Archive for Travel Healthcare

PATIENT’S GUIDE ON TRAVELER’S VACCINATIONS

Vaccination before traveling is essential to ensure an enjoyable journey. Everyone is encouraged to complete a course of these vaccinations.

Studies have shown that between 50-70% of short travelers to the tropics or subtropics encounter some health impairment or problems.

It is best for travelers to plan vaccination about eight weeks before the departure date.

If you have less than 4 weeks before departure, you should still see your doctor. You may still benefit from shots or medications and other information about how to protect yourself from illness and injury when traveling.

The following are recommended vaccinations for all travelers prior to traveling.

  • Hepatitis B / Influenza / Hepatitis A / Chickenpox / Typhoid / Cholera

Additional vaccinations for students studying abroad:

  • MMR (measles, Mumps, Rubella) / Meningococcal Meningtis / DT (Diphtheria, Tetanus)

HEPATITIS A

HOW IS HEPATITIS A TRANSMITTED?

Hepatitis A is transmitted through the oral-faecal route, e.g. via cintaminated food and water.

WHAT ARE THE SYMPTOMS OF HEPATITIS A?

It attacks the liver cells causing acute inflammation of the liver which may lead to hospitalization and patients with serious disease can suffer acute liver failure leading to encephalopathy and coma. This is completely preventable through vaccination.

COUNTRIES WITH HIGH HIPATITIS A INFECTION RISK

Hepatitis A vaccine is highly recommended for travelers visiting countries like Africa, the Middle East, South America and Asia where the disease is prevalent and transmission rate is high.

CAN I GO  FOR VACCINATION IF I AM NOT SURE WHETHER I HAVE IMMUNITY?

Hepatitis A vaccine can be given safely even to those who has previously contracted the disease.  Thus it is possible to vaccinate even though the immune status is unknown.

WHEN SHOULD I GET THE VACCINATION PRIOR TO THE TRIP?

The effective immunity is reached in 2 weeks’ time and the maximum effect is four weeks after a single dose. Thus it should be given 2 weeks prior to the trip.


HEPATITIS B

HOW IS HEPATITIS B TRANSMITTED?

Hepatitis B is transmitted through body fluid and blood products via sexual contact, blood transfusion, needle prick, and mother to baby transmission during labour. A significant portion of hepatitis B infection is contracted during travel.

WHAT ARE THE SYMPTOMS OF HEPATITIS B?

The hepatitis B attacks the liver cells and may lead to chronic inflammation, scarring and hardening of the liver (cirhrosis) and increase risk of liver cancer by more than 200 fold! Chronic hepatitis B infection although treatable, will require close monitoring and high cost of treatment.

COUNTRIES WITH HIGH HEPATITIS B INFECTION RATE

The risk is highest in sub-Saharan Africa and in parts of South East Asia and South America where the prevalent rate is high but this too will depend on the exposure risk of particular individuals.

WHO SHOULD BE GET VACCINATED?

Vaccination is recommended for long-term travelers, people who visit endemic areas, high risk group e.g. those engaging in unprotected sexual activities, health workers and anyone who may need medical or dental procedures where the risk of contracting this disease is high.

HOW AND WHEN SHOULD I GET THE CVACCINATION?

The routine vaccination schedule consists of three doses at 0, 1 and 6 months interval, given through the intramuscular route. However rapid immunization is possible with four doses at 0, 1, 2 and 12 months apart. An accelerated course (for adults over 18 years only) consists of four doses at 0, 7 and 21 days and 12 months, can also be applied when needed.

TYPHOID

HOW TYPHOID IS TRANSMITTED?

Typhoid fever is contracted through consumption of contaminated food, milk or water. The organism involve is Salmonella typhi.

WHAT ARE THE SYMPTOMS OF TYPHOID?

The disease causes diarrhea or constipation and may lead to high grade fever, rashes. It may spread to the brain, lungs, blood, bone, intestines and other parts of the body. The mortality rate in developing countries can be as high as 30%! The disease can be treated with antibiotics.

WHICH AREA HA A HIGHER INCIDENT OF TYPHOID?

Vaccination is recommended for travelers to areas where hygiene may be poor particularly in India, sub-Saharan Africa and part of South America.

HOW AND WHEN IS TYPHOID VACCINE GIVEN?

It is given through the intramuscular route and confers around 70% protection which may last up to 3 years. The vaccine takes effect in about 10 days. Thus vaccination is recommended 2 weeks before travel.

CHOLERA

HOW IS CHOLERA TRANSMITTED?

