Coronavirus – Guidelines for Travellers
- Travellers should avoid going specifically to the Wuhan region, and avoid all non essential travel to China.
- Other areas of Asia are considered safe and changing of any travel plans is not currently recommended at this time. Take a look at this interactive map of the virus.
- Before you travel, check CDC’s destinations pages for country-specific health information, including vaccine and medicine recommendations, along with many other travel tips.
Introducing myTMB World
TMB registered patients can now have access to their own records via the myTMB. Registered patients can also access myTMB World, a subscription service designed to provide our patients with easy access to a multitude of tools designed to help you stay healthy and well during your time abroad.
If you need further information please send an email to firstname.lastname@example.org including the following information:
Date of Birth
Bug Bite Relief
TMB Water Purification Tablets are the safest way of making sure you don’t drink any nasty germs on your holidays. Chlorine Dioxide (ClO2) is one of the most effective water disinfectants available. Effective against diseases such as Cryptospoidium and Giardia.
Each pack contains 30 individually foil wrapped tablets – each tablet will treat 1 litre of water.
- A powerful water treatment in convenient tablet form
- Kills a wide range of bacteria and pathogens
- Ideal for water sourced from rivers, wells and taps
- Extremely easy to use
- Ensures safe drinking water on the go
- Leaves no after taste or discolouration
- Provides 30 litres of clean drinking water per pack
- Far superior to chlorine
- Does not create harmful by-products or carcinogens
TMB branded products are now available on-line at travelshop.ie and the following retailers:
- Dunnes Stores
- Lloyds Pharmacies nationwide
- Pure Pharmacy (Dublin Airport)
- Ingredients: Sodium Chlorite (<10%)
- Effective on: 30 litres per pack
- Available in: Packs of 30, 100mg tablets
- Suitable for: Everyday use and all types of travel
TMB – we have you covered
Make the Tropical Medical Bureau part of your travel plans by calling into one of our 22 clinics nationwide. Get expert travel advice and any vaccinations that you require all under one roof. Plus, we offer all customers a 24/7 helpline while they are away and consultations upon your return if necessary. TMB – wherever you are, wherever you’re going, we have you covered.
Yellow Fever Vaccination
Yellow Fever is a viral disease transmitted by mosquitoes. Approximately 200,000 cases occur each year with the majority of these occurring in Africa. About 90% of all Yellow Fever cases are found in Africa. The disease occurs mainly in the western part of the sub-Sahara but occasionally in some of the eastern countries. In Africa reports are regularly received from Nigeria, Ghana, Sierra Leone, Senegal, Mali etc. In South America reports are received from Brazil, Bolivia, Columbia, Ecuador, Venezuela and Peru.
Yellow fever vaccinations are available at Tropical Medical Bureau travel health clinics around Ireland. Book your appointment today or contact us to find out if you require a yellow fever vaccination with our full pre-departure health screening service..
When You Return
Most international travellers experience no problems abroad. Others may have an upset stomach but nothing more. Its easy to become paranoid with every ache, cold or spot attributed to your trip abroad. There are some important things to remember.
Some illnesses like Malaria can harbour themselves in your body for many weeks or even months, it is important therefore to inform your doctor of any travel to ‘exotic’ countries in the past 12 months.
Typical symptoms of many tropical disease share common traits to disease found at home and include Fevers, Muscle Ache and Headaches. Other common signs to look for include diarrhoea, nausea, vomiting, lethargy, chronic fatigue or skin rashes.
If you return from overseas and experience fevers, sweating, shivering, aches and pains and other flu like symptoms you should seek medical advice as soon as possible. Even if you were on malaria tablets they do no offer full protection. Malaria can be a serious disease if left untreated. It is wiser to assume you have malaria until proven otherwise.
Travellers Diarrhoea is common however if the problems persist you should seek medical attention. Also keep in mind the risk of dehydration and use oral re-hydration salts if required. Viruses, bacteria or parasites can cause diarrhoea. Travellers returning with persistent bowl problems often experience good days and bad days this is often a sign of bacterial infection from a disease like Cryptosporida. Exhaustion and a feeling of tiredness can also be a common symptom.
Parasites and fungus just love warm humid places so it’s not surprising that such organisms are in plentiful supply in tropical regions.
Tissue Myiasis is caused by a fly larvae. The adult fly lays eggs on your clothing the eggs hatch and the larva burrows into your skin where it grows for a week or so. The first sign will be what appears to be a boil forming on your skin. Don’t be tempted to squeeze the boil as you might kill the larvae, which can lead to infection. Instead us some Vaseline to block the air duct at the top of the boil, this will force the larvae up for air where it can be more easily removed.
A small adult hookworm that usually infects animals causes Larva Migrans. The worm has actually entered the wrong host i.e. you. Unable to penetrate further into your body it wanders around just below the skin, which can cause irritation and discomfort. Most people get the worm in their feet from wandering around beaches. The condition isn’t dangerous and can usually be treated with creams.
