Travel Advice: US ends Covid Testing for International Travellers

15.06.2022 Category: News Author: Dr Richard Dawood

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12, 2022 at 12:01AM ET all COVID-19 testing entry requirements for international travellers to the United Stated were rescinded.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 As a result, this requirement which was needed at an earlier stage in the pandemic may be withdrawn.”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.

Hajj and Umrah: Travel Health

10.06.2022 Category: Travel Health Author: Dr Richard Dawood

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. 

COVID-19 Requirements:

It’s been announced that the Saudi Ministry will allow up to 1 million Muslims to participate in Hajj 1443H/2022. British citizens wishing to perform Umrah or Hajj are required to be: 

  • Under the age of 65 and received COVID-19 vaccinations which has been approved by the Saudi Ministry of Health
  • Travellers from outside of Saudi Arabia must submit a negative COVID-19 PCR test 72 hours before their departure to Saudi Arabia. 

Whilst Covid-19 vaccinations are not available privately, Covid-19 PCR travel tests are. We believe in access to rapid PCR testing to remove the worry of waiting for your results. We guarantee all our turnaround times – with our fastest being 90 minutes. For more information and pricing: Covid PCR travel tests at Fleet Street Clinic

 

Vaccine Requirements:

A pre-travel consultation should be scheduled at least 6 to 8 weeks before your trip.
Any mandatory or advised vaccinations will be discussed with a nurse. Initial doses can be given during this initial appointment and you can pre-book any required follow up doses in the lead up to Hajj or Umrah pilgrimage.

Before travelling to Hajj or Umrah, it is highly recommended that pilgrims be up-to-date in all their wellness vaccinations.

– Meningitis

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.

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.

Hepatitis B

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. 

If you require a vaccination, you can choose from our available appointments online – click to book your appointment.

Rabies

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 – 2 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.

If you require a vaccination, you can choose from our available appointments online – click to book your appointment.


TRAVELLERS DIARRHOEA

Travellers’ diarrhoea can occur in up to 60% of travellers. Eating contaminated food or water are the usual culprits. 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.


CLIMATE HEALTH

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 sin against the sun with high factor sun cream
  • Wear loose fitting, lightweight and light colour clothing 
  • Keep hydrated by drinking plenty of fluids and eating food with high water content (such as fruit)
  • 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


GENERAL HEALTH:

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 too 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.

 

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.

 

How to calm your flight anxiety before you fly

04.03.2022 Category: Travel Health Author: Lucy Mildren

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. 

Distract yourself
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.

Travelling for Chinese New Year?

01.02.2022 Category: Travel Health Author: Anna Chapman

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 2022 being the Year of the Tiger. Celebrations for Chinese New Year kick off on the 1st Feb, continuing until the 15th 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. Recently the Chinese Embassy in the UK announced a temporary suspension of entry into China by non-Chinese nationals in the UK holding Chinese visas or residence permits valid at the time of the announcement. If you are unaffected by these restrictions and 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, 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 2021-22, 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 Typhoid, 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! 

 

You can book online for a travel consultation appointment here.
Or for more information on all of our travel vaccinations, wellness vaccinations or travellers’ diarrhoea.

Travel Tips Thursday - Botswana

19.10.2019 Category: Travel Health Author: Anna Chapman

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.

Vaccines

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.

Find out more information about our travel and wellness vaccinations.

Malaria

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.

Insect prevention

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.

Book your travel appointment today

By Anna Chapman |  Travel Nurse | October 2019

Travel Tips Thursday - Albania

19.09.2019 Category: Travel Health Author: Anna Chapman

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.

Routine Vaccinations

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

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.

For more information on our vaccines, please visit our, travel and wellness vaccination pages.

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.

Book your travel appointment today

By Anna Chapman |  Travel Nurse | September 2019

Sexual Health and Travel

04.09.2019 Category: Sexual Health Author: Dr Belinda Griffiths

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.

Travel Tips Thursday - Bosnia

19.08.2019 Category: Travel Health Author: Anna Chapman

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.

Vaccinations

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.

Find out more about our travel and wellness vaccinations.

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

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.

