Travelling

You have to abide with following principles during your travel:

only drinks in original package, preferably from countries with high hygienic level
or else only drinks from boiled or other chemically treated water
disuse ice cubes to drinks
only shelled fruits or which is possible wash by unexceptionable water
don´t eat raw vegetables
don´t eat ice cream and heat unworked meals
don´t consume raw meats, fishes, other sea animals and foods which were not freezed
don´t buy foods and water by street salesmen
avoid unknown surface waters (washing, bathing, swimming or only extremities dip)
don´t bath in the sea near canalization outfall
don´t go shoeless on beach and don´t lie down to sand by naked body
avoid contact with freely moving animals

Immunization

1. Routine immunizations

Routine immunizations include those vaccinations which are indicated for routine use in Czech Republic.

2. Required immunizations

Required immunizations include those vaccinations which may be required for legal entry into a country or teritorry:

· Yellow Fever immunization

· Meningococcal vaccination is required for pilgrims travelling to Mecca, Saudi Arabia

3. Recommended immunizations

For protection against certain diseases, depending on your client's itinerary, planned activities and current health status. One or more of the following immunizations may be recommended: Polio, Typhoid fever, Hepatitis A, Meningococcal, Japanese encephalitis, Cholera, Influenza, Rabies, Hepatitis B, Pneumococcal and Tick-borne encephalitis etc.

Acclimatization

1. Heat illness

Tips for prevention:

· Drink plenty of fluids, avoid excess alcohol and beverages containing caffeine.

· Add extra salts through diet.

· Ensure adequate rest.

· Avoid over-exertion.

2. Sunburn

Tips for prevention:

· Wear sunglasses, a hat and other protective clothing when possible.

· Avoid direct sunlight between 11-14 o'clock

· Use a sunscreen with a sun protection factor of 15 or greater with frequent application. A high factor is recommended for children, 6 months of age or older.

· Avoid direct sunlight between 11-14 o'clock.

· Apply sunscreen 30 minutes before going out and reapply after swimming or excessive sweating.

· A sunscreen with a UVA blocker should be recommended for those taking tetracycline (doxycycline).

· Consider potential adverse interactions of sun with medications which travellers may be taking.

3. Skin fungus, prickly head

Tips for prevention:

· Frequent bathing.

· Ensure through skin drying.

· Wear loose fitting, light-coloured, cotton clothing.

4. Altitude sickness

Altitude sickness is caused from rapid ascent to altitudes over 3000m above sea level.

Tips for prevention:

· Make a gradual ascent by taking a one or two day break at an intermediate altitude.

· Drink extra fluids.

· Avoid alcohol, sedatives, aspirine, codeine.

· Under specific circumstances consider this preventative medication:

Acetazolamide (Diamox 250mg tbl.): 250mg every 8-12 hrs., beginnig 1-2 days before ascent and continuing at altitude for 48 hrs.

5. Motion sickness

Tips for prevention:

· In a car, the best place to be is the drivers seat; second best is a front window seat.

· On a bus, seat near the front by a window, preferably one that open.

· On a plane, the seats over the wings or wheels are the most stable.

· On a boat, try to get a mid-ship cabin close to the waterline.

· Medications for preventing motion sickness:

Dimenhydrinate (Travel-Gum 10, 20 tbl.), adult dosage: 50-100mg every 4 hrs., beginning 30 minutes before departure. children's dosage: 6-8 years: 15-25mg 2-3 times daily, 8-12years: 25-50mg 2-3 times daily, 12 years or more: 50mg 2-3 times daily.

Combinated medicament: Kinedryl tbl. (moxastini teoclas 25mg, coffeinum anhydricum 35mg). Adult dosage: 1/2-1 tbl. every 2-3 hrs. depending on need. Children's dosage: 2-6 years: 1/4 tbl., 6-15 years: 1/4-1/2 tbl. every 2-3 hrs.

Insect pracautions

Repellents

· Natural repellents

Eucalyptus maculata citriodon (Eucalyptus essential oil from leafs of White ash) repulsive mosquitos.