Ticks are a problem in forested or grassland areas and can be found in many regions in the world not just the tropics. For example Tick Bourne Encephalitis is found mainly in central Europe. Ticks can also spread diseases like typhus, relapsing fever and Lyme disease. Ticks can be treated with Vaseline in the same way as Tissue Myiasis. A little bit of Vaseline and suddenly breathing becomes more important then feeding and they’ll tend to fall off. Don’t be tempted to pick them off as you may leave a bit of the proboscis behind.
Other symptoms may point to a problem that you picked up while overseas, chronic fatigue and or blood in the urine could indicate schistosomiasis (haematobuim). Diseases like tuberculosis and brucellosis while rare do occur.
If you are concerned please visit your doctor and don’t forget to mention your journey even it was a year or so ago.
Volunteering for work overseas
It is a major decision to work overseas as a volunteer in a less well developed region of the world. Nevertheless in the vast majority of cases it is a decision which is never regretted as it exposes the volunteer to a life which they would otherwise never have known and it almost always helps to mould the individual into a different person – perhaps one who is less self-centred and more aware of what is going on in the ‘real world’ out there.
The volunteer needs to recognise that they will never ‘save the world’ but that their small input may have distinct life changing consequences for some of the individuals who cross their path. The other crucial issue which needs to be recognised is the fact that in almost every case the volunteer gains far more from the experience than they themselves put into the work and that they learn tremendously from those they will have contact with day by day.
In our 21st century world we hear that ‘patience is a virtue’ but it is not until we get to a place like central Africa where we see it in action! Those considering becoming a volunteer who display little of this essential attribute should perhaps reconsider their calling and look into another avenue for their lives.
Visiting Friends and Relations (VFR travel)
The world has become a ‘global village’ as has been stated many times over the past decades.
Cheap and regular international flights mean that we can now visit friends and relations in the far distant reaches of our world. Areas where in the past we would not have considered possible are now well within our grasp.
Nevertheless this easy accessibility has increased the risk of diseases being moved from place to place and also of our travellers being unprepared for the potential health risks of visiting regions of the world very different to our own.
Travelling while Pregnant
Many thoughts may go through your mind when you confirm that indeed you definitely are pregnant. If you have an overseas trip planned then this adds another level of complexity to your emotions!
- Is it safe to travel?
- Are you taking unnecessary risks?
- Are there extra precautions which can be taken to make it safe?
- What about the vaccines & even the malaria prophylactic drugs?
- Are they safe?
Obviously, every pregnancy is different but there are some guidelines which are worth considering as you consider whether or not to travel at this time.
Travelling safely with Diabetes
At times it may feel that because you have a condition like diabetes that it is not worth the trouble or the risk of undertaking a foreign journey.
Many opportunities to travel are lost because you may feel that it is just too much trouble.
Nonsense! All it takes is a bit of common sense and following a few basic rules.
Travelling safely with Children
Children can make a holiday but also some of the most harrowing experiences abroad are associated with them getting sick, having an accident, getting lost or being bitten by an animal while away from home. If you are planning a trip with young children then take some sensible care.
Too Old to Travel?
To define what is meant by ‘old’ is quite emotive. Many would think that anyone 20 years older than themselves is clearly within that category and obviously well past their ‘sell-by’ date. The era of receiving your free bus pass is being seen as the ultimate evidence of ‘old age’.
However for many people the older years are the first time that they have the twin joint blessings of some free time and the available resources to allow them travel to regions of the world where they have dreamt of visiting for many decades. So what holds them back and what sensible precautions should be taken?
What needs to be in place to ensure they have a marvellous trip and return home with only good memories to cherish?
The risk of Tick Borne Encephalitis
This viral disease is also called Central European Tick-Borne Encephalitis. It occurs in at least 18 central European countries and many thousands of cases occur each year. In general exposure risks are related to those spending time in more rural regions where they may run the risk of being bitten by an infected tick. Most risk occurs during Spring and Summer in the forested regions of these countries. Scouts, those planning to camp or trek rurally or those who will be living in high risk countries (especially children) may need to consider vaccination cover.
The risk of Japanese Encephalitis
Japanese B Encephalitis is a viral disease transmitted by mosquitoes. Over 50,000 cases are reported to occur each year. The disease is found in over 25 countries throughout the world.
The disease is transmitted through the bite of an infected female culex mosquito. In the majority of cases these may occur within rural areas of the endemic countries and especially in regions where pig farming is found. Transmission can occur in urban areas but this is uncommon.
The pleasures of swimming while abroad can be immense. Nevertheless there are risks and naturally care must be taken to ensure that silly and potentially dangerous mistakes are limited, if not fully avoided.
The risks are related to where you swim and the safety factors of that area.
Swimming pools in many regions are clean and safe especially if qualified lifeguard cover is on hand. The risk of drowning or infection is very small but certain basic care is needed.
- Are there lifeguards on duty when the pool is open?
- Check how clean the pool is kept. Are the water filters clogged?
- Is the pool well chlorinated?
