Hajj and Umrah are religious pilgrimages to Mecca, Saudi Arabia. Hajj is a mandatory Pilgrimage for every Muslim to take once in their lifetime, given that the individual is physically and financially able.
It takes place in the last month of the Islamic calendar and is taken annually by 2.5 million Muslims worldwide pre-pandemic. Whereas, Umrah is a shorter pilgrimage to Mecca taken any time of the year.
Muslims from all over the world gather annually in Mecca in a display of unity, faith and solidarity. Due to the large number of participants performing the pilgrimage there are some health risks you should be aware of.
There are also health requirements set by the Health Ministry of Saudi Arabia that you could affect your VISA. It is good to be aware of those requirements before travelling.
Ministry of Health KSA states that in order to perform Hajj pilgrims, one must have the proof for the following:
- A full course of COVID-19 vaccinations (second dose of a two dose vaccine or received a single dose vaccine) approved by the Saudi Ministry of Health. The approved vaccines’ list can be found here – Ministry of Health Approved Vaccines.
- There is no longer a requirement for PCR testing to perform Hajj or to enter KSA.
A pre-travel consultation should be scheduled at least 4 weeks before your trip.
Any mandatory or advised vaccinations will be discussed with a nurse and can be given in the appointment. Follow up doses can also be arranged in the appointment.
Before travelling to Hajj or Umrah, it is recommended that pilgrims be up-to-date with all of their wellness vaccinations.
All British citizens travellers performing Umrah or Hajj are required to submit a valid Meningitis ACWY vaccination certificate in order to obtain a visa. The MenACWY vaccine protects against meningitis (strains A, C, W & Y) and sepsis. Adults and children over the age of 2 are required to have the vaccine and provide evidence of immunisation no less than 10 days before you plan to arrive in Saudi Arabia. This requirement also applies to seasonal workers in Hajj areas.
You may also want to consider Meningitis B vaccine – this is not a mandatory VISA requirement.
If you require a vaccination, you can choose from our available appointments online – click to book your appointment.
All travellers must be vaccinated against Covid-19 to perform Hajj Pilgrim. The vaccines that are approved by the Ministry of Health KSA can be found here – Ministry of Health Approved Vaccines.
Travellers from countries reporting positive environmental sources samples of circulating vaccine derived polio virus 2 (cVDPV2), including the UK, are recommended to be vaccinated with at least one dose of IPV within the previous 12 months and at least four weeks prior to arrival, however there is no polio vaccination certificate requirement.
A polio certificate requirement will only apply to UK pilgrims if they are travelling to KSA via a country reporting WPV1, cVDPV1 or cases of cVDPV2 or Acute Flaccid Paralysis, and not if they are travelling directly to KSA from the UK.
If you require a vaccination, you can choose from our available appointments online – click to book your appointment.
– Flu Vaccine
Since both Hajj and Umrah both pose crowded conditions and close contact, seasonal flu vaccination is advised, especially for those who are more vulnerable to severe influenza diseases. This precautionary measure will help reduce the potential spread of the flu.
If you require a vaccination, you can choose from our available appointments online – click to book your appointment.
Hep B is spread by contaminated blood and bodily fluid. Pilgrims who intend to shave their heads as one of the rites of Hajj should consider taking the vaccination. Although licensed barbers performing head shaving are obliged to use a new blade for each pilgrim, unlicensed barbers may not adhere to this practice. Vaccinations require 3 injections to be given over a 3 week period and can be given from birth.
Rabies is spread through the bite of an infected animal such as cats, dogs, monkeys and bats. Saudi Arabia is classified as a high-risk country for rabies. Full protection is achieved with 3 doses – 3 vaccinations usually given over a 3 week period, however, we do offer a rapid course which can achieve full protection in 7-days. The rabies vaccine can be given from birth.
Travellers’ diarrhoea can occur in up to 60% of travellers. Although most cases are mild, taking sensible precautions with food and water can reduce the risk. Carrying medicines for self-treatments is useful such as antibiotics – take our Online Travellers’ Diarrhoea Consultation to see if it is suitable for us to prescribe you standby Travellers’ Diarrhoea treatment.
The best protection are preventative measures such as drinking bottled or purified water, washing your hands thoroughly and frequently and eating well-cooked, hot food.
Fore more information on Travellers’ Diarrhoea.
Saudi Arabia has had some of the hottest temperatures on record this year. Exposure to such high temperatures increases sweating, and results in loss of fluid and electrolytes which can cause rapid dehydration. This can result in heat exhaustion or heat stroke which can be life threatening if not dealt with promptly.
Heat related illness can be avoided by the following:
- Seek shelter and shade during the middle of the day (11am-3pm) when temperatures are the hottest
- If you are outside, ensure you protect your skin against the sun with high factor sun cream
- Wear loose fitting, lightweight and light colour clothing
- Keep hydrated by drinking plenty of fluids
- Ensure you are taking sufficient salt in your diet (sweating leads to electrolyte and salt depletion)
- Avoid caffeine and alcohol, which can worsen heat related illnesses
Both Hajj and Umrah pilgrimages require strenuous effort, it is worth considering having a full body medical check up before you travel to ensure you are in good health. To prepare for the miles of walking, try increasing your physical activities to improve mobility and movement. In case of unforeseen circumstances, remember to pack a first aid kit and extra supplies of any prescribed medication you are currently taking. We have an onsite pharmacy if you’d like to purchase any of these items during your appointment, speak with your GP or nurse whilst at the clinic.
DENGUE AND MALARIA:
Dengue is spread by day-biting mosquitoes and Malaria by mosquitoes that are active at night. You can reduce your risk of insect bites by using effective insect repellents and protective clothing. You can also sleep under a mosquito net that is impregnated with insecticide to have a peaceful sleep.
If you require complete protection from bugs and mosquitoes, you can check out our ultimate bug kit here.
Delaying your period:
If you decide you would like to delay your period for pilgrimage, you can do so by taking hormonal medication. In advance of your trip, book an appointment with a GP to discuss your options as soon as possible.
When you get home:
If you return home unwell it is important to book an appointment with a GP to determine the cause. If your symptoms worsen or becoming life-threatening do not wait to see a doctor, go straight to A&E for urgent medical care.
If you return with a stomach bug or persistent travellers’ diarrhoea, you may want to consider booking a Gastrointestinal (GI) Panel PCR test – it looks for any microbes (bacteria, viruses & parasites) that may be causing your symptoms and can quickly identify the exact cause. Results can be provided in as little as 1-hour, so that accurate and effective treatment can begin straight away. Firstly, you need to book a GP appointment, express your interest in a GI PCR test and they will advise whether you are suitable or not.
As a travel nurse based in London, I was concerned to hear the recent warning from health officials about the spread of tick-borne encephalitis (TBE) virus in several parts of the country. The UK Health Security Agency (UKHSA) has confirmed three cases of TBE virus in patients in Yorkshire, Norfolk, and on the border of Hampshire and Dorset. Further tests on ticks across the country have found that the disease, which was commonly found in parts of Europe and Asia until now, is now present in the UK. The experts have warned that it is unlikely that TBE virus will disappear, so it’s essential to establish a surveillance program.
Public health officials say the risk is low, but it’s essential for walkers to take precautions and seek medical help if they fall ill after being bitten, especially if by a tick.
As a clinic that specialises in travel, we are used to urging everyone to take precautions to protect themselves from tick bites anyway, but this news reinforces the importance of doing this at home as well as when travelling abroad. It is essential to cover your ankles and legs, apply insect repellent, and check clothes and your body for ticks, particularly when visiting areas with long grass such as woods, moorlands, and parks.
In most cases the TBE virus typically causes mild flu-like symptoms, but it can also lead to severe infection in the central nervous system resulting in meningitis or encephalitis a high fever with headache, neck stiffness, confusion, or reduced consciousness, and long-term impairment.
As a travel nurse, I think it is really important to educate people about the symptoms of TBE to encourage them to seek medical help immediately if they experience any of these symptoms, but also to emphasise the fact that infections are preventable.
Ticks are becoming more common in parts of the UK, mainly due to increasing deer numbers. They live in undergrowth and latch on to humans when they walk through long grass. It is thought infected ticks may have arrived in the UK via migrating birds. Scientists had suspected the virus had arrived in the UK in 2019, following a couple of cases, but complexities involved in testing meant these could not be confirmed.
It’s crucial to emphasise the significance of vaccination for individuals who are considered of a higher risk. You are much more likely to catch TBE if you work outdoors or if you enjoy outdoor activities such as camping, hiking, dog-walking, countryside rambling and even jogging. Children playing outside may be especially vulnerable.
Vaccines can provide protection, and as there is currently no known cure for tick-borne encephalitis virus, those individuals who would be considered at higher risk are advised to be vaccinated as a precaution.
It’s worth noting that a vaccine is used routinely in areas of high incidence in Europe, and its advisable to consider vaccination for individuals with outdoor occupations in regions where the virus is prevalent.
For the general public the risk of contracting TBE is relatively low. Therefore, it’s essential to educate people about TBE and encourage them to take precautions to protect themselves from tick bites, particularly when travelling to areas where the virus is found.
Related services available at Fleet Street Clinic
For further reading, more news coverage can be found here:
Dengue Fever has been in the news following two cases linked to travel to the Spanish island of Ibiza. This has sparked concerns about the spread of mosquito-borne illnesses in Europe, which is especially unusual for this time of year.
Dengue fever is a viral infection transmitted by the Aedes mosquito, which is found in tropical and subtropical regions worldwide. With rising temperatures and changing climates, there is a risk of mosquitoes and other disease vectors spreading to new areas, potentially causing outbreaks of diseases such as dengue fever.
The two cases of dengue fever in Ibiza were reported by the Spanish Ministry of Health and were both in residents of Germany who had visited the island before becoming ill. Each case was accompanied by two family members who were also suspected to have had dengue fever.
The risk of dengue fever in Spain is highest between the months of May and November, when mosquitoes are most active so to have cases at this time of year is uncommon.
So, why are we seeing cases outside of the usual infection months?
The reason is multi-facetted.
Our medical director and travel health specialist, Dr Richard Dawood explains:
“Firstly, there is the introduction or spread of mosquitoes to “pastures new” – places that might have been previously inhospitable, perhaps through temperature; or alternatively, that offer an environment with plenty of suitable breeding sites that they are suddenly able to take advantage of. These mosquitoes can bring disease with them, or can spread it around if there is a reservoir in the local population.
Secondly, there is the possibility of introducing disease to a vector population that is already established, ready and waiting. This is exactly the (long-standing) concern with yellow fever. There are mosquito species in Asia, for example, that are easily capable of spreading yellow fever were it to be introduced by an infected traveller – which is why Asian countries are so careful to insist on proof of yellow fever vaccination from travellers arriving from the endemic zones of Africa and South America. Asia is yellow fever-free, and wants to remain so. However, this type of introduction has already recently happened in Australia, where Japanese encephalitis (a virus infection that can cause rare but serious complications in humans) has recently established a reservoir of infection in farm animals, that may be impossible to reverse. It is also happening with Lyme disease spreading gradually into parts of Europe (and the UK) with a susceptible tick population.
Similar concerns apply to Zika – there is very large potentially susceptible mosquito population that could spread the virus in many tropical countries, if introduced; dengue fever; and also potentially malaria, in parts of the world that have been the target of successful elimination campaigns, but where mosquito populations could still spread it, were it to be reintroduced, if control measures are neglected or ceased.
With changing climates, a valid concern about global warming is that it could create conditions in which populations of mosquitoes and other vectors thrive and spread – hence the crucial importance of vigilance, surveillance, and early action if needed.”
How can you protect yourself from Dengue Fever?
There is no vaccine against dengue licensed in the UK, though several candidate vaccines are in development.
The best way to protect yourself against dengue fever is to take measures to avoid mosquito bites. This includes wearing protective clothing, using mosquito repellent, and staying in places with air conditioning or screens on windows and doors.
If you develop a high fever during or after travelling to an affected area, seek medical advice as soon as possible and provide details of your recent travel history. Dengue is often also accompanied by a rash and joint or muscle pain.
In conclusion, rising temperatures and changing climates have the potential to create conditions in which populations of mosquitoes and other disease vectors thrive and spread. It is crucial for public health authorities to remain vigilant and take early action if needed to prevent the spread of diseases such as dengue fever. By taking appropriate measures to protect against mosquito bites, travellers can reduce their own individual risk of contracting dengue as well as other insect-borne infections.
Suitable Medical Kits available to buy online
Related services available at Fleet Street Clinic
Travelling can have a significant positive impact on one’s physical and mental health, according to a study published in the Journal of Travel & Health. The study surveyed over 1,000 adults who had recently returned from a trip and found that the majority of them reported improvements in overall well-being, including increased energy and reduced stress levels.
One of the key reasons for these self-rated health benefits is that travelling allows individuals to step out of their daily routine and experience new environments and cultures. This can lead to increased physical activity, as travellers may be more likely to walk or bike instead of drive which may also expose them to different types of food, leading to a healthier diet.
Additionally, travelling can have a positive impact on mental health as well. The study found that the majority of participants reported feeling more relaxed and less stressed after their trip. This is likely because travelling can provide a sense of excitement and adventure, as well as a break from the demands and responsibilities of everyday life.
Another benefit of travelling is that it allows individuals to build new social connections, which can be important for mental health. Meeting new people and forming new friendships can provide a sense of belonging and can also help to reduce feelings of loneliness and isolation.
In conclusion, the study suggests that travelling can be good for one’s physical and mental health. It can help to increase energy levels, reduce stress and improve overall well-being. So, next time you are planning a trip, remember it’s not only good for your soul but also for your body.
To read the full study, continue reading here: https://www.sciencedirect.com/science/article/pii/S2214140522002079?via%3Dihub
Related services available at Fleet Street Clinic:
- Travel Vaccinations
- Jet Lag Calculator
- Travellers’ Diarrhoea Online Consultation
- DVT Rick Calculator
Chinese New Year is a festival celebrated annually by Chinese communities across the world to bring good luck and prosperity into the New Year. Every year corresponds with one of the 12 animals in the Chinese Zodiac, with 2023 being the Year of the Rabbit. Celebrations for Chinese New Year kick off on the 22nd Jan, continuing until the 5th February where the festivities culminate with the Chinese Lantern Festival. Every year, thousands of people travel to China to enjoy the celebrations. So, if you are one of those people who are planning to travel to China to join in with the festivities, please ensure you follow these tips to stay healthy whilst abroad.
Firstly, you may want to check the entry requirements for China in terms of required covid-19 testing. If you travel to China after 8th Jan, you would require a negative Covid-19 test and submit your negative result by filling a Health Declaration Form via China Custom Website or their app or WeChat account. You would also need a pre-departure Covid -19 test when coming back to England from China. If you are still travelling to China you can view what covid-19 testing entry rules are currently in place here: GOV.UK WEBSITE. You can find more information on our rt-PCR Testing service here and our Lateral Flow Testing here.
Covid aside, check your vaccination history. All travellers need to ensure they are up-to-date with their childhood vaccines, most importantly, Hepatitis A, Typhoid, Measles, Mumps and Rubella (MMR), and Diphtheria, Tetanus and Polio (DTP).
More information on our wellness vaccinations can be found here.
It is worth noting that it is still influenza season in the northern hemisphere and transmission can occur well into spring. Those travellers who haven’t received their annual flu vaccination to protect them against the most common strains for 2022-23, should ensure they receive it before travelling to China. You can still book your annual flu vaccine, here.
Travellers who are planning extended stays, and more remote and rural travel may also wish to consider vaccinations against Rabies and Hepatitis B.
More information on our travel vaccinations can be found here.
