-solution).

      Taking an anti-diarrhoea preparation (loperamide, e.g. Imodium®) can greatly reduce the number of bowel movements, with a considerable reduction of the complaints as a result. Imodium® may only be used by adults and older children and only for treating ordinary watery diarrhoea: 1 capsule after every loose movement up to a maximum of 4 per day.

      Antibiotics are indicated :

      1. If blood, mucus or pus are present in the stools.

      2. If after 24 to 48 hours, there is no sign of improvement and the diarrhoea is accompanied by fever (above 38.5 C) or severe abdominal cramps, or if there are more than six stools per 24 hours and especially when these also occur at night.

      3. Or if because of travel circumstances a quicker solution is absolutely desirable . Appropriate antibiotics are only to be used on doctor’s prescription

    • [Travel health]SEXUALLY TRANSMITTED DISEASES 

      Casual sexual contacts tend to be higher while on holiday abroad. Sexually transmitted diseases, particularly AIDS, form therefore an important risk for travellers.

      Quite often unintentional and unsafe sexual contact takes place under alcohol influence.

      Prevention while on holiday abroad is no different from the precautions you take at home. Adequate use of a condom, preferably bought at home, is absolutely essential. Only a water-soluble lubricant should be used, but it only offers a partial guarantee (e.g. KY gel).

      Vaccination against hepatitis B is advised. Always consult your doctor if you think you are at risk, even when there are no symptoms.

  • [Travel health]MALARIA (swamp fever, malaria)

    Malaria is an infectious disease caused by a parasite (called Plasmodium) transmitted by the bite of the Anopheles mosquito. There are four different types of which Malaria falciparum is the most dangerous and the most widespread.

    The incubation period – the time between an infecting bite and the appearance of the disease – varies from ten days to four weeks (rarely several months). The symptoms include attacks of fever, but can initially be quite similar to influenza.

    If adequate treatment is not started in time, an attack may sometimes result in death within a few days.

    [Travel health] Where does malaria occur? 

    Malaria only occurs in those areas in which Anopheles mosquitoes are present : in the tropics and in a large number of subtropical areas. From a height of 1.500 to 2.500 m onwards, depending on temperature and climate, Anopheles mosquitoes are either rare or non-existent.

    In most big cities there is little or no risk at all of infection, except in Africa where a real risk exists. Risk also exists in the suburbs of the big cities in Asia (e.g. in India). In a number of areas the risk varies according to the season.

    [Travel healthHow can malaria be prevented? 

    It is very important for travel health to avoid mosquito bites : the Anopheles mosquito only bites between dusk and dawn, is rather small and hardly makes any noise.

    – In the evening wear light-coloured clothing which covers your arms and legs as much as possible. Apply repellent cream with a DEET basis (20 to 50%, for children and pregnant women preferably 20 to 30%) to the uncovered parts of your body. Repeat this every four to six hours (it will not protect you all night).

    Non containing DEET repellents were less examined; Autan-Active. and Mosegor. are however excellent safe products.

    – Sleep in rooms that leave no access to mosquitoes, (mosquito nets on the sills, electrically-warmed anti-mosquito plates, air-conditioning) or sleep under a mosquito net impregnated with permethrine or deltamethrine hung over the bed with the edges tucked under the mattress.

    If these measures are carried out correctly, the risk of malaria will be reduced by 80 to 90% and travel health is maintained.

    [Travel health]The intake of pills as prevention : 

    There is no drug efficient enough to prevent malaria 100%, which means that quite often a combination of measures is preferable. Also the drugs used have changed over the years.

    Moreover, the advantages and disadvantages of drugs should be considered against the risk of malaria infection. These risks are dependent on the visited country, and on the region, the season, the duration of your stay and the kind of trip.

    Some people might be troubled by the side effects while taking antimalarial drugs. These are usually mild and are not always a reason to stop taking the pills. Sometimes it may be necessary to change to another type of medication due to intestinal problems, allergic reactions or other intolerance symptoms.

    Therefore it is the doctor who can best decide for each individual which drug to use. This explains why individuals from the same group may end up taking different drugs.

    Finally, as no drug is 100% effective in preventing malaria, it is important that if an attack of fever occurs in the first three months after your return from the tropics, a malaria infection should be considered as a possibility despite the correct use of the drug prescribed.

    However, it is reassuring to know that malaria, provided it is recognised in time, is easy to treat without any danger of recurrent attacks. The belief that “once malaria always malaria” is totally untrue.

    CAUTION:The information provided here should not be used during any medical emergency or for the diagnosis or for the treatment of any medical condition.A licensed physician should be consulted for any and all medical conditions.Call 911 for all medical emergencies.