Book your travel appointment today

By Anna Chapman |  Travel Nurse | August 2019

Travel Tips Thursday - Tanzania

19.08.2019 Category: Travel Health Author: Anna Chapman

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.

Vaccines

All travellers should ensure they are in date with all their routine immunisations, including diphtheria, tetanus and polio (DTP), and measles, mumps and rubella (MMR). 

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.

For more information on our vaccines, please visit our travel and wellness vaccination pages.

Yellow Fever

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.

Prevent Malaria

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.

Precautions include:

  • 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.

Climbing Kilimanjaro

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.

Book your travel appointment today

By Anna Chapman |  Travel Nurse | August 2019

Fleet Street Clinic Bug of the Week: Cyclospora

19.08.2019 Category: Travel Health Author: Anna Chapman

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.

The perils of walking barefoot on a beach

05.08.2019 Category: News Author: Dr Richard Dawood

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.

Travel Advice: Yellow Fever Certificate Required For Nigeria

25.07.2019 Category: Travel Health Author: Dr Richard Dawood

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.

Links:
World Health Organization

Travel Health Advice: Rugby World Cup 2019

23.07.2019 Category: Travel Health Author: Anna Chapman

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?
Be prepared…

Get Vaccinated


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.

Find out more about our travel and wellness vaccinations.

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:

  1. 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.
  2. 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.
  3. 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.
  4. Avoid touching your mouth, nose and eyes with your hands.
  5. Use clean, disposable tissues to wipe your mouth or blow your nose. Throw away used tissue immediately after use.
  6. Avoid getting overly cold and wet by wearing appropriate clothing.
  7. if you are already sick, wear a face mask to help lower the chance of spreading your illness to others.

First Aid


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. 

For convenience, we sell a ready to go Essential First Aid Kit, available online.

You can book a pre-travel consultation online.

For more details about the Rugby World Cup.

Inca Trail

19.07.2019 Category: Travel Health Author: Anna Chapman

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.

Vaccinations

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.

Altitude Sickness

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.

Stay Hydrated

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

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.

Foot Health

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!

Book your travel appointment today

By Anna Chapman |  Travel Nurse | July 2019

Travel Tips Thursday - Mozambique

19.07.2019 Category: Travel Health Author: Anna Chapman

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.

Vaccinations

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.

For more information on our vaccines, please visit our, travel and wellness vaccination pages.

…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.

…And Polio?

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.

Malaria

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.

Book your travel appointment today

By Anna Chapman |  Travel Nurse | July 2019

Don't forget this essential item on your next flight

11.07.2019 Category: Travel Health Author: Dr Richard Dawood

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.

For more travel advice, contact our expert travel team at Fleet Street Clinic – you can book an appointment online.

Dr Richard Dawood Headshot

 

Tips For A Healthy Long-Haul Flight

01.07.2019 Category: Travel Health Author: 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.

Dehydration

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).

Jet Lag

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.

Travel Advice: Measles Outbreaks Continue in Europe

28.05.2019 Category: Travel Health Author: Anna Chapman

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.’

Herd immunity

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 Tips Thursday- Bolivia

19.05.2019 Category: Travel Health Author: Anna Chapman

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:

 Vaccines

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

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.

Yellow Fever Map, Bolivia, Yellow Fever Vaccine at Fleet Street Clinic, London

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.

Altitude

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.

Insects

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

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.

First Aid

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.

Book your travel appointment today

By Anna Chapman |  Travel Nurse | May 2019

Do you need a Rabies Vaccine for your next trip?

19.05.2019 Category: Travel Health Author: Anna Chapman

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.

You can book a travel consultation or rabies vaccination appointment online.

Travel Tips Thursday - Uzbekistan

19.04.2019 Category: Travel Health Author: Anna Chapman

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.

Vaccinations

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.

Altitude

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.

Book your travel appointment today

By Anna Chapman |  Travel Nurse | April 2019

Travel Tips Thursday - Marrakesh

19.04.2019 Category: Travel Health Author: Anna Chapman

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.

Vaccinations


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.

Water


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.

Food Safety


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.

First Aid


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.

Altitude


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.