Those who are heading further south to rural areas where the weather is warmer may wish to consider vaccination against Japanese Encephalitis (JE), which is spread via the culex mosquito. You can also purchase our ‘Ultimate Bug Kit’ which will help protect you from mosquito bites.
There have been recent cases of Avian Influenza (bird flu) in both the UK and China. Bird flu is a very unpleasant illness which can cause people to fall quite unwell. It is passed on via contact with infected birds. Travellers can minimise risk by avoiding contact with any birds (dead or alive): avoid touching dead or dying birds, and steer well clear of ‘wet markets’ (marketplaces that sell meat, fish, and often live animals including birds).
Chinese New Year is heavily focused on food, with items such as fish, fruit and dumplings symbolising luck, wealth and prosperity. Travellers should ensure that they maintain good food and water practises to avoid tummy trouble whilst away. You should avoid tap water and ice made from tap water, instead stick to bottled water. Ensure you wash your hands thoroughly before eating and after using the toilet. Ensure all food that you eat is cooked thoroughly and served straight to you. And lastly, consider taking medicines for self-treatments with you, such as antibiotics – take our Online Travellers’ Diarrhoea Consultation to see if it is suitable for us to prescribe you standby Travellers’ Diarrhoea treatment.
By following these guidelines and ensuring you are generally sensible and hygienic, you will be able to relax and enjoy the sheer joys of travel and seeing the world.
Happy Chinese New Year!
Travelling with children can be an enlightening and wonderful experience for the family – creating memories and opening their minds to other cultures and ways of life. But on the flip side it also can be quite daunting, especially if this is your first time travelling with children. The best way to establish a safe travel experience abroad is to take early precautions.
Before Your Travels
When it comes to travelling with children, careful planning and preparation should be considered. It is highly advised to have a travel consultation well in advance of your travels. The travel nurse will make you aware of any travel risks and take into consideration your child’s current wellbeing. Depending on where you are travelling, your child may require certain vaccinations.
These preventative measures will safeguard your child from any diseases or illness.
Your may be advised the following vaccinations:
- Yellow Fever
– Some countries require this as a condition of entry and will ask for proof of vaccination when you arrive into the country.
- Hepatitis A
- Tick-borne Encephalitis
- Japanese Encephalitis
- Hepatitis B
- Meningitis ACWY
All vaccinations require a duration of time following vaccination to reach full protection, usually 10 – 14 days, so factor this time in before your travels. In addition, some vaccinations require a multi-course dose before they are considered effective, such as rabies which requires 3 vaccinations to be considered a complete course. Book a travel consultation early to ensure you have enough time before you travel.
In addition to travel vaccinations it is worth discussing any upcoming childhood vaccinations that could be beneficial to have at the same time so your child is protected against any other common diseases that aren’t necessarily associated with just travel.
If you intend to go to countries with a high malaria risk it is important to discuss antimalarial protection during your travel consultation. Malaria can be fatal and there is a higher risk for children. Antimalarials (malaria tablets) are generally taken for a duration before, during and after your trip and need to be purchased in advance of your travels. There are a number of different types and are suitable for different people so it is important to discuss your options with a travel health expert. The tablets work by ensuring the malaria parasite doesn’t reach unmanageable numbers, keeping you healthy whilst you travel.
Travelling abroad can be exhausting, especially for young children. Jet Lag is known to cause temporary sleep disturbance, which can have an impact on your mental health and other bodily functions. To prepare ahead, The Jet Lag Calculator can tell you how long it will take the body to adjust to your new time zone when you travel – and to adjust back again when you come home.
During Your Travels
Travelling can sometimes result in unexpected situations. For the protection of your child/ren and your family in general, always carry a First Aid Kit. This will reduce your need to seek medical aid for minor accidents or journeys to a chemist, especially if local towns are at a further distance.
When travelling to warmer climates, sun safety is crucial as young children are more vulnerable to sunburn from outdoor activities. To protect the skin apply sunscreen of at least SPF 30, with broad spectrum UVA and UVB protection throughout the day. In addition, hot weather can also pose a risk of dehydration and heat stroke. Ensure you and your child are hydrated throughout the day by drinking water from a safe source. This can be bottled water, boiled water, or water that has been filtered.
To further avoid traveller’s diarrhoea:
- Wash your hands regularly, especially before eating
- Carry an alcohol-based sanitiser
- Keep children from crawling or sitting on the ground
- Avoid swimming in contaminated water
- Don’t swallow any shower or pool water
- Eat raw fruits and vegetables only if washed in clean water or peeled
- Stick to foods that are well cooked and served hot
- Stick to canned or bottled beverages
- Avoid food that has been sitting on a buffet to avoid contamination
We have launched a new, free online consultation for Travellers’ Diarrhoea – by answering a few simple medical questions about yourself, we can check if antibiotics are recommended for your trip. You can pay online and we’ll dispatch them directly to you if you are suitable.
Alternatively, you can have a more comprehensive travel consultation in-clinic with one of our experienced travel nurses.
For more information on the prevention and treatment of Travellers’ Diarrhoea.
The feeling of discomfort from bug bites can truly be a nightmare whilst travelling. Insect bites such as mosquitoes, ticks, biting fleas and kissing bugs can cause pain, irritation and even spread diseases. However, they can be avoided through protective clothing. Our Ultimate Bug Kit has everything you need from repellents to aftercare. Alternatively, you could purchase individual items and create your own kit.
After Your Travels
Travelling can expose your child to certain diseases. If your child falls unexpectedly ill – contact your doctor or emergency services right away. A high temperature/ fever could mean an infection. For most people, travellers’ diarrhoea usually clears up within a few days. However, if your stomach bug has been ongoing for weeks after returning home, then you will need to do testing to investigate the root cause. Viruses, bacteria or parasites all cause similar symptoms but require an entirely different treatment approach. Our Gastrointestinal (GI) Panel PCR test looks for any microbes that are causing your symptoms and can quickly identify the exact cause of your Travellers’ Diarrhoea. Results can be provided in as little as 1-hour, so that accurate and effective treatment can begin straight away.
From Sunday, June 12, 2022 at 12:01AM ET all COVID-19 testing entry requirements for international travellers to the United Stated were rescinded.
Arrivals no longer need to show proof of a negative Covid-19 test or documentation of recovery prior to boarding a flight to the U.S nor upon arrival.
The Centre For Disease Control (CDC) has reached the decision based on the high vaccine uptake and widespread population immunity.
In the statement they released, they explain; “The COVID-19 pandemic has now shifted to a new phase, due to the widespread uptake of highly effective COVID-19 vaccines, the availability of effective therapeutics, and the accrual of high rates of vaccine- and infection-induced immunity at the population level in the United States. Each of these measures has contributed to lower risk of severe disease and death across the United States. As a result, this requirement which was needed at an earlier stage in the pandemic may be withdrawn.”
Most countries, including the UK, have already abandoned testing requirements in a bid to return international travel to pre-Covid levels and it seems the CQC have decided it is now time for the U.S to do the same.
Does this mean that the COVID-19 pandemic has ended?
No, but it does signify a shift in the pandemic. As we see a worldwide reduction in covid cases and death rates, the CDC statement clarifies that whilst testing may not be necessary right now, they will continue to monitor the data and adapt accordingly.
They state; “CDC continues to evaluate the latest science and state of the pandemic and will reassess the need for a testing requirement if the situation changes”.
What about covid vaccinations…
Do I need to be vaccinated to travel to the U.S?
Yes, foreign travellers from outside of the U.S are required to be double vaccinated from COVID-19 to enter the country. But for people under the age of 18, U.S citizens/ nationals or lawful permanent residents will be exempt from vaccination requirements. Currently, the Covid Booster vaccination is not a requirement and there is no set expiry date on the first dose of vaccination.
Overall, the easing of the US Covid restrictions is welcome news to the travel and tourism industry and demonstrates the possibility of international travel returning back to its pre-covid levels.
However, the absence of masks, vaccines, or travel mandates does not mean that the risk of catching Covid-19 has gone away.
We strongly recommend:
- Having comprehensive travel health insurance for all travel to the USA – hospital care should you require treatment for Covid is very costly.
- Wearing a high filtration (N95 or FFP3) mask during your journey
- Practising all the usual hygiene recommendations during your journey (e.g. hand sanitisers, distancing where possible
- Having an early test and avoiding travel if you have even minor symptoms.
For more information on the covid testing services available at Fleet Street Clinic.
Fear of flying, otherwise known as aerophobia, is an excessive worry about air travel. It is one of the most common forms of phobia and according to YouGov, around 24% of Brits have some form of anxiety about getting on a plane.
People suffering from fear of flying experience extremely anxious thoughts which are often so powerful they become physical symptoms. These can include shallow breathing, experiencing chest tightening, sweaty palms, feeling nauseated or lightheaded and sometimes these even develop into a panic attack, meaning many opt to avoid air travel altogether.
For some, it will have been a lifelong problem that has meant never flying at all. For others, who have flown many miles in their lifetime, it is a problem that slowly creeps up on them over time. In both circumstances, the fear can be debilitating and symptoms often trickle into other areas of life.
Like all phobias, there is little logic to support the anxiety that it causes – travel is in fact the safest form of transport and you are much more likely to die from a car accident than in a plane crash. Knowing that fact does little to ease the flying-related anxiety of an aerophobic sufferer.
So, what can be done to overcome our fear of flying?
Understand the reason why you’re a nervous flyer
Fear of flying is usually caused by a combination of factors. Understanding the root cause of your own phobia is perhaps the first step in overcoming it. Is it a fear of heights? Claustrophobia? Was it that film you watched as a child? Or has a particular world event sparked the fear? Many people suddenly developed a fear of flying after 9/11 for example. Figuring this out will then allow you to tackle it in the right way and using the appropriate techniques.
Fight fear with knowledge
Some experts suggest the first strategy for everyone suffering from a fear of flying is learning about the aeroplane and the science behind flight. Our anxiety is fed by ‘what if?’ catastrophic thoughts. Once you become knowledgeable, your ‘what if’ thoughts will be limited by the facts. There are professionally designed courses that will explain aspects like air traffic control, anti-terrorism measures, and what happens during turbulence. Some courses use Virtual Reality (VR) to simulate a flight, explaining everything along the way with the aim of injecting logic into an illogical fear.
Seek medical help for anxiety, fear and panic
From here, a form of therapy may help to identify and break anxiety cycles. There are many different types of therapy and choosing the right one for you will depend on your own needs and goals. Hypnotherapy and cognitive behavioural (CBT) are some of the most commonly used, but there are countless more to choose from. Deciding which is the most appropriate form of therapy can be daunting, so it may be helpful to seek advice from your GP or a travel nurse.
For those who manage to make it onto the plane, there are quite a few, simple personal techniques that can be used to calm your nerves.
Deep breathing techniques
Making a conscious effort to breathe slowly and deeply can interrupt panic. Deep breathing is known to trigger a comfort response and will help prevent hyperventilation.
Reading a book or listening to a good podcast can refocus your mind and attention.Distracting yourself from the fact that you are flying can be a great way to keep calm if you’re a nervous flyer.. Time tends to pass much more quickly when adequately distracted.
Tell the flight attendants
Alerting the flight attendants of a nervous flyer could also help – with their training and expertise, they are ideally placed to provide reassurance and will regularly check in on you during the flight.
Avoid coffee and wine
Nervous flyers in general should avoid drinking coffee and wine before and whilst flying. Both can leave you more dehydrated than normal. The extra caffeine in coffee can aggravate anxiety issues and the Dutch courage wine offers will pass leaving you more susceptible to jet lag. Stick with water where possible.
Tea really does help
It’s very British to recommend tea to make everything better, but there are many different herbal teas available which can help with relaxation, reducing stress and calming anxiety. Peppermint, camomile, lemon balm and lavender teas are the most commonly used.
We advise nervous flyers and people with aerophobia to seek further information and guidance from their GP who will be able to make a formal diagnosis and treatment options.
For more advice and information you can book a travel consultation appointment.
The Philippines is a fascinating archipelago, made up of thousands of islands where you can explore stunning beaches and enjoy superb surfing and diving.
Ensure you follow our top travel tips to stay healthy.
7,641 islands, of these islands, only 2,000 are inhabited.
The Philippine archipelago is divided into three island groups: Luzon, Visayas, and Mindanao.
If you are heading to the Philippines you should ensure that you are up to date with your routine immunisations. There have been outbreaks of measles and polio this year in the country so all travellers should ensure they have received 2 doses of the MMR vaccination and a full course of diphtheria, tetanus and polio (DTP) vaccinations.
In addition, it is advised that vaccinations against hepatitis and typhoid are given. Other vaccinations that can be considered are hepatitis b, rabies and Japanese encephalitis. Find out more about our wellness and travel vaccinations.
Rabies is an especially high risk in the Philippines. It is a virus found in the saliva and bodily fluids of mammals. It is transmitted to humans by the bite, scratch or lick to open skin. Once the virus enters the body and the nervous system, it is fatal. There is a large number of stray animals in the Philippines so extra care should be taken to avoid contact with animals. Pre-travel rabies vaccinations are strongly recommended for travellers to the Philippines. There have been reports of falsified rabies vaccinations and immunoglobulin circulating in the country meaning anyone exposed to the virus seeking medical treatment in-country may not receive the proper treatment.
The majority of the Philippines is low to no risk of malaria. Palawan, Tawi Tawi, Zambales and Zamboanga del Norte present a higher risk of malaria. Most travellers will not require anti-malarial medication providing they are careful not to get bitten by mosquitoes. The malaria mosquitoes are most active during the evening, so if you plan to visit a high-risk area, ensure you are cautious between the hours of dusk and dawn and aim to sleep under a mosquito net to prevent bites whilst you sleep.
The Philippines has a risk of several non-vaccine preventable viruses that can be spread by mosquitoes. Dengue fever, chikungunya and zika virus are the main culprits. These viruses are spread by mosquitoes that predominantly bite in the day. As there is no vaccination nor medication that will prevent this illness, strict precautions must be taken to prevent their bites. Wear long loose clothing and cover up as much as possible, particularly between dawn and dusk. Wear a good insect repellent with a minimum of 50% DEET in it, and treat clothes with the insecticide permethrin for added protection.
See our ultimate bug kit.
The Philippines is made up of over 7000 islands and the main way of reaching them is by boat. If you are prone to travel sickness you may want to ensure you pack some medication to prevent this so not to interrupt your experience. There is an abundance of pristine coral reefs throughout the archipelago making the country perfect for water sports. Whether you are snorkelling, surfing or scuba diving, if you plan to take the plunge you need to be careful to avoid coral cuts and abrasions. Extra care needs to be taken with coral cuts to prevent them from becoming infected. Packing a small first aid kit with tweezers, waterproof dressings and antiseptic is a sensible idea.
The availability of medical care varies across the Philippines, and may not meet the standards of care in the UK. Although adequate in major cities, medical care is limited in more remote areas.
By Anna Chapman | Travel Nurse | November 2019
Myanmar is becoming an increasingly popular destination to visit in South-East Asia.
The golden pagodas of Yangon and the stupors of Bagan are top on most travellers itineraries, alongside a trip down the Irrawaddy river to Inle Lake.
The more adventurous may head to the islands on the Myiek archipelago or hike the hill station of Kalaw. Whatever the itinerary, it is essential to ensure you have sought pre-travel advice to ensure you stay healthy whilst abroad.
Travellers should ensure they are up-to-date with their routine immunisations. All travellers should ensure that they have received a vaccination against diphtheria, tetanus and polio (DTP) in the last 10 years. Other vaccinations that all travellers should ensure they are up-to-date with are Hepatitis A and Typhoid. Some travellers may wish to consider vaccination against hepatitis b, rabies, cholera and Japanese encephalitis. It is best to book a travel consultation with a travel nurse to discuss your route and your plans to ensure you are protected for all circumstances.