It is spread through contaminated water and food by human faeces. It is caused by the organism called Vibrio Cholerae.

WHAT ARE THE SYMPTOMS OF CHOLERA?

Cholera is an acute diarrhea disease that can in matter of hours, result in profound dehydration and death. It causes a sudden onset of painless water diarrhea that is often described as ‘rice water’. Progression is usually rapid and unless promptly treated, death will ensue. Fever is usually absent and muscle cramp is common.

WHO ARE AT RISK FROM CHOLERA?

The prime risk factor is being in an area which has endemic cholera or poor water and sewage facilities.  Careless travelers to such areas do have an increased risk, and regularly bring the disease home.

WHO SHOULD GET VACCINATED AGAINST CHOLERA?

Currently, no country or territory requires vaccination against cholera as a condition for entry. In some circumstances, local authorities may require documentation of this vaccination. A single dose or oral vaccine will satisfy local requirements. It is an oral vaccine (e.g. Dukoral) given orally and confers around 50% protection that may last from a few months to 3 years.


INFLUENZA

HOW IS INFLUENZA TRANSMITTED?

Influenza is a highly contagious airborne disease that occurs worldwide. Outbreak are recorded virtually every year. It is caused by influenza viruses classified as influenza A and B. The propensity of the H and N antigens of influenza A enables it undergo periodic antigenic variation. Therefore pandemics can occur resulting in substantial mortality.

WHO SHOULD GO FOR THE VACCINATION?

Influenza vaccination is recommended for individuals below 6 months of age who are at increase risk of complications, especially those with chronic heart or lung disorders (e.g. asthma, COPD), residents of  nursing home and other chronic care facilities, health care workers, the elderly above 65years old and patients with diabetes, renal disease, hemoglobinopathies or immunosuppression.

HOW FREQUENT SHOULD I GET VACCINATION?

Inactivated influenza vaccine is given through intramuscular route and confers around 50-80% protection. It should be repeated annually to maintain immunity against the most current strains of influenza virus.

CHICKENPOX

HOW IS CHICKENPOX TRANSMITTED?

Chicken pox is caused by Varicella zoster virus. It is transmitted through direct contact of the fresh skin lesions or through airborne transmission.

WHO SHOULD GO FOR THE VACCINATION?

Chickenpox vaccine is now included in the standard childhood vaccination programs in many countries. It is recommended for all those who have not been vaccinated and have not contracted the disease before.


MMR

HOW ARE MEASLES, MUMPS AND RUBELLA TRANSMITTED AND WHAT COMPLICATIONS DO THEY CAUSE?

Measles, mumps and rubella spread through airborne transmission.

Measles is a highly contagious disease that causes high fever, cough and spotty rashes all over the body. It may also causes complications e.g. ear infection, lung infection and may involve the liver, heart and brain leading to progressive mental deterioration and fatal outcome.

Mumps cause painful swelling of the salivary glands. It can cause meningitis and infertility in males.

Rubella (German measles) is a mild disease but it has worldwide distribution and can be dangerous to pregnant women. It can cause miscarriage or congenital anomalies e.g. blindness and defect of the baby’s heart, mental retardation and deafness.

HOW IS MMR VACCINE GIVEN AND WHO SHOULD GO FOR THE VACCINATION?

MMR is live attenuated vaccine given through subcutaneous route. MMR vaccine is standard feature in most countries childhood vaccination program.

Adults of age 18 years and above going to further their studies in countries with specific requirement for this vaccination should get another dose of MMR, 2 doses, separated for at least 28 days are recommended for all travelers who have not been vaccinated previously.

WHEN SHOULD I GET VACCINATED?

It provides protection 7-10 days after 1st dose and 7 days after 2nd dose. Protection may last for a longtime. Thus vaccination is possible 10 days prior to travel.


YELLOW FEVER

WHAT IS YELLOW FEVER?

It is caused by the Yellow fever virus. It is transmitted through mosquito bites.

WHAT ARE THE COMPLICATIONS?

It will lead to fever with bleeding and severe liver ells damage.

WHICH AREA HAS THE HIGHEST INCIDENT OF YELLOW FEVER?

Certain parts of Africa and South America.

WHO SHOULD GET VACCINATED?

Vaccination are suitable for everyone except infants less than 1 year old. Vaccination is highly recommended for travelers to high risk areas. A vaccination certificate is required for entry into many counties, particularly for travelers arriving in Asia from Africa or South America.

WHEN SHOULD I  GET VACCINATED?