Book your travel appointment today

By Anna Chapman |  Travel Nurse | April 2019

Damian King: Indian Adventure for CALM

22.03.2019 Category: Clinic News Author: Lisa-Marie Ryan

As a specialist travel clinic, we are passionate about travel and get inspired by stories from our patients every day.

We meet interesting people day in, day out, both at the clinic and when we’re doing trade shows.

Following a chance meeting at the Adventure Travel Show in January, we felt inspired to support Damian King as he embarks on an extreme adventure across India.

Damian explained his plans to walk from North India to South India – starting at Kashmir and ending in Kanyakumari. This is a total of 2,547km aiming for 30miles per day – which is no easy feat!

Not only is Damian’s mission a personal extreme adventure to tick off the bucket list but a way to raise awareness and fundraise for CALM, Campaign Against Living Miserably (CALM). If you are unfamiliar with this charity, they are leaders in the movement against male suicide. Which, unfortunately, is still the single biggest killer of men under 45 in the UK.

It is a sad fact that on average 84 men take their lives every week in the UK. As a society, we need to remove the stigma of mental health as a whole but specifically around gender expectations, gender norms and toxic masculinity which has embedded itself with our culture. As healthcare professionals, we strongly believe in promoting a healthy lifestyle, advocate for disease prevention and highlighting the importance of self-care and wellbeing. This is why we so passionately decided to support Damian. To be in some way a small (but essential) part of his adventure and assist in raising awareness for male suicide felt thrilling and essential. Part of our company ethos is to support the adventurous traveller so we said yes to becoming his medical partner, offering support for vaccinations, travel advice, medical kits, podiatry advice and also nutritional advice.

“The decision to work with the guys at Fleet Street Clinic was quite simple. I required a varied number of services which they offered. They are centrally located in between the West End and City, and more importantly, it doesn’t have the clinical feel of a doctors surgery like many do.”

              – Damian King

As a specialist travel clinic, we advocate the importance of good health whilst travelling and assist travellers to view health as one of the most important aspects of their adventure holiday. We have assisted with Damian in his preparation for his adventure from top to toe. Important parts of his pre-travel preparation were travel vaccinations alongside travel advice; highlighting risks from the weather, insects, animals, food and water. Other important health checks included a visit to the podiatrist to ensure his feet remained healthy during training and whilst walking, the nutritionist to speak about the impact of his diet whilst travelling and what he should and shouldn’t be eating in preparation for such a drastic amount of exercise and an in-body scan to document his training efforts which looks at weight distribution, muscle mass and body fat percentage.

We are proud to be a part of Damian’s journey and we wish him a fantastic and safe adventure. If you would like to follow Damian King’s adventure, you can find out more on his blog or on his Instagram.

If you are thinking of embarking on your own travel adventure and need a travel consultation appointment, you can book online.

Travel Tips Thursday - Bahamas

19.03.2019 Category: Travel Health Author: Anna Chapman

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…

Vaccinations

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.

Sun

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.

Insects

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.

Gastro 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.

Cruise Health

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).

Book your travel appointment today

By Anna Chapman |  Travel Nurse | March 2019

Travel Tips Thursday - Jordan

19.03.2019 Category: Travel Health Author: Anna Chapman

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.

Vaccinations

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

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.

Book your travel appointment today

By Anna Chapman |  Travel Nurse | March 2019

Travel Tips Thursday- Belize

19.02.2019 Category: Travel Health Author: Anna Chapman

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…

1 – Vaccinations are important.

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.

Book your travel appointment today

By Anna Chapman |  Travel Nurse | February 2019

Travel Tips Thursday - Panama

19.01.2019 Category: Travel Health Author: Anna Chapman

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.

You can find more information on our wellness and travel vaccinations.

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.

Book your travel appointment today

By Anna Chapman |  Travel Nurse | January 2019

Team Announcement: Lucy Mildren

23.10.2018 Category: Clinic News Author: Lisa-Marie Ryan

Travel Clinic nurse, Lucy Mildren, has been awarded the International Society of Travel Medicine’s Certificate in Travel Health.