The cities of Yangon and Mandalay have no risk of malaria. The majority of areas that travellers visit such as Bago, Inle Lake, Kyaikto Padoga and Bagan have a low risk of malaria and anti-malarial medication is not usually advised. The states of Chin, Kachin, Kayah, Rakhine and Sagaing have a high risk of malaria. Travellers visiting these areas are advised to take anti-malarial for this part of their trip. The malaria mosquitoes are most active during the evening. So, if you plan to visit a high-risk area, ensure you are cautious between the hours of dusk and dawn. Aim to sleep under a mosquito net to prevent bites whilst you sleep.
Myanmar has a risk of several non-vaccine preventable viruses that can be spread by mosquitoes. Dengue fever, chikungunya and Zika virus are the main culprits. These viruses are spread by mosquitoes that predominantly bite in the day. As there is no vaccination or medication that will prevent these illnesses, strict precautions must be taken to prevent being bitten. Wear long loose clothing and cover up as much as possible. Particularly between dawn and dusk. Wear a good insect relevant with a minimum of 50% DEET in it. Treat clothes with the insecticide permethrin for added protection. For short adventures, this can be done before your trip.
See our Ultimate Bug Kit.
Fancy a dip in Lake Inle?
Think again. Temperatures in Myanmar can reach 40 degrees and a quick dip in the lake may sound like a good way to cool off. However, there have been recent outbreaks of schistosomiasis infection in Myanmar. Schistosomiasis is a parasitic blood fluke. The fluke lives in freshwater snails and enters through the skin when an unsuspecting person takes a dip. The fluke causes infection of the liver, bladder and bowels and can lead to long term damage. The best way to avoid this is to avoid swimming or bathing in freshwater. The detection of schistosomiasis can take up to 8-weeks. You should visit a GP for a health assessment 2 months after your suspected exposure date, even if you haven’t yet returned to the UK.
Some areas of Myanmar are remote. The further in-country you travel, the harder it will be to access medication and first aid supplies. In some areas, access will be non-existent. Packing a good basic first aid kit is essential to help treat minor injuries and illnesses. Include items such as dressings, plasters and antiseptic cream. They can help with minor cuts, scrapes and blisters. It is useful to pack items that can alleviate pain and treat upset stomachs, as these are common traveller’s health problems. Another medical kit you may want to consider is a worldwide gastro kit. Other items you may want to consider are anti-histamines for any mild allergic reactions.
If you take prescription medication to ensure you pack sufficient for your trip and carry a record of the medication with you.
By Anna Chapman | Travel Nurse | November 2019
Botswana is one of the greatest safari destinations.
The Okavango Delta offers exceptional opportunities to view wild creatures and birdlife. Elephants roam freely and herds of buffalo crowd around the winding waterways the river. The stark and desolate landscape of the Kalahari desert can be found in the south with the longest unbroken stretch of sand there is. Whatever your itinerary, ensure you follow our top travel tips.
All travellers should ensure they are up-to-date with their routine vaccinations including measles, hepatitis A, typhoid, diphtheria-tetanus and polio (DTP). You may want to consider getting vaccinations for rabies and hepatitis B as well. Both these diseases are classed as high-risk in Botswana. We would advise you to speak with a travel nurse ideally 4-6 weeks before travel. At this appointment, you can discuss where you’re going and what you plan to do. They can then advise you of all the recommended vaccinations you should consider.
There is a high risk of malaria throughout the year in the northern areas of Botswana including the Okavango Delta, Chobe and Moremi. There is a low risk of malaria in the rest of the country including the central Kalahari, Gaborone and Gemsbok. Individuals travelling to hight risk regions are advised to take anti-malarial medications to prevent the disease. As well as taking precautions against mosquito bites. The mosquitoes that spread malaria predominantly bite at night. For that reason, it is essential you sleep under a mosquito net.
All travellers need to take extra precautions against insect bites. Mosquitoes, ticks, mites and lice are able to spread diseases such as African tick bite fever, dengue fever, filariasis and myiasis. Travellers should wear good insect repellent with at least 50% DEET and try to cover up with long loose clothes. You can add extra protection to your clothes by treating them with an insecticide. We would recommend using a permethrin spray.
See our Ultimate Bug Kit.
What about Yellow Fever?
The is no risk of Yellow Fever in Botswana. It is therefore not recommended that travellers get vaccinated. Travellers may require a valid Yellow Fever Certificate if they are entering Botswana from a country that has yellow fever, or who have transited through a country with a risk of yellow fever.
First Aid Supplies
Areas of Botswana can be remote, and access to medication and first aid supplies can be limited. Packing a good basic first aid kit is a good idea to help treat minor injuries and illnesses. Basic items such as anti-histamines, pain relief and medicines to treat upset stomachs are useful. Likewise, pack small dressings, plasters and antiseptic cream to treat minor scrapes and scratches. If you take prescription medication to ensure you pack sufficient for your trip and carry a record of the medication with you.
By Anna Chapman | Travel Nurse | October 2019
Albania, located in Southeastern Europe, is a tourist haven this time of year.
Albania has much to offer, from stunning mountain scenes to crumbling castles to picture-perfect beaches all with easy-going charm and a friendly atmosphere. Right now the tales of its beauty haven’t quite reached the masses, but we have a feeling this is likely to change in the not too distant future.
If you plan on staying in Albania‘s capital, Tirana, be sure to see the rotating restaurant/ bars for spectacular city views. Or take to the countryside and seashores to take in the ubiquitous sight of the abandoned concrete bunkers of Albania. Fearing invasion during the Cold War, Albania’s leader Enver Hoxha forced his country to build tens of thousands of bunkers throughout the country. These days you’ll see most in a state of slow decay but some have been given a new lease of life as a hotel, home or museum.
Visit Berat, to see the ‘town of a thousand windows’. This fascinating city dates back to the Ottoman Empire. The most striking feature of Ottoman architecture is the collection of whitewashed houses and towering minarets which adorn the hill to its castle. It is easily a highlight of visiting Albania. If, however, you prefer the great outdoors scale the peaks and troughs of the Accursed Mountains and take in the captivating castles of Gjirokastra.
Whatever your plan to do, be sure to follow our top travel tips to stay healthy in Albania.
All travellers to Albania are advised to be in-date with their routine immunisations. These include diphtheria-tetanus and polio and measles, mumps and rubella. Europe has seen huge outbreaks of measles in recent years. Therefore, all travellers should make sure they have received at least two doses of the vaccination, MMR.
If you’re unsure of your immunity, you can have a simple blood test to find out. Some travellers may wish to consider vaccinations for Hepatitis A and Hepatitis B, Rabies, and Tick-Borne Encephalitis. It is best to book a pre-travel consultation with a travel nurse to discuss your holiday plans. Together you can discuss what vaccines you’ll need.
Trekking and Ticks
The dramatic peaks of the Accursed Mountains spread their spoil between Kosovo, Albania and Montenegro. Those who plan to take advantage of the great outdoors should strongly consider vaccination against tick-borne encephalitis (TBE). TBE is a bacterial infection spread via tick bites or the consumption of unpasteurised dairy produce (between spring to autumn). Contracting the illness causes a fever with neurological complications.
TBE is vaccine-preventable and consists of 2 doses of the vaccination being given at least 2 weeks apart. A third dose is given 5-12 months later to give longer-term protection. Travellers should also avoid ticks by wearing long trousers and socks, and using DEET insect repellant. If you spot a tick on you, it needs to be removed promptly with some flat tweezers or a tick remover and cleaned with alcohol to reduce the risk of infection.
Rabies is a fatal virus found in the saliva of infected mammals. Travellers can be exposed to it through a bite, scratch or a lick to an open area of skin. Therefore, you should avoid contact with animals, especially wild and stray animals. The vaccination against rabies means that treatment can be given easily and in the country should a risk of rabies occur.
You will require a series of 3 vaccinations to be given over a 3 week period. Or over 1 week if a rapid course is needed. Travellers at greater risk are those who plan to do outdoor activities such as hiking, trekking, cycling or caving.
First Aid Kit
For those trekking in the hills, packing good basic first aid kit is essential. The availability of health care and first aid supplies are very limited in rural areas, particularly outside Tirana. Therefore, you should make sure you bring your own adequate basic provisions. These include pain relief, plasters and medication to treat an upset stomach, such as loperamide and oral rehydration salts. Cuts, scapes blisters and even a twisted ankle can occur, so take blister pads, some waterproof dressings and a bandage to deal with any minor injuries whilst you are there.
Access to safe water may be limited. You should consider packing chlorine dioxide tablets to purify your own water. Alternatively, you can purchase a water-to-go bottle which has a built-in filter. If you take regular prescription medication, be sure you pack enough to last your entire journey. And, remember to carry the prescription with you just in case.
By Anna Chapman | Travel Nurse | September 2019
Holidays are a time to relax, unwind and have fun!
However, this excitement can lead to us making decisions we may not usually make when we are at home. If you have unprotected sex whilst abroad whether it is oral, vaginal or anal you are at risk of catching sexually transmitted infections.
You could be at risk of catching these common STIs: HIV, chlamydia, HPV, herpes, syphilis and gonorrhoea.
What can you do to prevent an STI?
Abstaining from sex is the most reliable way to avoid infection. However, if you wish to be sexually active follow some of the tips below:
- Use a condom from start to finish every time during sex including oral, vaginal and anal.
- Get vaccinated to protect against diseases such as Hepatitis B and HPV.
- Do not assume that your partner is STI-free. Talk openly and discuss your sexual health histories.
- Taking drugs and/or alcohol can lead to bad decisions. Be cautious when having sex whilst inebriated as you are more likely to take risks. These include not wearing a condom or having sex with someone you usually would not.
What are the symptoms of an STI?
Symptoms are different depending on the infection. Some diseases also do not cause any symptoms which makes them very hard to spot. If symptoms do occur, they could be some of the following:
- Pain when you urinate or have sex
- Discharge from the vagina, penis, or anus
- Unexplained rash, sore, or ulcer on your skin, genitals, or throat
- Jaundice (yellow colour of the skin and eyes)
What do you do if you think you have an STI?
Having an open and honest conversation, discussing your sexual health with your doctor is a good start to help guide you towards any tests or medication that you may need.
Long-term problems can be prevented by testing for STIs early and also prevent the spreading to other partners.
If you are worried that you may have an STI you should:
- Not have sex with anyone. This will reduce the risk of spreading the disease to anyone else.
- See a doctor or nurse as soon as possible.
- Discuss your sexual history and international travel with the doctor or nurse as some diseases are more common in some countries.
- If you have a positive result notify your recent partners. They may also be infected and unaware.
Fleet Street Clinic offers a discreet and trusted sexual health service including confidential sexual health advice, instant testing, and comprehensive STI screening.
You can book a sexual health appointment online.
Yellow Fever Update:
Recent news reports have raised concerns about yellow fever vaccine safety. It is important to understand the risks and benefits.
For decades, the yellow fever vaccine was considered to be extremely safe. More recently, however, we have become aware of a low rate of serious adverse effects occurring when older travellers are vaccinated for the first time. The two main types of adverse effects are called YEL-AVD and YEL-AND – the first involves damage to organs such as the liver, and the second damages the nervous system. Yellow fever vaccines contain live viruses that do not harm people with a normally functioning immune system but do seem to cause harm in a tiny proportion of people with an ageing immune system, as well as those with reduced immunity from other causes.
In one of the largest medical studies of yellow fever vaccine safety, the rate of YEL-AND in people aged 60-69 was 2.5 per 100,000 people vaccinated, and in over 70s was 1.6 per 100,000. For YEL-AND, the rates were zero and 4.0 per 100,000 respectively.
According to the US Centers for Disease Control, in the absence of a yellow fever outbreak, the “background” risk of yellow fever occurring in unvaccinated travellers on a 2-week trip to a zone where yellow fever is present is calculated to be:
- West Africa: 50 cases per 100,000, with 10 deaths per 100,000
- South America: 5 cases per 100,000, with 1 death per 100,000
Yellow fever vaccinating centres normally explain these risks to everyone they vaccinate, and in particular to travellers aged over 60. Vaccination for personal protection is recommended where benefit outweighs the risks, and a medical waiver is given when it is not safe for the vaccine to be used. Age alone is not a reason for issuing a waiver.
Other factors that complicate the picture include the following:
- There are active outbreaks of yellow fever in several parts of the world, notably at present in Brazil as well as in several African countries, so the risk to travellers is often much higher than that quoted above.
- Vaccination is the only way to prevent and control yellow fever and is often the only possible public health measure for entire populations.
- Many countries therefore rigorously enforce vaccine requirements as a condition of entry.
- Yellow fever vaccine shortages are common – there is currently a serious shortage in the USA, and the vaccine is not always available when needed.
- Awareness of vaccine risks has come with a stricter approach to recommending vaccine only when travellers are definitely going to be at risk; however, an unintended consequence of this has been to delay the opportunity to vaccinate travellers for the first time until they are older and at greater risk of adverse effects.
The World Health Organization now considers vaccine protection to be life-long, though border officials in several countries do not always recognise this. A small number of recent cases of yellow fever in Brazil among people who had been vaccinated previously has raised further doubt about this policy, and Brazil currently recommends revaccination every 10 years. Revaccination has not been linked to adverse effects.
There is currently extensive UK press coverage (that has also been picked up in the US) of YF vaccine adverse effects – one death occurred shortly after vaccination in a distinguished cancer researcher, and a psychotic reaction in a former BBC journalist vaccinated in Greece. Both cases were attributed to the vaccine because of the timing. Further clinical details are not available, so we can’t yet be certain of a direct link, but this news will undoubtedly have a considerable impact on public perception of the vaccine.
Written by: Richard Dawood, Medical Director and specialist in travel medicine
Book your yellow fever vaccination today.
- Cancer pioneer Martin Gore’s sudden death from routine jab – Source: The Times
- I had a yellow fever jab, then the voices told me: ‘Kill! Kill! Kill!” – Source: The Times
Bosnia is where East meets West.
It is a country on the Balkan Peninsula in southeastern Europe and has become somewhat a destination for adventurous travellers.
Beautiful Ottoman architecture, rugged mountains, captivating castles, raft-able rivers, and humble hiking trails are all reasons why travellers are choosing Bosnia as their next travel destination. The unveiling of the Via Dinarica mega hiking trail means the number of tourists to the Balkan country of Bosnia Hercegovina is expected to rise steeply. The 1930km trail provides a corridor linking traditional cultures between the former Yugoslavian nations. So whether you plan to mill about the city of Mostar, stroll the streets of Sarajevo, or take a hike in the hillside, ensure you follow our top travel tips to stay healthy.
All travellers are advised to be in date with their routine immunisations, including diphtheria, tetanus and polio (DTP) and measles, mumps and rubella (MMR). Europe has seen huge outbreaks of measles this year alone, so all travellers should make sure they have received at least two doses of the measles-containing vaccination. A simple blood test can be done for all those who are unsure about their immunity. Some travellers may wish to consider vaccinations for Hepatitis A and Hepatitis B, rabies and tick-borne encephalitis. The activities you plan to do whilst travelling will determine which vaccines would be required. If you have any doubts or concerns, we also suggest booking a pre-travel consultation with a specialist travel nurse to discuss your options.
Trekking and Ticks
Bosnia offers a wealth of outdoor activities. Those who plan to take advantage of the great outdoors should strongly consider vaccination against tick-borne encephalitis (TBE). TBE is a bacterial infection. Usually, it is spread through an infected tick bite. However, during Spring to Autumn, the consumption of unpasteurised dairy produce also carries a risk. Contracting the illness causes a fever with neurological complications. It is vaccine-preventable. Protection requires 2 doses of the vaccination, given at least 2-weeks apart. A third dose is given 5-12 months later to give longterm protection. You should also avoid ticks by wearing long trousers and socks. Using DEET insect repellant should also repel them.
