Marsden Medical Practice

Travel Health Advice

 

Travel insurance - general advice

Air travel - general advice

Deep Vein Thrombosis (DVT)

 

 

For travel OUTSIDE of Australia, Northern Europe, North America, Japan or Major Cities such as Hong Kong or Singapore

Vaccination

Traveller’s diarrhoea

Treating traveller’s diarrhoea

Avoiding insect bites

Precautions against malaria

Travelling to high altitude

Swimming

Animal Bites

Travelling to high altitude

Your First Aid Kit

More information - links

 

Travel insurance

·         Comprehensive health and travel insurance is essential if you are travelling to countries where no reciprocal relationship exists between the country and New Zealand regarding hospital care.  Unfortunately this means insurance is advisable for travel to most countries.

·         The cost of health care overseas is horrendous – tens of thousands of dollars is common for any hospitalisation.

·         You need insurance to cover you even for brief stops in countries such as USA.

·         Insurance which excludes known conditions is of little value.

·         New Zealand citizens on holiday in Australia and UK are covered by the public system for acute problems (injury and illness) but it is still wise to have insurance to cover the cost of:

·         private investigation and treatment – when on holiday the public system may be too slow

·         medical evacuation by air.

Air travel

·         If you are anxious about flying, a small dose of tranquilliser taken immediately before the flight can be very effective – discuss with the doctor.

·         If you are likely to be slow boarding and leaving the plane e.g from arthritis or stroke, ask the airline or travel agent to arrange a wheelchair, even though you might not normally use one.  The airline prefers this as it avoids delays to other passengers.

·         Discuss with the doctor if you have any medical condition which may prohibit or delay flying including:

·         pregnancy after 35 weeks

·         major surgery or injury within the preceding month

·         unstable heart conditions such as angina or heart failure

·         following a heart attack until your condition has been stable for a month

·         severe anaemia

·         following ear and sinus operations or skull fractures for up to 2 months

·         leg fracture in plaster

·         severe chronic obstructive pulmonary disease (emphysema).  You may need to ask the airline to provide oxygen but this is expensive.  If you can walk 50 metres on the flat without undue breathlessness you are unlikely to need oxygen.

·         To reduce jet lag:

·         for a few days before your journey adjust sleeping schedule by one hour each night closer to destination time

·         during the flight, sleep at your destination's normal bedtime

·         avoid coffee and alcohol on the flight

·         on arrival get some exercise and sunlight.

·         Scuba divers shouldn’t fly within 12 hours of diving.

·         See “DVT” below about avoiding thrombosis when flying.

Deep Vein Thrombosis (DVT)

What is DVT?

·         Deep vein thrombosis is a blood clot within a deep vein, usually in the thigh or calf.

·         Pulmonary embolism is when the clot breaks free, travels to the lung and blocks an artery. A pulmonary embolism can be life-threatening.

·         DVT may be caused by prolonged immobility on a plane flight, or even a long car, bus or train journey.

Risk factors

·         Most DVTs occur in those who already have one or more risk factors including:

·         the elderly

·         previous DVT

·         family history of DVT

·         on contraceptive pill or hormone replacement therapy

·         pregnancy

·         smoking

·         recent heart attack or stroke

·         recent immobilisation e.g after fracture, illness or surgery

·         cancer.

What to look for

·         Seek urgent medical help for

·         pain and swelling of the leg – possibly a DVT

·         sudden chest pain, breathlessness or coughing – may indicate a pulmonary embolism.

How to minimise the risk of DVT

·         Drink plenty of fluids but not alcohol or coffee.

·         Walk around the cabin or transit lounge whenever you can.

·         Stand up in your seat area and stretch your arms and legs.

·         Wriggle your toes and flex your ankles to keep your circulation going.

·         Avoid smoking.

·         Wear loose fitting comfortable clothes.

·         If you have any of the above risk factors, then before travelling see the doctor who may advise:

·         anti-embolic stockings

·         anti-coagulant medication.

Vaccination

·         The doctor and nurse will recommend what vaccinations you need

·         Most immunisations take 2 weeks to work. 

·         The duration of protection of some vaccines is not fully known but the following list gives an indication:

Tetanus/Diphtheria........ A single booster injection gives immunity for 10 years

Polio........................... A single booster injection gives immunity for 10 years

Hepatitis A................... A single injection gives immunity for 1 year. 
If you have a booster injection 6–12 months later, immunity lasts 25 years.

Hepatitis B................... 3 injections over 6 months gives immunity for 15 years or more, but persons at high risk should check their immunity by blood test. 
If you need immediate protection the course can be given over 3 weeks, but then you need a booster after 12 months

Typhoid (injection)........ 3 years.  Immunity is not total and declines during the 3 years

Cholera........................ Approximately 3 years

Yellow fever.................. 10 years

Meningococcus............ 3 years

Japanese encephalitis... 3 years

Rabies......................... 2-3 years

Traveller’s diarrhoea is very common; it is caused by bacteria in food and drink.