- Can you see the bottom of the pool?
- If it’s an open-air pool is there any shade available?
- What are the changing facilities like?
The risk of picking up an infection in a well chlorinated pool is generally quite low. Over chlorination can cause eye and skin irritation. Some sensitive people can contract conjunctivitis this may be caused by infection or chemical agents like chlorine. In either case the use of goggles or eye bathing solutions will ease the effect. Infection is more likely to occur in and around the pool area. Children’s pools can also be a source of contamination due to faecal matter from inadequately secured nappies.
Never underestimate the power of the sea especially when you’re not familiar with local currents and conditions. Coral reefs are a big attraction but often have unexpected strong currents that catch even the best swimmer. Get good local advice and stick to it.
Irish people are used to seeing jellyfish and the odd dolphin around their coast. As a traveller be aware of the other ‘monsters of the deep’ that may lurk around the shores of your chosen destination. In addition to jellyfish, sharks, sea snakes and poisonous fish may share your bit of sea. Again heed local advice.
In some areas untreated sewage is pumped into the sea be sure to scan the resort area for signs of contamination or suspicious looking pipes protruding into the sea. The shoreline line itself can be source of contamination. If dogs and other animals roam the beach it is likely that parasitic diseases may be present. Lie on a beach towel or sun bed and wear sandals or flip-flops when possible.
Scuba diving is becoming an increasingly popular sport but it does have its risks. Always check out the operator and choose the one with the best equipment and most sensible approach. Before you dive make certain you well prepared. If you suffer from heart problems, asthma or other respiratory disease always inform you instructor. Some special scuba diving holidays require you to under go a medical before being allowed to dive.
Finally always wear a life jacket when boating or canoeing being on holidays doesn’t make you float any better unless of course you’re in the Dead Sea.
We’ve all seen Tarzan dive majestically into some idyllic lake in the middle of Africa take on the a few crocodiles and emerge on the other side unscathed. He never seems to get eaten or pick up some parasitic disease. The lakes and rivers in Africa, South America and some parts of Asia can present a significant risk to travellers.
Most travellers that take a plunge into these waterways are on safari and the temptation is often too great especially if the rest of the group is going in. Often guides will incorrectly inform you that those diseases like schistosomiasis do not occur in their area. Many Irish travellers return from a swim in lake Malawai with schistosomiasis after being informed that the part of the lake they were in was safe.
Apart from crocodiles hippopotamus present a real danger and are responsible for almost as many deaths and injuries as crocodiles. Their favourite activity is over turning canoes and other small boats that get too close. While your avoiding crocodiles and hippopotamus keep an eye out for snakes as well!
Swimming in fresh water lakes and rivers in Africa and South America is generally not a good idea. Wait until you get back to the resorts pool or the beach.
Living in Ireland has many blessings but acceptable exposure to the sun does not happen to rate well on its list of attributes. So, when we escape overseas we frequently soak up the sun’s rays in excess just in case we don’t see them for a long time. You see it all the time; pale and pasty leaving Dublin airport and red and roasting on their return.
- Sun burn is associated with skin cancer and is becoming a more serious problem as the years go by.
- Travellers must ensure that they take care especially during the first few days of their trip.
- Gentle limited exposure must be the rule while using adequate sun blocking agents.
- Those with very sensitive skin should start with factor 20+ and only work down towards the lower factors if they are not burning.
- Skiing and sea adventure holidays are a particular risk in this regard.
- Remember that dreadful sun burn can occur closer to home on the Mediterranean holidays.
- If you are badly burnt make sure you drink plenty of fluids and use the after sun creams to lessen the effects.
- If you are travelling alone and get badly sun burnt never lock yourself into your room to recover. You must tell others of your predicament in case your absence is not noticed and the situation becomes severe.
- Severe dehydration and sunstroke can kill.
- Remember children get burnt very easily and they should wear sensible clothing to cover up well while playing in the sand.
- Pack your sun cream
- Start with a high factor and work down
- If burnt take plenty of fluids
- Seek medical attention early
- Take especial care with chlidren
Staying safe at altitude
The effects of the low oxygen levels experienced at altitude can be devastating and frequently fatal in the unprepared.
At sea level the normal oxygen concentration is 21%. At 12,000 ft the amount of oxygen is reduced by 40% and so breathing rate and cardiac activity need to increase to compensate for this deficiency. Unfortunately many of those affected by the condition still push onward despite warning signs and the body just cannot cope.
It can affect different people in a variety of ways ranging from mild headaches to sudden death. Both male and female can succumb rapidly and the condition can be seen at any age.
Frequently the deaths which occur are in the younger age group who tend to disregard the early warning signs.
Staying healthy on your Skiing Holiday
Skiing holidays have become a regular pastime for many travellers each year. In some cases it is their first venture into an unknown activity and for others it has become a routine part of their yearly activities. Both these groups can potentially face some serious health risks associated with their activity.
