Things to know before you go

Blood group

• If you do not know your blood group you can have it checked. .Knowing your blood group will enable prompt treatment in an emergency.If a transfusion is required your Embassy may be able to find an expatriate donor. In some parts of the world this will substantially reduce your risk of being given contaminated blood.
  
• The Blood Care Foundation is a charity dedicated to the provision of fully screened and tested blood to travellers in countries where these are not readily available.It is based on a world wide network of blood banks and regional supply points. In an emergency abroad a supply of grouped and tested clean blood will be made available to those registered in the programme.Travel clinics can give further advice for enrolement.

Embassy/High Commission/Consulate

• Find out the address and telephone number of the your Embassy, High Commission or Consulate in the country or countries that you are visiting. Consulates can be helpful in emergency situations.

Medication and medical history

• Make a not of all your tablets and check that you have enough.
  
• Keeping a record of any current or past illness, including allergies, may be helpful in emergencies.

Travel insurance

• Having adequate travel insurance is advisable, to cover emergency medical attention and you should check that cost of repatriation is covered.
  
• EU residents are entitled to emergency medical care when travelling within the EU.You need form E111 from the post office to show this entitlement, however you should still have adequate insurance cover all possibilites.
  
  The following advice is based on the information in the Health advice for Travellers booklet produced by the Department of Health in the UK.You can also click here to go to the the Dept of Health website, to get information on other topics, including world wide health warnings.

Eating and drinking

• Take care with what you put in your mouth!. Food and water may be contaminated in a variety of ways and do not forget that it is best to try to avoid swallowing water where ever you may be swimming.
  
• Travellers’ diarrhoea is common, especially in hot countries. Travellers’ diarrhoea, as well as diseases such as cholera, typhoid and hepatitis A can all be caught from contaminated food and water.
  But they can also largely be avoided by simple precautions:
  
• wash your hands after going to the lavatory, before handling food and before eating.
  
• If you have any doubts about the water available for drinking, washing food or cleaning teeth, boil it, sterilise it with disinfectant tablets or use bottled water – preferably carbonated with gas – in sealed containers.
  
• Avoid ice unless you are sure it is made from treated and chlorinated water. This includes ice used to keep food cool as well as ice in drinks.
  
• It is usually safe to drink hot tea of coffee, wine, beer, carbonated water and soft drinks, and packaged or bottled fruit juices.
  
• Eat freshly cooked food which is thoroughly cooked and still piping hot.
  
• Avoid food which has been kept warm.
  
• Avoid uncooked food, unless you can peel or shell it yourself.
  
• Avoid food likely to have been exposed to flies.
  
• Avoid ice cream form unreliable sources, such as kiosks or itinerant traders.
  
• Avoid – or boil – unpasteurised milk.
  
• Fish and shellfish can be suspect in some countries.
  Uncooked shellfish, such as oysters, are a particular hazard.

Take care in the sun

• Over exposure to sun can cause sunburn, premature skin ageing and an increased risk of skin cancer. It is the ultraviolet (UV) rays which cause this; even in the UK they can damage your skin, and UV is much more powerful the nearer the equator you go.
  
  Never underestimate how ill careless exposure to the sun can make you – there is no excuse for not protecting your children properly.
  
• If you want to avoid trouble – take care not to burn. Take particular care for your children, and babies should not be placed in direct sunlight at all. Stay out of the sun for at least 2 hours around midday, use what shade there is at other times, and cover up with a wide brimmed hat, and tightly woven but loose clothing. Protective creams suitable for your skin type can help protect unavoidably exposed parts of the body. Wear sunglasses which filter UV to protect your eyes.
  
• Sunstroke or heat stroke is caused simply by overheating. Avoid strenuous activity during the hottest hours, and drink plenty of non-alcoholic liquids to balance the loss of body fluid through perspiration. What you drink must be safe – either soft drinks from sealed cans or bottles, or water which has been boiled.

Avoid insect and animal bites

• Avoid insect and animal bites, tick borne diseases such as tick borne encephalitis and borreliosis (Lymes disease) are prevalent in temperate climates. It is therefore not only in tropical wooded areas one needs to cover legs and arms. Use insect-repellent preparations.
  
  Click on Malaria and rabies for further information.
  
• Animal bites can set up infections which can be serious and sometimes fatal. Be aware of even apparently tame animals.

Take care in water

• Do not go swimming alone.Fatal accidents can happen very easily and in the most unexpected conditions. Adults should watch each other for signs of trouble when in the water. Children should always be supervised by an adult who can swim well. Young children should never be left unattended near a stretch of water, even a paddling pool.
  
• If you are going to dive into water, make sure that it is deep enough for you to do so safely. Each year, many people are permanently paralysed as a result of injuries sustained from diving into shallow water.

