Travel advice

Take care when you travel abroad

Travelling is fun but unfortunately full of pitfalls. Many people travel to ever more remote destinations and often forget to think about the potential risk to health this may entail. It is so easy for a 'dream' holiday to be ruined by illness.

Don't leave it until the last minute to prepare for your trip. Please COMPLETE & RETURN the travel risk questionnaire at least 2 weeks before planned travel and post or send via email to Kristyn.whitmore-craw@gp-h81064.nhs.uk

Please click here for travel risk questionnaire

If possible, seek advice about travel immunisations 6-8 weeks before leaving the UK. Do not forget to check whether or not anti-malarial prophylaxis is needed in addition to travel vaccinations. Help is available from many online resources as to which vaccinations to have for a particular destination. As requirements for any particular destination may change it is best to look at the available resources on the internet for the most up to date recommendations.

Avoiding mosquito bites

Mosquitoes can transmit several diseases including dengue fever, Japanese encephalitis, malaria and yellow fever. Most (but not all) bite after dusk and at night. To reduce the chance of being bitten:

	Wear long sleeved shirts and long trousers after dusk.
	Spray your room or tent before going to bed with a knockdown spray (flyspray).
	Sleep in a screened room if possible, otherwise use a bed net. The new wide mesh nets impregnated with residual insecticide (permethrin) are particularly effective.
	Use mosquito nets to cover cots. This is essential to protect babies.
	Use a plug-in electric insecticide vapouriser. Smoke coils are an alternative.
	Use air conditioning as this eliminates mosquitoes in sleeping areas.
	The new, natural, eucalyptus based insect repellents have been shown to provide many hours protection when applied to skin. DEET impregnated into cotton is effective for many hours. Ankle and wrist bands are very useful for local protection.
	Spraying of walls by the local authorities with residual insecticides is practiced in many towns and cities and greatly reduces the risk of being bitten.
	Remember mosquitoes breed in stagnant water wherever this collects (e.g. drains, old tins, open sewers, marshes etc.). Long term residents should therefore ensure that breeding areas within 500 yards of accommodation are regularly sprayed or eliminated.
	Try to return from country trips before dark as there is much less risk in towns and cities than in the country.

Certain mosquitoes are active mainly during the day (day time biters). To reduce the chance of being bitten by them:

	Avoid shady conditions outside in the late afternoon.
	Do not take late afternoon siestas indoors unless protected by a net ideally in a screened and air conditioned room.

Avoiding contaminated food

Contaminated food is a frequent source of common infections.
In general you should have a high level of suspicion of any food presented to you unless you know it is made from fresh ingredients and has been thoroughly cooked.

The following guidelines will help reduce the risk of contracting diseases from contaminated food:

	Always wash your hands before eating and dry them thoroughly on a clean cloth
	Thoroughly wash all fruit and vegetables before eating. Salads are best avoided but if eaten should be washed well and left to soak in water containing chlorine based sterilizing tablets or household bleach (4 drops per litre). Washing in water at 60°C will reduce the risk.
	Peel all fruit and vegetables to be eaten raw.
	Protect food being left for any period of time with a fly net.
	Residents abroad should make certain that house staff follow strict kitchen hygiene rules
	Don't eat raw vegetables or salads in public restaurants
	Don't eat under-cooked or raw meat, fish or shell fish even if they are the local delicacy.
	Inadequately cooked shell fish are a potential major source of infection.
	Don't drink unpasteurised cow, sheep or goats' milk. If in doubt you can pasteurize by bringing almost to the boil and then cooling. Dairy products such as ice cream, butter and cheese, if from an uncertain source, should be avoided.
	Don't eat food left un-refrigerated for more than 2 - 4 hours.

Do not make the mistake of assuming that because a meal looks and smells delicious it will be safe.

Avoiding contaminated water

Water is a frequent source of infection. Most cities and large towns have large piped water systems but the water is only safe to drink if it has been fully treated and chlorinated. Even in areas where the tap water is safe to drink the level of chemical treatment may be sufficient to render it unpalatable to the United Kingdom traveler.
To be entirely safe the following alternative means of sterilization are available.

	Bring it up to a rolling boil and allow it to cool, prolonged boiling is unnecessary.
	Disinfectants. These are often ineffective if the water is visibly cloudy.
	Iodine is very effective. 4 drops of 2% tincture of iodine should be added to each litre of water and left for 15 minutes. Prolonged use of iodine should be avoided (longer than 6 weeks).
	Sterotabs and Puritabs. These are chlorine based and are less effective against amoebic cysts than iodine.
	In an emergency use household bleach (2 to 4 drops per litre of clear water) and leave for 15 minutes, this is safe and effective but will taste of chlorine.
	Iodine resin water purifiers: These light modern systems both filter and purify fresh water from any source. They are convenient and effective (for example MASTA Travel Well Trekker).