Following some commonsense rules may make the difference between an uneventful trip or a serious accident which could incapacitate the individual for many months – or worse. Each year a number of deaths also occur due to severe exposure and/or avalanches.
Sexually Transmitted Diseases
Whether travelling on business or on holiday’s peoples behaviour often changes, inhibitions come down and alcohol consumption goes up. Holidays in particular are about entertainment and in some countries the sex industry is very much a part of this ‘entertainment’. Irish travellers fall into two categories.
The Business Traveller and Casual Tourist
This type of traveller finds him or herself in ‘trouble’ usually due too much alcohol or too much temptation close to the hotel. They did not intend to have any causal sexual encounters but it happened nonetheless. The next morning begins in panic with the traveller left worrying about the consequences of previous night. If you can’t remember the previous night this will cause you greater concern.
Remember that it’s not just other nationalities that carry these diseases, you may fly a 1000 miles and meet the girl or guy that lives next door, a few drinks and…
The Sex Tourist
This is just as big an issue with Irish travellers as it is with other nationalities. While both males and females fall into this category but the majority travelling from this country are often young males travelling in small groups. Their prime intention is to engage in sexual activity will abroad. For some countries this is a major industry bringing in valuable foreign currency even if its not officially encouraged. Whatever about the moral views, this type of ‘tourist’ are exposing themselves and other partners to the risk of many diseases like AIDS, Hepatitis B, syphilis an so on. It is estimated that over 80% of prostitutes in Thailand have AIDS.
Condoms do not offer fully protection and diseases like Hepatitis B have other ways of spreading. Often locally produced condoms may not be of the same standard and so may place the traveller at greater risk.
When you return seek immediate advice from your doctor, you could be placing yourself, partner or children at risk. The best advice is not to put yourself at risk in the first place. Watch your alcohol consumption and don’t leave your brain at the Airport!
Protection from Insect Bites
- Where Possible avoid going out of doors between dusk and dawn
- Wear long sleeves to cover your arms and long trousers
- Avoid dark coloured clothing
- If possible choose an air-conditioned room
- Keep doors and windows closed
- Avoid using perfumes and aftershaves
- Choose a room above the third floor. Insects don’t tend to fly to this height. Of course they do get carried.
- If living in the area ensure there are no open water containers. Still water is often the preferred breading ground of some insects.
Insect Repellents and Other Items
- Use repellents with between 30 to 50% Deet (diethyltolumide) are the most effective. Higher dosages and non-Deet products are available for Children.
- Wash excess of your skin before going to bed.
- Use a Mosquito net if necessary and ensure it is correctly fitted
- Use Mosquito nets impregnated with permethrin to discourage insects from landing on the net.
- Use sprays around dawn and dusk.
- Mosquito coils and plug-in repellents are very effective.
- High pitched buzzers are not effective.
Reactions and Allergies
- Creams which contain steroids or antibiotics are most effective against bites
- Carry some anti histamine tablets. Remember these react with alcohol so reduce your intact or abstain.
- If your allergy is very severe you may need to take anti histamine throughout your time abroad. In this case start the day before you arrive and for a day after you return. More modern anti histamines are now non-sedative.
- If you are prone to collapse or anaphylactic shock when bitten or stung make certain your wear a medi-alert bracelet all the time. Also inform your courier and ensure other members of your party are aware of your condition. In some cases you may consider carrying an epi-pen. This contains a single dose of adrenaline for instances of anaphylactic shock.
Easing and Soothing
- Try and avoid scratching bites as this is how they become infected. Rubbing gently will have the same soothing effect and lead to less trouble.
- Try a luke warm bath or shower
- If irritation is severe try sleeping tablets at night.
Seek medical advise before you travel especially if you are prone to reactions If you have been badly bitten attend a doctor on your return.
Myiasis – the need to iron your clothes
While abroad, washing your clothes and leaving them to dry in the open air can lead to significant problems for the international traveller. In many of the hotter regions of the world a fly can actually lay her eggs on damp clothing which has been laid out to dry.
This usually happens when the clothes are drying in shaded areas and not so often if they are left in the direct sunlight. The unsuspecting traveller may then put on the clothes when they dry (without ironing them first) and this leads to irritating skin infection known as Tissue Myiasis.
Leaving on a Jet Plane
There comes a stage in most young people’s lives when they need to break free of parental control and show that they are capable of independent living!
Nowadays this often comes about as the almost compulsory overseas trip where they circumnavigate the world with their one year travel pass.
The day finally arrives when their plans come to fruition and they are off at last – disappearing to some far flung destination – promising their parents to stay in contact and not to do anything silly!
Any travel, especially if it involves travel at night, may be associated with sleep disruption and subsequent fatigue. However, flight across time zones results in different body rhythms that are not initially synchronised with the day-night cycles at the time zone of destination. This causes the combination of day-time sleepiness and night-time alertness, the major features of jetlag. Symptoms of jet lag are common with time zone changes of 5 hours or more. Problems of jet lag may also increase with age.