We’re happy to announce another of our travel nurses, Lucy, has obtained the International Society of Travel Medicine (ISTM) Certificate of Knowledge.

The ISTM Certificate of Knowledge is an examination that proves an individual has demonstrated the expertise in the travel profession and a solid knowledge of travel medicine care and consultation. The exam is held in a different location annually, Lucy attended the Atlanta examination earlier this year.

The field of travel medicine has grown dramatically over the years, as greater numbers of people travel to remote and exotic destinations. Almost a billion travellers cross international borders annually for both work and leisure. However, research worryingly suggests that very few seek pre-travel health advice.

Fleet Street Clinic is one of the UK’s leading providers in travel medicine, vaccinations and travel advice. Knowing another member’s of the team has obtained this certification in travel health provides greater confidence to the public and patients we treat that our experience and knowledge is all-around exceptional.

Travel medicine has become increasingly complex due to a number of reasons, such as increased drug resistance, global migration patterns and the rise in travellers with chronic health conditions.

Congratulations Lucy, from us all at Fleet Street Clinic.

Book your Travel Vaccines Today

For more information about the Certificate of Knowledge from ISTM website 



Travel Vaccines are a key component of pre-travel preparation.

If you would like to speak to Lucy or another of our travel nurses prior to travelling, you can book an appointment online.

Travel Tips Thursday: Dublin

19.09.2018 Category: Travel Health Author: Laura Berry

A weekend in Dublin

The unique mixture of hedonism and heritage makes Dublin the perfect city break.
Be ready to eat and drink your way around the city, indulge and celebrate, both these things are encouraged wherever you go. The Irish definitely know how to live life to the full.

Here is our flu coordinator Laura’s guide to ensure you have a memorable weekend in Dublin.

Plan Ahead

Dublin requires a certain amount of pre-planning especially if you’re wanting a budget city break. Prices tend to steadily increase the closer you book to the date of travel. So, expect to pay more if you’re more of the spontaneous adventurer.
Depending on if you’re taking the whole family or travelling alone, we’d always book flights in advance. Especially expect to pay more on St Patrick’s weekend!
Book your accommodation early! There is a big rental shortage in Dublin and popular times throughout the year can result in overpriced accommodation at hostels, hotels and even Airbnb’s.

Clothing

The Irish weather has a reputation for having four seasons in one day and for that reason pack clothes for all types of weathers. Layering is key, that way you can add and remove layers depending on the weather. An absolute essential is a lightweight raincoat for those unexpected downpours.

Footwear

If you are an adventurous traveller, you will find your normal running trainers might not be enough for the unexpected weather and puddles! We’d recommend investing in some hiking boots, these will come in handy for those out of city days and will make sure your feet stay nice and dry.

Guinness

No trip to Dublin is complete without a trip to the Guinness Brewery. This is a must do!
Believe it when people say the Guinness tastes different in Ireland, it definitely does. Just a tip – Save yourself from the huge queues and book your ticket online. Be ready to drink – your tour comes with a free taster at the end!

Natural Beauty

The city can be all-encompassing but make time to visit the landscapes and explore the natural beauty of the beautiful Irish cliffs. One of the natural wonders to visit would be the Giant’s Causeway. Breathtaking scenery!
You might find it easier to do this by renting a car, remember to bring a credit card and your passport. It can be very cheap, and lets you see all the best stops in your own time.

Locals know best

It is always handy if you know a local, they have all the insider knowledge and are able to steer you away from all the overpriced tourist traps and find something truly authentic. If like me, you don’t know a local, my advice is to ask around, you’re sure to find a friendly local who’ll share the history of Ireland with you in exchange for a pint of Guinness (or two!)

A bit of history

There are no shortages of bars and pubs in Dublin. A couple to definitely make sure you visit would be The Brazen Head and The Temple Bar.
The Brazen Head is Ireland’s oldest pub, the present building was built in 1754 as a coaching inn. However, it appears in documents as far back as 1653.

The temple bar is very loud and very busy, so not to everyone’s liking but if that is your scene then you won’t be disappointed. Many famous Irish legends have taken to their stage and entertain large crowds with their iconic songs and ballads throughout the years. Definitely sink an Irish whisky here!