Take care on the roads

Traffic accidents are the major cause of death among travellers.

• Whether driver or pedestrian, always check on local traffic regulations. If you are in a car, always wear seat belts. If on a motor or pedal bike, always wear a helmet and put children in a child restraint. If you hire a care or a bike, check its condition and the insurance cover. And never drink and drive.

Hazardous sports

• Be careful and follow the relevant safety guidance;check that there are adequate emergency medical facilities on hand; and that you have medical insurance which covers you fully in the event of any accident.

"NO GO" Areas

• In many countries, there are areas which are unsafe for travellers to visit because of the risk of violence. For guidance and information, please use the Foreign Office Advice to Travellers telephone line: 0171 270 4129.

Day trips

• Even if you are only going on a day trip to another country, accidents can happen. So please make sure you have adequate travel insurance, and a completed form E111 if you are visiting a country in the European Economic Area.

Major Diseases and the Precautions to Take

• Malaria
• Rabies
• HIV/Aids
• Bilharziasis
• Cholera
• Dengue
• Diptheria
• Hepatitis
• Hepatitis A
• Hepatitis B
• Hepatitis C
• Japanese Encephalitis
• Legionnaires Disease
• Meningitis
• Poliomyelitis (POLIO)
• Tetanus
• Tick-borne Encephalitis
• Tuberculosis
• Typhoid
• Yellow Fever

Malaria

• A parasitic disease, spread by the bites of infected mosquitoes, malaria produces fever and, in some cases, complications affecting the kidneys, liver, brain and blood, and it can be fatal.
  
• Malaria is a major health problem throughout the tropics and some forms are particularly life threatening. If you live in a malarial region, you may build up some immunity to the disease but this can be lost quickly. If you have children born in the United Kingdom, they will have no immunity at all.
  
• If you are going to visit, travel through, or even just stop over, in a malarial country, even if you have lived there before, take the following precautions:
  
• Ask your doctor about anti-malarial measures in the areas to be visited.
  Many areas have malaria parasites which are resistant to anti-malarial medicines. If in any doubt about which anti-malarial medicines are most suitable for you, your doctor may wish to check with the Public Health Laboratory Service Malaria Reference Laboratory, the Scottish Centre for infection and Environmental Health or other professional sources of information. You and your children should take the medication after food, for a week before travelling, throughout your stay, and for a month after returning.
  
• Avoid mosquito bites.
  - Use insect repellent, preferably one containing DEET (diethyltoluamide)
  - Keep your arms and legs covered after sunset
  - Sleep in a properly screened room and employ a "knock down" spray to kill any mosquitoes in the room
  - Use a mosquito net around the bed at night. Preferably the net should be impregnated with an insecticide. check that there are no holes in it and that it is well tucked in. Nets can be brought in the UK d from travel clinics.
  
• However none of these precautions will give absolute protection. So if you develop a fever, or feel ill, while abroad or up to three months after returning, it is essential to seek medical attention immediately. If you develop these symptoms after you have left a malarial region, tell the doctor that you have been to a country where malaria is a health risk.

Rabies

• Rabies is an acute viral infection of the nervous system. Its symptoms include delirium and painful muscle spasms in the throat. Once symptoms develop in human beings, the disease is usually fatal.
  
• Rabies occurs in animals in Europe and North America as well as in the less developed countries. You can contract the disease if you are bitten by any infected animal. So be careful not to touch any animals, whether wild, stray or apparently ‘tame’. If you are bitten, ‘post-exposure’ treatment – if given early enough – usually prevents the disease developing.
  
• If you are bitten by an animal while away from the United Kingdom:
  
  Wash the wound immediately, using soap or detergent; or flush with clean water. Apply alcohol if possible.

Get medical attention – FAST. Go to the nearest doctor or hospital. You may need a rabies vaccination and the course of injections must be started immediately. Ask for ‘human diploid cell vaccine’, if possible. In case of any difficulty, contact the nearest British Consular official.

Note the date and place of the incident, the animal’s description and whether it was wild or stray.

If the animal was not wild or stray, try to identify its owner as soon as possible to ascertain if it is already – or if it becomes – sick. If the animal can be kept under observation for two weeks following the incident, exchange names, addresses and telephone numbers with the person responsible for it, and arrange to keep in contact to find out whether the animal becomes sick or dies. Find out whether it has had rabies vaccine and ask to see the certificate. But even if one is produced, do not assume there is no risk.

Inform the local police.

Whether or not you receive treatment outside the UK, consult your doctor as soon as you return.

