Fit for travel Health advice for travellers

Transcription

1 To conclude When travelling, bring a small travel health kit, documentation of your vaccinations and (if necessary) your prescriptive medicine documents. For a travel checklist, see lcr.nl. For some medications, such as strong pain killers, ADHD-medication, antianxiety pills and medicinal cannabis, a declaration signed by your doctor is necessary. You can find more information about this on: farmatec.nl (Dutch and English). It is not recommended to buy medications online or abroad from a non licensed source. Often, such medications don t have any, or have insufficient active drug content, and will not be effective. Make sure you have an adequate and appropriate travel insurance; it can cost you a lot of money if you need to be returned to your home country in case of an emergency! Seek medical care in case of prolonged fever or other health problems that occur during or after your journey. Always tell your doctor at home that you have travelled in a foreign country. Extra information You can find more information on the following websites: Public health Service Amsterdam: ggd.amsterdam.nl (dutch) the National Coordination Centre Travel Advice (LCR): lcr.nl (Dutch) the Dutch Ministry of Foreign Affairs: minbuza.nl (Dutch, English) Colofon Fit for travel: Health advice for travellers. Edited by Travel Advice and Vaccination Clinic, Public Health Service (GGD) Amsterdam. Nieuwe Achtergracht 100 P.O. BOX CE Amsterdam ggd.amsterdam.nl 2015 GGD Amsterdam Version july 2015 Since January , the Travel Advice and Vaccination Clinic of the Public Health Service (GGD) Amsterdam has been officially certified. This means the clinic s applied quality system meets the HKZ quality standards for prevention and control of infectious diseases, version Fit for travel Health advice for travellers

2 Being fit for travelling is one thing; returning in good health is another. In some countries, you can contract uncomfortable and sometimes even life-threatening diseases. Most frequently encountered conditions are diarrhoea, malaria, skin problems, and sexually transmitted diseases. Note that the availability and quality of medical facilities may be less than in western countries. Fortunately, you can minimise the risk of illness by vaccinations and/or malariatablets. At the Public Health Service (GGD) Amsterdam a consultant can give you all necessary information based on the guidelines of the National Coordination Centre for Travel Advice (LCR). The consultant takes your health, your travel destination and duration, your itinerary and travel conditions into account. There are simple precautions you can take to lower the risk of (severe) illness. These precautions are described in this brochure. It also describes what you can do if you get ill. Note that children are more vulnerable than adults. In general, they contract infectious diseases more easily and often are more seriously ill. This brochure offers some additional information about health in these younger travellers. Have a good and safe journey! 2 Hygiene Wherever you travel, wash your hands after using the toilet and before you prepare and/or eat food. Use clean water, utensils, dishcloths and cleaning towels. Keep persons with bowel complaints and/or diarrhoea out of the kitchen. In warm and humid climates take extra care to avoid skin infections. Even small wounds and insect bites should be disinfected with betadine iodine or 70% alcohol dilution and covered with a sterile band aid. In countries with low hygienic standards, diseases such as hepatitis B can be contracted from non-sterile medical instruments, for example at a hospital or dentist s office. Infection can also occur through non-sterile instruments used for body piercing, tattooing or shaving. Food and water One out of ten travellers will have diarrhoea when travelling. Good personal hygiene (like mentioned before) and adequate sanitary conditions will lower your chances of suffering from diarrhoea. It is also important to be careful what you eat and drink! Certain foods are unsafe to eat, especially raw food and food that has been standing at room temperature in warm environments for a while. You should only eat freshly prepared food that is thoroughly cooked and served hot. Don t eat raw or undercooked meat, seafood or shellfish. Avoid dairy products that are unpasteurised including ice cream and milk. Avoid raw fruits and vegetables, unless you have washed and peeled them yourself. Not all water is fit for drinking. In countries with poor sanitation, tap water can be unsafe to drink, even in luxury hotels. Ice cubes, drinks, and salad greens can also be unsafe if tap water has been used in preparation. Bottled (fizzy) drinks with an intact seal are safest, as is water boiled for at least one minute. Caution: street vendors sometimes sell bottled water that may have been refilled with tap water. In summary: Cook it, boil it, peel it or leave it! Besides boiling, water can also be purified by filtration or by using chemical disinfectants such as iodine and chlorine. These can be obtained from specialist travel shops and they kill most bacteria, viruses, and in lesser amount also parasites. You can use vitamin C tablets to improve their flavour. Don t use iodine when you have a thyroid gland disease or when you are pregnant. 3