The protective effect occurs within one week in 95% of the people vaccinated. A single dose of vaccine provides protection for 10 years and probably for life.

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Be Safe In The Sun

People on holiday spend more time under the sun sight-seeing and traveling compare to when they are staying at home. Even for people who stay in tropical countries who are used to the sunny, hot climate , need protection from the sun when they are traveling.

How Ultraviolet (UV) light can damage to our skin?

Ultraviolet light (UV) light is damaging to our skin. UV is divided into two types, UVA and UVB. UVA causes skin tanning and aging, while UVB makes the skin burn and can lead to skin cancer with long term exposure. Nothing can stop UVA and UVB rays. This means that you are still not fully protected even if you remain in a shade or wear long-sleeved clothes. Nonetheless, covering yourself up or staying in the shade is still beneficial as it does provide some protection.

Different people have different susceptibility to the effects of the sun. Darker skinned people can stay in the sum longer that fairer skinned people.

SUN PROTECTION FACTOR (SPF)

Sun Protection Factor (SPF) indicates how much protection is provided by the sunscreen product. The higher the number, the greater is the protection. For example, if you normally get burnt after being pout in the sun for 30 minutes, an SPF of 15 protects you 15 times longer, which means that you can be out in the sun 15 x 30 minutes before you get burnt.

SPF CHART – BASIC PROTECTION GUIDELINES

SKIN TYPE 1 HOUR 2 HOURS 3 HOURS 4 HOURS 5 HOURS
Type 1 – Very fair skin,
never tans always burns
SPF 15 SPF 30 SPF 30 SPF 60 SPF 60
Type 2 – Fair skin, slow
tans, burn easily
SPF 15 SPF 30 SPF 30 SPF 60 SPF 60
Type 3 – Light skin,
gradual tan, initially burns
SPF 8 SPF 15 SPF 15 SPF 30 SPF 30
Type 4 – Medium skin, tan
well, minimal burns
SPF 4 SPF 8 SPF 8 SPF 15 SPF 15
Type 5 ,6 – Dark skin,
easily tans, rarely burns
SPF 4 SPF4 SPF 4 SPF 8

SPF 8


HOW TO PROTECT YOUR SKIN FROM SUN?

  • Use sunscreen products, preferably water-resistant ones. Creams, lotions gels and sprays are all effective. Since oils tend to fry the skin, it should only be reserved for those who tan very easily.
  • Always reapply sunscreen regularly and generously, especially after swimming even if it’s a water resistant product.
  • Avoid exposure to the midday sun when the sun is at its hottest. Ears, lips, noses, breasts, bald heads and other areas not normally exposed to the sun are more sensitive and hence, require more protection. Sunblocks with SPF30 and above are recommended.
  • Children burn more easily and should be protected from the sun. Children under 6 SHOULD NOT be expose to the sun without cover of protection.
  • Hats. clothing and shades are recommended.

SUNBURN

When a person is over-exposed, the skin may turn red, sore and irritated. In extreme cases, blistering might occur.

For adult s with mild sunburn, the best treatment is to:

  • Keep out of the sun and cover up until completely healed.
  • Keep the burned skin cool by showering or bathing in cool but not cold water.
  • Soothing creams can be applied.
  • Drink plenty of non-alcoholic fluids.

SUNSTROKE AND HEAT EXHAUSTION

Sunstroke occurs suddenly while heat exhaustion comes on a little slower. The victim becomes weak and sick with high temperature and headache. The best treatment is to drink plenty of non-alcoholic fluids and rest. Seek doctor treatment is condition did not improve.

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WHAT IS DVT?

Deep vein thrombosis is a clotting of the blood in any deep veins, usually in the calf. ‘At risk’ travelers are exposed to this problem when they remain immobile for an extended period of time e.g. travelling by plane, car, coach or train.

WHAT ARE THE SIGNS AND SYMPTOMS OF DVT?

It can occur days or weeks after the trip. There may be no symptoms. However, if the clot is large and it prevents the blood flowing through the veins, intense pain may be experienced in the affected calf. The pain is exacerbated by walking or standing. In some cases complications may occur if the blood clot breaks off and travels up to the lungs causing breathlessness and chest pain.

ARE YOU AN ‘AT RISK’ DVT TRAVELER?