The following guidelines may help in avoiding contaminated water:-

	Remember ice may be made from contaminated water and is therefore not safe.
	Bottled water and drinks are normally safe, especially fizzy drinks.
	Use safe water for brushing teeth and for washing vegetables or salad which are to be eaten raw.
	The water from the hot tap in your hotel is likely to be safer than the water from the cold tap. Run it for a minute or so first. It can be used for brushing teeth in an emergency.
	Don't drink the water from open wells and rivers unless using an iodine resin water purifier.

Safe sun exposure

Overexposure to the sun can cause sunburn, leading to premature skin ageing and an increased risk of skin cancer. Take care not to burn in the sun and remember the following:

	Avoid sun exposure between 12 and 2pm when the sun's rays are at their strongest. Where possible stay in the shade.
	Be careful in and around water. Ultra-violet rays are reflected by water.
	Wear loose-fitting, closely woven cotton fabrics that you cannot see through.
	Wear a broad-rimmed hat to protect head, face and the back of neck.
	Use a broad spectrum (blocks UVA and UVB rays), high protection factor sunscreen (SPF 15) and apply frequently especially after being in water.
	Wear sunglasses that filter out UVA and UVB rays to protect your eyes from sun damage.
	Keep babies under six months of age out of direct sunlight. Their skin is easily damaged.
>	Children should wear hats and sunglasses and be covered up when out in the sun. A broad spectrum, high protection factor sunscreen should be applied frequently especially after bathing.

Another risk of overexposure to the sun is becoming dehydrated.

	Avoid strenuous exercise during the hottest hours.
	Drink plenty of non-alcoholic fluids to replace the fluid lost through perspiration.
	Ensure you are wearing clothing appropriate to the weather conditions.

Accidents

More travellers die from accidents than any other cause and most of these accidents could have been avoided. The consequences of having an accident abroad are often far more serious than if they occur at home. Emergency treatment may be limited and of an uncertain standard and there may be communication difficulties if you cannot speak the local language. You should know how to deal with an emergency and how to summon help locally but above all, try to avoid exposing yourself to unnecessary danger.

Take Care on the Roads

If you must travel on motorcycles or mopeds always wear a helmet and protective clothing.

	Always check on local traffic regulations and stick to the speed limit.
	Wear a seatbelt when travelling by car and ensure children are strapped into a car seat or child restraint.
	Check the condition of cars and bikes for hire and the insurance cover provided.
	Never drink alcohol and drive.

Take Care in Water

Children should always be supervised by an adult who can swim well when playing in or near water. Even a shallow paddling pool is a potential danger for young children.
Ensure when diving into water that it is deep enough for you to do so safely. Each year, many people are left permanently paralysed as a result of injuries sustained from diving into shallow water. A useful slogan to remember is "Feet first, first time".

Sports and Special Pursuits

These often involve a certain degree of risk which adds to their enjoyment and attraction. When accidents do occur, the cause can usually be traced back to avoidable factors such as poorly maintained equipment, lack of training or an inadequate level of fitness. Ensure equipment is maintained to a high standard, that you have adequate training with appropriately qualified personnel and that if the activity to be undertaken involves strenuous exercise that you build up your fitness gradually and not "over-do things". Also check your travel insurance policy covers you for all the pursuits that you will be undertaking. Not all policies will cover activities such as mountaineering, scuba diving or motorcycle riding.

Safe sex

Travellers have been shown to be at increased risk of acquiring sexually transmitted diseases as people often behave differently when they are abroad. There are many factors influencing behaviour such as being away from the usual constraints of home, seeking adventure and new experiences and wanting to make new friends.

Diseases such as HIV and hepatitis B are more prevalent in some parts of the world than in the UK and the risk of infection may be much higher (for example HIV is principally a disease of high risk groups in the UK but is spread mainly through heterosexual intercourse in much of sub-saharan Africa).

It is best to avoid casual sexual intercourse and, in particular, activities where the skin may be damaged or there may be contact with bodily fluids. The risk of transmission of HIV, hepatitis B and other sexually transmitted diseases is reduced but not eliminated by the use of a condom which should be used throughout sexual contact.

Condoms purchased abroad may not be as reliable as they may not be of the same high standard as those purchased in the UK. Take a supply with you.

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©2003 The Fairlands Practice	\| Last updated 8 July 2008			Part of the Surrey Primary Care NHS Trust

The Fairlands Practice

Travel advice

General information

Help and advice

Take care when you travel abroad

Avoiding mosquito bites

Wear long sleeved shirts and long trousers after dusk.