3 sell ORS and loperamide over-the-counter; a prescription is not needed. Read the instructions before you use any medication. Adults should seek medical care in case of: diarrhoea with fever (i.e., body temperature higher than 39 degrees Celsius). diarrhoea containing blood and/ or mucus. diarrhoea for more than three days. Elderly should also seek medical care in case of: diarrhoea with vomiting. diarrhoea for more than one day. Breastfeeding is the safest way to feed your baby. Follow the above recommendations when preparing food and formula for children. Only use cooked or pasteurised milk. Diarrhoea In general, diarrhoea is a mild and self-limiting illness. Most travellers will recover with little or no treatment. Diet restrictions are not needed. However, an adequate fluid intake is very important to prevent dehydration. Drink two to three litres fluid per day. Avoid unsafe water and drink for example hot tea, clear soup, or bottled water. ORS (Oral Rehydration Solution) is a fluid, containing a balanced amount of glucose and salt to prevent dehydration 4 in case of (severe) diarrhoea. and elderly are more susceptible to dehydration. ORS can be particularly useful for them. Healthy adults with mild diarrhoea can rehydrate simply by using available fluids; for this group of travellers ORS is only advised for severe, watery diarrhoea. An antidiarrhoeal drug containing loperamide (Imodium, Diacure, Diarem ) can be taken if you have watery stools. Use it cautiously, as excessive intake may lead to constipation. Never use loperamide if you have diarrhoea containing blood or mucus. Don t use activated carbon in any case of diarrhoea. This drug reduces the effect of medications, such as anti-malarial drugs and the contraceptive pill. Drug stores and pharmacies worldwide with diarrhoea can dehydrate very easily. Give your child extra fluid and ORS. Anti-diarrhoeal drugs, such as loperamide, should not be given to children younger than two years. Use it cautiously in children younger than six years; children get constipated easily. Never give loperamide to a child who has diarrhoea with blood or mucus. Seek medical care for children in case of: diarrhoea for more than one day in infants. diarrhoea for more than three days in older children. inadequate fluid intake and persistent vomiting. diarrhoea with fever (i.e., body temperature higher than 39 degrees Celsius). diarrhoea with blood and/or mucus. signs of dehydration such as drowsiness or irritability, decreased urine production, or dark-coloured urine. Mosquitoes and ticks In many tropical and subtropical regions, infected mosquitoes can transmit diseases such as dengue fever, malaria, yellow fever and chikungunya. Mosquitoes that carry malaria are most active in the evening and during the night. Mosquitoes that carry the dengue virus, yellow fever virus and chikungunya virus are most active during the day. Other insects, such as ticks and sand flies, can also transmit diseases. Moreover, an insect bite usually causes an itchy or painful bump, which may easily get infected. There are several simple ways to protect yourself against insect bites: Cover your body with proper clothing. Wear long pants, long-sleeved shirts, shoes and socks. Use insect repellent containing 3040% DEET on your exposed skin. Products with higher concentrations of DEET last longer but do not improve protection. - Avoid rubbing DEET onto lips or into your eyes. Don t apply DEET on damaged or irritated skin. - Wash off the repellent with soap and water when protection is no longer needed. - Use DEET again after swimming, excessive sweating or in warm and humid weather. 5

