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Introduction Whether you are travelling for business or pleasure, visiting friends and family, staying in a luxury hotel for a fortnight or planning a year-long backpacking trip, the first leg of your journey should always start with a visit to your doctor or specialist travel clinic to discuss what vaccinations or malaria cover you may need. To get the most from your holiday you need to concentrate on the important things... like enjoying yourself! That said, it is important to be aware of situations that could potentially ruin your trip, such as poor health and lost or stolen belongings, and to be as prepared as possible.


Travelling to exotic places can be adventurous and exciting, but it can also carry risks. In order to reduce the risk of problems during your holiday, there are a few things you can do before you set off: •

 Visit your GP or travel clinic for advice on healthy travel at least six weeks before your trip. When booking your trip through your travel agent or online, remember that vaccinations should be administered up to 28 days before travel. Such preventative action can help you have a stress free, healthy trip and keep you free from disease. Vaccinations minimise the risk of contracting some diseases whilst abroad. You wouldn’t go away without your sunscreen, so why travel without the appropriate vaccinations?

Travel insurance should be a vital item on your shopping list before setting off. This will cover you for a range of incidents from accidents to car trouble or stolen possessions. When booking insurance through your travel agent or insurance company, ensure that they are aware of any pre-existing condition as non-disclosure may invalidate your insurance. Any eventuality can be covered with the right policy tailored for you; however, make sure you are covered for any activities you plan to partake in such as watersports or skiing. Health insurance is extremely important when travelling to foreign countries, especially countries which are deemed to be at risk from serious diseases. Always check the small print on your travel insurance to see if your health is covered or contact your private health insurance company (VHI, Laya Healthcare, AVIVA).

Vaccinations are a way of preventing disease and looking after your health. Sky-diving may be your risk of choice, but do you also realise how risky brushing your teeth with local water could be? High standards of sanitation and hygiene levels need to be maintained at all times in order to minimise your risk of disease. By being aware of potential dangers you can save yourself the hassle of finding out the nature of common diseases first-hand. This booklet can help you to reduce the risks and let you concentrate on enjoying yourself.


Getting Vaccinated Travelling is a great source of enjoyment and excitement for many people. Visiting exotic places and exploring vibrant lands can be adventurous or relaxing, depending on what you prefer. To truly get the most from your trip talk to your doctor or practice nurse, or visit your local travel clinic about healthy travel. If you have received the usual childhood vaccinations, you will already be protected against certain diseases, but your GP or practice nurse will be able to advise you on travel precautions and what vaccinations are needed for the areas you will be travelling to. Alternatively, you can contact your local travel health clinic. The clinics provide up-to-date medical advice and details on travel-related risks to your health. Your GP may have one or know where the nearest one is located.


Statistics In surveys of travellers to ‘at risk’ countries: •

37% of those traveling to at-risk countries considered getting vaccinations before travelling, yet just 23% got a vaccination despite travelling to a an exotic country in the past 2 years1.

Of those that had vaccinations, the most common diseases they vaccinated against were diphtheria and tetanus, typhoid fever, hepatitis A and hepatitis B.1

Of those that had vaccinations, just 35% had them within the recommended time period of more than 28 days before travelling 2.

The public’s understanding of how hepatitis A, hepatitis B and typhoid fever are caught is extremely poor2.

80% of travellers took part in an at-risk activity while travelling (i.e. using tap water to brush teeth, eating food from street markets, having ice in drinks) and did not recognise the risks involved with these activities2.

One in eight people in Ireland (13%) know someone who has contracted an infectious disease while overseas1.

References: 1. Sanofi Pasteur MSD Data on File 2013 IR00193 2. Shread, K. & Packman, J. (2007) Travellers to At-Risk Countries 2007 - Travel Consumer Omnibus


Preventable Diseases Hepatitis A: Hepatitis A is a viral disease which affects the liver. It is mainly spread through contaminated food and water. Hepatitis A occurs all over the world but particularly in countries where sanitation and hygiene is poor. Symptoms include fatigue, loss of appetite, fever, nausea, headaches and abdominal discomfort. The most distinguishing symptom is jaundice – you will turn yellow. Just two doses of hepatitis A vaccine will cover you beyond 10 years. Tip: Boil it, cook it, peel it or forget it!

