The Department of Health's booklet 'Health Advice for Travellers' has been revised and is now available free of charge by phone any time from the 'Health Literature Line' on 0800 555777.

The information is also available, and regularly updated, on the computerised data service PRESTEL. It contains information on health risks around the world, how to avoid them, and how to get treatment abroad in an emergency. It also incorporates a copy of form E111, the certificate that entitles you to emergency treatment within the countries of the European Union.

An application form and the E111 document itself have to be completed and handed in at a post office. The stamped and signed E111 form is then returned to you for safekeeping and must be carried with you when traveling and presented to the medical services in the event that you require medical assistance.

Before you travel

Spinney Travel Clinics: Our Practice Nurses provide a travel clinic service and endeavour to provide the best service possible.

Patients travelling abroad should take some time to consider any potential risks in the areas being visited. If you are pregnant or have some existing illness you should seek specific advice from your doctor.

It is important that any immunisation requirements are identified as early as possible as a course of vaccinations may be required to achieve the desired level of protection. Some vaccines have to be specially ordered and may carry a charge.

Please contact our Reception Team on 0844 477 3603 giving information about your journey - the time and duration, locations you will be passing through or staying at, and the type of accommodation. Our Practice Nurses will check your medical records and advise on any immunisations and special precautions required. Our Reception staff will contact you and invite you to make an appointment to attend one of the clinics.

Travel Proforma

Vaccinations are available for many infectious diseases, immunity is never immediate or total, and can sometimes take several weeks to obtain the required level of protection. Don't risk it - make enquiries as early as possible before your planned trip.

Insurance: Always take out adequate travel insurance and make sure your level of cover is sufficient to cover the cost of being flown home in an air ambulance. In Europe the form E111, available from the Post Office (as detailed above), will enable you to receive treatment in the countries of the European Union.

Medicines: Carry adequate supplies of any medicines you take regularly as it may not be possible to get more whilst you are abroad. A simple first-aid kit will help you cope with many eventualities - speak to the Practice Nurse about what it should contain.

Malaria: If you are going to a country where malaria is a risk you will need to speak to your Doctor or a Practice Nurse about some preventative medication.

Malaria is a potentially fatal blood disease and must be taken seriously. It is caused by a parasite transmitted by certain types of mosquito. The mosquito becomes infected when it bites an infected person, and then spreads the disease when it bites someone else. About 2000 cases of imported malaria are reported in England and Wales each year, an increasing proportion being due to the more severe falciparum malaria. Most victims have not taken, or have been poorly compliant with, prophylaxis (preventative tablets and anti-mosquito measures). Recommendations for prophylaxis are available from our Practice Nurses via the Travel Clinics and are updated on a monthly basis. Up-to-date information is also available from the Malaria Reference Laboratory on a recorded message (Tel 01891 600350).

No regime of drugs is 100% effective and any fever while in, or within 6 months after leaving, an endemic area could be malaria. Symptoms usually occur 7 to 30 days after infection though occasionally up to 6 months later! They vary, but include any feverish illness, chills, sweats, sore throat, muscle aches, tiredness, vomiting and diarrhoea. Any feverish illness in the 8 weeks after your trip may be malaria and you should seek medical advice. Diagnosis is usually confirmed by a blood test.

Prevention: Take appropriate anti-malaria tablets (these depend on the area you are visiting), which you can buy from your pharmacist.

It must be emphasised that whilst anti-malarial tablets can reduce the risk of catching malaria, because they are not 100% effective, it is essential that you also take steps to avoid being bitten. These simple guidelines will help you avoid catching malaria and other insect borne diseases:

• Apply insect repellents containing Diethyl-Toluamide (DEET) to exposed skin. They are safe and very effective.

• Malaria mosquitoes are most active at dusk and at night so cover arms and legs between dusk and dawn.

• If your accommodation does not have insect screens or windows which close, sleep under a mosquito net. Mosquito nets are more effective if impregnated with insecticide such as permethrin. Do not sleep touching the net - the mosquito can bite through it if your skin is adjacent.

• If necessary, use 'knock-down' insecticide sprays. Try to clear the room of mosquitoes.