If you spot a tick on you, it needs to be removed promptly. Use some flat tweezers or a tick remover and clean the bite with alcohol to reduce the risk of infection.
See our Ultimate Bug Kit.
Rabies is a fatal virus that can be found in the saliva of an infected mammal. Most commonly a wild dog. Exposure can happen through a bite, scratch or a lick to an open area of the skin. You cannot catch rabies from another person and it cannot spread through unbroken skin. You should, where possible avoid contact with animals when travelling, especially wild or stay animals.
Rabies is almost always fatal once symptoms appear, but treatment before this is very effective. Pre-travel rabies vaccination offers great protection. And means that in the unlikely event you come into contact with the rabies virus, fast and effective treatment can be given easily and in the country of the incident.
Pre-travel rabies protection requires a series of 3 vaccinations given as injections into your upper arm. Your vaccines will be given over a 3-week period, or over 1 week if an accelerated course is needed, prior to travel. Travellers at greater risk are those who plan to do outdoor activities such as hiking, trekking, cycling or caving. You should consider a rabies vaccine if you plan to do any of these activities whilst visiting Bosnia.
First Aid Kit
For those trekking in the hills, packing good basic first aid kit is essential. When travelling in rural areas, access to healthcare can be limited. Travelling with a medical kit will give you access to basic provisions needed to treat minor injuries and pains.
Basic provisions include pain relief, plasters and medication to treat an upset stomach, such as loperamide and oral rehydration salts. If access to safe water may be limited, consider packing chlorine dioxide tablets. Cuts, scapes blisters and even a twisted ankle can occur, so take blister pads, some waterproof dressings and a bandage to deal with any minor injuries whilst you are there. If you take regular prescription medication, ensure you pack enough for the duration of your trip and carry the prescription with you.
By Anna Chapman | Travel Nurse | August 2019
Tanzania is the perfect haven for adventurous travellers. Not only does it boast three of Africa’s Seven Natural Wonders, but it is home to the ancient nomadic stewards, the iconic, Maasai people. It is also the perfect place for an African safari adventure, with it’s 16 national parks accounting for more than 30% of the country.
Tanzania is blessed with the highest peak in Africa. Mount Kilimanjaro beckons visitors from all over the world. It is the world’s highest free-standing volcano and gets an estimated 30,000 travellers attempting to summit the peak each year. Climbers by the thousands venture here to challenge themselves on its muddy slopes, rocky trails and slippery scree.
It’s crowning jewel is the island, Zanzibar. The island is famous for its mix of exotic white sand beaches, dense palm trees and coral seas. A true paradise. It hosts famous spice plantations and is rich with diverse culture. Unguja (the main island in Zanzibar) is also home to many endangered species including the red colobus monkey and green turtle.
Whether you are visiting for an action-packed safari, challenging yourself to reach the peak of Mt. Kilimanjaro or relaxing on the island of Zanzibar, ensure you follow our top travel tips to stay healthy in Tanzania.
You should consider specialist travel vaccinations prior to travel. Hepatitis A and Typhoid are highly recommended. Furthermore, some travellers may also wish to be vaccinated against Rabies, Hepatitis B and Cholera for extra precautions. Especially if travelling to more rural areas.
In Tanzania, there is no risk of yellow fever. If you are only travelling directly from the UK and back, it generally isn’t advised to have yellow fever vaccine. There is, however, a requirement for travellers to have a certificate of vaccination if they enter Tanzania from another country that has Yellow Fever. Bordering countries such as Kenya, Uganda, Rwanda, Burundi & DRC would all require a certificate. In this instance, a vaccination or a waiver certificate may be advised. It is best to speak with a specialist travel nurse, who will look at your route and access what vaccinations and certificates you would require.
Whether you plan to visit Zanzibar or the mainland, all areas of Tanzania have a risk of malaria. Therefore, you should take anti-malarial medication. Malaria is spread by mosquitoes that are most active between dusk and dawn. A common question is whether or not you need to take them if you plan to trek Mount Kilimanjaro. Even though the risk of malaria is low in areas above 2,500m, the start and finish of the trek take you well below this altitude. In short, you should take medication to prevent it. You should take precautions to reduce the risk of being bitten in the first place.
- Wear long, loose clothing
- Wear plenty of mosquito repellent with a minimum of 50% DEET
- Use clothes spray containing permethrin – you can spray before you travel for short-duration trips
- Sleep under a mosquito net
See our Ultimate Bug Kit for everything you need to keep the mosquitos at bay.
If you are trekking Kilimanjaro, make sure your pre-travel plans take this into account. Trekking is physically demanding and exposes you to the risk of altitude sickness. The summit of the peak is 5,895m and treks can take anything from 5-9 days. Altitude sickness is unpleasant. Not only this but it can develop into something more serious and become life-threatening. Take time to acclimatise. This will reduce your risk of developing altitude sickness. Ideally, choose a longer trek. A slower ascent over more days will reduce your risk considerably. Alternatively, you can get a prescription of acetazolamide (Diamox) to aid the process. Speak to a specialist travel nurse about this at your pre-travel consultation. Don’t let altitude sickness ruin your trip.
By Anna Chapman | Travel Nurse | August 2019
What is Cyclospora?
Cyclospora is a tiny, single-celled parasite, spread by contaminated food. It can cause diarrhoea, abdominal cramps, nausea, loss of appetite, bloating, gas, fatigue, mild fever, and weight loss.
Why is it in the news?
There’s been an outbreak in travellers to Mexico, with at least 204 reported cases in returning holidaymakers since June. However, it is difficult to detect using standard tests. Because it is uncommon in the UK, most labs don’t look for it and may miss the diagnosis. So the true number is probably much higher.
What’s the most reliable way of detecting it?
The best way is called a rapid PCR test, which detects the parasite’s DNA. The test also looks for DNA and genetic material from 21 other diarrhoea-causing parasites, bacteria and viruses at the same time – so there is a very high probability of finding the right cause. As you’d expect, the test is available at the Fleet Street Clinic. Importantly, we can have a result within an hour or so of receiving a sample.
How can I prevent it?
Outbreaks have been linked to eating fresh uncooked berries/unpeeled fruit and salad items that have not been washed in safe water. Sticking to foods that have been freshly and thoroughly cooked, when you travel, is the safest option.
How is it treated?
Confirmed cases can be treated with an antibiotic called co-trimoxazole. Some of the more commonly-used antibiotics for travellers’ diarrhoea may not be effective.
If you have any concerns about cyclospora and other parasites, our PCR test service can help detect the exact cause of any issue you might have. What this allows is proper diagnosis and treatment. Usually, guess-work on what bug a patient is carrying or general prescriptions to tackle the illness might be given by medical professionals. The PCR test offers accuracy like nothing else.
You can book an appointment online.
Imagine you’re holidaying in a tropical paradise, walking barefoot on the beach. Would you consider this a health risk? What if this simple, carefree activity could turn your trip into a nightmare?
Unfortunately, this is what happened to a Canadian couple in the Dominican Republic, who contracted hookworm in Punta Cana after walking on the beach without shoes.
Fleet Street Clinic’s medical director, Dr Richard Dawood, is Telegraph Travel’s medical expert and shared his medical opinion on the case in a recent article.
The article details the story of the couple, who shared their plight on social media to raise awareness of the parasitic worm infection.
Hookworm can infect humans if soil contaminated with their larva comes into contact with bare skin. Most commonly, hookworm infection can occur in Africa, the Americas, China and south-east Asia, according to the NHS.
Dr Dawood explained to the Telegraph how you can spot a hookworm infection:
“Typically there is a linear rash that follows the track of the migrating larva. It can become almost unbearable itchy, much worse than an insect bite, which is an important clue. There’s a local allergic reaction, which can then blister, making the line pattern harder to spot.”
And how to treat: “There are a number of different anti-parasitic treatments that work, either taken as tablets, or made into a cream and applied locally. The larvae can sometimes also be killed using cryotherapy to freeze them. Blisters or scratching can easily lead to infection, necessitating antibiotic treatment.”
To avoid hookworm, avoid coming into contact with soil or sand that could be contaminated. If walking on the beach, it’s advisable to wear shoes at all times!
Dr Richard Dawood at Fleet Street Clinic
Dr Richard Dawood is founder of Fleet Street Clinic in London and has practiced for over 35 years. He was one of the first doctors in the UK to establish Travel Medicine as a distinct speciality. Richard is the most senior UK travel medicine specialist working exclusively in a private setting.
You can book a travel consultation appointment online.
UPDATED RECOMMENDATIONS FOR Yellow Fever VACCINATION: Nigeria
The World Health Organization recently updated the yellow fever recommendations and requirements for residents and travellers to Nigeria.
As of 1 July 2019, the yellow fever certificate requirement for travellers to Nigeria changed. All travellers aged 9 months or over are now required to travel with a yellow fever vaccination certificate along with a valid visa. Failure to provide a valid certificate where required could deny entry to that country, or result in quarantine.
Previously a certificate was only required for those arriving from risk areas countries. However, an on-going outbreak of yellow fever, which started in September 2017, is continuing therefore a revised classification has been made. Between January and April 2019, a total of 930 suspected cases were reported in 447 Local Government Areas.
Advice for travellers
The Fleet Street Clinic would like to remind all travellers from the United Kingdom that there is a risk of yellow fever transmission throughout Nigeria.
We are a Certified Yellow Fever Centre with availability throughout the week and are usually able to accommodate same day appointments requests.
What is Yellow Fever?
Yellow Fever is an acute viral haemorrhagic disease transmitted by infected mosquitoes and has the potential to spread rapidly and cause serious public health impact. There is no specific treatment, although the disease is preventable using a single dose of yellow fever vaccine, which provides immunity for life.
For more information about Yellow Fever & the Vaccine.
Anyone travelling to Nigeria should book a Pre-Travel Consultation. One of our specialist Travel Nurses will access if a Yellow Fever vaccine is suitable for you.
World Health Organization
Japan is hosting the biggest Rugby event of the year in September.
Starting 20th September, across 12 Japanese cities, 48 matches will be played to determine the winner of Rugby World Cup 2019. Millions of people from around the world are expected to travel to Japan to attend this amazing sporting event. Much like any other reason for travelling, it does come with some health risks.
Big sporting events, like the Rugby World Cup, attract huge numbers of people which increases the risk of getting sick and spreading diseases. Venues are sometimes described as giant Petri dishes, where viruses and bacteria can flourish and spread.
But how can you prepare yourself so you remain healthy throughout your holiday?
It is advised that individuals are up-to-date with routine immunisations including diphtheria, tetanus and polio (DTP).
If you plan to venture outside of the major cities and explore Japan whilst you are there, you may need to consider some travel vaccines, such as Rabies and Hepatitis A or Hepatitis B. If those plans include visiting more rural areas, Japanese Encephalitis could be considered. For those trekking, hiking or camping, a vaccination against tick-borne encephalitis will provide protection against the disease.
MMR is a must
Ensure you are immune to measles before you travel. Japan has had multiple large outbreaks of measles this year and it is a highly contagious disease.
The best protection against measles is to ensure you have received 2 doses of the MMR vaccine. You may not have received the full course during your childhood vaccines which means you’re not fully immune. A simple blood test can determine immunity if you are unsure.
Beware of Flu Season
Flu season for the Northern Hemisphere begins in Autumn, which coincides with the start of the Rugby World Cup. It’s possible people could pick up the flu virus at these events as the Flu is a highly contagious viral disease. Transmission of the flu is always amplified when large groups of people congregate in enclosed space. People travelling to and from mass gatherings can also spread flu to other communities and to family members when they get home. An infected person can transmit the virus before even realising they are sick.
Getting a flu vaccine every year is the best way to avoid getting seasonal flu.
Those travelling from mid-September onwards should consider getting the flu jab as soon as it becomes available.
Minimize Your Risk
Besides the flu vaccine, here are a few tips on how to minimize your risk of contracting an illness at the Rugby World Cup:
- Keep a distance from people coughing and sneezing – droplets from coughs or sneezes containing flu virus can travel at least 3 feet, so keeping this distance from sick people can help lower your chance of becoming ill.
- Wash your hands often, before eating or after contact with sick people, public places and bathrooms to limit your chances of contact with the virus.
- Carry hand sanitizer to use when hand washing is inconvenient or not available. Ensure it has a minimum of 60% alcohol content to be most effective.
- Avoid touching your mouth, nose and eyes with your hands.
- Use clean, disposable tissues to wipe your mouth or blow your nose. Throw away used tissue immediately after use.
- Avoid getting overly cold and wet by wearing appropriate clothing.
- if you are already sick, wear a face mask to help lower the chance of spreading your illness to others.
Despite having a good reputation for health care, it’s worth being prepared for minor illnesses and injuries when travelling abroad. Pack an essential First Aid Kit for your travels and include some basic items such as pain relief, plasters, antiseptic creams and something to treat minor wounds. Being able to treat minor accidents whilst abroad means less time hunting down a pharmacy or time wasted visiting a doctor should you need it.
You can book a pre-travel consultation online.
Greenland is home to truly magnificent mountainscapes and glaciers.
Jakobshavn Glacier, the world’s fastest-moving glacier in the Northern Hemisphere can be found here.
In the Winter, tourist travel to this wonderland to potentially see the wondrous the Northern Lights. Things are quite different in the Summer.
Chasing the Midnight Sun
Summer in Greenland is an image not often associated with the country. Summertime offers eternal light in the land of ‘The Midnight Sun’ whereby the day has neither a beginning nor an end. Those wanting to experience this time-shifting experience must travel north or the Arctic Circle. The low-lying sun makes the surrounding scenery appear almost dreamlike; icebergs and hilltops are bathed in a surreal palette of pink, purple, yellow and red. Travellers to Greenland have options of hiking the land or sailing the fjords between icebergs.
If you plan to travel to Greenland this summer follow our top travel tips to ensure you stay healthy.
Even though Greenland resides in the Arctic Circle, travellers should still ensure they receive appropriate pre-travel vaccinations. This includes being up-to-date with Measles, diphtheria-tetanus and polio. Greenland has a high risk of Rabies, a virus spread through the infected bite of a mammal. Travellers who plan to trek inland may wish to consider this vaccination before they travel to reduce the risk.
Despite Greenland having long, dark winters, the summer months provide almost constant light. Bright sun, combined with the effects of lights reflection from snow and water can increase the risk of sun damage from UV light. Despite temperatures remaining cold, travellers still need to be sun smart. Ensure you wear a high factor SPF, and use lip balm to prevent cracking. Polarised sunglasses that wrap around will prevent the UV rays causing damage to your eyes.
Many activities in Greenland involve taking to the water and visiting the infamous Disko Bay in search of Icebergs. Sometimes the seas can be rough which can make for a miserable time if you are prone to travel sickness.
Sea Sickness can be reduced by:
Sit in the centre of the boat where the motion will be less aggressive
Close your eyes or focus on a point on the horizon, this can help your inner ear balance.
Avoid alcohol and large heavy meals, instead, keep hydrated on water and eat smaller lighter meals
Sucking on a mint or ginger sweet can help with nausea
Seas Sickness medication tablets
Patches that can be used to prevent sea-sickness
Parts of Greenland can be remote so taking a good First aid kit with you is essential. Basic provisions include pain relief, plasters and medication to treat an upset stomach, such as loperamide and oral rehydration salts. If you take prescription medication to ensure you pack enough and carry the prescription with you. If you plan on trekking the hinterland, pack additional items such as blister dressings and plasters.