Hepatitis B: Hepatitis B is also a viral disease which attacks the liver. It is extremely infectious and is contracted through bodily fluids of an infected person, e.g. unprotected sex, blood transfusion or sharing needles. Symptoms include nausea, loss of appetite, tiredness, tenderness in the abdomen, and jaundice. If you require vaccination for hepatitis B, you should ideally seek advice and vaccination at least six months before your trip. A booster vaccination may be recommended for some individuals; however, you should consult your doctor or practice nurse for further information. Tip: Avoid high-risk behaviour and stay protected


Typhoid fever: Typhoid Fever is a bacterial disease which is spread through contaminated food and water so it is very important to try and maintain a good standard of sanitation and hygiene while travelling. Symptoms include fever and severe headaches, constipation or diarrhoea and weakness. A single injection will help to protect you for three years. Tip: Watch out for under-cooked shellfish

Yellow Fever: Yellow fever is a viral disease which is spread by mosquitoes. Infection can cause a wide range of symptoms ranging from mild to severe illness and death. Symptoms (acute) include fever, muscle pain and backache, headaches, shivers, loss of appetite, nausea, and/or vomiting. After 3-4 days symptoms improve and most people recover from the disease. In a small but significant number of cases, the disease may be more serious. There is no specific treatment for yellow fever. A single dose of vaccine provides at least 10 years’ protection. Yellow fever occurs in parts of tropical South America and sub-Saharan Africa. Some countries deny entry without proof of vaccination i.e. an International Certificate of Vaccination or Prophylaxis. This certificate is considered valid for ten years. Other countries may require proof of vaccination if you are arriving from a country where there is a risk of yellow fever transmission. Tip: Avoid mosquitoes – bring insect repellent


Meningococcal Meningitis: Meningococcal meningitis is a dangerous bacterial infection which is spread through direct contact like sneezing and coughing. It occurs throughout the world, but is most commonly found in sub-Saharan Africa. Symptoms include stiff neck, fever, sudden severe headache, nausea, vomiting and intolerance of light. You may have already received vaccination against menigococcal C disease; however, for travel, vaccination against meningococcal strains A, C, W135 and Y may be needed. Vaccination is particularly recommended for longer visits (generally one month or more). Vaccination against the meningococcal strains A, C, W135 and Y is mandatory for entry to Saudi Arabia in order to attend the annual Hajj pilgrimage or to perform Umrah and proof of vaccination is required. One dose of vaccine should help provide protection for three to five years; however, the vaccination certificate is only valid for three years. Tip: Get vaccinated where necessary

Rabies: Rabies is a dangerous disease as it is nearly always fatal. The virus is found in saliva and is contracted from the bite or scratch of an infected animal. It occurs in many countries, especially where there is limited control over animals. Encourage your children to stay away from animals. Once bitten, symptoms may not occur for some time. The bite may have healed before any effects are experienced. If you are bitten, scratched or nicked by an animal in a country where rabies is present it is important to get immediate medical help even if you have already been vaccinated. Infection is most frequently from a dog, but in some parts of the world other animals such as monkeys, bats, cats and rats are important sources of exposure. A pre-exposure course is recommended consisting of three doses: One on day 0, day 7 and day 21 or 28. In Ireland, periodic booster injections are currently not recommended for general travellers. However, people who may be at risk of rabies because of their job may need further booster doses. If you think you may come under this category, check with your GP or practice nurse. Tip: Beware of the dog, seek urgent medical help if bitten, scratched or nicked


Malaria: Malaria is a parasitic disease that occurs mostly in hot tropical countries. The disease is transmitted by mosquito bites and travels through the blood and into the liver cells. There is no malarial vaccine available so you need to take preventative medication and use insect repellent to avoid being bitten. Take advice on the most appropriate antimalarial for your destination and remember that the tablets need to be taken before travel and after you return. Symptoms include fever, sweating, shivering and headaches – flu-like symptoms. They may not occur until long after the disease is contracted so keep this in mind if you experience fever after your travels. Malaria can be fatal so prevention is key but be aware that malaria can still occur even if you have taken your anti-malarials carefully. Seek immediate medical attention if you have any of these symptoms. Tip: Avoid mosquitoes – bring insect repellent


Visiting Friends and Relatives If you are a migrant from a low-income country living in a high-income country and you return to your country of origin to visit friends and relatives, it is important not to believe that you are immune to malaria. Any immunity you had gradually disappears when you live in a non-malaria endemic country. Most cases of imported malaria occur in this group of so-called VFR travellers. Follow carefully the advice regarding mosquito bite avoidance and comply with the antimalarial medications prescribed by your doctor. You may also be at risk of acquiring tuberculosis (TB) when you are in close contact with affected friends or relatives. •

Ask your travel medicine physician about receiving BCG vaccination against TB for you and your children

•

Hepatitis A and typhoid vaccination are strongly recommended. Hepatitis B vaccination may also be recommended

Protecting only your children against such diseases rather than taking precautions yourself is not appropriate. Consider the consequences if you, as their parents, develop severe illness and are unable to care for them. Take protective measures to reduce the risk of sexually transmitted infections including HIV. Ensure that you take out medical insurance to cover all of your travel.