It must be emphasised that taking prophylaxis (malaria tablets taken to prevent infection) does not lead to dangerous delays in the diagnosis of malaria. Studies have shown clearly that malaria is much less likely to be severe at the time of diagnosis in patients who have taken prophylaxis than in those who have not. As far as adverse reactions are concerned, the three major antimalarials currently used as prophylactics (chloroquine, mefloquine and proguanil) are all much less hazardous than would be their avoidance in the countries for which they are recommended. Patients who have conscientiously taken malaria prophylaxis are unlikely to die even if they catch malaria. It is those patients who do not take, or stop taking the drug too early on return to the UK, that are at risk of developing the rapidly fatal form of malaria. Malaria can kill within hours in the unprotected. After the infected mosquito has bitten and transmitted the malaria parasite into the bloodstream, the parasite has a dormant stage when it hides in the liver. For this reason it is essential to continue taking the malaria prophylaxis on return to the UK. If you take whilst abroad and stop on returning to the UK you are unprotected.

Depending on the type of malaria, prophylaxis this should be started prior to travel (for example, Malarone and Doxycycline should be started 1 - 2 days before travel). The reason for this is to determine whether or not side effects will occur, so that an alternative drug can be prescribed for you before you leave. Adverse effects from chloroquine and proguanil are generally mild. Chloroquine may lower the seizure threshold in epileptics and occasionally causes a rash. It frequently causes itching in black-skinned people. Proguanil may cause aphthous-like mouth ulcers. Mefloquine's adverse effects include rashes, nausea, diarrhoea and dizziness. Rarely it may cause anxiety, sleep disturbance and depression, and in these circumstances should be discontinued.

Remember

• Do not stop your malaria pills when you return to the UK.

• If you develop fever or flu-like symptoms, even several months after leaving a malarious region, see a doctor immediately and ask if you might have malaria.

Yellow fever, Cholera and Men Vax ACWY: Yellow fever and Men Vax ACWY are vaccines for which certificates may be required for entry into a country (but note the yellow fever vaccine is also recommended for all travellers to endemic areas regardless of the official requirement). Cholera immunisation is no longer officially required by any country and should not normally be recommended.

While you are travelling

Regular Medication: Always carry medicines in your hand luggage and make sure you have an adequate supply for the duration of your journey. After take-off, set your watch to the time at your destination and take your medicine according to the new time. Avoid unnecessary medical treatment whilst abroad especially where hygiene standards are unreliable.

Jet Lag: This is common if flying across several time zones and your body can take days or even weeks to adjust to the new day and night cycle. To help your body to try and adjust more quickly, try to include stopovers in your travel plans, drink plenty of fluids during the flight but avoid alcohol, coffee and fizzy drinks. After take-off, set your watch to the time of your destination and eat, drink and sleep according to the new time.

Long haul flights: There has been much publicity about the problems caused by long haul flights, especially to Australia and New Zealand. The major complication is one of 'Deep Vein Thrombosis' (DVT). This is when a blood clot forms in the major veins on our legs. This clot can then move to the heart and lungs, causing the heart to stop.

Precautions you can take to prevent a DVT

• Do not wear tight clothing - wear loose belts and open neck shirts.

• Drink plenty of fluid and restrict the amount of alcohol you drink. If you want to drink alcohol, drink the same amount and more of water or fruit juices.

• Wriggle your legs around regularly when you are seated.

• Get up and walk around the plane regularly, do a few exercises to promote your circulation.

• Try and get as fit as possible before you fly - stop smoking!

Whilst away

Heat and Sunshine: Sunburn and sunstroke can cause quite serious headache, chills, nausea, vomiting and premature skin ageing as well as increasing your risk of skin cancer. Even in the UK, ultraviolet (UV) radiation can damage your skin (weather forecasts from the Meteorological Office may now contain predicted mid-day solar UV levels). UV is much more powerful at holiday destinations nearer the equator. A separate risk of over-exposure to strong sun is sunstroke or heatstroke, caused by overheating. Travellers abroad are advised to avoid strenuous activity during the hottest hours, and to drink plenty of safe, non-alcoholic liquids to replace body fluid lost through perspiration. Time your exposure carefully, and try to avoid the sun from 11.00am to 3.00pm. Always use appropriate strength sun block for your skin type. When necessary, cover up with long-sleeved clothing and a hat. Take special care if you have red hair and/or fair skin. Free telephone advice is available on: 0800 556655.

Remember - SLIP on a shirt, SLOP on some sunscreen and SLAP on a hat!