By Anna Chapman | Travel Nurse | July 2019
June to September is the best months to trek to Machu Picchu, although you can visit all year round. The weather is at its driest and coolest with gloriously sunny days. Trekking to the roof of the Andes is a rewarding experience that many travellers to Peru sign up for. Travellers who are trail-blazing their way on the Inca road to catch a glimpse of the forgotten city should follow our top travel tips to ensure they stay healthy on the road.
All travellers to Peru should ensure that they are up-to-date with measles, diphtheria, tetanus and polio (DTP), and have received vaccinations against Hepatitis A and Typhoid. There is a risk of Rabies and Hepatitis B in Peru, and all travellers attempting the Inca Trail should consider vaccinations against these.
There is no risk of Yellow Fever on the Inca Trail or Cusco. However, the vaccination may be recommended to travellers who are doing further travel in Peru, such as the Amazon rainforest. Those planning to extend their trip to South America may require the Yellow Fever vaccination for personal protection. Additionally, you may require a valid yellow fever certificate to enter some other countries. It is best to book in a travel consultation with our specialist travel nurses to discuss your route.
The highest altitude of the Inca trail is 4,215m, a whopping 1,800m higher than Machu Picchu itself! Most people start the hike from Cusco which lies at 3,400m, meaning trekking this wonder of the world poses a real risk of altitude sickness. Altitude sickness is unpleasant and can develop into something serious and become life-threatening. It is best avoided by taking time to acclimatise. Ideally, if you are arriving from sea level, spend a few days in Cusco before your trek begins to adjust to the different altitude. Choose a longer trek, a slower ascent over more days will reduce your risk considerably. Alternatively, you can get a prescription of acetazolamide (Diamox) to aid the process. Speak to a specialist travel nurse about this at your pre-travel consultation. Don’t let altitude sickness ruin your trip.
Treks on the Inca trail usually last around 5 days, meaning that an average trekker will probably consume at least 15 litres of water over the course of their trek. Unclean and unsafe drinking water can lead to sickness and diarrhoea so it is important that travellers have access to safe water. Carrying 15 litres of water on the trail is a near impossibility so travellers should ensure that they have a way to make water safe to drink. Carrying water purification tablets, or a bottle with a filter can ensure you have access to safe drinking water throughout.
Travellers diarrhoea and other common gastrointestinal infections can put a dampener on any adventure but especially when hiking. Access to toilets is likely to be limited throughout your journey so it is important to stay healthy. Ensure all food you eat is thoroughly cooked. Pack an alcohol hand gel so you can keep your hand clean before you eat and after using the toilet. It is wise to carry medication with you, so, if you do become unwell you have doctor-approved medication available to take. We recommend packing one of our Worldwide Gastro Kits. Inside there is medicine to prevent and treat travellers diarrhoea, dehydration, mild infections, nausea and vomiting. Hopefully, you won’t have to use this kit, however, for peace of mind, it is better to be safe than sorry.
The Inca trail typically consists of between 6-9 hours of walking a day, with shared tent accommodation. Hiking the Inca Trail through the Sacred Valley to Machu Picchu is both arduous and awe-inspiring. Make sure you have good walking boots that are broken in before you start. Book an appointment with a podiatrist and osteopath if you have any niggles or pain before setting off. Take care of your feet throughout your adventure – keep them clean and dry to avoid problems. Any blisters should be cleaned and covered with a dressing to prevent pain and infection. Pack your own first aid kit with some basic medications for pain, allergies and upset stomachs in case you do become unwell. Access to medical supplies will not be until Aguas Calientes at the end of the trek. You can buy a Fleet Street Clinic Essential First Aid Kit online to save you the hassle of assembling yourself. We would recommend considering a medical pedicure upon your return. Treat our feet a little bit of TLC for taking you on an adventure of a lifetime.
We would encourage all those taking on the Inca trail adventure to consider booking a travel consultation with either myself or another of our specialist travel nurses. We all have extensive knowledge on what vaccines and health precautions you should take on an individual basis to remain healthy throughout your adventure. Chances are at least one of us has done a similar adventure so we can give you some first-hand experience on what to expect too!
By Anna Chapman | Travel Nurse | July 2019
The Southern African nation, Mozambique is gaining popularity amongst the adventure traveller community. Often referred to as ‘The Pearl of the Indian Ocean’, it is well off the usual tourist trail of Africa. Mozambique offers rustic beaches, delightful architecture, superb national parks, and plenty of diving opportunities.
Many choose to start their adventure exploring the capital city, Maputo. It is easy to understand why. It is rich in culture with beautifully preserved Portuguese colonial architecture. You could easily spend a week enjoying the hospitality of the friendly locals, eating the delicious food and partying the night away. Maputo is a largely-underestimated African capital city.
Mozambique is also known for having some of the most pristine dive sites in the world. Tofo is arguably one of the greatest places on Earth to see megafauna marine life. Crystal clear water provides perfect visibility to view the abundant marine life. The beautiful tropical Islands of the Bazaruto and Quirimbas Archipelagos are some of the most romantic and secluded beach destinations in the world – ideal for honeymooners.
Whatever your holiday entails, ensure you read out top travel tips to stay healthy in Mozambique.
Travellers should ensure they are up-to-date with their routine immunisations including measles, mumps and rubella (MMR) and diphtheria-tetanus and polio (DTP). Additional travel vaccinations are advised including hepatitis A, typhoid, rabies and hepatitis B. It’s best to speak with a travel nurse about any specific travel vaccinations you may need in a pre-travel consultation.
…What about Yellow Fever?
Yellow Fever is a viral haemorrhagic illness spread from the infected bite of the Aedes mosquito. Whilst it can occur in parts of Africa, there is no risk of Yellow Fever in Mozambique. Therefore, travellers do not need to be vaccinated.
The only exception to this will be for travellers who are entering Mozambique from a country which does have a risk of the illness. In this case, it is best to speak to a travel nurse to see if you require the vaccine. If you do, you will need to be in possession of a Yellow Fever Vaccination certificate as a condition of entry. Ask your travel health specialist for advice.
Polio is a viral infection. As it is contagious, you can get polio from contact with an infected person. In addition, consuming food or water that has been contaminated by a person with poliovirus also puts you at risk. There has been a worldwide effort to eliminate polio, which is proving highly successful. However, Mozambique still remains at risk due to vaccinate-derived circulating strains. All travellers should ensure they are up-to-date with their polio immunisation. The polio vaccine is a combination vaccination, given with diphtheria and tetanus. It provides protection for 10 years.
If you plan to stay for longer than 4 consecutive weeks, it’s advised that your polio vaccine be administered within the last 12-months. You should also have the dose recorded on an International certificate of vaccination prophylaxis card as proof of immunisation. Furthermore, long-term travellers to Mozambique may be required to show this when they leave the country, as proof they have been immunised.
All of Mozambique has a risk of malaria. Malaria is an infection spread by the Anopheles mosquitoes which are most active during dusk till dawn. You should take strict precautions against mosquito bites. This includes wearing long loose clothing and using an insect repellent with a minimum of 50% DEET. You can reduce the risk of indoor mosquito activity with the use of plug-in vaporisers. Plus, sleeping under a mosquito net can help reduce night-time bites.
We recommend taking antimalarial medication for the duration of your trip. As there are different options available, it’s best to speak to a travel nurse to find the best option for you and your family.
See our Ultimate Bug Kit.
Special precautions post-Cyclone Idai
Cyclone Idai battered the coast of Mozambique on the 9th March 2019. The storms brought heavy rains, winds and flooding. As a result of the initial impact alone, there were hundreds of fatalities. The storm created many serious health risks. Firstly, like most natural disasters, the storm has displaced a huge number of local people. Which as a result, will increase the risk of diseases spreading. Secondly, it has placed a strain on the countries structural and health infrastructure. Which as a result, and can lead to further flooding and increases the risk of water-borne infections such as cholera. Thirdly, the increase of water has led to an increase in breeding sites for mosquitoes. Therefore, there is an increased risk of malaria and other mosquito-transferred diseases.
Although the risk for tourists will be much lower than that of the local population, extra precautions to avoid infectious diseases should be taken. You should pay extra attention to the food and water hygiene you consume. This will minimise the risk of you getting a diarrhoeal illness.
If you are travelling to an area with a known outbreak, the Cholera vaccine can be considered. Similarly, those undertaking humanitarian work or those with inadequate access to safe water and sanitation should also consider the vaccine.
By Anna Chapman | Travel Nurse | July 2019
Every year, Brit’s take more than 70 million trips abroad. Most notably for holidays, business trips and to visit family and friends. Whilst the majority of people have a safe trip, some people do experience illness or have an accident. In most cases, minor accidents and illnesses don’t require a visit to a medical centre or hospitalization and can be self-treated with the help of a medical kit.
Where you are travelling to and the activities you plan to do there will dictate what type of medical kit(s) you would need.
If you are planning to travel outside of a major city, you’re best to travel with an Essential First Aid Kit. It’s very easy to get scratched, twist an ankle or develop a blister. Particularly if you’re sight-seeing, hiking or even just taking a trip to the beach. Having a few essential supplies handy will reduce the need for a trip to the local chemist. Inside this kit, you will find items aimed at treating minor cuts, grazes, blisters, cleaning wounds, minor burns and sprains.
When you travel to a developing country, you have a high likelihood of catching a stomach bug. Also known as traveller’s diarrhoea. This is not always brought on by unsafe water and can be due to a change in diet or the high levels of impurities in the local water that you’re not used to. However, if the cause is a microorganism such as bacteria, parasite or virus, your symptoms may be much more severe and lead to complications. Travelling with a Worldwide Gastro Kit covers all eventualities. Including preventative items, plus medications for common symptoms such as nausea, vomiting, dehydration and travellers diarrhoea.
The adventure traveller is likely to travel to remote areas where medical supplies are not sterilised to a safe standard or medical care in a hospital setting is not available at all. In these scenarios, it is safest to travel with a Sterile Needle Kit. This kit is to be provided to a medical professional to be used for medical emergencies such as a blood transfusion, fluid replacement, general vaccinations or blood tests. This kit is to reduce the spread of diseases such as HIV & Hep B.
There are many female-specific health concerns that may occur whilst travelling. Unfortunately, urinary tract infections (UTI’s) and thrush (yeast infections) are common among female travellers. Therefore travelling with a Gynae Kit is highly recommended.
Travelling with a fit-for-purpose medical kit is not glamorous. However, you’ll be glad you have it if you suffer any mishaps. Saving you time, money and stress involved in finding a local chemist, medical centre or hospital quickly when you are abroad. And if you don’t, then at worst you’ve lost out on a tiny amount of suitcase space.
Before International Travel you should consider a pre-travel consultation with a specialist travel nurse to discuss the health risks at your destination. You can book a travel appointment online or email us for more information at email@example.com.
Have you ever thought of applying sunscreen before taking a flight?
If not, you may want to reconsider.
A recent article in the Telegraph Travel with contribution from Fleet Street Clinic’s medical director, Dr Richard Dawood, has highlighted a study published in the Journal of the American Medical Association (JAMA) Dermatology. It reports that pilots flying for about 56 minutes at 30,000 feet were exposed to the same amount of carcinogenic UVA radiation as one would receive 20-minute session on a tanning bed.
The plane’s windshield blocked only about half of the UVA rays, dangerous enough to contribute to cancer risk.
However, applying this potential risk to all types of aircraft and to the cabin space outside the cockpit is “a bit speculative”, notes Dr Dawood. The aforementioned study was based on UV radiation measured from the cockpit of a Socata TBM850, a single turbo-prop private plane.
“Awareness of the issue is a good thing – especially for pilots; and for passengers, sensible use of window shades to avoid strong direct sunlight, which most people probably do anyway,”
– says Dr Richard Dawood.
Planning a trip abroad?
Whether you’re travelling afar for business or pleasure, the long-haul travel involved can be a daunting prospect. But with a little preparation you can enjoy a comfortable journey, and prevent the health risks associated with travel.
At Fleet Street Clinic, we regularly see frequent travellers for travel health-related consultations and vaccinations. Our travel experts have compiled some tips to ensure you are in great shape throughout your travels, starting with a healthy outbound flight:
Deep Vein Thrombosis (DVT)
Travelling on long-haul flights with extended periods of immobility can leave you at an increased risk of DVT (blood clots), especially if you have any pre-existing conditions.
To prevent DVT during your flight:
- Wear loose comfortable clothes.
- Keep moving during the flight – get up regularly to walk around the cabin to aid circulation.
- Keep hydrated by drinking plenty of water- drink at least one cup of water for every hour spent in the air.
- Avoid alcoholic and caffeinated drinks.
- Wear compression socks which apply gentle pressure to the ankle to help with blood flow.
Air in the plane’s cabin is recirculated, which results in a loss of moisture. This can cause dry skin, lips, and eyes.
To prevent dehydration:
- Contact lens wearers should remove lenses prior to travel and wear spectacles to avoid dry eyes and prevent damage to the cornea.
- Dry skin should be moisturised, and if nasal irritation occurs, a saline spray can be used.
- Keep hydrated – don’t be afraid to ask cabin staff for water outside of mealtimes.
Travel / Motion Sickness
Motion sickness occurs when there is confusion between what the eyes see, and what the inner ear senses. With turbulence, cramped spaces and lack of fresh air, susceptible travellers can suffer.
To minimise the risk of travel sickness:
- Keep hydrated.
- Avoid large meals prior to and during the flight.
- Request a seat near the front wing – the most stable part of the plane.
- Use preventative medication such as Cinnarizine (to be taken 2 hours prior to boarding the aircraft).
Flying can leave you feeling sleep deprived and jet lagged.
To reduce avoidable risks and arrive at your destination in good shape, here’s how you can prevent or combat the effects:
- Avoid night-time flights when possible – otherwise make sure you build a rest period into your schedule on arrival.
- Give your body clock clues as to your new time zone – adjust your watch, observe local mealtimes and bedtimes.
- Use melatonin and timed exposure to bright light – talk to your doctor or consult a specialist travel clinic about using medication to aid both sleeplessness and wakefulness.
- Use our Jet Lag Calculator – whether you’re using timed exposure to bright light, melatonin, both or none of these methods, our calculator can calculate timings based on your exact travel details.
Book An Appointment
If you’re taking a long-haul flight and need travel vaccines or advice, you can book an appointment online to ensure a smooth transit to your destination.
A safari in Namibia is a unique experience in Africa. It has the highest sand dunes on the continent, the world’s oldest and uninhabited deserts, the Skeleton Coast and a lush jungle to the north. Whatever you have planned on your trip, ensure you follow our top travel tips to stay healthy.
All travellers need to ensure they are up-to-date with Hepatitis A, Typhoid and Diphtheria, Tetanus and Polio (DTP). These are your basic traveller vaccine requirements. You may wish to consider further vaccinations against Rabies and Hepatitis B.
There is no risk of Yellow Fever in Namibia, however, travellers who will arrive in Namibia having transited from a country with a risk of Yellow Fever will be required to be in possession of a valid Yellow Fever Certificate.
Countries this would apply to include Kenya, Nigeria, Zambia, Ethiopia, Brazil, Peru and Bolivia. For the full list of countries with risk of yellow fever transmission as per the World Health Organisation.
There is a risk of malaria in the northern areas of Namibia of the Kunene River, Caprivi and Kavango regions and Etosha National Park. Windhoek, Swakopmund and the Skeleton coast have a low risk of malaria. If you intend to visit malarial regions, ensure that you take the antimalarial medication with you. Mosquitoes that are responsible for the spread of malaria are most active between dusk and dawn, and therefore you need to be extra cautious during this time against mosquito bites.