Dengue Dengue infection is a viral illness spread by a daytime-biting mosquito with bites generally occurring around the face. High risk regions include the Caribbean, South and Central America, Mexico, Africa, the Pacific Islands, SE Asia, Indian subcontinent, Hawaii and Australia, although there have been outbreaks on Madeira island (Portugal) in recent times. With global warming, it is likely to spread further from the equator in the future. It tends to be more common during the rainy season. Infected travellers show symptoms after 5 to 8 days, though many show no symptoms at all. Symptoms begins with a fever and a blanching red rash, beginning on the trunk and spreading to the face and limbs. Other symptoms include headache, muscle and joint pain. Most patients recover without treatment within 4 days of the appearance of the rash however infected travellers may experience prolonged lethargy/ tiredness and depression. Aspirin should be avoided where dengue fever is suspected. Though rare in short-term travellers, dengue haemorrhagic fever occurs when a person is exposed to another of the 4 versions of the virus on a future occasion. This is characterised by sudden deterioration, bleeding and low blood pressure. This very serious condition requires intensive hospital treatment. Avoid mosquito bites throughout the day, especially around dawn and dusk. There are several dengue vaccines under development but these are not likely to be available for several years.


Diphtheria: Diphtheria is a bacterial disease which occurs all over the world. It spreads to humans mainly through droplets contained in coughs and sneezes. Symptoms include sore throat, low grade fever and difficulty in swallowing.

Tetanus: Tetanus is a global disease which is also present in Ireland. It can be fatal. It is found in spores in the soil and is transmitted through cuts and scrapes on the skin. Symptoms include muscular spasms, sore throat, rapid heart rate, breathing problems and paralysis. Tetanus can be fatal in people who have not been vaccinated. Vaccination is recommended whether you plan to travel out of the country or not. Tip: Take care of that scratch

Polio: Polio is a viral disease which can cause paralysis and sometimes death. It is fairly rare due to the concentrated vaccination programmes throughout the world; however, it is still a risk in some developing countries with poor sanitation. Travelling to an area with polio or that has recently suffered an outbreak increases the risk of contracting the virus. Most people who become infected with polio have no symptoms but can still pass on the disease. Others will have mild symptoms such as fever, sore throat, headache and muscle pain. However, the disease can lead to paralysis and death. Tip: Take care in high-risk areas

Vaccinations for diphtheria, tetanus and polio are part of the childhood vaccination programme in Ireland. Check with your GP or practice nurse that your vaccinations are up to date. A single dose is all that is required as a booster once you’ve had these primary vaccinations. More information may be obtained from www.immunisation.ie


Other diseases to be aware of: Cholera: Cholera is a serious bacterial disease causing severe diarrhoea and dehydration, and is found in countries which have poor sanitation and low standards of hygiene. It is an acute illness caused by an infection in the intestine from bacteria. It occurs when a person eats or drinks contaminated food and water. Tip: Watch what you eat and drink

Tick Borne Encephalitis: This is a viral disease which can be found in more than 18 European countries. It is contracted by the bite of hard back ticks or sometimes by drinking unpasteurised milk from an infected animal. Symptoms range from mild to severely intense such as fever, headache, muscular aches and general flu symptoms. If the disease progresses to stage two, there will be a sudden rise in temperature, then the central nervous system begins to be affected which can result in meningitis, encephalitis and/ or paralysis. Symptoms can include aversion to light, seizures, vomiting and stiff neck. Tip: Hikers beware! Wear long sleeves and trousers

Japanese Encephalitis: This is a life-threatening viral infection which affects the brain. It is transmitted through mosquito bites during rainy seasons in the Far East and South East Asia. Symptoms include flu-like illness, fever, chills, nausea and vomiting. People may also feel agitated and confused. If you are travelling to an ‘at risk’ area, you may need to be vaccinated against this disease.


