Immunisation and anti-malarials
Make sure you plan your travel vaccinations well in advance, you will often need to start receiving immunisations at least 8 weeks before you leave Leeds.

Immunisation and anti-malarials
Make sure you plan your travel vaccinations well in advance, you will often need to start receiving immunisations at least 8 weeks before you leave Leeds.

We recommend that you spend some time planning your trip and understanding the health risks you may face during your travels

You can  find very useful information on a variety of travel topics at the Government web site Fit For Travel 

Sexual Health
Remember that unprotected sex can result in anything from Chlamydia to HIV to unwanted pregnancy. The Sun newspaper reported in July 2005 that a Syphilis outbreak in Manchester was quickly replicated in Amsterdam, Dublin, and Paris as a result of people jetting from place to place and having unprotected sex – everyone going on holiday should take condoms, don’t leave it to chance, it’s not worth the risk.

Rabies
Rabies is present in many parts of the world. If a person develops rabies death is 100% certain. There are 40,000 deaths worldwide every year from Rabies. Do not be complacent – do not touch any animal, particularly; dogs, cats, monkeys, bats. If you are travelling to remote areas, it is particularly important that you consider getting vaccinated against rabies before you travel.

What to do if you are scratched or bitten by a mammal in another country where rabies is present
– Vigorously clean wound with soap and running water for 10 minutes

– Encourage the wound to bleed a little

– Apply tincture of aqueous iodine solution if you have any, or 40% alcohol or stronger (e.g. Whisky)

– Obtain information about the animal concerned

– SEEK MEDICAL HELP IMMEDIATELY (AT THE LATEST WITHIN 24 HOURS OF INJURY). If you have not been vaccinated you will probably require 5 injections plus an injection of rabies immunoglobulin. If you have been vaccinated you may still require 2 further injections within 48 hours

– Do not allow the wound to be stitched unless absolutely necessary

– It is vital that you complete the appropriate course of post-exposure treatment offered

– Please report the incident back to your GP on your return to the UK

An article in the British Medical Journal in September 2005 reported the case of a British woman who travelled to India. Whilst there a puppy bit her, leaving a slight graze. She had not been vaccinated against Rabies, but thought nothing more about it and did not seek medical help. Three and a half months after returning to the UK she was admitted to hospital with severe shooting pains in her lower back and left leg. She was diagnosed with rabies and died after eighteen days in hospital

Schistosomiasis (Bilharzia)
Prevalence: Africa (90% of cases), some parts of Latin America and South-East Asia

If swimming in fresh water lakes and rivers in Africa, Latin America and South-East Asia you are at risk of contracting schistosomiasis. Common hotspots are Lake Malawi (Malawi) and Lake Victoria (Uganda) The best advice is to avoid swimming in freshwater lakes or rivers, or if you do, check the risk of schistosomiasis in that area. In addition it is wise never to go barefoot, but to wear protective footwearwhen out, even on the beach. Other diseases and parasites can be caught from sand and soil, particularly wet soil

If you are exposed to risk, you need a blood test at least 12 weeks after your last exposure to the potentially contaminated water. (In 2011 we identified 15 cases in 6 months)

Schistosomiasis is a disease caused by blood flukes acquired when wading or swimming in infested fresh water lakes and streams.  When you are in the water, microscopic parasites burrow through your skin and migrate through your body until they come to their final destination in the veins of the bowel or bladder.  Light infections may pass unnoticed but more severe infections may cause blood in the urine or faeces, together with other symptoms

Insect Bites
Mosquitoes, certain types of flies, ticks and bugs can transmit many different diseases. e.g. malaria, dengue fever, yellow fever. Some bite at night, but some during daytime. The main way to avoid illness is to avoid being bitten, so where possible:

If your room is not air conditioned, but screened, close shutters early evening and spray room with knockdown insecticide spray. In malaria regions, if camping, or sleeping in unprotected accommodation, always sleep under a mosquito net (impregnated with permethrin). Avoid camping near areas of stagnant water, these are common breeding areas for mosquitoes etc

Electric insecticide vaporisers are very effective as long as there are no power failures! Electric buzzers, garlic and vitamin B are not effective

Cover up skin as much as possible if going out at night, (mosquitoes that transmit malaria bite from dusk until dawn). Wear light coloured clothes, long sleeves, trousers or long skirts

Use insect repellents on exposed skin. (Choose those containing DEET or eucalyptus oil base. A content of approximately 35% DEET is recommended for tropical destinations.) Clothes can be sprayed with repellents too. Impregnated wrist and ankle bands are also available. Check suitability for children on the individual products

Report any unexplained illness with symptoms such as fever, headache, malaise, muscle aches and fatigue

Malaria
Malaria is probably the most common and most serious disease you will be exposed to when travelling.  Malaria is caused by a microscopic parasite transmitted by female mosquitoes when they take a blood meal at your expense.  There are four species of malaria parasite, of which Plasmodium falciparum is the most dangerous and can lead to cerebral malaria and death

Malaria usually starts as a fever and you will feel very unwell.  Other symptoms may include diarrhoea, headache or a cough.  In a malaria area, all illnesses with fever should be considered to be malaria until proved otherwise.  Seek medical help as soon as you can if you become ill

Check carefully the areas you plan to travel to and take anti-malarial tablets (prophylaxis) if advised by the travel-health nurse or doctor. Some tablets can be bought over the counter in a chemist but others are only available on prescription. Do not take over-the-counter tablets if prescription-only prophylaxis has been advised