Ticks, flies and mosquitoes all have the ability to transmit unpleasant disease in Namibia. The best prevention against these diseases is to avoid mosquito bites. Cover up as much as possible and apply a minimum concentration of 50% DEET to any areas of exposed skin. Clothes can be treated with permethrin before setting off to provide an extra level of protection. Sleep under a mosquito net especially if you plan to stay anywhere remote or rural.
See our Ultimate Bug Kit.
Food and water
Travellers should exercise caution with food and water when travelling to Namibia to avoid tummy troubles. Do not drink tap water in Namibia, stick to bottled water or water that has been boiled. If you are undertaking a self-drive trip and plan camping in remote areas it is a good idea to take either a water bottle with a filter or some chlorine dioxide tablets to make water safe to drink should you not be able to find a shop with bottled water. The Namib Desert is one of the aridest in the world so always ensure you pack extra water.
See our Worldwide Gastro Kit to help with any travellers tummy troubles.
Book your travel appointment online today.
By Anna Chapman | Travel Nurse | June 2019
Parents are being urged to get their children vaccinated for measles, mumps and rubella following outbreaks of measles across Europe:
Anyone who is eligible to get vaccinated should get the MMR vaccine.
A measles outbreak across Europe has left UK officials urging parents to get their children vaccinated for measles, mumps and rubella. As measles is highly infectious, anyone who has not received 2 doses of the MMR vaccine is at risk. Particularly those unvaccinated people travelling to countries where there are currently large outbreaks of measles.
In the first three months of this year, there have been 231 confirmed cases of measles and 795 of mumps. While Public Health England (PHE) figures showed while measles cases were lower than the 265 reported during the same period last year, they had more than doubled compared to the 97 reported between October and December. The number of mumps cases has nearly tripled compared to the 275 cases during the first three months of 2018. No new cases of rubella have been reported.
PHE has now appealed to parents to make sure their children receive the MMR vaccine when it’s offered, or to get a GP appointment booked if they missed it. Officials have also warned that not only is measles highly contagious, but it can also kill a child if they are not vaccinated. Anyone who has not received two doses of MMR vaccine is at risk of measles as it is highly contagious.
There have been 3,789 cases of measles in Europe during the first three months of this year, according to the European Centre for Disease Prevention and Control. The highest numbers were in Romania, France, Poland and Lithuania.
Advice for travellers
For all those planning to travel to Europe, make sure you are up-to-date with all currently recommended UK vaccines. This includes two doses of the MMR vaccine for protection against measles, mumps and rubella.
Anyone who is not sure if they are protected should check with their GP practice. Vaccination is usually done within your childhood vaccinations. However, the MMR vaccine is available to all adults and children who have not had their two-dose course. In some cases, the MMR vaccine can be offered to babies from six months of age. Cases such as travelling to countries where measles is common, or during an outbreak situation. Book a travel consultation with our travel nurse for advice on the best option for your children before you travel.
Head of immunisation at PHE, Dr Mary Ramsay, warned with measles outbreaks across parts of Europe, families should make sure they are vaccinated before travelling. ‘There are measles outbreaks happening across Europe so if you are planning to travel, make sure you check with your GP and catch-up if needed.’
Measles elimination can only be sustained by maintaining and improving coverage of MMR vaccine in children, and by using all opportunities to catch up older children and adults who missed getting the MMR vaccine.
To achieve herd immunity for measles at least 90 to 95 per cent of the population needs to be fully protected. PHE said 94.9 per cent of eligible children aged five received their first dose of MMR in quarter 4 of 2018. However, the second dose of protection falls to 87.4 per cent for children aged five.
Fleet Street Clinic’s medical director, Dr Richard Dawood explains, ‘When the rate of vaccination in the general population falls below 95%, outbreaks occur and can easily spread, with the highest impact on those most vulnerable populations, undermining years of hard work around the world to bring measles under control.’
Vaccination against Measles, Mumps & Rubella
One dose of the MMR vaccine is about 90 to 95 per cent effective at preventing measles. Protection rises to around 99 per cent after the second dose. Two doses of MMR in a lifetime are needed for a person to be considered fully protected.
The MMR vaccine schedule:
- Two doses, to be given at least 4 weeks apart.
- If the first dose is given before 12 months of age (due to the need for early protection), this should be discounted and the child should continue to receive 2 doses as per the normal schedule.
- The vaccine is also available to all adults and children who are not up-to-date with their 2 doses.
Anyone who is not sure if they are fully vaccinated should check with their GP.
You can book all vaccination appointments online.
Travel nurse Anna takes us on a journey to Tel Aviv. A city on Israel’s Mediterranean coast steeped in history and a vibrant cultural scene. From vaccinations to sun protection follow the top tips to travel safely.
All travellers are advised to ensure that they are in date with their routine vaccinations. Measles outbreaks have been reported in Israel since September 2018, and there are concerns that the increase of travellers heading to Israel for Passover in mid-April could see cases rise. Travellers should ensure that they have received two doses of measles vaccination (often referred to as the MMR) prior to departure.
Other travel vaccinations to be considered are diphtheria, tetanus and polio, and Hepatitis A. Some travellers may also wish to consider vaccinations against Hepatitis B and Rabies. It is always best to discuss which vaccinations are necessary for your trip with a travel nurse.
However, vaccinations cannot protect you from many diseases and dangers in Israel, the risk can be reduced through your behaviours…
Israel lies within the sub-tropical region with a Mediterranean climate. Summer temperatures can reach 40 degrees Celsius, and even higher in the Negev desert. Don’t let the Mediterranean summer breezes deceive you and stay sun safe. Keep hydrated, wear a high factor sunscreen and avoid the suns rays between 11am-3pm when at its strongest.
Food and Water
Israel is foodie heaven but travellers should still maintain good food and water practices to avoid tummy trouble whilst away. Avoid tap water and ice made from tap water: stick to bottled water. Ensure you wash your hands thoroughly before eating and after using the toilet. Ensure all food you eat is cooked thoroughly and served straight to you. For those who would still like the freedom to eat and drink without worry, it is advisable to carry a gastro kit with you. Inside will be various medications that can assist with travellers’ diarrhoea, should it occur.
Mosquitoes and sand flies can be particularly problematic during the summer months. Not only can their bites cause irritation, but they can also spread diseases such as West Nile Fever, dengue fever and leishmaniasis. There are no specific vaccinations and preventative treatments for these diseases, and bite avoidance is the only way. Try and cover up especially between dusk and dawn, and wear a good insect repellant that contains at least 50% DEET.
See our Ultimate Bug Kit.
From Red to Dead…
From the riches of the coral seas in the red to the abyss of the dead sea, take sensible precautions when taking the plunge. The dead sea lies 413m below sea level and is actually rather tricky to swim in. Tourist usually come to float on its surface as the high salt content makes it hard to submerge. Be careful. Cover any cuts you have with waterproof plasters to avoid a sharp sting. Do not splash when in the water, as it may cause injury or irritation to your eye if it enters. If you wear contact lenses, it’s best to swap to your glasses.
You can book all vaccination appointments or travel consultations online.
By Anna Chapman | Travel Nurse | May 2019
Bolivia is famous for its salt flats and varied terrain spanning over the Andes Mountains, the Atacama Desert and Amazon Basin rainforest. Located in South America, the climate varies drastically from one eco-region to the other. Travelling around Bolivia you’ll experience different climatic extremes, such as humid tropical climates to subtropical climates to desert-polar climates. It is important to seek travel advice before travelling as medical advice can vary dependent on the area/s you plan to visit.
Our general advice includes:
Routine immunisations are a high priority; it is good to check that they are all up-to-date before travelling anywhere. Given the current worldwide outbreaks, we strongly recommend checking your immunity status to measles. A simple immunity test can confirm all those who are unable to source vaccine proof. The best protection against measles is having 2 doses of a measles-containing vaccination, such as the MMR.
Travel vaccinations for Bolivia vary depending on where you plan to travel, and what you plan to do. It is best to book a consultation with a travel nurse to discuss your upcoming adventure. They will assess what risks you will potentially be exposed to. From this, they can develop a bespoke treatment plan specifically for your holiday.
As a minimum, travellers should be protected against Hepatitis A, and diphtheria, tetanus and polio. Certain travellers may consider vaccinations against typhoid, Rabies, Hepatitis B and Yellow Fever.
Yellow Fever is an unpleasant virus spread by the Aedes aegypti mosquito. This mosquito tends to bite during the day and is present in many lowland areas of South America and in all areas below 2,300m in Bolivia. Travellers who intend to visit the lowlands, such as the Chaco, Santa Cruz district and the Amazon may be advised to have the vaccine.
If your travel route includes other South American countries, you may also require the vaccination and an accompanying Yellow Fever Certificate in order to enter that country. The vaccination is not suitable for everybody. A careful risk assessment should be undertaken by a practitioner that specialises in the vaccine. Yellow Fever can only be given at designated Yellow Fever vaccination centres (YFVCs) – Fleet Street Clinic is a registered clinic.
Bolivia is home to some of the highest peaks of the Andes mountains, with elevations of over 6,000m. The frequently visited cities of La Paz, Potosi and Uyuni all soar over 3,500m, making altitude sickness a real risk. The risk can be reduced by ensuring you stay hydrated, plan a slow ascent and factor in some acclimatisation days. Acetazolamide (Diamox) can be used to help aid the process. Book a pre-travel assessment and speak to a travel nurse about your options.
Mosquitoes, bugs and flies do more than just bite. They have the ability to transmit diseases that aren’t always preventable by vaccination or medication. Illnesses such as dengue fever, chikungunya, Zika, yellow fever, malaria and sleeping sickness are a few risks.
The best prevention is to entirely avoid mosquito bites. Cover up as much as possible and apply a minimum concentration of 50% DEET to any areas of exposed skin. Spraying your clothes with permethrin before travelling can provide extra protection. Sleep under a mosquito net, especially, if you plan to stay anywhere remote or rural.
See our Ultimate Bug Kit.
Malaria occurs in the northern parts of Bolivia, in the Beni and Pando districts. Travellers heading to these areas should ensure they take anti-malarial medication. Mosquitoes that spread malaria are predominantly night-time biters. So, extra precautions should be taken between dusk and dawn. Any travellers who experience fever or flu-like symptoms on return from their trip should ensure they get tested for malaria, as unfortunately, no single prevention method is 100% effective.
Whilst medical services and pharmacies are available in bigger cities, access to basic services is limited or even non-existent in the remote regions. Travel prepared and take a small medical kit that can treat basic complaints. Pack painkillers, antiseptic cream, plasters or dressing, and medication in case you suffer from an upset stomach. Head over to our online shop to purchase an essential first aid medical kit. This contains all your travelling medical essentials.
If you are prone to allergies, a non-drowsy antihistamine is helpful. Furthermore, if you take prescription medication, be sure to pack enough to last you for your entire trip.
By Anna Chapman | Travel Nurse | May 2019
Brazil: Yellow Fever
The incidence of Yellow Fever cases in Brazil has been increasing recently, with over 1000 cases of Yellow Fever in Brazil since July 2017. The cases were reported in Sao Paolo, Minas Gerais, Rio de Janeiro, Espiritu Santo and Distrito Federal.
As well as an increase in human cases of yellow fever, 738 cases of yellow fever virus in monkeys have been reported. Since the outbreak, several unvaccinated travellers have contracted yellow fever, and there has been at least one death. Due to the ongoing outbreak, travellers going to at risk areas of Brazil are advised to get the Yellow Fever vaccination.
In addition the World Health Organisation also advised travellers heading to the states of Parana, Santa Catarina and Rio Grande do Sul should receive the vaccination, irrespective of location.
What is Yellow Fever?
Yellow Fever is a flavirus found in the tropics of Africa and South America.
Monkeys are a natural carrier for the virus and it is spread between monkeys and humans via the bite of an aedes mosquito.
Illness: It causes an acute viral illness which has a 50% mortality rate.
Prevention: The yellow fever vaccination should be considered for travellers who are visiting a high risk area. A single vaccination affords life long protection. The vaccination many not be suitable for everyone, so ensure you seek a full travel consultation.
Map of current areas with a risk of Yellow Fever
By Anna Chapman | Travel Nurse | February 2019
The risk of rabies is still widely unknown to the general public.
If caught and symptoms develop, rabies is almost invariably fatal.
Rabies is spread through the saliva of an infected animal and is present in over 150 countries worldwide. Up to 100 children die each day from rabies, and more than 55,000 people a year are killed from the disease, mainly in Asia and Africa.
If bitten or scratched by an infected animal you need to act quickly. Even with pre-travel vaccinations, a course of post-exposure vaccinations are required to prevent disease. If you haven’t had pre-travel vaccinations, the treatment is much more intense. If treatment is given correctly and promptly after exposure, then rabies can be cured but once symptoms develop, it is too late.
Some countries are deemed high-risk of rabies.
Considering this, it’s alarming when we experience resistance from travellers who feel this vaccination isn’t necessary for travel, especially if they are visiting a high risk location.
We feel so passionately that if you are travelling somewhere with a known risks of rabies it only seems sensible to protect yourself against it. Rabies is a vaccine-preventable disease, so make sure you get vaccinated before you travel.
For more information on rabies and travel health, visit our rabies page here.
The Fleet Street Clinic is passionate about travel. We have provided rabies vaccinations for over 20 years. Our team of expert travel medical professionals provide advice and detailed consultations to ensure you have a healthy trip.
Measles Outbreak – What You Need to Know
The WHO has issued a warning about recent outbreaks of measles in Europe and the USA. Cases of measles have risen rapidly in recent months in Italy, Romania and most recently in US.
Measles is a highly contagious virus with potential for serious complications.
Initial symptoms can include:
- Runny nose
- High Temperature
- Spots in the mouth
- Aches and pains
- Sore eyes and swollen eyelids
A rash appears after 2-4 days which can present as blotchy spots, often starting at the head and progressing down.
Medical Advice for Measles
If you think you may be suffering from measles, or are concerned about risk of infection when travelling, please see your doctor straight away.
Travelling to areas with a risk of measles
Make sure you are up-to-date with your vaccinations before you travel, including the measles, mumps and rubella (MMR) vaccine. If your child will be travelling, the MMR can be given from 6 months of age. If you have not had measles or if you have not had two doses of MMR, you may be at risk. Measles is easily passed from person to person and can be a serious illness in adults as well as children. It is never too late to have the vaccine.
With summer just around the corner, many are busy shopping for essentials. Sun cream, swimwear and toiletries are more likely on the list rather than travel vaccines. Many forget to check if they are up-to-date on the recommended travel vaccines. To make sure you get full enjoyment out of your holidays it’s important to stay safe during and after your break.
Below we have highlighted some health concerns you need to know if you are travelling this Summer:
Throughout this year we have seen an increased rise in measles cases all over the world. The disease can be easily prevented with two doses of the safe and efficient MMR vaccine. A review of your childhood vaccine records will indicate if you have had the MMR course or if in need of a booster or the full course. Those struggling to confirm their immunity can have a simple immunity blood test which will either confirm if they are immune or not.
When visiting areas with poor sanitation, which can affect the water and food consumed, travellers, should consider the Hepatitis A vaccination. A safe and effective vaccination which prevents the viral infection and stop travellers falling ill whilst away. In addition to the vaccination, travellers also should take caution and ensure all food is cooked thoroughly and served hot, stick to bottled water which is sealed and avoid ice (usually tap water).
Hepatitis B is a viral infection spread by contaminated blood and bodily fluids. Examples in which travellers can be at risk are contaminated medical equipment which may be used in an emergency for example needles and syringes. Hepatitis B can also be prevented with a vaccine course before travelling.
Every year there are more than 200 million new cases of malaria, another preventable and treatable disease. The World Health Organizations lists 91 countries and territories at risk of malaria transmission. Preventative medication can be taken to reduce the risk of catching Malaria as there is currently no vaccination.