Dress: Wear clothing appropriate to the climate. In the heat it is better to wear light-coloured, loose cotton clothing. Long trousers and sleeves protect the skin and a broad brimmed hat will protect the head and face. Keep your feet well covered. Cover as much of the body as possible between dusk and dawn to avoid insect bites and avoid wearing dark colours in malaria-risk areas.

Accidents and Injuries: These are the major cause of serious health problems among travellers, mainly caused by -

• Ignorance of local road laws and rules.

• Riding a motorcycle without a helmet.

• Poorly maintained vehicles.

• Increased alcohol consumption.

Water Hazards

• Take care when swimming and remember that lakes and rivers may be infected, especially in Africa.

• Ask about risks at local beaches e.g. strong currents or rocks.

• Wear life jackets for any water sports.

• You may need extra insurance for scuba diving (as for mountaineering or any other dangerous sport)

Thirst and Rehydration: In hot climates, you should drink as much as possible, even more than you think you might need. Avoid alcohol as it dehydrates and take extra salt on food or very diluted in your drinks.

Safe Water: In some countries diseases can be caught from contaminated water - by drinking it, swimming in it, or from eating shellfish living in it!

To avoid this risk, drink branded cans and bottles of soft drinks and use bottled water at all times (even to clean your teeth).

Safe Food: Outside Europe, North America and Australasia never assume food is safe unless you know it has been thoroughly and freshly cooked. All food should be cooked right through. Shellfish should not be eaten raw - boil for at least 10 minutes.

Take extra care with personal hygiene to avoid any risk of traveller's diarrhoea or hepatitis. If you suspect that the local water is not safe do not use it to drink, clean your teeth, wash fruit or salad, or make ice cubes. Use only boiled or bottled water. If the drink must be cold, sit the glass in a bowl of ice - but don't put the ice in the glass.

Avoid Eating

• Unpeeled fruit.

• Homemade ice cream.

• Unpasteurised dairy products.

• Food from street traders.

• Food that has been kept warm or exposed to flies.

Remember - If you can't boil it, cook it or peel it, forget it!

Insects: Many insects bite and can transmit disease. Put insect repellent on exposed skin, use knockdown insecticides in rooms just before dusk and keep windows closed if possible. If you are bitten by ticks you can remove them by a small pull at right angles to the skin. Ticks need to be killed first. To remove leeches - cover them with salt or burn them with a cigarette lighter and they will drop off. Do not try to pull them off.

Animals: Avoid close contact with local animals since there is a risk of rabies. In particular, avoid wild animals that appear to be tame since this is often a symptom of rabies. Rabies, if left untreated, is always fatal. If bitten, wash the wound immediately and seek qualified medical advice as soon as possible. This action is necessary even if you have been previously vaccinated.

Hepatitis: Of all the vaccine-preventable diseases likely to affect travellers, hepatitis A and B - potentially serious diseases of the liver caused by a virus - are the most significant causes of illness and death. Hepatitis A is spread by direct contact with an infected person or by faecal contamination of food and water, so take care about what you eat and drink and where you indulge in water sports. Hepatitis B and HIV infection (AIDS) is spread by contact with infected blood or body fluids, for instance during medical or dental procedures with inadequately sterilised equipment, by sharing equipment for non-prescribed drugs, through tattoos, ear-piercing or acupuncture - all of which should be avoided, from blood transfusions or via unprotected sex. Travellers on expeditions should consider taking a medical kit containing sterile needles and syringes for use in an emergency.

Safe Sex: Hepatitis B and HIV infection (AIDS) are risks in all parts of the world to varying degrees and are mostly transmitted sexually. Casual sex is risky and condoms should always be used (better to pack an adequate supply of good quality condoms - they may not be easily available or of good quality abroad), but remember that they provide good, but not complete, protection.

Diarrhoea: Diarrhoea of some kind affects a high proportion of travellers. It may simply be caused by a change of diet or be due to contaminated food or water. If you have been vaccinated against hepatitis A and typhoid before you leave, your risk of such illness will be significantly reduced. Go prepared with some commercially available sachets to replace lost salts and fluids. Alternatively dissolve one level teaspoon of salt and one of sugar in a glass of freshly boiled water, flavoured with juice if required. Continue to eat as this shortens illness and fluid loss.

Seek medical advice if

• Blood is present in the faeces.

• Illness is accompanied by fever.

• The patient becomes confused.

• There is no improvement in 24 hours in adults or 12 hours in children and the elderly.

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