Schistosomiasis: Often referred to as ‘Bilharzia’, this disease is spread by a parasite flatworm. Most cases in travellers occur in sub-Saharan Africa. However travellers to Africa, South America (primarily Brazil), central China, the Philippines, and in the Mekong river running through Laos, Cambodia and Vietnam, should be aware of this infection. The worm infects humans by penetrating through skin exposed to fresh water in rivers, streams or lakes. When infected, a traveller may complain of a so-called ‘swimmer’s itch’. An acute form of the disease called ‘Katayama fever’ develops when the mature worms produce eggs in the bowel or bladder of the infected host. This can occur weeks later. Symptoms include fever, loss of energy and itchy hives, with possible diarrhoea, weight loss, blood in the urine, headache and joint pain. Rarely, the patient may develop seizures or paralysis of the limbs. In the chronic form of the disease, the liver may be scarred, producing a build-up of fluid in the tummy or bleeding from the upper gut. The bladder may become damaged, causing blockage of urine flow or recurrent kidney infections. Since no vaccine exists, prevention is by avoiding contact with freshwater, even for bathing or wading. Wearing a wetsuit does not give protection. Towel drying after swimming in freshwater is also ineffective. Swimming in the sea or in chlorinated swimming pools poses no risk of infection. The condition, once diagnosed in the returned traveller, is easily treated with specialised medication.


General Travel Advice Food and Water: It is vitally important to be careful about what you eat and drink while abroad. Your digestive system may not be able to handle food which is native to the country you are visiting and can be sensitive to new cuisines. Indigenous water supplies may be poorly sanitised - leading to waterborne diseases - or have high levels of naturally occurring minerals which your body may not be used to. Though the locals may remain unaffected, bear in mind that you might react differently as your body is used to drinking treated water back at home. You also need to be aware that eating certain foods raises the risk of contracting a disease. In countries where sanitation and hygiene are poor it is advised to steer clear of the following: • • • • • • •

Shellfish Raw vegetables Unpeeled Fruit Salads Food on street stalls Tap water Ice

Always make sure that your food is fully cooked and drink bottled water. Remember: BOIL it, COOK it, PEEL it, or FORGET it Use bottled water when brushing your teeth as using tap water can also lead to illness. If you do experience diarrhoea, increase your fluid intake and take anti-diarrhoea tablets. Dehydration is the most important problem associated with diarrhoea. Increase your intake of water and seek medical advice if necessary. Children and the elderly are particularly at risk of dehydration. Stay strict with your hygiene habits and always wash your hands after using the toilet, before handling food and before eating.


Sun Protection: •

A lways use sun-cream or sun-block when you are out in the sunshine, regardless of your skin-type.

 hildren and people with fair skin are particularly at risk so C cover up.

Avoid the sun between 10am and 3pm as this is the hottest and most dangerous time of the day for harmful UV rays.

Wear a hat and sunglasses to protect your head, skin and eyes.

Drink plenty of water to avoid over-heating and dehydration.

Insects: Mosquitoes are not only annoying but they are dangerous too. Many diseases can be contracted from mosquito bites, so repellent is a must. Other insects can also be harmful so make sure you bring antihistamine tablets and cream to soothe any bites. •

Wear long sleeves and trousers at night to avoid being bitten.

Use insect repellent.

Use plug-in insecticide vaporisers or burn coils to ward off insects.

Use mosquito nets if needed.

Safer sex: Unprotected sex carries the risk of transmission of infections including gonorrhoea, chlamydia, genital warts, hepatitis B and HIV. Many STIs (Sexually Transmitted Infections) are widespread throughout the globe so transmission can occur anywhere. Always practise safe sex - use a condom (but remember that condoms reduce but do not eliminate the chances of getting STIs).


Jet-Lag: Jet-lag occurs when you are on a long-haul flight and have to pass through different time-zones. Your body rhythm can become skewed and it can take a while before you adjust to the new time difference. Generally it takes one day to recover for every hour time difference. Symptoms of jet-lag include headache, feeling fatigued, suffering from mood disturbances, anorexia, or gastrointestinal symptoms. To combat jet lag, make sure you have two or three good nights’ sleep before travelling. While on the flight avoid alcohol, set your watch to the destination time and try to sleep and eat at times synchronised with your destination. Once you arrive, get some exercise and try to stay awake until the destination’s night-time, as this will help your body to adjust faster.

Foot Care: It is very important to take good care of your feet while you are travelling. Your feet carry your entire body weight and can be put under a lot of strain if you are backpacking or sightseeing. Try to keep your feet as dry, clean and as odour-free as possible because mosquitoes are attracted to smelly feet. Athlete’s foot is a risk when your feet perspire heavily. It is itchy, unpleasant and very contagious, so make sure you bring anti-fungal powder. Cracked heels are another problem for travellers. If they are not looked after properly, they can become infected.