Book your travel appointment today

By Laura Berry |  Flu Project Coordinator | September 2018

Travel Tips Thursday: Madagascar

19.08.2018 Category: Travel Health Author: Anna Chapman

Madagascar

Madagascar is a large country off the south east coast of Africa. It is well known for its rainforests, hiking and diving, beaches and reefs.

Make sure you are aware of what you need, such as visas, vaccines and other medical requirements.

Check your flight route

You may need a Yellow Fever certificate. Whilst most flights involve a change of plane in Paris, some flights route via Nairobi, Kenya. If you have a long lay over in Nairobi you will be required to provide on entry to Madagasgar, a valid Yellow Fever certificate.

Don’t risk rabies

Rabies is a virus found in mammals and is fatal if not treated promptly. Treating rabies can be difficult in Madagascar, but is made much simpler for those who receive rabies vaccinations prior to travel. If the focus of your trip is the mammals of Madagascar, rabies vaccinations pre-trip is strongly recommended.

Banish the bites

Make sure you wear plenty of insect repellent whilst away as Madagascar has several diseases that can be spread via the bite of a mosquito or fly. Insect repellent should contain at least 50% DEET. Anti-malarial medication is always advised for Madagascar. Protect yourself from mosquitos with our Ultimate Bug Kits.

Travel with Insurance

Ensure you take out comprehensive travel insurance before you go to Madagascar, and ensure that it covers you any activities you may have planned (such as scuba diving).

FLEET STREET TRAVEL CLINIC

Book your travel appointment today

By Anna Chapman |  Travel Nurse | August 2018

Could your flight be making you ill?

19.06.2018 Category: Travel Health Author: Dr Richard Dawood

How to avoid getting ill on flights – The Telegraph

How many times have you come down with an illness after taking a flight? Are you concerned about germs when flying? If so, you may (or may not!) want to read the findings of a study showing how infections spread on planes.

The Telegraph reported the study with advice from Fleet Street Clinic’s medical director, Dr Richard Dawood.

Essentially, where you sit in relation to sick passengers and cabin crew will determine your chances of catching an infection.

The study shows:

  • Passengers sitting nearest the aisle are most likely to catch an infection from an ill cabin crew member.
  • For the best chance of protecting yourself from cabin crew bugs, sit in the window seat.
  • Sick passengers pose less risk, although if you are sitting very close to an infected passenger then watch out, as you are at high risk of catching their illness.

It’s not all bad for passengers though, as cabin crew were reported more likely to infect one another than passengers. To avoid catching anything, make sure you wash their hands and avoid touching your face throughout the flight. If you feel ill yourself, make sure you keep your hands clean, avert your face when you cough and turn on the air to reduce the spread of bugs.

Dr Richard Dawood said airlines should not allow anyone to travel who was obviously ill.

“It’s a contravention of airline regulations for someone who’s showing overt signs of infection to be allowed to travel in the first place,”

– he said.

He said the best way travellers could protect themselves was by asking someone to wear a face mask.

“The ideal thing to do would be to get the person who’s ill to wear a face mask. You could escalate it to captain level and say, here’s a person who’s a danger to other passengers and they should wear a face mask. However, you could end up with a pretty nasty incident if someone digs in their heels,”

– he said.

You can read the full article here.

For travel advice, you can book a travel consultation appointment here. Or you can learn more about our travel clinic.

WHAT REALLY HAPPENS DURING A MEDICAL EMERGENCY AT 35,000FT?

19.06.2018 Category: Travel Health Author: Dr Richard Dawood

Dr Richard Dawood, Medical Director of Fleet Street Clinic, was featured in an article published in The Telegraph:  Is there a doctor on board? What really happens during a medical emergency at 35,000 feet’.

The article discusses the issue of a medical emergency in the air, and Dr Dawood recounts some of his experiences where his medical expertise has been required during a flight.

Dr Richard Dawood Fleet Street Clinic The Telegraph
Dr Richard Dawood

 

Dr Dawood shares how he is happy to volunteer if a doctor is required, and details his experience of caring for a cabin crew member after she was taken ill during an 11 hour flight to Toyko.  As an eminent Travel Medicine specialist, Dr Dawood is accustomed to helping with all kinds of travel-related health issues both pre and post travel, and as the article demonstrates, sometimes during travel as well!