Symptoms can include Fatigue, Mood disturbance, Anorexia, Gastrointestinal symptoms. In general westward flight is better tolerated then eastward travel. As a rule of thumb its takes one day for every hour time difference to recover.
Combating Jet Lag
- Before Departure
- Have 2 to 3 good nights sleep before travelling
- Choose best flights for sleep – direct flights usually during ‘Home’ daytime If you’re not able to sleep on flights have a nap the afternoon of the flight. Use a short acting hypnotic e.g. Benzodiazepines.
During the Flight
- Set your watch to the destination time. If possible sleep and eat according to this time.
- Try to sleep at local night time.
- Restrict alcohol intake.
- Allow nap opportunities for 40 minutes during the day for the first few days.
- Expose yourself to sunlight and exercise.
- Consume caffeine drinks during the day but avoid them 4 to 6 hours prior to sleep.
- Use sleeping tablets if required.
- Westward is better then Eastward
- It takes One Day for every Hour time difference
- Rest before you travel
- Set your watch to the Destination time
- Sleep and eat according to the local time.
Hajj Travel – Recommendations & Requirements 2012
Every devout Muslim seeks to perform the Hajj on at least one occasion during their life. This pilgrimage, which is a central duty of Islam, brings Muslims from all over the world together as they visit the holy cities of Mecca and Medina in Saudi Arabia. Each year over two million gather to celebrate the five ‘pillars’ of Islam.
All travellers are required to provide evidence of vaccination against Meningococcal Meningitis (ACYW-135). This vaccine has to have been given to every traveller within the previous three years and at least 10 days before arrival into Saudi Arabia. (Other vaccinations against Meningitis C or Meningococcal A&C are not acceptable.)
Even though it is not a requirement of entry to perform the Hajj or visit Saudi Arabia, travellers are strongly advised to consider the following vaccinations;
- Influenza / Pneumococci
- Pandemic Influenza
- Hepatitis A / Typhoid
- Hepatitis B
Golf and International Travel
This short leaflet outlines some of the health risks associated with playing golf in a warmer climate.
Foot Care while Travelling
Travelling brings significant stress and strain to your feet. Following some simple commonsense care before and while travelling will make a huge difference to your overall enjoyment and to your general health. You can divide the possible care of your feet into two associated areas – firstly stress & strain and secondly infection.
Food and Water
There can be no doubt that this is the one main areas where travellers fail miserably during their trip overseas. It is all very well to want to taste the local produce but commonsense and care must be maintained at all times. Probably, your stomach is an Irish stomach! It is an integral part of you and deserves to be treated with some respect. If you take chances and play games with your stomach you can be fairly sure just who will win and what the final outcome will be! Spending days looking at the loo walls is not too pleasant and can ruin a really expensive holiday.
Eat freshly cooked hot food (physically hot that is – not spicy hot). If the food is hot and fresh then the risk of contamination is very small and your stomach will be protected. Cold foods (either salads or cold meats) can easily be infected with a variety of organisms such as bacteria, viruses and parasites.
Stay away from lettuce and undercooked shellfish. These two are the main culprits and responsible for many a spoiled trip overseas. Oysters, shrimps, prawns and mussels are frequently harvested from infected waters and then mildly steamed in preparation for human consumption. This steaming will not sterilise them and you will frequently end up eating what amounts to raw human sewage – not a very pleasant thought!
Check out the restaurant before you order your meal. Look to see if the tables are clean and the cutlery is sparkling. If you are unsure be careful and try to find another eating establishment where possible. Probably a wise precaution is to take a visit to the toilets. If they are well maintained then you can usually be assured that the care taken in the kitchens will be of a higher standard.
Choose food from the menu that you recognise and make certain all meat is very well cooked. None of this eating rare bloody steaks while overseas. If you are not convinced I can point you in the direction of many patients who have come home infected with 20 foot long tape worms! Despite your request, if your meat dish is still bloody on arrival send it back for reheating – just make sure that you get your own meal back! (Cut a wedge out of one corner).
Everybody knows that the tap water supply overseas may be questionable and so they would never dream of drinking from the taps in their bedrooms. Nevertheless we often hear that travellers have used this same water for brushing their teeth. Again not a wise move. Water will be absorbed from your mouth very rapidly no matter whether or not you actually swallow.
In regions where the tap water is untreated (smell for chlorine) don’t use ice in your drinks. Again this ice will be made from tap water and so may be contaminated. In some of the ‘better’ hotels they will provide a jug of ‘fresh’ water each day. Treat this with extreme caution and only use this water for washing your face if necessary. Frequently this jug will have been filled from a tap down the corridor – rather like the one in your bedroom!
Bottled mineral water is a much safer option so long as the bottle is well sealed. One of the other major pitfalls from drinking overseas comes from buying ‘freshly squeezed’ juices from roadside stalls. Often as the coach pulls to a stop they will have seen that they have too little juice for the travellers so they may top up the drink with ordinary tap water and some sugar.
- Eat freshly cooked fresh food
- Avoid bivalve shellfish such as mussels, oysters and clams.