Remaining immobile throughout a long trip increases your risk factor especially if you have one or more of the following conditions;

  • obesity (BmI>30)
  • over 60 years old
  • existing or a history of cardiac problems
  • pregnant or 2 months post-partum
  • on hormone therapy or oral contraceptives
  • existing abnormal clothing
  • recent surgery or leg surgery
  • a personal or family history of DVT
  • any other chronic or acute medical illness
  • travel for more that 3 hours in the four weeks before and after surgery
  • active cancer or cancer treatment
  • varicose veins
  • dehydration

HOW TO REDUCE DVT RISK?

Exercise through out the journey – ‘At risk’  travelers should try to exercise at least every hour during the trip. Rotating the ankles and exercise the calf muscles are some of the methods used to reduce risk of developing DVT.

Avoid wearing tight clothing that will restrict blood circulation. Well-fitted stockings and socks may help reduce risk. Consult doctors for size of stocking or socks required.

Avoid alcohol, tea or coffee while traveling to prevent problems of dehydration.

JET LAG

WHAT IS JET LAG?

Our bodies are naturally adjusted to promote sleep at nigh and to be active and alert during the day. When we travel across differing time zones, this rhythm is altered, disturbing our sleep and concentration.

HOW CAN JET LAG BE REDUCED?

  • Get good and sufficient sleep before the journey.
  • Rest well if possible during the journey.
  • Plan your arrival time so that you arrive at your destination at the time when you normally go to sleep.
  • Changing you watch to destination time on the plane helps sometimes.
  • Exposure to light is a good way to adjust your body to local time on arrival.
  • Mild sleeping pills for travelers with important schedules and meetings might be beneficial as it can help with jet lag. Please discuss with your doctors.

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Diarrhea is the change in normal stool pattern, in which the stool becomes more frequent and less formed (more watery and softer). It may also be presented along with abdominal cramps, bloating, nausea, vomiting and fever.

Diarrhea is defined as three or more loose stools in an 8 hour period, especially when accompanied with nausea, vomiting, cramps and fever.

WHAT CAUSES DIARRHEA?

Infection with bacterial, protozoa or viruses that are ingested by eating contaminated food or water, and even a change in diet may cause diarrhea.

How to prevent Diarrhea

  • Abide by the ‘Cook it, boil it and peel it’ rule if you are traveling to a place where hygiene and public sanitation is poor.
  • Drink bottled water, or water treated with purifying tablets.
  • Use bottled water for washing salad and fruits, even for mouth washing and cleaning teeth.
  • Avoid eating ice cream, seafood, fruit and vegetables from street hawkers, and ice cubes in the drink.
  • Food should be well-cooked. Avoid eating left-overs, re-heated or under cooked food.
  • Practice strict hygiene especially after using the bathroom and before you eat. Never use communal, damp towels in public conveniences. Instead, use disposable paper towels, antibacterial wipes or hot air dryer.
  • Avoid swallowing water in swimming pools, lakes, river or the sea when swimming.

HOW DIARRHEA IS TREATED

Traveler’s diarrhea is self-limiting, which means that it stops itself. Get plenty of rest. Drink plenty of clear fluids. It is important to prevent dehydration in children and the elderly, especially in hot climates. If you are vomiting, small sips of liquid is necessary to prevent dehydration.

Banana, salted crisps, rice, clear soups and [plain food such as bread are good. Avoid alcohol.

Since vital salts and minerals are lost during bouts of diarrhea, the best treatment for diarrhea is to take Oral Rehydration Salts (ORS). ORS comes in sachets which should be dissolved in water for drinking. It is suitable for both children and adults. (Read instruction on the packet carefully when consume)

If ORS is not available, it can be replaced with:

  • 6 level  teaspoons of sugar
  • 1 level teaspoon of salt
  • in 1L of safe-drinking water (boiled, cooked water)

OTC medication such as loperamide can also stop diarrhea by slowing down the movement of the gut/bowel. This allows more water to be absorbed from the stools. It stops diarrhea quite quickly and is very effective in short term treatment in adults.  Loperamide should not be taken if you are passing blood or have a history of bowel problems. Please consult your doctor for alternate treament before you  leave for the trip.

For women on contraceptive pills, please note that the effectiveness of the pills may be affected by traveler’s diarrhea. Alternative protection together with your pills is necessary if this occurs.

ALERT

  • ORS is the only suitable treatment recommended for children.
  • Loperamide is not recommended for children 6years and below.

SEEK MEDICAL HELP

If diarrhea is severe or bloody, if fever occurs with shaking chills, if abdominal pain becomes marked, or if your condition dose not improve or worsens after 24-hours, seek medical attention.

It is important to know that diarrhea could also be caused by some antibiotics or medicines. This may also indicate other conditions or diseases that require medical investigation.