As founder of Fleet Street Clinic, Dr Dawood has developed a multidisciplinary medical practice with a strong focus on Travel Medicine. If you require a travel appointment, you can book online.

Travel Consultations - Why So Important?

19.06.2018 Category: Travel Health Author: Anna Chapman

Anna Chapman, one of our experienced Travel Nurses, gives her top 5 reasons why having a travel consultation is so important … food for thought if you’re planning a trip abroad.

1 – Reputable advice from a trusted source

Clinics that specialise in travel have practitioners who have completed extra qualifications in travel medicine, such as a Diploma in Travel Medicine, Diploma in Tropical Medicine and Certificate of Travel Health.  These qualifications ensure the practitioner gets specialist knowledge that is kept up-to-date by attending conferences and participating in research in the field.  Many practitioners who work in travel medicine have experienced health care abroad, through extensive personal travel or through working or volunteering.  This means the travel advice that a patient receives is always current and accurate.

Our travel nurses at the Fleet Street Clinic have a Diploma in Tropical Nursing and a Certificate in Travel Health and both GPs have a Diploma in Travel Medicine and a Certificate in Travel Health.  All the practitioners in our Travel Clinic have travelled extensively and practiced their profession in developing countries.  This means they are more aware of the risks that travellers face and have a greater understanding of how to deal with health issues on the road.

2 – Personalised travel consultation

No two people are the same and no two travel itineraries are the same.  Travel consultations take this into account and give detailed and bespoke travel advice, not only for the itinerary but also for the individual.  Seeing a practitioner face-to-face means that personal risks can be evaluated to ensure all travel health needs are met, rather taking a “one size fits all” approach.

3 – Travel health is NOT just about travel vaccinations

Whilst vaccinations are important, there are many aspects to staying healthy while abroad.  In addition to vaccinations, there are considerations such as avoiding insect bites, use of medical kits, coping with jet lag, use of stand-by medications and coping with altitude sickness – all things that can be discussed when you have a travel consultation

4 – On-going care

Just because you have had your vaccinations before your trip, it doesn’t mean that your care ends when you leave the clinic. Specialist clinics can provide on-going care for subsequent trips and/or post-travel health concerns

5 – Time to talk

When a clinic has a specialist travel service, ample time is allocated to each appointment.  Having a team of dedicated staff committed to travel medicine means that appointments can be completely flexible and can accommodate individuals, groups or families, both at the clinic or off-site, as well as offering appointments for last minute travellers.

You can book a travel health consultation online.  Or see here, or more information about our travel health services.

Yellow Fever Advice - New Video!

19.05.2018 Category: Travel Health Author: Dr Richard Dawood

Dr Richard Dawood, our Medical Director and Travel Medicine specialist answers frequently asked questions about Yellow Fever and the Yellow Fever vaccine in our new video.

You can book a Yellow Fever vaccination appointment online.

Dengue Fever Advice from our Travel Clinic

19.05.2018 Category: News Author: Anna Chapman

The popular Thai tourist resorts of Krabi and Phuket are reporting high incidences of dengue fever this year.

Since January 2015 over 400 cases of dengue fever have been reported, resulting in one fatality.

Cases of dengue fever also soared in Malaysia with over 40,000 reported cases this year.  It is estimated between 6-10 cases of dengue are diagnosed each day – double the rate of last year.  The most dramatic increases have been seen in Penang,  Johor and the state of Selangor.

Dengue Fever Advice for Travellers

Unfortunately, there is no vaccine or medication that can prevent dengue.  The only way to reduce the risk is to prevent mosquito bites, particularly during daylight hours.

If you are off on an Asian adventure this summer, follow these simple steps to reduce the risk of dengue fever:

  • 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

Our Ultimate Bug Kit contains everything you need to help keep mosquitos at bay and is available to purchase online.

Fleet Street Clinic

For more information on Dengue or any other travel-related topic, you can book travel consultation appointment online.