·         You should:

·         eat foods that are well-cooked and served piping hot

·         eat fruits, nuts, and vegetables (including tomatoes) with thick skins, peels, or shells that you remove yourself

·         eat canned foods

·         eat baked food such as bread and crackers

·         drink hot coffee or tea, canned or bottled drinks, beer or wine

·         carry safe drinks with you if you are going out for the day

·         always wash your hands with soap before eating and after using the toilet.

·         You should not:

·         eat uncooked vegetables and salad

·         eat food which may have been re-heated, e.g. a buffet

·         eat salad dressing and sauces

·         eat cold desserts and ice cream

·         have ice in drinks or desserts

·         drink from wet cans or bottles - the water on them may be contaminated

·         brush your teeth with tap water.

·         Some fish are unsafe even when cooked because of toxins. Take local advice about seafood, but when in doubt avoid.

·         To sterilise water:

·         use an immersion coil to boil water for 3 minutes

·         as a last resort add Betadine solution 8 drops (20 drops if the water is cloudy) to 1 litre of water and let stand for 30 minutes – not advised if pregnant or thyroid disease.  Vitamin C can be added to remove the taste of iodine.  Kits are available from tramping shops.

Treating traveller’s diarrhoea

 

·         If you have mild loose stools but you don’t feel unwell:

·         drink plenty of fluids

·         take loperamide (Imodium) for comfort during sightseeing or travel. Don’t take for more than 2 days and be careful of rebound constipation.

·         If you have an abrupt onset of moderately loose or frequent stools with cramps or nausea you have almost certainly got a bacterial infection:

·         drink plenty of fluids, if possible oral rehydration fluids such as Gastrolyte, usually readily available overseas

·         take two norfloxacin tablets together.  (In Thailand take one azithromycin tablet).

·         only take loperamide if you have to travel

·         avoid alcohol, coffee, strong tea, spicy or greasy food and dairy products.

·         If the diarrhoea becomes severe with intense cramps, nausea, bloody stools, dehydration:

·         continue norfloxacin one tablet twice daily.  (In Thailand take a second azithromycin tablet the following day)

·         take oral rehydration fluid

·         stay in your room.

·         avoid antimotility drugs (loperamide, Diastop)

·         seek medical attention if symptoms do not rapidly improve.

·         If  diarrhoea begins gradually with general fatigue you probably have a protozoal infection:

·         seek medical attention for proper diagnosis and treatment

·         often this condition doesn’t become apparent until you return home.

Avoiding insect bites

 

·         Mosquitoes spread malaria, dengue, yellow fever and Japanese encephalitis.

·         Malaria mosquitoes bite at any time of day but mainly evening and night. Mosquitoes that transmit dengue bite during the day.  Dengue is common in the Pacific islands and there is no treatment – therefore it is very important in these areas to protect yourself during the day.  Dengue mosquitoes may be present in urban areas.

·         Whilst out and about you should:

·         use insect repellent, Repel is recommended.  Re-apply several times during the day.

·         keep your arms and legs covered after sunset, tuck your shirt in.

·         wear light colours and avoid perfume

·         in high risk areas, impregnate clothing with permethrin – lasts for 5 washes.

·         In your accommodation:

·         use Raid fly-spray before going to bed

·         if there is air-conditioning, no further precautions are necessary

·         in backpacker’s and similar accommodation

·         use an impregnated mosquito net over your bed.  Make sure there are no holes, no mosquitoes inside and tuck it in under the mattress

·         make sure window screens are fixed and free of holes

·         burn a mosquito coil during the night.

·         Permethrin impregnated mosquito nets and permethrin clothes spray or solution are available from some tramping shops (e.g. Mainly Tramping)

Precautions against malaria

 

·         The doctor or nurse will advise you of the malaria risks in the areas you are to visit and what prophylactic medication is required.

·         In general during the dry season, in temperate areas, in arid regions and at high altitude the malaria risk is absent or small.

·         If you are taking malaria prophylaxis:

·         remember that you only get partial protection – you must still avoid mosquito bites

·         start one week before you travel (2½ weeks for mefloquine)

·         it is very important to continue for four weeks (one week for Malarone) after you leave the malaria zone

·         side effects include:

·         chloroquine. Nausea and abdominal pain, skin rashes, mouth ulcers

·         mefloquine. A few people experience psychiatric disturbance or fits (not to be used if you have epilepsy or a history of psychiatric illness).  Not advised for scuba divers.

·         doxycycline.  May make the contraceptive pill less effective.  You may find your skin is much more sensitive to the sun.  Wash the tablet down with a glass of water, if it sticks in the gullet it will cause severe pain for several days.

·         Malarone - headaches and stomach irritation.

·         For children, pregnant or breast feeding mothers – discuss the medication with the doctor or nurse.

·         If you get a fever between one week after first exposure and up to two years after your return, you should tell the doctor that you have been in a malaria zone.

Swimming

 

·         Swimming in the sea – take advice about local hazards.