- Eat fruit you can peel yourself
- Check out the restaurant and choose a busy one with lots of people
- Avoid ‘rare’ or under cooked meat
- Smell water for chlorine
- Drink sealed bottled water
- If the water is untreated don’t use it to brush your teeth
- Avoid ice in your drinks
- Don’t sing in the shower!
- Beware of those tempting roadside stalls
Deep Venous Clots and Travel
Deep Venous Thrombosis (DVT) is relatively rare, but nevertheless it is a potentially life-threatening condition which is usually associated with those who are bedridden or those who have had significant surgery. The disease can be painless and the affected individual may have no knowledge of the seriousness of their situation before the clot moves towards the heart and lungs.
DVT, in association with long haul travel, has recently been highlighted through publicity in the media and so travellers are becoming increasingly aware of the potential risks. Even though the numbers involved are small when compared to the total number travelling, venous blood clots are believed to kill more than 100 air passengers a year worldwide. Even then, it is thought that this figure may be a gross underestimation. Many patients may develop the condition some weeks following their return home and so not associate it with their recent travel.
Dealing with Ticks
If you are going to be spending any time outdoors during the Spring and Summer, it is important to learn to protect you and your family from diseases that can be caused by ticks, including: (depending on the region of the world)
- Lyme disease
- Rocky Mountain spotted fever
- Southern tick-associated rash illness
- Tick-borne relapsing fever
- Tick-borne Encephalitis
- Colorado tick fever
Unfortunately, no matter how careful you are in trying to protect yourself from tick bites, you may occasionally find a tick and you will need to remove it.
Dealing With Diarrhoea
These guidelines are written for adults with no history of allergies or other serious underlying medical conditions. In all other situations you should arrange for specific guidelines from a doctor before your journey. Used sensibly these guidelines may help to lessen the severity of diarrhoea while abroad.
If you have had a significant problem while overseas always attend for medical screening on your return.
Two to four loose bowel motions in 24 hours and you feel generally well. There is no fever, no blood or mucous in the motion and you are not unusually thirsty.
- Increase your intake of clear clear fluids.
- Use Oral Rehydration Salts (ORS) if they are available.
- Flat 7-up or Coke/Pepsi are usually helpful.
- Take a light diet – mainly soups etc.
- Try and change your itinerary so that you can stay close to adequate facilities.
- Watch for any change in your health which might suggest that the diarrhoea is becoming more serious.
In these circumstances your mild diarrhoea is inconvenient to your travel plans. You may need to attend an important meeting or have move from place to place. In these circumstances you still are generally well but the frequent trips to the loo are causing concern, more a social problem rather than any actual medical worry.
- Follow the guidelines outlined for treating mild diarrhoea.
- You may also add a drug to slow down bowel transit such as Imodium or Lomotil.
- Continue to watch for signs which would suggest that the situation is becoming more serious. (See danger signs section).
Under these circumstances your diarrhoea will have become very significant. Dehydration will be more evident, a temperature may have developed and mental awareness may become impaired. You must remember that severe diarrhoea can kill at any age and must always be treated very seriously. Even if vomiting is occurring small regular amounts of fluids may usually be taken by mouth and will help the situation.
- Inform others and try to be obtain competent medical attention.
- Ensure that plenty of clean clear fluids are taken.
- Sips and teaspoons every five minutes are usually better tolerated than a full glass given less frequently.
- Suck clean pure ice if possible.
- Soak a piece of cloth in clean water and suck the corner. Rewet the cloth regularly.
- Use Oral Rehydration sachets to replace the lost fluid. If the diarrhoea is very severe it will be difficult to overdose, otherwise just use two or three sachets per day supplemented with other fluids.
- Antibiotics may sometimes need to be self administered if competent medical attention is not easily available.
With diarrhoea, patients, especially children, may rapidly slip from general good health to a more severe state. Watch out for the following:
- Diarrhoea 2 or 3 times each hour
- Severe fluid loss through diarrhoea
- Dry Tongue
- Sunken eyes
- Sighing breaths
- Rapid pulse
- Decreased mental state (confused / uncertain)
- Fever greater than 100F
- Blood or mucous in the bowel motion
- Check your temperature
- Replace fluid loss with clean, clear fluids
- Use sachets of ORS if available
- Watch out for blood or mucous in the motion
- Inform others if the situation is becoming more severe
- Look for competent medical attention, if possible
- In the more severe cases, (in patients with no history of allergy) consider using antibiotics such as Cotrimoxazole 2 tablets twice a day for 5 days or Ciprofloxacin 500mgs twice a day for 3 days.
- If you are in an isolated situation try and move back to a larger town or city where medical attention is available
Many cases of mild/inconvenient diarrhoea abroad are associated with sunstroke. Take care to ensure that your fluid intake is always maintained if the climate is hot or if you are exercising significantly.
When the body perspires it excretes both water and salts. Oral Rehydration Salts (ORS) are the best way to ensure that you do not lose a significant amount of salt and potassium.