World Malaria Day

25.04.2018 Category: News Author: Anna Chapman

World Malaria Day

Reaching the zero Malaria target

World Malaria Day takes place on 25th April each year, highlighting the global efforts to control malaria and celebrate the gains that have been made. Since 2000, the world has made historic progress against malaria, saving millions of lives. However, half the world still lives at risk from this preventable, treatable disease, which costs a child’s life every two minutes.
The heartbreaking truth is that malaria is a preventable and treatable disease.
In Western countries, nearly all malaria is caused by travelling, which is why it’s important to be prepared before you visit an area at risk of malaria. On World Malaria Day,  April 25th, the World Health Organisation has called for a focus on uniting the world to beat the disease once and for all.

How You can Prevent Malaria

Together with diagnosis and treatment, in areas where malaria is rife, WHO recommends:

  • Using antimalarial medication
  • Spraying indoor walls and your clothing with insecticides
  • Using insecticide-treated nets and window screens
  • Wear light-coloured, long sleeve clothing
  • Get rid of any stagnant water

Since 2017, the World Health Organization has supported a group of 21 malaria-eliminating countries through a special initiative called the “E-2020”. This report charts their progress towards a common goal: eliminating malaria within the 2020 timeline. According to this report, 8 E-2020 member countries reported zero indigenous cases of malaria in 2020, a remarkable achievement in view of the ongoing global COVID-19 pandemic. Maintaining zero cases is a testament to their commitment to protect hard-won gains and keep the disease at bay. You can find more on this report here.

More Information

Read more about malaria and how to you can prevent it.

For further information and a consultation with an experienced member of our travel team, you can book an appointment online here.

Top 10 Travel Health Tips for the 2016 Olympic and Paralympic Games in Rio de Janeiro

19.05.2016 Category: Travel Health Author: Anna Chapman

Will you be traveling to Rio de Janeiro to attend or work on the Rio 2016 Olympics and Paralympics games?  It is a common phenomenon for people to focus heavily on attending or working at the Olympics – then having to spend much of their time seeking medical care, having to leave early, or even be hospitalised, for a problem that should have been resolved prior to travel.

Take a moment to review our travel health checklist for Rio 2016 to help keep you enjoying your time at the games!

Before you go:

>>Come and see us four weeks before you depart – don’t forget to bring along a record of any past vaccines you have received.

1.    Vaccinations

Routine vaccines should be up to date.

  • Diphtheria/Tetanus/Polio (within past 10 years)
  • MMR
  • Possibly pneumococcal vaccine for adults aged over 65
  • Chickenpox (varicella) – CDC recommended as these are routine immunisations is USA
  • Whooping Cough (Pertussis) – CDC recommended as these are routine immunisations is USA

Travel vaccines: The following travel vaccines may also be recommended for your trip:

  • Hepatitis A
  • Typhoid
  • Hepatitis B –
  • Yellow fever (certificate NOT required for entry – may be required by other countries for onward travel)
  • Rabies
  • Flu (Southern hemisphere strains – ask us for details)

While you are there:

2.    Insect-borne diseases

Dengue, chikungunya and Zika are mosquito-borne virus infections that cause rash, fever, joint and muscle aches, and eye pain or conjunctivitis.

Malaria

Rio de Janeiro is malaria-free, with no risk of yellow fever at present.

If you will be travelling to the Amazon basin or other places in South America that have a risk of malaria, you may need to take preventive medication.

Preventing insect-borne diseases

Vaccination gives long term protection against yellow fever and malaria medication is an important precaution if you are at risk.

Bite avoidance is the best available approach.

Preventing bites

Reduce your risk of dengue, chikungunya, Zika, yellow fever and malaria by doing all you can to reduce the numbers of bites. Disease-carrying mosquitoes bite during the day as well as in the evening and at night:

  • Cover up
  • Using plenty of DEET-containing insect repellent
  • Wear clothing impregnated with permethrin when working in the open
  • Using mosquito nets or plug-in killers in your room at night
  • Using our Ultimate Bug Kit.