• Rabies vaccine before travel is only recommended for those who may be exposed to an unusual risk of infection or who are undertaking long journeys in remote areas where medical treatment may not be immediately available. This vaccine is not normally provided free for travellers under the NHS. Even if you are immunised, however, this dos not remove the need for urgent treatment if you are bitten by an infected animal.
  
• Do not bring any animals into the country without a licence. This is not only illegal and involves severe penalties, it could endanger lives.

HIV/Aids

• AIDS (Acquired Immune Deficiency Syndrome) has now spread across the world. There is no vaccine or cure for AIDS. AIDS is caused by a virus known as HIV (Human Immuno-Deficiency Virus). Infection with HIV is more common that AIDS itself. People infected with HIV remain infected and infectious all their lives. There is no vaccine or cure for HIV infection.
  
• HIV/AIDS can be passed on in four main ways:

Through unprotected sex with an infected person.

Through the use of infected syringes, medical and dental instruments, and anything else which punctures the skin, such as tattooing equipment.

By transfusions of HIV infected blood.

From an infected mother to her baby, before or during childbirth or through breast-feeding

• HIV/AIDS cannot be passed on through everyday social contact nor through insect bites, dirty food or crockery, nor activities such as kissing, coughing or sneezing.
  
• To protect yourself against HIV/AIDS:

Do not have sex except with your usual partner. Casual sexual intercourse can be very risky. People can be infectious even though they may not be aware of it, and even if they look and feel well.

If you do have sex with a new partner, always use a condom. They are the most effective protection against HIV/AIDS and other sexually transmitted diseases. Pack an adequate supply of condoms, if you think you may need them when travelling, as they might not be easily available or of good quality in some countries. Those bought in the UK should carry the British Standards Kite mark or the European Standard mark. If you drink, remember that alcohol can make it easier to forget about safe sex.

Do not inject non-prescribed drugs. If you do, never share equipment.

Do not have a tattoo, acupuncture, or your ears pierced, unless you can be sure that the equipment is sterile.

Since some countries do not have the same standards of medical and dental hygiene as the UK, needles and other equipment may not be adequately sterilised, nor blood screen for the presence of HIV or hepatitis B or C, so:

try and ensure that any medical treatment, particularly a blood transfusion, is absolutely necessary;

make sure that any medical equipment used is freshly sterilised or is taken from a sealed pack;

if you need a transfusion, ask for screened blood. If you are going to an area where the availability of sterile needles and syringes for medical treatment is in doubt, consider taking a special kit with you.

• Some countries have introduced HIV antibody testing for visitors, or require an HIV antibody test certificate. If in doubt, check with the Embassy or High Commission of the country concerned.

Bilharziasis

• A parasitic disease caused by a worm which penetrates the skin and can cause damage to the intestines, the liver and the urinary tract
  
• most common in waterways in Africa
  
• No vaccine is available, but is treatable
  
• Visitors to areas where bilharziasis is present should avoid wading or bathing in streams, rivers and lakes.

Cholera

• An intestinal infection that can cause severe diarrhoea, dehydration and can cause death
  
• Caught from contaminated food and water
  
• An increasing problem in areas of poor sanitation in South America, the Middle East, Africa and Asia, it is relatively uncommon among travellers
  
• Avoided by scrupulous attention to food and personal hygiene
  
• No vaccine against cholera is currently available (the old one was not effective) and no country now requires cholera immunisation as an official condition of entry.

Dengue

• Dengue, and its more severe form, dengue haemorrhagic fever – occur throughout the tropics
  
• Transmitted by the bite of an infected mosquito
  
• No vaccines against the disease
  
• Prevention is by avoiding mosquito bites at all times.

Diptheria

• Remains a serious disease , especially in tropical countries where there is overcrowding and poor hygiene
  
• It is caught by close contact with an infected person
  
• Until the 1930s, it was one of the most important causes of childhood death worldwide but the mass immunisation of children since the 1940s has effectively eradicated the disease in developed countries
  
• In recent years there were large numbers of cases in Russia and Ukraine because of falling levels of childhood immunisation
  
• For unimmunised adults, a special low dose vaccine is available.

Hepatitis

• Viral hepatitis is an infection of the liver which can cause yellow jaundice. There are several forms of the disease; including hepatitis A( also called infectious hepatitis), hepatitis B and hepatitis C.

Hepatitis A

• Usually caught by consuming contaminated food and water
  
• Spread from person to person, since the virus is present in the faeces
  
• Risk of infection in areas of poor sanitation
  
• Need to take care over what you eat and drink, and washing your hands after going to the lavatory and before handling food
  
• There is a vaccine against hepatitis A. Alternatively, an injection of normal immunoglobulin (gamma globulin) shortly before travelling helps reduce risk. Discuss the options with your doctor.