Spray your room or tent before going to bed with a knockdown spray (flyspray).

Sleep in a screened room if possible, otherwise use a bed net. The new wide mesh nets impregnated with residual insecticide (permethrin) are particularly effective.

Use mosquito nets to cover cots. This is essential to protect babies.

Use a plug-in electric insecticide vapouriser. Smoke coils are an alternative.

Use air conditioning as this eliminates mosquitoes in sleeping areas.

The new, natural, eucalyptus based insect repellents have been shown to provide many hours protection when applied to skin. DEET impregnated into cotton is effective for many hours. Ankle and wrist bands are very useful for local protection.

Spraying of walls by the local authorities with residual insecticides is practiced in many towns and cities and greatly reduces the risk of being bitten.

Remember mosquitoes breed in stagnant water wherever this collects (e.g. drains, old tins, open sewers, marshes etc.). Long term residents should therefore ensure that breeding areas within 500 yards of accommodation are regularly sprayed or eliminated.

Try to return from country trips before dark as there is much less risk in towns and cities than in the country.

Avoid shady conditions outside in the late afternoon.

Do not take late afternoon siestas indoors unless protected by a net ideally in a screened and air conditioned room.

Avoiding contaminated food

Always wash your hands before eating and dry them thoroughly on a clean cloth

Thoroughly wash all fruit and vegetables before eating. Salads are best avoided but if eaten should be washed well and left to soak in water containing chlorine based sterilizing tablets or household bleach (4 drops per litre). Washing in water at 60°C will reduce the risk.

Peel all fruit and vegetables to be eaten raw.

Protect food being left for any period of time with a fly net.

Residents abroad should make certain that house staff follow strict kitchen hygiene rules

Don't eat raw vegetables or salads in public restaurants

Don't eat under-cooked or raw meat, fish or shell fish even if they are the local delicacy.

Inadequately cooked shell fish are a potential major source of infection.

Don't drink unpasteurised cow, sheep or goats' milk. If in doubt you can pasteurize by bringing almost to the boil and then cooling. Dairy products such as ice cream, butter and cheese, if from an uncertain source, should be avoided.

Don't eat food left un-refrigerated for more than 2 - 4 hours.

Avoiding contaminated water

Bring it up to a rolling boil and allow it to cool, prolonged boiling is unnecessary.

Disinfectants. These are often ineffective if the water is visibly cloudy.

Iodine is very effective. 4 drops of 2% tincture of iodine should be added to each litre of water and left for 15 minutes. Prolonged use of iodine should be avoided (longer than 6 weeks).

Sterotabs and Puritabs. These are chlorine based and are less effective against amoebic cysts than iodine.

In an emergency use household bleach (2 to 4 drops per litre of clear water) and leave for 15 minutes, this is safe and effective but will taste of chlorine.

Iodine resin water purifiers: These light modern systems both filter and purify fresh water from any source. They are convenient and effective (for example MASTA Travel Well Trekker).

Remember ice may be made from contaminated water and is therefore not safe.

Bottled water and drinks are normally safe, especially fizzy drinks.

Use safe water for brushing teeth and for washing vegetables or salad which are to be eaten raw.

The water from the hot tap in your hotel is likely to be safer than the water from the cold tap. Run it for a minute or so first. It can be used for brushing teeth in an emergency.

Don't drink the water from open wells and rivers unless using an iodine resin water purifier.

Safe sun exposure

Avoid sun exposure between 12 and 2pm when the sun's rays are at their strongest. Where possible stay in the shade.

Be careful in and around water. Ultra-violet rays are reflected by water.

Wear loose-fitting, closely woven cotton fabrics that you cannot see through.

Wear a broad-rimmed hat to protect head, face and the back of neck.

Use a broad spectrum (blocks UVA and UVB rays), high protection factor sunscreen (SPF 15) and apply frequently especially after being in water.

Wear sunglasses that filter out UVA and UVB rays to protect your eyes from sun damage.

Keep babies under six months of age out of direct sunlight. Their skin is easily damaged.

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Children should wear hats and sunglasses and be covered up when out in the sun. A broad spectrum, high protection factor sunscreen should be applied frequently especially after bathing.

Avoid strenuous exercise during the hottest hours.

Drink plenty of non-alcoholic fluids to replace the fluid lost through perspiration.

Ensure you are wearing clothing appropriate to the weather conditions.

Accidents

Always check on local traffic regulations and stick to the speed limit.

Wear a seatbelt when travelling by car and ensure children are strapped into a car seat or child restraint.

Check the condition of cars and bikes for hire and the insurance cover provided.

Never drink alcohol and drive.

Safe sex