In about 20% of travellers with diarrhoea, more than one bug turns out to be responsible for the illness. Bugs can be caught from drinking tap water and eating uncooked food or salads washed in tap water. It can put a dampener on holiday plans and make you feel under the weather. Antibiotics can be prescribed prior to travel, in case of a severe infection. Our gastro kit is designed to help travellers who may need medication to help cases of infectious diarrhoea whilst travelling.
“There may be avoidable risks to your health depending on your overall health, destination and planned travel activities. We can assess the risks and provide you with the best travel health advice to ensure you have an enjoyable trip and return healthy.”
“There may be avoidable risks to your health depending on your overall health, destination and planned travel activities. We can assess the risks and provide you with the best travel health advice to ensure you have an enjoyable trip and return healthy.”– Richard Dawood, Medical Director of the Fleet Street Clinic.
If you wish to discuss how to stay safe on holiday or would like more advice on what vaccinations you may need, our travel nurses can help. Book a travel consultation to discuss your needs.
Uzbekistan is home to spellbinding architecture and ancient cities. In terms of sights alone, Uzbekistan is Central Asia’s biggest draw and most impressive showstopper. Fabulous mosques, medressas and mausoleums are just some of the pulls for tourists when visiting Uzbekistan while more eccentric views can be seen at the fast disappearing Aral Sea and Nuratau Mountains.
Travel Nurse, Anna, shares her top tips on how to stay healthy during your trip to Uzbekistan.
Ensure you are up-to-date with your travel vaccinations. The minimum advised for a trip to Uzbekistan is diphtheria tetanus and polio, and Hepatitis A. Typhoid, Hepatitis B and Rabies can be considered by some travellers. It is advisable to attend for a pre-travel assessment with a travel nurse 6-weeks before your trip as some vaccinations requires several injections to complete the course.
Food and water
Precautions against the dreaded traveller’s diarrhoea should be taken to prevent an upset stomach ruining your trip. Do not drink tap water in Uzbekistan, stick to bottled water or water that has been boiled. If you are trekking or visiting remote areas it’s a good idea to take either a water bottle with a filter or some chlorine dioxide tablets to make water safe to drink, should you not be able to find a shop with bottled water.
Sour milk dishes dominate the Uzbek cuisine. Cue caution if you want to try ‘kurt’, the famous fermented cheese balls. There is a risk of a bacterial disease called brucellosis that can be spread through unpasteurised dairy products such as cheese and milk.
Travelling further afield
Uzbekistan forms one of the countries on the old silk route. If you plan on a tour of the ‘Stans’ or attempting the whole Beijing to Istanbul route, you may need to consider other travel health precautions. Depending on your route, and also the time of year you intend to travel, you may wish to consider vaccinations against Tick-Borne Encephalitis and Japanese Encephalitis.
Khazret Sultan, Uzbekistan’s highest peak stands at 4643m. Many popular walking and hiking routes such as Big Chimgan exceed over 3000m, making altitude related illnesses a hazard. Tips for reducing altitude sickness include a slow ascent route, keeping hydrated, ensuring that your sleeping altitude doesn’t exceed 500m per day. Diamox (acetazolamide) is a prescription medication that can reduce the symptoms of altitude related illness.
By Anna Chapman | Travel Nurse | April 2019
Marrakesh is a former Imperial City and the heart of Morocco. Whether you plan on visiting the medinas of Marrakesh or branch out to the sands of the Sahara or the heights of the Atlas mountains, ensure you follow our top travel tips to stay healthy.
All travellers should ensure they have received vaccinations against Hepaitis A and diphtheria-tetanus and polio. Vaccinations against typhoid should be considered for those who cannot guarantee safe food and water during their trip, Hepatitis B and Rabies vaccinations can be considered for some travellers, especially those travelling to more remote locations.
Travellers should be careful when dining in Morocco. This will help to prevent food and water-borne illnesses. You should avoid drinking tap water, and stick to boiled water, or bottled sealed water. Those who are trekking may wish to take a water bottle with a filter or a supply of chlorine dioxide tablets to make water safe when in remote locations.
Stick to the mantra of cooking it, peel it, boil it, forget it. If you cannot cook, peel or boil what you plan to eat or drink, it is probably safest to avoid consuming. Food contaminated with local water, such as salads are considered high risk and best to be avoided. Ensure all food is cooked thoroughly and served straight away. Avoid buffet items which may have been sat for long periods of time and could be contaminated. You can also purchase our worldwide gastro kit.
The availability of health care and first aid supplies are limited in Morocco. Whether you are visiting the median of Marrakesh or ambling around the Atlas, taking a good first aid kit with you is essential – click here to buy online now.
Basic provisions include pain relief, plasters and medication to treat an upset stomach, such as loperamide and oral rehydration salts. If you take prescription medication to ensure you pack enough and carry the prescription with you.
The peak of Mount Toubkal exceeds 4,000m and can be summited in 5-7 hours. High altitude and fast ascent rates can put travellers at risk of altitude sickness and acute mountain sickness. The risk can be reduced by ensuring you stay hydrated, plan a slow ascent and factor in some acclimatisation days. Acetazolamide (Diamox) can be used to help aid the process, speak to a travel nurse about this at your pre-travel assessment.
It is always best to seek travel advice before any holiday. A pre-travel assessment is quick and easy, vaccinations and prescriptions can be given within a single appointment and any follow-up treatments to complete courses arranged for a convenient time straight away.
By Anna Chapman | Travel Nurse | April 2019
ADVICE ON TICK-BORNE DISEASE IN EUROPE
Tick-borne Encephalitis (TBE) is a viral disease that is spread by the bite of an infected Ixodes tick. It is estimated that the disease infects at least 13,000 people every year.
Symptoms can occur from 4-28 days post-bite and include fever, fatigue and muscle aches.
The virus can also go on to affect the brain and spinal cord, causing meningitis, with up to 20% of cases resulting in death. Unfortunately, there is no specific treatment for TBE.
TBE occurs in 3 main geographical locations:
European TBE – Western Europe
Siberian TBE – Urals, Siberia, Far-Eastern Russia and Finland
Far Eastern TBE – far Eastern Russia, China and Japan
Transmission of TBE occurs mainly during the summer months, mainly via wild vertebrate animals such as rodents. It can be transmitted either by ingestion of unpasteurised milk, or milk products from infected animals or by the bite of an infected tick.
If you’re travelling to affected countries during the transmission period, you are most at risk if you are doing outdoor activities such as hiking, camping and walking in forested areas where ticks are abundant.
Take the following precautions to avoid infection:
Wear long trousers and sleeves. Impregnating clothing with permethrin and using insect repellents such as DEET are also good ways of preventing tick bites.
Get vaccinated. Ticovac (and Ticovac Junior for children) is advised for travellers who may be at risk. It requires two vaccinations prior to travel, and the third dose after a year can provide up to 5 years protection.
Check your body for ticks -especially in the armpits, groin and behind the knees.
Remove ticks promptly and correctly and clean the bite site with antiseptic.
|Where||Eastern Europe, Scandinavia, Siberia|
|How||Infected bite of a tick|
|Can it be prevented?||Yes – Vaccination and tick-prevention|
Tick Removal Tips
If you find a tick embedded on your skin you need to remove it, asap:
To remove a tick follow these steps :
- Use a pair of fine tweezers or a tick-remover
- Grasp the tick head as close the skin as possible
- Pull upwards at right-angles to the skin
Top tip: Avoid putting pressure on the body to avoid incomplete removal which may cause infection.
TICK-BORNE ENCEPHALITIS VACCINATION
There is a vaccination against tick-borne encephalitis (Ticovac and Ticovac Junior) which is highly effective against TBE. The primary schedule requires two vaccinations to be given 14 days apart, and a third dose to be given one year later. A booster vaccination is recommended after 3 years. The vaccination is suitable for adults and children over the age of one-year-old.
You can book a travel consultation appointment online to find out if you beed a tick-borne encephalitis vaccine for your next trip.
Boating in the Bahamas
The best way to see the Bahamas is by boat. As an archipelago of over 700 islands and cays all strung together like pearls over a turquoise sea, the majority of visitors choose to cruise to see the many delights that this country has to offer. Whether you only visit the Bahamas or take an all-encompassing Caribbean cruise, it is important to remember those travel vaccinations and travel health advice are essential if you are to enjoy a happy healthy holiday.
Here are our top travel tips for staying healthy in the Bahamas…
All travellers should be in date with diphtheria, tetanus polio and Hepatitis A. There is no risk of the Yellow Fever virus in the Bahamas, however, if your cruise takes you to an area that does have a risk of the virus (such as South America), you will need to provide evidence of vaccination in the form of a valid Yellow Fever certificate. Cruise ships are confined spaces with a high volume of passengers which makes you more susceptible to infections. If you plan on travelling during the winter months, it is sensible to consider a flu vaccination as respiratory viruses can spread easily.
The Bahamas lie in the tropical Caribbean seas making the sun, sea and sand the major attraction. Remember to be sun safe. Wear a high factor sun cream throughout your holiday. The sun’s rays are particularly strong between 11am-3pm so it’s best to avoid direct exposure during this time. Slap on a hat, slip on a shirt and slop on some sunscreen.
The Bahamas have a risk of dengue fever, chikungunya and the Zika virus. These illness are spread via the bite of an infected Aedes mosquito. Whilst causing mild illness in many, they can cause more serious complications and are best avoided. Zika virus is associated with a serious complication during pregnancy and those who are pregnant or plan to become pregnant soon after the trip are advised against travel to the area. There are no specific vaccinations against these mosquito-borne viruses so bite prevention is the only defence. Cover up exposed skin and wear an insect repellent containing at least 50% DEET.
See our Ultimate Bug Kit.
The majority of Bahamian cuisine comes straight out of the sea. Whilst seafood and fish are delicious, ensure that any food consumed is cooked thoroughly and served fresh to you. The Bahamas has an abundance of fresh tropical fruit but it is wise to adhere to the ‘cook it, boil it, peel it or forget it’ saying to avoid the dreaded traveller’s diarrhoea. We advise travellers to take a gastro kit with them which can help prevent and treat the commonest gastrointestinal symptoms that occur when travelling.
If you do plan to see the Bahamas by boat, ensure you follow some sensible precautions to avoid getting sick from fellow passengers. Wash your hands regularly, make use of the alcohol-based sanitizers stations on board, carry a small alcohol-based hand sanitiser to keep your hands clean when off the ship. Ensure you stay hydrated, but make sure you drink water from a safe source (bottled, boiled or purified).
By Anna Chapman | Travel Nurse | March 2019
An Arab nation on the east bank of the Jordan River, Jordan is one of the safest countries to visit in the Middle East. Awash with biblical heritage, ancient sites and large swathes of desert; it is a natural wonder with historical sights to tempt any traveller.
The daytime temperature rarely drops below the high teens, and flight time is less than 5 hours from the UK. Whether you are ambling in Amman, wandering the Wadi’s, dipping in the Dead sea or plodding around Petra, be sure to follow our top travel tips to stay healthy.
All travellers should ensure they are up to date with their routine vaccinations. Vaccinations include diphtheria, tetanus, polio and hepatitis A. Hepatitis B and rabies can be considered for those at risk (speak to a travel nurse prior to departing).
Rabies is a fatal virus spread through the bite, scratch or lick from an infected animal, most commonly a cat, a dog or a bat. The risk is greatest when the animal pierces the skin and/ or makes contact with an open wound. There are many ‘high risk’ countries, in Jordan, dogs, cats and bats are the biggest culprits and the risk of these animals carrying the disease is high. Once the rabies virus enters the nervous system there is no treatment and it is fatal. Travellers can reduce the risk of rabies by receiving pre-travel vaccinations against the disease. This doesn’t exempt the traveller from treatment if they have been exposed, but simplifies the process and provides the best outcome. Rabies treatment is scarce and can be very difficult to source in some countries, so having pre-travel immunisations puts you in the best possible position should something happen. Those who are trekking, camping or going off the grid to places like Wadi Rum are at highest risk of the disease.
Food and Water
Jordanian cuisine is delicious, but ensure you avoid the dreaded traveller’s diarrhoea by following some sensible precautions. Ensure you are up-to-date with Hepatitis A vaccination as this viral illness are spread through contaminated food and water. Wash your hands regularly, especially after using the toilet and before eating. Ensure water is either boiled or bottled with a good, unbroken seal. Do not drink tap water or brushing your teeth with it and avoid ice. Ensure all food you eat is served piping hot and straight to you.
All that bites
Take precautions against sand fly bites that are ubiquitous in Jordan. Aside from producing a painful bite, they can also carry a parasite responsible for Leishmaniasis. Sand flies tend to feed at night and fly close to the ground. Prevent them from feeding on you by covering up, especially between dusk and dawn. Wear long trousers and socks to prevent bites around your ankles as they are flow flyers. Wear good insect repellant with a minimum of 50% DEET. Sleep under a mosquito net, especially if you are camping or hiking in the more rural areas of Jordan.
See our Ultimate Bug Kit.
From red to dead…
From the riches of the coral in the red sea to the abyss of the dead sea, take sensible precautions when taking the plunge. The dead sea lies 413m below sea level and is actually rather tricky to swim in. Tourist usually come to float on its surface as the high salt content makes it hard to submerge. Be careful. Cover any cuts you have with waterproof plasters to avoid a sharp sting. Do not splash when in the water, as it may cause injury or irritation to your eye if it enters. If you wear contact lenses, it’s best to swap to your glasses.
By Anna Chapman | Travel Nurse | March 2019
Stay healthy at Holi
Holi is a famous spring Hindu festival that is celebrated in every part of India. It is known as the festival of colours and is mostly celebrated in March in Rajasthan.
The celebration signifies the beginning of spring beginning and the end of winter. It is sometimes known as the “festival of colours” or the “festival of love”. During the festival, it is encouraged to throw powdered paint (gulal) into the air. This symbolises the abundance of colours of spring and the celebration of a new season.
Here are top travel tips to stay healthy at Holi.
Don’t forget your travel vaccinations
Travellers going to India should ensure they are up-to-date with their travel vaccinations. These include Hepatitis A, Typhoid and Diphtheria, Tetanus and Polio. Rabies, Hepatitis B and Japanese Encephalitis are sometimes suggested and are dependent on where you’re travelling to and the activities you plan to do there. A consultation with a travel nurse will provide you with all the information needed to make an informed decision either way.
Eat, drink and be merry…
India is food heaven but don’t let travellers diarrhoea turn it into a Holi holiday hell. Avoid tap water or ice from an unknown source. Ensure bottled water has an intact seal if buying from a vendor. Alternatively, invest in a water-to-go bottle which has a built-in filter making unsafe water safe to drink. You can pick one up during a travel appointment at the clinic whilst getting your vaccines.
Eat well-cooked food served piping hot, and avoid fruits and salad items that might have been washed in the local water. It is worth investing in a gastro medical kit which contains all the necessary medicines should you get sick at any point during your travels.
Holi festival is synonymous with the throwing of coloured powder. Contact lens wearers should stick to their glasses during the festival so to avoid getting dye in their eyes. Any dye that makes its way into your eye could cause a chemical injury and lasting damage. If any powder does get in your eye, wash it well with clean running water.
Don’t let the dye stop the DEET.
Dengue fever, chikungunya, Zika, Japanese Encephalitis and even malaria can occur in parts of India. Therefore, banish the bugs bites by covering up as much as possible, wearing a good insect repellent with at least 50% DEET. See our Ultimate Bug Kit.
If you are trying to conceive, travelling to ‘at-risk countries’ is not advised.
For more information on the Zika virus and advise, you can speak to one our travel nurses during a travel consultation.
We’d always recommend for travellers to book a 30-minute travel consultation with a travel nurse prior to travelling to ensure all necessary vaccinations are given and any risks are discussed.