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5 - Don t use DEET more than 6 times a day (table 1). For more information on DEET go to lcr.nl for the DEET brochure. A mosquito net impregnated with permethrin or an air-conditioned room with screened windows protects against mosquito bites during the night. Because malaria can be fatal, antimalarial drugs are advised when travelling to high-risk regions. Diseases such as dengue and malaria can be more dangerous for children. are not able to protect themselves against insect bites. Make sure your child is well-protected against insect bites: While outdoors, children should wear proper clothing that covers arms legs, feet and ankles. This also prevents sun burn. Use insect repellent containing DEET. - Don t use DEET in concentrations more than 30% in children younger than 2 years (table 1). - Don t apply DEET repellent to children s hands, as children tend to put their hands in their mouths and eyes. Put your child to bed under a mosquito net at night, but also during daytime naps. Anti-malarial drugs may be advised, depending on travel destination. Note that the dosage for children can be different than for adults. The drug of choice and drug dosage depend on age, weight and health. Keep the tablets in childproof containers and out of the reach of infants and children. Follow the instructions carefully and consistently. Drinking or eating sweet substances together with the tablets may help children accept them more easily. Amount (%) of DEET in repellent up to 30% 31 to 40% 41% and higher Adults Max 6 times per 24 hours Max 2 to 3 times per 24 hours from 2 years untill 2 years Max 6 times per 24 hours Max 6 times per 24 hours Don t use Don t use Don t use Sunbathing and swimming You will be exposed to stronger UV sunlight in tropical and subtropical regions than in the Netherlands, even on cloudy days. When you re swimming or wearing thin clothes you can get sunburned without noticing. Sun burn may cause skin ageing, skin cancer, skin rash, inflammation, and fever. Your skin needs some time to get used to the blazing sun. Avoid sun exposure from 11 am to 3 pm. Cover as much skin as possible with sun-protective clothing, and use a sunscreen with a high sun-protection factor (usually 15 or higher). When using both sunscreen and repellent, apply the sunscreen one hour before the repellent. Otherwise, sunscreen protection is diminished. Chemical pollution of swimming water may cause a skin rash or symptoms of poisoning. A variety of micro-organisms can be transmitted in ponds, lakes and rivers. Without you noticing, parasites may enter your body by penetrating the skin of your feet or legs. Don t wade, swim or paddle in fresh, non-chlorinated water, even if the water looks fine. Seawater and chlorinated swimming pool water are usually safe. Coral reefs can cause serious injury. Beware of wild life in seas and rivers. Don t go swimming under the influence of alcohol or drugs. are more sensitive to sunlight and polluted or contaminated swimming water than adults. Therefore, the above recommendations are of extra importance for them. Wearing protective footwear when playing in the sea can avoid serious injury from coral reef or other hazards. 8 9

6 Sexually Transmitted Disease (STD) Sexually transmitted diseases (STDs) such as HIV/AIDS, are a worldwide threat, and travelling raises your risk of contracting a STD. Even persons who intend to avoid such risks, may end up having sex while travelling. Note that reliable condoms are not available in every country. Take condoms from the Netherlands, even if you don t intend to have sex on your trip. Carry the condoms in your hand luggage during a flight. The low temperature in the hold of an aircraft can damage condoms. Proper use of a condom can help to decrease the risk of STDs. Rabies In most tropical and subtropical countries, as well as in Eastern Europe, dogs and cats may carry rabies. Other animals, such as monkeys and bats, may also carry rabies. You can contract the disease when an infected animal bites or scratches you. It s also possible to contract the disease when an infected animal licks onto damaged skin or mucous membrane. Avoid animals while travelling, especially stray dogs. Don t touch sick or dead animals. If an animal bites or scratches you, wash the wound immediately with copious amounts of water and soap and disinfect with betadine iodine or a 70% alcohol dilution. Always visit a doctor as soon as possible. Avoid caves! In caves with bats, rabies and other viruses can also be transmitted through the air. Tuberculosis During the travel consultation, the doctor or nurse told you if you are visiting a country where there is an increased risk of tuberculosis. You can also find this information on our website: ggd. amsterdam.nl > Reizigersvaccinatie. Tuberculosis is most commonly an infection of the lung. If a person with lung tuberculosis has a cough, bacteria from the lung can enter the air and infect other people who inhale them. You can reduce the risk of infection by turning your face away from somebody who is coughing. If you complain of an ongoing cough for more than 3 weeks after your trip, you should visit your doctor. Remember, always tell the doctor that you have recently travelled abroad. For more information, see tuberculose.nl (Dutch). Air travel is allowed for healthy children older than 2 weeks. Changing air pressure during flight may cause earache, especially in infants and little children. Swallowing may ease the pain, especially at take-off and landing. So, give your child something to eat or drink. are more susceptible to motion sickness. Don t give your child too much sweet or fatty food before and during the journey. If your child has had motion sickness before, tablets can be given to prevent it. Vaccinations Side effects In most cases, vaccines cause no side effects. Mild reactions may occur such as soreness and stiffness at the injection site. A slightly elevated body temperature may also occur. Such Don t let children play with animals. 10 and air travel reactions usually last for only a few hours or days. Paracetamol (acetaminophen) may be helpful in reducing pain or fever. If a more severe reaction occurs, you can contact the Public Health Service (GGD) Amsterdam or your general practitioner (huisarts). Having a symptom after vaccination doesn t certainly mean that it s due to the vaccination, you may coincidentally have the flu for example. Duration of protection and vaccination schedule Most vaccinations provide protection for many years. Sometimes, one or more booster vaccinations are required to get or to maintain protection. More information on the duration of protection and (booster) vaccination schedules per vaccine can be found on the website of the LCR: lcr.nl (Dutch). 11