Deep Vein Thrombosis: Deep vein thrombosis is a blood clot that can develop in a deep vein, usually in the thigh or calf, but can also occur elsewhere. It is caused by a blocked or narrowed vein and this hinders the flow of blood in the vein. It has been found to develop in people who are confined to small spaces or who have to sit down for long periods of time. To protect yourself from developing deep vein thrombosis when travelling on long-haul flights: •

A lways get up and move around, this will help your circulation and protect you from forming blood clots.

 end and straighten your arms, legs, feet and toes as much B as possible.

Make sure you are as comfortable as possible in your seat.

Take a few walks up and down the plane to stretch your legs.

Wear properly fitting flight socks.

Drink lots of water.

Avoid alcohol as it dehydrates you.

Avoid sleeping pills.

Swimming: Think about where you are swimming, even if you are a strong swimmer. Seek local advice and try to swim only where the area is supervised. Supervise children near water at all times. If you are swimming in a pool, make sure you know how deep it is. If you are in the sea, bear in mind that this can be risky, as unexpected strong currents can have disastrous consequences. Jellyfish, sharks and other dangerous creatures may be lurking so make sure you are fully informed of the risks. Listen to the advice of locals and do not swim alone.


Travel to High Altitude More and more people are travelling to high altitude regions for recreational or charity fundraising treks. The Inca trail in Peru, Kilimanjaro in Tanzania and the Everest Base Camp trail in Nepal are among the most popular destinations.

Top Tips •

Try to find out your ascent profile as this is an important factor in preventing high altitude illness; the faster you ascend, the greater the risk of becoming ill.

Make sure that your medical insurance covers you for injuries or sickness occurring at altitude.

Wear your hiking boots on the journey rather than packing them in the aircraft hold; you do not want to break in a new pair of boots on an arduous high altitude trek.

Blister plasters and high sun protection factor sun cream are a must on high altitude treks.

Try to avoid travellers’ diarrhoea before you reach the mountain as dehydration already occurs at altitude and this will only compound it.

It takes several days for your body to acclimatise to the lower levels of oxygen in the air and this process varies from person to person.

Being physically fit at sea level does not protect you against high altitude illness.

If you have a rapid rate of ascent or you suffered from severe altitude sickness previously you should speak to your doctor to see if there is any preventative medication suitable for you for your trip.


Slow rate of ascent - no more than 300-500m per day above 3000m, with a rest day every 2-3 days - is the most important preventive measure.

Travellers must rest if they develop acute mountain sickness (AMS) and not continue until the symptoms have resolved. Symptoms include a headache and at least one of the following: tummy upset, tiredness, loss of appetite and nausea or difficulty sleeping.

Take a painkiller for the headache and an anti-nausea medication and drink plenty of fluids, until symptoms clear.

Even if you feel like being alone, always have a tent buddy to report your symptoms to.

AMS will resolve in hours to days, usually without having to lose altitude as long as you do not climb any higher. However, if you develop high altitude cerebral oedema (HACE) or high altitude pulmonary oedema (HAPE), you must descend immediately, preferably having received treatment. HACE usually develops above 4000m in about 10% of people with pre-existing AMS and consists of the symptoms of AMS plus confusion, exhaustion and/or unsteadiness. HAPE presents with shortness of breath, a cough, which may be blood-stained, and bubbling sounds in the chest. Both HACE and HAPE may occur at the same time and both are fatal unless the victim descends.

Oxygen, if available (rarely seen except on technical treks to extreme altitude), a portable hyperbaric chamber and certain specialised drugs may be used under medical supervision to facilitate descent or if descent is delayed because of weather or terrain. Travellers with pre-existing medical conditions such as chronic lung disease or diabetes should consult a specialised travel medicine clinic if they are considering a trek to high altitude.


Cruise-ship Travel Cruises are becoming more popular and can be a pleasant way to visit several countries on one trip.

Top Tips •

Make sure you take out adequate medical insurance prior to travel as medical or dental care received on board is not usually free of charge.

If you have pre-existing medical conditions such as diabetes or chronic kidney disease ask to be put in touch with the cruise-ship doctors to ensure that they are familiar with your healthcare needs. NOTE: Cruise ship doctors are only present if the ship carries more than 100 crew members.

Email them a scanned medical summary and prescription from your own GP.

Cruise-ships have on-board pharmacies but you should carry ample supplies of your own medication and not assume that the ship pharmacy will stock your particular medications.

Do not expect that on-shore medical facilities in many popular cruise destinations will meet European standards.

Vaccines may be required or recommended for travel to a country as part of a cruise itinerary. Consult your travel medicine clinic at least 8 weeks prior to travel to see if vaccines or malaria tablets are indicated for your trip. Unless your ship docks or you stay on shore in malaria areas, malaria tablets will not be necessary in most cases. If you are prone to motion sickness cruise-ship travel may not be ideal for you although modern large cruise liners use stabilisers, making the voyage more comfortable.