Especially remember that children are very prone to dehydration and you need to make certain that they maintain a high fluid intake under these circumstances.
Cultural Concerns while Travelling
The world is shrinking to the extent that we can now very easily move from one region to another within a matter of hours. We recognise the change in climate and other issues relating to what is happening around us, but often we don’t recognise that customs and actions which are regarded as perfectly acceptable at home areÂ socially wrong or just plain rude in the country or among the people group we are now visiting.
Doing some research and learning about the country’s culture and beliefs will go a long way towards ensuring that your visit is not only worthwhile but also a pleasant experience.
The attached leaflet is modified from “The Responsible Traveller” which is available fromÂ the International Society for Travel Medicine at http://istm.org/
Cryptosporidosis is a parasitic disease of the gastrointestinal tract which has only been recognised as a disease of humans since 1976. There have been large outbreaks of the disease in many parts of the world including over 400,000 people in Milwaukee (USA) in 1993 and many hundreds of cases occur in western Europe including ones in England and also some in Ireland.
Cruising safely in the Caribbean
Over the past years cruising has become a much more popular option for the standard tourist with many individuals and couples , and also family groups, benefiting from the falling prices and the superb level of service which the major cruise liners are now offering.
No longer is cruising seen as the haunt for only the mega rich!
Coping with Business Travel
Ask any business colleague and they will confirm that inter-continental travelling brings it’s own special brand of stress and strain.
Missed connections, climatic changes, new unfamiliar contacts, language uncertainty and many more difficulties all add together to ensure that the `glamour’ of business travel is not all that it is made out to be.
The business traveller faces problems each day and it is essential that they remain in good, if not perfect, health in order that they stay well and that the business of the day can be completed to everyone’s satisfaction.
Building Hope & showing love in action
The Irish have clearly shown over the years how very generous they are towards those in desperate need. We have seen this through huge financial giving but also there are many others (like you) who have personally travelled to distant lands to share their skills and to make an improvement into the lives of others.
These volunteers are certainly ‘building hope’ but the structures they leave behind only show one element of what is achieved. The knowledge that people in Ireland care enough to travel to help others less well off is worth its weight in gold and, in many cases this is the greatest benefit to the programme.
Being healthy as a Backpacker
The continuous upsurge in backpacking holidays leads to some difficulty for those of us trying to advise on good health care so that your personal health can be protected to the greatest possible extent during this trip. Vaccines, avoiding mosquito bites, what to eat and drink and many other issues need to be covered by the travel doctor.
It is essential to ensure that your personal health will be sufficient for the trip you have planned. If you have a significant medical condition (eg heart problems, diabetes, epilepsy, asthma etc) then it will be important to talk this through in great detail to make sure you are not taking unnecessary risks. If you have never camped in the Dublin Mountains how come you think you will be able to cope with a tent on the Thai/Myanmar border or in some hut at 18,000 feet in Nepal!
Avoiding West Nile Fever
The disease was first diagnosed in blood taken from a woman living in the West Nile district of Uganda in 1937. Since that time the disease has been found in many other countries including Egypt, Israel, South Africa, parts of Asia and more recently in the American subcontinent. During 2003 three cases were diagnosed in Western Europe; one in the Netherlands and the other two in Southern France (may have been imported from Spain).
Avoiding Respiratory illnesses while travelling
Over the past decade the world has seen a number of specific illnesses which have moved very rapidly from the initial location to a distant country within a matter of days due to the ease of international travel and the lack of specific symptoms in the first few days of an illness.
This was particularly evident with SARS in 2003 and more recently with the emerging problems associated with what is referred to as ‘Avian Influenza’ (H5N1). The current outbreak of Swine Influenza (H1N1) appears to have moved into a human to human pattern and cases have been confirmed in a number of countries where travellers have returned home from their time in Mexico.
Avoiding Dengue Fever
This viral disease is transmitted by the bite on an infected mosquito. The disease is found in many of the hotter tropical and sub-tropical regions of the world. Many cases are reported from the very popular tourist islands of southern Thailand and also from Viet Nam (particularly around the Mekong Delta region). However it is worth remembering that Singapore has experienced one of its worst Dengue Fever outbreaks in well over a decade. See the associated pdf file for further information.
Advice on current SWINE INFLUENZA outbreak
The international advice regarding the risks associated with contracting H1N1 Influenza, and how best to avoid it, is changing almost daily and so it really is difficult for those planning a trip abroad at this time. Should you go or should you stay? What can you do to lessen your risks and what happens if you suddenly find yourself ill overseas with a sore throat, high fever and muscle aches and pains? Should you carry self treatment in case you get ill while abroad?
While abroad, if you report any illness to the local health authorities they will almost certainly isolate you to lower any risk to others but where will you be sent and what healthcare can you expect to receive? What happens to your travelling companions? Should they be given treatment? Should they be allowed to continue with their trip or perhaps they too should be isolated and quarantined?