You can get malaria even when taking prophylaxis, but this happens more commonly in individuals who forget to take one or more tablets. It is essential that you take the tablets you are prescribed regularly and on time and for the whole of the recommended time after leaving a malaria area (sometimes for 4 weeks after)

Mosquitoes that transmit malaria bite mainly at night, but this can be any time from dusk onwards and even just after dawn. Use insect repellent containing at least 35% DEET, wear long, loose clothing when possible and consider taking a mosquito net impregnated with permethrin to sleep and rest under.  These can be bought in outdoor/camping shops. Do not rely on insect repellent and mosquito nets alone if you have been advised to take prophylaxis as well; all forms of protection are important

Take adequate supplies of the antimalarial agent suited to your area of travel and remember to take it. People die every year from malaria in the UK

Even with the best prophylaxis you may still catch malaria so have a high index of suspicion

Report any unexplained illness with symptoms such as fever, headache, malaise, muscle aches and fatigue

Malaria can occur up to two years after being bitten by an infected mosquito

If you become unwell with fever up to a year after returning from a malaria area, see your GP and tell them you have travelled abroad

View the Malaria Prophylaxis page which contains prices and sources for all anti-malarial medicines

Sun Sense
Sunburn and heat-stroke cause serious problems in travellers. Both are preventable – to avoid, use the following precautionary guidelines:

Increase sun exposure gradually, 20 minutes limit initially

Use sun blocks of adequate Sun Protection Factor strength (SPF 15 minimum). Reapply often and always after swimming and washing. Read manufacturer’s instructions

Wear protective clothing – sun hats etc

Avoid going out between 11am – 3pm, when the sun’s rays are strongest

Take special care of CHILDREN and those with pale skin/red hair

Drink extra fluids in a hot climate

Be aware that alcohol can make you dehydrated

Why factor 15?

The reason experts recommend factor 15, is that this represents the best balance between protection and price. You will get over 90 per cent protection from UVB rays with SPF 15. But no sunscreen, no matter how high the factor, can offer 100 per cent protection

Factor 15 sunscreen offers about 93% protection

Factor 30 sunscreen offers about 96% protection

Factor 60 sunscreen offers about 98% protection

www.cancerresearchuk.org/sunsmart/staysafe/sunscreen/

When Buying sunscreen:

Choose one with an SPF of 15 or above – this will give you over 90% protection

Make sure it is labeled ‘broad spectrum’ – to protect against UVA and UVB

Choose water resistant – it is less likely to wash or be sweated off

Check the ‘use by’ date – most sunscreens have a shelf life of 2-3 years

You don’t have to pay for expensive brands. All types are tested and the cheaper brands are just as effective if used properly – just remember factor 15+

Tips for using sunscreen properly:

Try to apply it 15-30 minutes before going out in the sun

Apply to clean, dry skin and rub in only lightly

Use generous amounts

Re-apply once outside to ensure even coverage

Then re-apply according to manufacturers instructions or more frequently if washed, rubbed or sweated off

Put on before make-up, moisturiser, insect repellant, and so on

Never use it to spend longer in the sun – this will put you at risk of sun damage that could lead to skin cancer

In hotter climates and hotter days in the UK avoid direct sun exposure between 11am and 3pm

Take special care of children and those with pale skin / red hair

Use SPF 60 on any areas of recent scarring / skin damage

You can get severe sunburn in the UK

Do not store sunscreens in very hot places as extreme heat can ruin their protective chemicals

Travel at High Altitude
Medex offer a comprehensive booklet on travelling at high altitude which you can download.

Have you been travelling to tropical or sub-tropical countries over the summer?

Please maintain a high degree of suspicion of Malaria if you develop any flu-like illness (characterised by fever, headache, joint aches, etc)

If you have been travelling and have returned feeling unwell, especially with an unexplained fever or prolonged diarrhoea you should make an appointment with a doctor

Travel occasionally brings some negative experiences. Please seek support for any unresolved issues from whomever you feel most comfortable with: friends/family/doctor or counselling services

Medical Indemnity
Contact MPS or MDU and arrange an elective study indemnity policy

Psychological Support
On your elective you may have many new and sometimes distressing experiences including helplessness and frustration witnessing preventable deaths. You may experience significant culture shock and have difficulty adjusting on your return to the UK. It is important to prepare for this and also to ask for help from peers, colleagues, counselling services or your doctor if needed

HIV PEP (Post exposure prophylaxis)
If you think you will need HIV-PEP on your elective please contact  Occupational Health at St James’ University Hospital

The following links to web sites are for your interest and assistance, however LSMP personnel may not be familiar with all the content of these sites and we may not agree with or endorse the views contained within them

Centre for Infectious diseases – Travellers’ Health

Fit for Travel

Foreign Office

Health Protection Unit Malaria

High Altitude Medicine

Malaria Hotspots

MASTA – Medical Advice Centres for Travellers Abroad

MEDEX – Medical expeditions

NATHNAC – National Travel Health Network and Centre

NOMAD – Online travel shop including sterile medical kits

Objective Travel Safety Training

PADI – Scuba diving

The British Mountaineering Council

The Travel Doctor – Scuba page

TravelTurtle

United Nations Web Site

WHO (World Health Organisation)