By Anna Chapman | Travel Nurse | February 2019
Senegal is one of West Africa’s most visited countries; it is considered one of the most stable democracies in Africa, which is probably why it is more popular than it’s neighbouring countries. Senegal offers the hustle and bustle of Dakar, the sand dunes of the Lompul Desert, the clear waters of the Casamance and tropical backwaters of the Sine-Saloum Delta. Unfortunately, a tropical environment comes with tropical diseases, especially ones that fly!
Don’t wing it with your health, follow our top travel tips to stay healthy and have a bug-free break …
Sleeping sickness, also known as “human African trypanosomiasis”, is caused by the tsetse fly, which is native to the African continent and generally active during the day. If an infected tsetse fly, which is carrying the parasite, bites you, it can cause acute trypanosomiasis. Sleeping sickness infects the brain causing confusion, disturbed sleep (hence the name) and can be fatal if not treated.
Malaria is prevalent throughout the whole of West Africa, including Senegal. It is spread by the bite of an infected Anopheles mosquito. Generally, these mosquitos bite most often during dusk til dawn. All travellers to Senegal should take anti-malarial medication and take preventative measures against mosquitoes.
Yellow Fever is a virus spread by the Aedes mosquito, that is most active from dawn till dusk. Catching Yellow Fever can be fatal but can be prevented by vaccination. The vaccination gives a lifetime of protection, however, it is not suitable for everyone and a comprehensive risk assessment should be sought from a travel clinic. Additionally, there is a requirement to be in possession of a valid Yellow Fever certificate when entering Senegal from another infected country, especially those who plan onwards travel to Gambia or Guinea-Bissau.
Zika Virus is spread by the Aedes mosquito which commonly bites during the day in urban settings, such as Dakar and St Louis. The majority of people who are infected with Zika virus have no symptoms, but if contracted during pregnancy or close to conception it can cause Congenital Zika Syndrome. Currently, there is no vaccination nor cure for Zika virus infection and strict precautions against mosquitoes should be taken.
Best prevention to banish those bugs?
- Wear long loose clothing and cover-up. If the insects can’t bite you, they can’t transmit their diseases to you.
- Use a minimum of 50% DEET spray on any exposed areas of skin and reapply regularly
- Sleep under a mosquito net
- Treat clothes with permethrin
- Ensure you receive a travel consultation prior to departure to receive the appropriate pre-travel vaccinations and medications against malaria and Yellow Fever
- You can purchase one of our Ultimate Bug Kits to help protect yourself
By Anna Chapman | Travel Nurse | February 2019
The Blue Hole in Belize is famous for being a natural wonder with a unique diving experience. It’s world-class diving rates as one of the top 5 diving sites in the world. Belize is a great travel destination for the adventure traveller.
Avoid getting that sinking feeling by following our top 5 tips for staying healthy…
Ensure you are up-to-date with your travel vaccinations including diphtheria, tetanus and polio and Hepatitis A. Speak to a travel nurse before you travel to ensure you are protected for your trip, especially if you have multiple destinations planned.
2 – Pack a small first aid kit.
A small first aid kit packed with travel essentials will cover you for minor injuries. Forceps or tweezers are useful for removing foreign bodies, such as sea urchin spines, and antiseptic wash or cream can be used to treat any coral cuts or abrasions. We stock a perfect essential first aid kit on our online shop.
3 – Be sun-safe to avoid sunburn.
Be conscious of how much sun exposure you get. The Caribbean sun can be strong with an increased risk of sunburn if you’re not careful. Wear sunscreen in between your dives with a protection level of at least SPF50 and spend time in the shade, especially in the midday sun between 11am and 3pm. Cover up with clothes, a hat and sunglasses to protect your skin, scalp and eyes.
4- Keep hydrated.
Although you are surrounded by water, diving and the sun exposure can cause dehydration. Ensure you drink plenty of fluids to prevent it. It is best to avoid drinking tap water directly, unless using a water bottle with a filter or chlorine dioxide tablets, both of which will make the tap water safe to drink. Another alternative is to buy bottled water with a seal although, those trying to reduce their plastic footprint should opt for the former options.
5 – Avoid sea sickness.
The journey from the mainland to the blue-hole can take up to 3 hours and is often crossing bumpy seas. If you are prone to travel sickness you may want to ensure you pack some medication to prevent this so not to interrupt your experience.
By Anna Chapman | Travel Nurse | February 2019
Sri Lanka was recently voted as the number one country to visit in 2019 by Lonely Planet. Our travel nurse Lucy spent two weeks exploring this award-winning country and here, she shares her top tips for a healthy trip.
January is an ideal time to visit Sri Lanka thanks to warm temperatures and clear skies. From tea tasting to surfing, hiking to whale watching, this ancient spice island has something for everyone.
If you are a wildlife lover, taking a guided jeep tour into one of Sri Lanka’s National parks is a must! Amongst the most popular are Yala and Udawalawe, where you are guaranteed to spot elephants by the dozen and if you’re fortunate a leopard. Prepare to wake up early and pack your mosquito repellent – most jeeps leave at dawn for the best chance of sightings, but mosquitos are also the most active during this time.
Although Sri Lanka is currently a Zika free zone, making it a popular choice for honeymooners, it is important to remember that mosquitos transmit other diseases such as Dengue and Chikungunya. Good bite protection is therefore essential and should include a mosquito repellent containing 50% Deet, as well as wearing long and loose clothing – also good for keeping the sun off your skin! Protect yourself from mosquitos with our Ultimate Bug Kit.
With new and improved services throughout the country, train travel is a highlight of any Sri Lankan trip and widely considered as some of the most scenic in the world. The most famous stretch is between Ella and Kandy; a journey that will last around 7 hours and takes you through lush jungle, tea plantations and waterfalls. Remember your antibacterial hand sanitiser though, because, as convenient as the onboard toilet is on a long journey, hand washing facilities aren’t always of a good standard. Perhaps pack some tissue as well!
Sri Lankan food is delicious and an essential part of the culture. As with all travel to tropical destinations, however, caution should be taken when trying out the local delicacies because contaminated food can cause travellers’ diarrhoea. So, before you sample the famous string hoppers and sambal, here are some simple food and water precautions to avoid an upset stomach:
- Make sure your food is served piping hot. Be cautious of food that has been sitting at room temperatures such as buffet and street food.
- Only drink bottled water, with an intact seal. This applies to the water you use to brush your teeth and the ice in your drinks.
- Avoid salads and uncooked vegetables that may have been washed in contaminated water.
- Always peel your fruit. If you can’t – don’t eat it.
- Ensure dairy products are pasteurised – many harmful organisms are transmitted through unpasteurised dairy.
It is worth investing in a gastro medical kit which contains all the necessary medicines should you get sick at any point during your travels.
Travellers’ diarrhoea is a common complaint in the returning traveller here at Fleet Street Clinic. If you are still experiencing stomach troubles on your return, our GP’s can run same day PCR testing to find the cause and most appropriate treatment.
If you would like aa travel appointment, you can book online.
By Lucy Mildren | Travel Nurse | January 2019
Panama sits on both the Pacific and Atlantic coasts. With its cloud forests, coffee farms, magical islands, world-class diving and a canal that connects two oceans, many people choose to make Panama their holiday destination.
If you plan to go, follow our travel tips to have a safe and healthy holiday.
Vaccinations for vacation
It is advised that all travellers be up-to-date with Diphtheria, Hepatitis A, Tetanus and Polio. Higher risk travellers may want to consider vaccinations against Typhoid, Rabies and Hepatitis B. It is best to speak with a travel expert to see what they advise for you.
Prevent mosquito bites
It is no longer necessary to take anti-malarial medication if visiting Panama. However, precautions against mosquito bites should be taken as viruses such as dengue fever, Zika virus and chikungunya can be transmitted in the region. Pack some insect repellent with at least 50% DEET, and take a mosquito net if you plan to stay in traditional accommodation that may not provide one. You can help protect yourself from mosquitos with our Ultimate Bug Kit.
Find out if you need a Yellow Fever Vaccination
Yellow Fever exists east of the Panama canal. If you plan to visit this area the vaccination is recommended. Also, those who plan to enter Panama from a country that has a risk of Yellow Fever (such as Colombia) will need to be in possession of a valid Yellow Fever Vaccination certificate.
Pack a first aid kit
A first aid kit with necessary medication and first aid items is a good idea. Accessing medical care and medical supplies in parts of the region can be difficult, especially for those who plan to visit the San Blas Islands, cloud forests or coffee farms. Those who plan on diving in the Bocas del Toro may wish to take out items such as ear drops for an infection, and antiseptic cream for any coral cuts.
Don’t get travel sick
A huge attraction in Panama is the coastline and archipelago, including the San Blas and the Pearl Islands. Accessing parts of Panama often involves long bumpy journeys by road and boat trips to the islands can often be choppy. If you suffer from travel sickness, ensure you pack medication to prevent this, and take it before you set out on the journey to prevent feeling queasy.
By Anna Chapman | Travel Nurse | January 2019
Be sun smart on the slopes
Even if it is snowing, don’t assume that the sun’s rays are safe. The sun’s rays reflect off the snow and intensify them. Ensure you wear a high factor SPF, and use lip balm to prevent cracking. Polarised sunglasses that wrap around will prevent the UV rays causing damage to your eyes.
Don’t get caught out in the cold
Winter temperatures on the slopes often fall below zero, putting travellers at risk of cold-related injuries such as hypothermia and frostbite. When travelling in cold climates, ensure you wear warm clothing in layers. Heat is rapidly lost through hands and feet, so wearing a hat and gloves will help minimise heat loss.
Stopping altitude sickness at the summit
Some of Europes best slopes are found at altitudes higher than 2500m putting skiers at risk of altitude sickness. If you plan on skiing from the summits, make sure you prepare. Know the altitude you are going to, and recognise the symptoms of altitude sickness. Skiers could consider the use of altitude sickness medication acetazolamide (more commonly knows as Diamox) to prevent developing altitude related illness.
If you would like more travel advice we’d recommend an appointment with one of our travel nurses.
Book your travel appointment today
By Anna Chapman | Travel Nurse | November 2018
Christmas is coming and who doesn’t enjoy a Christmas market (or two!) A popular Christmas city break destination is Germany and visiting the fantastic Christmas markets is top of most travellers to-do list.
Read our advice on how to stay healthy during a winter city break in Germany:
Coughs, sneezes and Christmas wheezes
Christmas markets can be crowded places. A combination of cold damp weather and crowded areas means that it is easy to pick up a viral infection. Preventing the common cold can be helped by observing good hand hygiene to avoid that transfer on infection. If you do start with the sniffles, ensure you use a tissue to ‘catch it, kill it, bin it’ to stop the spread to others.
Don’t let the flu spoil your festive fun. In the Northern Hemisphere, seasonal influenza occurs during the winter months, with peak season around Christmas. Flu is spread from one person to another via coughing and sneezing and it very contagious in populated areas. It can, however, be easily prevented with a single flu vaccine, which ideally should be given several weeks before the ‘flu season’ begins to provide optimal protection.
Have a Merry measle-free Market
In recent years, many countries in Europe have seen dramatic surges in the cases of measles. Measles is an acute viral infection that has the potential for severe complications. Merry market goers should ensure that they have received 2 doses of the measles-containing vaccination, commonly known as the MMR, to ensure they have adequate protection against the disease.
If you would like more travel advice we’d recommend an appointment with one of our travel nurses.
By Anna Chapman | Travel Nurse | November 2018
Have a bug-free beach life
Apart from causing an itch and inflammation, mosquitoes can leave more than just an irritation.
In the Caribbean, they have the ability to transmit diseases such as Dengue Fever, Zika Virus and Chikungunya.
Mosquito bite avoidance is recommended, here are our recommendations on how:
- Cover up with clothing
- Use insect repellents containing a minimum of 50% DEET on any exposed skin
- Consider treating clothes with permethrin
- Sleep under bed nets and use insect screens on doors.
- Reduce mosquito breeding sites by removing any water containers from outdoor areas
- Use air-conditioning
- Consider the use of plug-in electrical vaporisers which deter mosquitoes
- Use our Ultimate Bug Kit.
Dengue Fever & Chikungunya
There is currently no vaccine available to prevent either dengue nor chikungunya in travellers. However, without mosquitoes, individual sufferers are not directly contagious.
The risk for both diseases is thought to be higher during periods of intense mosquito feeding activity (two to three hours after dawn and during the early evening).
There is currently no vaccine available to prevent the ZIKV infection in travellers. Those infected with the infection normally have no symptoms. When symptoms do occur they are usually mild and short-lived. Serious complications and deaths are not common.
The concerns with the Zika virus and primarily to do with birth defects and as a result pregnant women should postpone non-essential travel until after pregnancy. More information on Zika Virus and pregnancy concerns from Public Health England.
So say ‘zip off’ to zika and ‘do one’ dengue and enjoy a bug-free beach life!
If you would like more travel advice we’d recommend an appointment with one of our travel nurses. You can book your travel appointment online.
By Anna Chapman | Travel Nurse | November 2018
Public Health England has issued a health warning aimed at travellers highlighting the risk of rabies.
Following the recent news whereby a UK resident sadly died after becoming infected with rabies following a cat bite during a visit to Morocco, there is need to remind travellers of the dangers of viral infections when outside of the UK.
Rabies is a virus infection of the brain which is usually transmitted from contact with an infected animal, through injuries such as bites and scratches.
Dogs are the main source of infection in most parts of the world, although almost any mammal can become infected.
Although not a concern in the UK, PHE highlights the dangers of animals whilst travelling:
‘Rabies is common in other parts of the world, especially in Asia and Africa. All travellers to rabies-affected countries should avoid contact with dogs, cats and other animals wherever possible, and seek advice about the need for rabies vaccine prior to travel.’
When visiting countries with rabies endemic it is best to avoid contact with animals especially stray or wild animals.
People are usually infected following a deep bite or scratch from an animal with rabies, and transmission to humans by rabid dogs accounts for 99% of cases.
The virus cannot infiltrate intact skin.
Initial symptoms of rabies include a fever with pain and unusual or unexplained tingling, pricking, or burning sensation (paraesthesia) at the wound site. As the virus spreads to the central nervous system, progressive and fatal inflammation of the brain and spinal cord develops.
What to do if bitten?
If a traveller has been bitten or licked, they should immediately wash the wound with soap and water as soon as they can. That will inactivate and wash out a lot of the virus (if there is virus present), and urgently seek medical care.
Once symptoms have developed, left untreated rabies is almost always fatal. Rabies is a 100% vaccine-preventable disease.
You should consider getting vaccinated against rabies if you are travelling to a country which is considered high-risk especially if you’re planning on travelling to more remote locations.
Rabies vaccination requires a course of 3 vaccinations for complete protection. Depending on how much time you have prior to travelling would determine which course of treatment is suitable for you.
Alternatively, those with time constraints can opt for the accelerated rabies vaccination course.
The accelerated option can be provided over 7 days; giving full protection within a week.
This option is suitable for spontaneous travellers and last-minute business trips to countries affected by rabies.
All travellers who think they have been exposed to the rabies virus should urgently seek medical care and post-exposure vaccinations.
- If you’ve had your immunisations, you will require two doses of rabies vaccination, 3 days apart.
- If you are exposed to rabies and have not been vaccinated, a more intensive treatment of 5 vaccinations over a 30-day period, plus an injection of immunoglobulin is required.
Overall travellers should take precautions when travelling to countries where rabies is present.
Rabies: The Facts by The World Health Organisation
For more information on the risk of rabies in different countries, see the country information pages on the National Travel Health Network and Centre’s (NaTHNaC’s) website, TravelHealthPro.