Hepatitis B

• This occurs world wide and is spread in the same ways as HIV/AIDS, that is through:

intimate person-to-person contact;

sharing contaminated needles or syringes;

transfusions of contaminated blood or the use of inadequately sterilised equipment in medical treatment, tattooing and ear or body piercing.

• There is a vaccine which gives good protection against the disease. However, it can take six months to become effective. The best way to prevent infection is to avoid the high-risk activities listed above and also to take a travel kit for use in medical emergencies.

Hepatitis C

• Increasingly recognised world wide
  
• spread in the same way as HIV/AIDS and hepatitis B
  
• There is no vaccine
  
• Take the precautions recommended against HIV/AIDS and hepatitis B to avoid infection.

Japanese Encephalitis

• Viral inflammation of the brain which can be life-threatening
  
• Occurs throughout South east Asia, mainly in rural areas and during the monsoon season
  
• A vaccine is available and is recommended for travellers who are staying in risk areas for a month or more. However, the vaccine is not normally supplied under the NHS and you will have to pay a fee

Legionnaires Disease

• Can cause an uncommon form of pneumonia which occasionally occurs in holiday makers
  
• Spread through aerosols of water containing the legionella germ, usually through poorly maintained cooling towers or air conditioning systems
  
• It is treatable with antibiotics
  
• There is no vaccine

Meningitis

• This is inflammation of the membranes covering the brain and spinal cord
  
• It particularly affects children and young adults and can result in death
  
• Meningococcal meningitis is more prevalent in some areas of Africa and Asia than in this country, and a vaccine is available. This vaccine, however, does not cover the strain most common in the UK
  
• Saudi Arabia requires the immunisation of all those going on Hajj, the great annual Muslim pilgrimage

Poliomyelitis (POLIO)

• A viral infection which can case paralysis of the muscles
  
• Everyone travelling outside North and Western Europe, North America, Australia and New Zealand should have up to date polio immunisations
  
• Previously unimmunised people should receive a full course of three doses of vaccine
  
• Those immunised more than then years ago require a booster dose

Tetanus

• This is a potentially dangerous disease which causes severe and painful muscle spasms
  
• Bacterial spores can infect body through even a slight wound
  
• The spores are mainly in soil and manure
  
• Everyone should be protected by immunisation, especially those who travel to remote areas,where immediate medical facilities may not be available. If you were immunised as a child, ask your doctor about a booster. If you were not, you will need a course of three injections.

Tick-borne Encephalitis

• Inflammation of the brain , which can be serious,contracted from the bite of an infected tick
  
• Occurs in forested parts of Austria, Northern Europe and Scandinavia, especially where there is heavy undergrowth
  
• More common in late spring and summer
  
• In disease prevalent areas wear clothing which covers most of the skin and use insect repellents as well
  
• A vaccine is available but not free of charge under the NHS

Tuberculosis

• TB is increasing world wide again
  
• If travelers have not been immunised against the disease, and are going to stay in Eastern Europe, Asia, Africa, Central or South America, you should discuss the need for BCG immunisation with your doctor – preferably at least two months before departure. You will need a skin test first
  
• Immunisation is particularly advisable for those who will be travelling, living or working closely alongside the indigenous population, and for members of ethnic groups visiting their country of origin. It is not necessary for short visits if you are staying in international-style hotels. Once immunised, reimmunisation is unnecessary.

Typhoid

• Caught through the consumption of contaminated food or water
  
• Immunisation against the disease should be considered by those travelling to places where sanitation is primitive. It is also essential to take scrupulous care over food and water

Yellow Fever

• Caught from the bite of an infected mosquito
  
• Occurs in parts of Africa and South America
  
• Some countries require a vaccination certificate for entry
  
• The vaccine can only be given at a designated Yellow Fever Vaccination Centre – your doctor will be able to advise you. It is not available free of charge on the NHS. The certificate itself is valid from ten days after vaccination for a period of ten years.

Immunisation Summary: What may be recommended for different countries

For all areas

If you have not previously been immunised against diphtheria, polio or tetanus, this is an ideal opportunity to have the immunisations carried out.

For all areas except North and Western Europe, North America, Australia and New Zealand

Poliomyelitis.

For areas where standards of hygiene and sanitation may be less than ideal

Hepatitis A

Typhoid

For infected areas

(Please check with your doctor or a travel clinic.)

Anti-malarial tablets and precautions against insect bites.

Yellow fever (compulsory for some countries).

In certain circumstances

(Please check with your doctor or a travel clinic)

Meningococcal meningitis

Tick-borne encephalitis

Tuberculosis

Japanese encephalitis

Rabies

Hepatitis B

Diphtheria booster

Measles/MMR