Top Tips •

Take care not to slip on wet deck surfaces or stairways, particularly in rough seas, and when getting on or off the vessel.

Never sit on the balcony or deck railings for fear of falling overboard.

You will need to become familiar with the ship’s emergency evacuation procedures.

You are more likely to sunburn while at sea so protect your skin from the sun.

Wash your hands frequently and use the hand sanitisers provided to reduce the risk of contracting infections from other people such as norovirus and influenza.

Report any illness promptly to the ship’s crew or medical personnel, so that prompt treatment may be given and isolation measures taken, if necessary.

Keep your alcohol consumption moderate and take protective measures against the spread of sexually transmitted infections.


Personal safety and security It isn’t possible to completely control your travel environment but it is very important to maintain a heightened sense of awareness. Road traffic accidents cause more injuries and deaths in travellers than infectious diseases, and over 90% of deaths occur in developing countries. The Department of Foreign Affairs provides excellent destination-specific travel and security advice.

Top Tips: •

Ideally register your details with the local Irish Embassy or Consulate so that they can provide better assistance in the event of a disaster or terrorist attack.

Keep your family and friends updated on your itinerary and record contact numbers (next of kin, embassy, insurance providers, credit card companies) in case of emergency.

Make sure you have adequate travel and medical insurance to cover all of your intended destinations and activities; this should also cover repatriation costs.

Travellers should avoid hiring a car after a long flight due to the effects of jet lag and a lack of familiarity with the local rules of the road.

Take great care when crossing the road and never walk a busy street or cross a road wearing headphones.

Keep your money concealed in a money belt and wear bags with straps diagonally across your chest rather than over your shoulders.

Be alert for traffic. The traffic in city destinations can be very congested with motorcyclists weaving their way through car and bus traffic.

Never hitch-hike and try to avoid travelling at night. Make sure you only travel in a vehicle with functional seat belts. Insist that your taxi driver wears one too.


Bring a child restraint seat with you as they may not be provided.

Always wear a bicycle or motorcycle helmet, but try to avoid motorcycle taxis where alternative transport is available.

Ensure that you have an international drivers’ licence and that your insurance covers you for travelling on a motorcycle.

Use discretion when choosing which form of transport to take. Public buses, in particular, can be overcrowded and poorly maintained. The speedboat from Chiang Mai in Thailand to Luang Prabang in Laos, for example, may be exciting but its safety may be questionable.

Be wary of using domestic airlines in developing countries without first checking their safety record online.

Alcohol is a major factor in drowning’s amongst travellers. Pay attention to lifeguards, beach flags and local warnings regarding jellyfish and rip currents. Safety standards for water sports such as water skiing or whitewater rafting may be poor in developing countries.


Top Tips •

Always check water depth before diving and wear life jackets during water sports or while travelling by boat.

Keep a close eye on children around water, including the hotel swimming pool.

Never attempt to jump off a balcony into the hotel pool as some unfortunate holidaymakers have done while under the influence of alcohol.

When you check into your hotel take a business card at reception or record the name and address. Check out the hotel fire exits.

Deposit your valuables, including passport (carry a photocopy) and jewellery in the hotel safety deposit box.

Try to observe the landmarks in the area should you get lost on your return.

Use recommended taxi firms.

Only use maps on the street if absolutely necessary and use your phone discreetly with your back against a wall while doing so.

If you are unfortunate enough to be mugged do not make eye contact with your aggressor and surrender valuables without a struggle.

Never photograph local people without their consent and do not photograph airports or military areas.

Dress modestly and don’t wear items that attract undue attention.


Steer clear of public protests and demonstrations.

Report all crimes to the local police as you will need a police report to make an insurance claim.

Never accept parcels or packages for strangers. There are severe penalties, including the death penalty, in many countries for drug use, possession or dealing.

In Case of Illness: •

A lways have details of the nearest medical clinic or hospital in case of emergency.

Y our insurance company may provide a telephone number to contact in an emergency - make sure you keep a copy of the number with you.

If your illness is very serious contact your local embassy or consulate for further advice.

S tay calm and try to explain the problem to your doctor as best you can.


Psychological Health Stress Travel can be stressful. Of course it is also exciting and so much depends on the traveller’s outlook and coping ability.