3.    Food and water safety

Gastro-intestinal illness is by far the most likely problem that visitors to the Olympics will encounter. On a recent 8-week stadium tour of South America, up to 40% of tour members experienced travellers’ diarrhoea. Hot, crowded conditions and a “mass gathering” environment add to the risk: it is very important to take extra care with food hygiene.

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.

 

4.    Sun and heat exposure

  • Cover up & wear a hat
  • Good quality sunglasses
  • Stay well hydrated – even more important should you become ill with travellers’ diarrhoea.
  • Use plenty of high SPF sunscreen (Apply insect repellent after sunscreen; reapply both regularly).

5.    Sexually transmitted infection

There are very high rates of sexually transmitted infections, blood-borne infections, and HIV. Avoid putting yourself at risk, or travel with appropriate barrier contraception.

6.    Personal security and safety

This has been a real problem in Rio in the past, and in other parts of Brazil: be alert to the risks. According to the FCO, “Crime levels are high. Violence and crime can occur anywhere and often involve firearms or other weapons. You should be vigilant, particularly before and during the festive and carnival periods.” Visiting favelas is not advisable.

Rape and other sexual offences against tourists are rare, but there have been attacks against both men and women. Some have involved ‘date rape’ drugs. Buy your own drinks and keep them within sight at all times.

Brazil has a high road traffic accident rate and a zero tolerance policy on drink driving. Always wear seatbelts.

7.    Medical kit

Pack a travel medical kit. Include all prescription and over-the-counter medicines you rely on using at home – medicines you take only occasionally as well as regularly (most medicines are easily available in Brazil but are packaged in Portuguese with much scope for confusion). Take first aid items. Include medicines for travellers’ diarrhoea (oral rehydration solution,nausea medication, loperamide, antibiotics). Take insect repellent, plug-in mosquito killers, and permethrin. Consult us for further advice, or to provide bespoke supplies. See more about our kits here.

8.    Local medical care

Public hospitals provide free emergency care but are not recommended. English is not widely spoken, you may need an interpreter. Many private hospitals offer a very high standard of care.

Recommended hospitals:

  • Hospital Samaritano
  • Hospital Pro Cardiaco
  • Americas Medical City

The emergency ambulance number is 192.

There are no reciprocal health agreements in place so comprehensive travel insurance is essential. We recommend membership of the Blood Care Foundation, available at very low cost, to guarantee access to safe blood for transfusion.

9.    Getting there (and back): Flying and DVT

The direct flight time from London to Rio is approximately 12 hours: consider the risk of DVT, wear comfortable non-restricting clothing for the journey, keep well hydrated, stretch and move frequently, and don’t take sleeping pills or excessive alcohol if the journey will be spent in an upright, seated position. Consider wearing compression stockings. If you have any increased risk factors for DVT, talk to us about further steps that may be advisable.

Use our free calculator to see your DVT level of risk by clicking here.

After your return home

10. Post Travel Health

Report symptoms (e.g. fever, flu-like illness, rash, continuing diarrhoea) promptly, seek medical advice.

Don’t forget to mention your time in Brazil to anyone looking after you, if you need medical attention for any reason up to one year following return home.

If you need a pre-travel consultation, or have a health concern following a trip abroad, you can book an appointment online.

Further advice:

Centers for Disease Control & Prevention (US advice): http://wwwnc.cdc.gov/travel/notices/alert/2016-summer-olympics-rio

National Travel Health Network & Centre (NATHNAC) UK: http://travelhealthpro.org.uk/olympic-and-paralympic-games-2016-brazil/

Health Protection Scotland: http://www.fitfortravel.scot.nhs.uk/advice/general-travel-health-advice/rio-2016-olympicparalympic-games-brazil.aspx

European Centre for Disease Prevention and Control: http://ecdc.europa.eu/en/publications/Publications/Risk-assessment-mass%20gathering-Rio-2016-10May2016.pdf

Lancet Infectious Diseases: http://www.thelancet.com/journals/laninf/article/PIIS1473-3099(16)30069-X/fulltext

Blood Care Foundation: http://www.bloodcare.org.uk

Foreign & Commonwealth Office: https://www.gov.uk/foreign-travel-advice/brazil/safety-and-security