If you don’t report it (either before you leave home or while abroad) and turn up at the airport trying to look healthy and well are you likely to go down in the history books as someone similar to a modern day ‘Typhoid Mary’ who spreads devastation and disaster everywhere you go? Could you live with yourself if you infected others and perhaps even some died?
For international travellers these are just some of the questions they need to face at this time. Being ill in your home country is one thing but getting such a potentially serious illness overseas in a strange country, where the healthcare system may be less than ideal, is not a pleasant thought.
The best estimates suggest that a specific vaccine against H1N1 Influenza A may be available internationally in mid to late Autumn. Prior to that there really is no way of ensuring you could not contract the illness – even here within Ireland. As with many respiratory illnesses (including the ‘normal’ human Influenza) there are a few simple ways to lessen your risks even if these do not provide perfect protection.
Respiratory diseases are usually coughed and sneezed from person to person. The range of this droplet spread depends greatly on a number of varying factors including the strength or the cough/sneeze, the proximity of the individuals and the blocking methods used (handkerchiefs, tissues etc) by the person themselves. Therefore staying away from individuals with symptoms makes sense where at all possible. Crowded places such as airports, planes, cinemas, markets, lecture halls and schools/nurseries are best avoided in the midst of any serious outbreak. Local transport on crowded buses and taxis are also commonly associated with disease spread.
Most of the available face masks usually only lessen the chance that you will cough infection out to others rather than specifically purify or filter the air that you breathe in yourself. Therefore giving masks to anyone with respiratory symptoms certainly does make sense to help the community but actually for the individual’s own protection they would needÂ most specialised marks which clearly are designed to filter the air breathed.
The other major method of transmission is self induced. This is where there is personal hand contact with an infected individual or infected surface which then places the virus on the individuals hand and can then be all too easily moved to their mouth or eyes and thus allow the disease easy access to the body. Shaking hands has been discouraged in many countries as a way of lessening disease transmission but also opening doors, holding the escalator rail or pushing the buttons on lifts etc are all possible ways to allow your own hands become infected. Regular washing and the use of antiseptic gels has been long known to be very helpful to lower these risks.
However, trying to protect against this level of exposure is very likely to induce very severe paranoia in any community and you can easily imagine that many will become afraid even to venture outside their homes. This of itself could all too easily lead to more risk for the individuals especially in the older and more vulnerable individuals as we move into the colder damper winter months. Commonsense still has to prevail and it is essential that we maintain a high level of community awareness to ensure protection of the most vulnerable members of our society.
The specific vaccination is awaited throughout the world and of course there will be very serious competition (both between countries and also within any territory) for the initial batches of vaccines once they are produced. This is sure to cause much heartache and despair but it should be remembered that the more people who do receive the vaccine the less the global risk of contacting the disease in the first place. The effectiveness and safety of the initial vaccine will always be a question which needs to be answered but this is no different to the mid 1950’s with the very urgent introduction of the Polio Salk vaccine in the midst of that horrific disease outbreak. That vaccine saved many lives and helped thousands avoid major handicap. The rushed introduction of H1N1 vaccination this Autumn will almost certainly run along similar lines.
While awaiting the specific H1N1 Influenza A vaccine it is strongly advised that all individuals (not just those in particular higher risk groups) should receive the appropriate ‘normal’ Influenza vaccination. This should lower the amount of morbidity within any community and also, quite importantly, help protect against any misdiagnosis or confusion in international travellers.
So the question at this time is whether or not to travel. There is no one answer which covers every situation and so individuals will need to consider this through in detail depending on their actual plans. Certainly it is correct to state that if the individual themselves is showing any signs of possible infection with H1N1 Influenza A then they should seek urgent medical attention and do everything possible to avoid putting others at risk. These people should not travel but, providing they receive a medical certificate confirming the clinical diagnosis, they should be able to receive a reimbursement from their travel insurance company – assuming they did take out correct cover in the first place.
For others who are perfectly healthy and well it appears that the risks associated with contacting H1N1 Influenza A from international travel are approximately the same as if the individual stayed in their home country – assuming that the commonsense precautions mentioned above are followed.On this basis there appears to be a good general consensus among the international experts that these travellers should not alter their plans at this time and that they can proceed with their trip in the knowledge that this does not place them at any higher risk of contracting the illness.
There is a huge amount of information available on the Internet relating to H1N1 Influenza A and the varying approaches being recommended by international authorities to face this pandemic. Probably the most useful for Ireland are either the WHO site ( http://www.who.int/en/ ) or the Irish HSE’s Health Protection Surveillance Centre’s web site ( http://www.hpsc.ie/hpsc/ )
A list of the TMB Clinics throughout Ireland
The Tropical Medical Bureau has a series of clinics throughout Ireland. Their locations and services are shown on the web pages http://www.tmb.ie/clinics-map.asp
However, if you would like to have a paper copy please download the current pdf file.
Many of our staff have worked in Aid & Development settings & have a keen understanding of your needs.
We assist with educational seminars, vaccination visits etc, to coordinate your group travel plans.