·         Swimming in chlorinated water – generally safe.

·         Swimming in fresh water lakes and river – beware of schistosomiasis (bilharzia):

·         schistosomiasis is caused by parasitic worms released from fresh water snails

·         it is common in Africa, Latin America, Caribbean, SE Asia, India and the Middle East –  don’t believe diving schools, etc. if they tell you the water is safe

·         the parasites penetrate the skin if you wade, swim or wash in contaminated water – a wet suit doesn’t provide protection

·         if you are exposed to possibly contaminated water, immediately towel your skin vigorously – ask your doctor for a check up when you return home or if you get sick

·         there may be some itching at the time of exposure;  it then takes 2-4 weeks for the parasites to travel to other organs before you become unwell

·         don’t paddle or swim in fresh water lakes, streams or rivers in affected countries.

Animal Bites

·         Rabies is worldwide except in the UK, Australia and a few other countries.

·         It can be transmitted by animal bites, usually from dogs.

·         Untreated rabies is always fatal.

·         Avoid contact with animals, do not stroke dogs, cats and monkeys.

·         In rabies areas, if you are bitten or licked by an animal:

·         immediately cleanse the wound with soap and running water for 5 minutes

·         apply antiseptic e.g Betadine or alcohol

·         seek medical assistance fast, even if you have been vaccinated against rabies.

·         Rabies vaccine before travel is only recommended for those who may be exposed to an unusual risk of infection or who are undertaking long journeys in remote areas where medical treatment may not be immediately available.

Travelling to high altitude

 

Where is it a problem?

·         Altitude sickness can occur at any height above 2500m.

·         These altitudes may be found in popular tourist destinations such as:

·         in the Andes – several of the major cities are at 2500 – 4000m

·         Nepal and Tibet

·         skiing in Colorado

·         Kilimanjaro and Mount Kenya

When does altitude sickness occur?

·         If you ascend too rapidly, especially over 2500m

Prevention.

·         Avoid direct travel to high altitudes

·         Avoid ascents of greater than 500 metres per day if starting from above 3000 metres.

·         Break the journey for 2–3 nights at 2500–3000 metres

·         Avoid overexertion, large meals and alcohol

·         Acetazolamide (Diamox) tablets can be used as prophylaxis. Take with plenty of fluids.

Treatment

·         Symptoms include headache, fatigue, shortness of breath, nausea, poor appetite and difficulty sleeping.  Severe cases may be fatal.

·         Assume any illness or poor performance at altitude is due to altitude sickness until proved otherwise.

·         If early signs of mountain sickness appear, rest for a day at the same altitude.  Take paracetamol, don’t take sleeping tablets. Seek medical advice.

·         If symptoms continue or increase, descend at least 500 metres – descent to a lower altitude is all that is needed for rapid and complete treatment.

·         If symptoms become severe - immediate evacuation or descent and oxygen if available.

·         Remember - the best form of treatment is descent.

Travellers with health problems

·         Travellers with pre-existing heart or lung disease or anaemia should seek medical advice before travelling to a high altitude.

Your First Aid Kit

·         Prescribed by doctor:

·         Bactroban antibiotic cream

·         paracetamol (Panadol)  tablets

·         Gastrolyte power for fluid replacement

·         loperamide (Imodium) anti-diarrhoea tablets

·         norfloxacin antibiotics for diarrhoea (azithromycin in Thailand) and urinary infections

·         amox/clav antibiotics for skin or chest infections

·         malaria prophylactic tablets if required

·         acetazolamide (Diamox) for high altitude

·         clotrimazole cream for vaginal thrush

·         condoms, emergency contraceptive pill

·         personal regular medication

·         list of current medical problems and medication.

·         Skin protection:

·         Repel insect repellent

·         Raid fly spray

·         impregnated mosquito net

·         permethrin spray for clothes

·         mosquito coil

·         sun-block.

·         Minor injuries

·         Band Aids

·         dressing strip

·         roll of Elastoplast

·         non-stick dressings

·         crepe bandage

·         scissors

·         5ml syringe and needle (to be given to medical staff if you require injection)

·         Betadine antiseptic solution (can also be used for water sterilisation).

·         Spare spectacles.

·         Sea Legs for motion sickness.

·         First aid book and these notes for reference..

 

Links

·         These notes are intended for tourists and back-packers travelling to popular destinations – if you are going to more remote areas, travelling for several months or living in conditions of poor hygiene (e.g relief workers) you will need much more detailed advice.

·         More information is available at the following websites

·         International Travel & Health (WHO) - www.who.int/ith

·         Centers for Disease Control (US Government) - www.cdc.gov/travel

·         Health Advice for Travellers (UK Dept of Health) - www.doh.gov.uk/traveladvice

·         Fit fir Travel (Scottish NHS) - www.fitfortravel.scot.nhs.uk

We try to keep these notes accurate and current but if you need authoritative up-to-date information refer to the above web-sites.


Last Updated: April 4, 2004