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WHAT IS MOTION SICKNESS?

Motion sickness occurs when a disagreement exists between your visually perceived movement and your vestibular system’s (inner ears) sense of movement. For example, when you are travelling in a moving vehicle and at the same time concentrating on a still object such as a book, your brain will be confused by the messages of movement coming from your inner ear and the conflicting messages of being still coming from the optic nerves. Anxiety from previous attacks, a full stomach and a stuffy atmosphere can make matters worse.

WHAT ARE THE MO SICKNESS SYMPTOMS?

Nausea, vomiting and dizziness are the common symptoms of travel sickness. In some case, sweating and general feeling of discomfort may be experienced.

HOW TO PREVENT MOTION SICKNESS?

Look out of the window of the moving vehicle and concentrate on something on the horizon in the direction of travel. Sit in the front seat when travelling by car and look at the distant scenery. On a boat, go up on the deck and watch the motion of the horizon. In an airplane, sit by the window and look outside. Sitting over the wings in a plane is beneficial since the motion is minimized.

Fresh, Cool air can relieve motion sickness. Foul odors can worsen nausea.

Avoid reading or studying close objects. When travelling by car or train or coach and make regular stops if possible. Do not sit in a seat facing backward.

Avoid excessive alcoholic drinks.

Avoid eating or drinking too much before travelling.

Acupuncture bands for the wrist might be helpful. alternatively, applying pressure for about 5 minutes on a certain acupressure point on either wrist can relieve nausea.

Herbal preparations containing ginger have also been shown to reduce sickness.

Medicines for prevention and treatment are most effective when administered well before the motion activity takes place.

MEDICINE FOR MOTION SICKNESS

Antihistamines (promethazine, cinnarizine)

  • May cause drowsiness, not suitable for drivers.
  • Good for journeys that last 4-12 hours, to be taken 2 hours before travelling, some preparations can be taken the night before or at the start of the journey.

Hyoscine

  • May cause drowsiness, not suitable for drivers.
  • More suitable for shorter journeys.
  • Best taken 20 minutes before travelling.

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Alert!!

People with diabetics who are on regular medication, should not reset their watches until thy are able to adjust their medication to local time on arrival.

  • Get a letter from your doctor to confirm that you are a diabetic. This might be useful when you are asked to explain why you have needles in your possession.
  • Bring along sufficient anti-diabetic medicines for the trip.
  • It is not necessary to order ‘diabetic meals’ when travelling by air. Monitor your carbohydrate intake regularly during the journey and balance it with snacks if required.
  • Do not hesitate to request for more food or slice of bread from the flight attendant if needed.
  • Do not take insulin until you see the food coming down the isle. All kind of things can happen to hold up or delay the food from getting to you.
  • Take plenty of snacks with you to prepare yourself  for unforseen circumstances during the trip.

Insulin is absorbed more quickly in the heat and slower in cold climate.Therefore, monitor your levels regularly and adjust your diet accordingly. Keep in mind that perfect control might not be possible in the first few days.

  • Always keep your insulin with you and carry it in your luggage. Keep them pout of direct sunlight or freezing conditions, such as an aeroplane hold.
  • Keep your insulin cold, ie. a cold pack or next to a cold water bottle especially if you are travelling in a warm country.
  • Adjust your insulin times only after you reach your destination. When you cross time zones, it might be necessary to adjust your dosages.

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It is important for people with asthma who go on holiday travel or working trip to plan for their medication, equipments, travel insurance and consult their doctor to make sure their asthma is controlled.

  • Bring along sufficient medicines for the trip. It is a better idea if you always spare extra medicine in other baggage just in case you lost 1 set in the journey. Do not forget to take copy of your prescriptions to prove that it is for your own use.
  • Carry your inhalers with you all the time and keep a spare one in your hotel room.
  • Know your destination, especially on weather, temperature and pollution in that area and make sure your living environment is clean.
  • Asthmatics should not dive within 48 hours of a wheezing attack, even if it is a mild one. Be careful when you go scuba-diving.
  • Asthma may be exacerbated in cold, dry air. Beware when travelling to high attitude.
  • Exposure to certain allergens, such as those from hotel pillows or blankets is common when you travel. Beware of such problems and avoid any such exposure by bringing your own personal items or inform the hotel ahead of time.
  • Take insect repellent with you if you are known to develop serious reactions to insect bites, stings or nuts.
  • Make sure your travel insurance cover your healthcare expenses related to pre-existing asthma.

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