Culture Shock Some travellers may develop feelings of guilt and anger when they witness extreme poverty having arrived from high-income countries. Escaping from difficult situations in one’ s home country or to ‘find oneself’ are never good reasons to travel and may lead to dangerous risk-taking behaviour, such as excessive alcohol intake, recreational drug-taking, sexual risks, or open hostility abroad. Culture shock is very real and you should always research your travel destinations and speak to friends who have visited the same countries before you travel. Travelling alone can bring feelings of homesickness and isolation while those not used to travelling in groups may find integration into the group difficult. Tensions are often strained when living in close quarters and sharing primitive toilet facilities with a group of strangers on a remote mountain trek.

Pre-existing conditions If you have a pre-existing psychiatric condition such as depression, bipolar disorder, anxiety or schizophrenia, travel may exacerbate these conditions, you should consult your GP or Psychiatrist well in advance of your proposed departure date. Medications may need to be adjusted or potential drug interactions highlighted between your medications and medications used to prevent malaria or altitude sickness. Ask for a medical letter on headed paper outlining your psychiatric history and current medications. Readjustment to home life, especially after an extended stay, such as in expatriate workers, can be distressing and family support is essential.


Medical Tourism •

Most people who travel to access medical treatment receive dental treatment or cosmetic surgery, but some also undergo elective (planned) surgery or infertility treatment.

Tourists seek medical treatment in many worldwide destinations.

Make sure you carry a European Health Insurance Card if you are obtaining emergency treatment in another country within the European Economic Area.

Ask to see a detailed contract from the treating clinic or hospital. This should include arrangements for follow-up, the complaints procedure and details of medical repatriation if necessary. Do not depend on your local embassy if financial complications arise.

You may need a hepatitis B vaccination prior to travelling for medical treatment overseas. There may be a risk of this and other blood borne viruses, including HIV, if you receive invasive treatment in less developed countries.

If you have been immobile after an operation you may be at increased risk of deep vein thrombosis. Preventive measures will include walking along the cabin aisle, wearing flight socks or perhaps even receiving a heparin injection before flying home. Discuss this with your treating physician.


Before embarking on such travel you should research: •

The credentials and experience of the medical staff.

Their English-speaking ability.

Their plans for treatment before and after the procedure.

Their success and complication rates.

Their emergency protocols, adherence to infection control.

Avoid responding to an advertisement but prefer instead to be referred by a specialist in your own country where possible.


Last Minute Travel It is better to attend late for a pre-travel health consultation than not at all, but bear in mind that there may not be adequate time to develop full protection against diseases for which a vaccine is available. Most vaccines protect you after 5 to 10 days. •

If you have a pre-existing medical condition which is not adequately controlled, your travel health specialist may advise you to defer travel.

There are accelerated schedules for hepatitis A and hepatitis B (combined) and rabies vaccines but a minimum of 21 days is required to complete this rapid course. Your physician may give you the first two doses with instructions on how to receive the remaining doses while abroad where this is appropriate. In the case of hepatitis B or the combined hepatitis A and B vaccine, a booster dose will be given at 1 year when the day 0, 7, 21 schedule is followed.

There is no limit to the number of vaccines which can be given on a single visit and 3-5 injections per visit may be necessary if you are a last minute traveller. Booster doses can be given right up to the day of travel although there is a remote risk of serious adverse reactions occurring during travel.

In the case of yellow fever vaccination, your vaccination certificate is a legal document which will not be recognised for 10 days following its administration. You may be refused entry, quarantined or vaccinated at the port of entry if you do not have a valid yellow fever certificate.

It is possible to start the most commonly prescribed anti-malarial mediation as late as a day before exposure to malaria. You will not be given the drug Mefloquine (Lariam) unless you complete a 3-week trial before departure to assess your tolerance to it. An exception can be made if you have previously had a good tolerance to the drug.


Special Groups of Travellers Children •

If you are travelling with children, ensure you pack a suitable travel health kit.

If you are visiting overseas on and off for a prolonged period, consider arranging vaccine doses during visits back home.

Warn your children about the dangers of approaching seemingly tame animals and discuss the need for rabies vaccine with your travel medicine physician.

Try to avoid non-essential travel with children to malarial areas.

Store all medications, including antimalarial tablets, out of reach of children.

Ideally avoid flying while the child has a current or recent ear or respiratory infection.

Your children should carry emergency contact numbers and you should carry photos of your children in case they go missing.

If a child is not travelling with both parents or guardians, a notarised letter of consent will need to be carried.

Use appropriate child restraint systems in vehicles.

Children should be taught to swim and should wear buoyancy aids when necessary.

Always supervise children near water and on balconies.

For babies prepare bottle feeds using boiled and cooled water, or bottled mineral water.

Know when to use oral rehydration solutions to treat dehydration and have a low threshold for seeking medical advice if a child suffers from a diarrhoeal illness while travelling.

You can use up to 50% DEET insect repellent on children over 2 months of age.

Good sun protection is essential to protect your child’s skin.


Diabetics Diabetic travellers should obtain specialist travel insurance. Additional quantities of insulin should be carried in the hand luggage and not put in the hold of the aircraft where it will freeze. Insulin can be stored for up to one month at room temperature, but please check this with the manufacturer first. A MedicAlert bracelet should be worn at all times. •

Discuss how to adjust your insulin doses with your diabetes or travel medicine specialist if you are crossing more than 6 time zones.

Monitor your blood sugar frequently.

Carry snacks in case of delays in serving meals on board aircraft.

Glucose tablets or sweets should be carried to relieve symptoms of hypoglycaemia and your travelling companion should be instructed how to use glucagon in the event of a severe ‘hypo’.

If female and using doxycycline to prevent malaria, you should carry an anti-fungal tablet in case of vaginal thrush.

Wear comfortable, well-fitting shoes and do not remove your shoes on a flight or walk barefoot. Keep bites clean and do not scratch them to avoid infection.


Pregnant women •

Pregnancy may need to be delayed for a period of time following live vaccines or antimalarial drugs. Speak to your doctor for specific advice in relation to the vaccines or medications you require for your trip.

The early pregnancy scan should ideally be carried out prior to travel.

Travel to malarial areas is ill advised during pregnancy.

Obstetric care may be limited or non-existent in certain regions of the world.

Pregnant women are more likely to be bitten by mosquitoes, so precautions must be strictly followed to avoid mosquito bites; use an appropriate insect repellant.

Commercial air travel is permitted in uncomplicated pregnancies up to 36 weeks and up to 32 weeks for a multiple pregnancy.

Check the airline’s policy when booking flights. In general, the second trimester is the safest time to fly for a pregnant woman.

After 28 weeks the airline will probably require a medical certificate from your doctor.

Deep vein thrombosis is a greater risk in pregnancy and the usual precautions should be taken during flights.

Pregnant women must avoid unpasteurised dairy products, under-cooked meat and soft cheeses.


CHECKLIST 1. Vaccinations – make sure you get them within the recommended time limit 2. Anti-malarials if necessary 3. Health and travel insurance 4. Passport 5. Traveller’s cheques and bank card 6. Banking details 7. Sun cream with high SPF 8. Lipbalm with SPF 9. Sunglasses 10. Language guide 11. Small First Aid kit 12. If travelling to an area with poor medical facilities, consider taking a sterile medical kit with you 13. Antibacterial soap 14. Insect repellent 15. Tablets for diarrhoea and oral rehydration sachets


Useful Phone Numbers Department of Foreign Affairs: Health Service Executive, Customer Service:

+ 353 1 478 0822 1850 241850

Passport Office Dublin:

+ 353 1 671 1633

Passport Office Cork:

+ 353 21 494 4700

International Reverse Charge Calls: Ireland (Direct Freephone): Bank of Ireland 24hr Lost/Stolen Credit Cards:

1800 404 100 + 353 567 757 007

AIB 24hr Lost Stolen Credit Cards:

+ 353 1 668 5500

Permanent TSB 24hr Lost/Stolen Credit Cards:

+ 353 1 212 4290

International Emergency Number:

112 / 999/ 911

VHI:

+ 353 567 753 200

HIBERNIAN AVIVA: + 353 1 481 7840 (Alternative number + 353 1 619 3620) Laya Healthcare:

1890 700 890

Some useful web pages: Centers for Disease Control and Prevention (US): Exodus Software:

www.cdc.gov/travel

www.exodus.ie/appointments/make.asp

Fit for Travel (NHS Scotland): Travel Medicine Society of Ireland:

www.fitfortravel.scot.nhs.uk www.tmsi.ie

Irish Travel Agents Association:

www.itaa.ie

Tropical Medical Bureau:

www.tmb.ie

World Health Organization: Department of Foreign Affairs and Trade:

www.who.int/ith/en www.dfa.ie


Personal Details Name:__________________________________________________ Passport No:______________________________________________ If found, please return to: ____________________________________ _______________________________________________________

Medical Details Blood group:______________________________________________ Health problems:___________________________________________ Current medication:_________________________________________ Known allergies:___________________________________________ In case of emergency, please contact:___________________________ _______________________________________________________

__________________________________________ _______________________


Notes


Notes


Notes


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Healthy Travel Booklet 2014