Extract of Peppermint-Mentha haplocalyx

Fluid extract of Basil-Ocimum sp.

· Synthetic repellents

Slow evaporation and small skin absorbtion.

For skin usage: diethylamides of benzoon acid-Diethylbenzamid

Diethylamides of metamethylbenzoon acid-Diethyltoluamide

· The higher the percentage of Diethyltoluamide, the greater the duration of action: 30% 4-6 hrs. protection, 90% 8-10 hrs. protection.

· Products with a concentration of 35% or more should be used sparingly on children.

· Reapplication may be necessary after swimming or excessive sweating (this is not required for Ultrathon and FiteBite 6 hour repellents).

Water treatment

1. Recommended precautions

· Consume only canned or commercially bottled "carbonated" beverages.

· Ensure ice cubes are made from purified water.

· Filtration alone is not recommended.

· Water for brushing teeth should be purified. If purified water is not available, tap water which is too hot to the touch should be used.

2. Purification methods

· Boiling - bringing water to a boil is sufficient.

· Chemical treatment: a) 2% tincture of iodine can be added to purify water as follows: clear water source = 5 drops/l, cloudy water source = 10 drops/l. b) chemically treated water should stand for 30 minutes after treatment prior to consumption.

· Portable water purifiers.

3. Don't swim in fresh water

Tips for prevention:

· Do not swim, wade or walk in slow moving fresh water lakes, rivers or streams where schistosomiasis is known to occur.

· If fresh water contact is unavoidable, dry off quickly to prevent the parasite from penetrating the skin.

· If you must swim in a lake, use the deepest area and avoid the edges where snails are likely to breed.

· Infested water which is allowed to stand (e.g. in a barrel) for 48 hrs., loses its infectivity and may be safely used for bathing.

Swim in the ocean or chlorinated pools.

Food hygiene

1. Food consumption tips

· Do not leftovers, food from street vendors, or unpasteurized dairy products.

· Avoid cold cuts, salads, watermelon and puddings.

· Never eat raw shellfish.

· Do not eat canned food if the tin appears "blown" or "swollen".

· Ensure that all food is well cooked - especially meet and seafood.

· Ensure that food is served hot since bacteria grow quickly as food cools.

· Do not let heated food stand and cool before eating.

2.T ips for eating fresh fruits and vegetables

· Eat only fruits and vegetables that you wash and peel yourself.

Cook or bake fruit and vegetables that can not be peeled or washed.

Traveller's diarrhea

1. Tips for self-treating travellers' diarrhea.

Drink plenty of fluids, containing some sugar, to prevent dehydration.
Drink clear broth or eat salted crackers to compensate for loss of salt.
Avoid milk products.
Use an oral rehydration method: a) WHO electrolyte/glucose mixture, b) Gastrolyte sachets (commercially prepared), c) Do-it-yourself rehydration technique

Glass #1

Glass #2

227g of fruit juice, 1/2 tsp of corn syrup or honey, 50g of salt

227g of purified water, 1/4 tsp of backing soda

2. Preventing travellers' diarrhea in short term travellers.

(less than 3 weeks in duration, Quinolone antibiotics are the drugs of choice)

Medications	Dose	% Protection
Ciprofloxacin (Ciprinol, Cifloxinal, Ciprobay)	500mg daily	90
Norfloxacin (Nolicin)	400mg daily	88
Trimethoprim (Triprim)	200mg daily	52-59
Co-trimoxazole (Biseptol)	adults: 1 dose 2 tbl. daily, children: 15-30mg/kg/day	73-95
Ofloxacin (Tarivid, Ofloxin)	200mg	uknown

* Antibiotics should be taken during exposure and for 2 days afterwards.

3. Treatment options for travellers' diarrhea.

Standard therapies	Dose
Ciprofloxacin 500mg	2x daily 3-5 days
Ofloxacin 200mg	2x daily 3-5 days
Norfloxacin 400mg	2x daily 3-5 days
Trimethoprim 200mg	2x daily 3-5 days
Doxycycline (Deoxymykoin, Doxybene, Doxyhexal, Doxycyclin)	200mg daily
Rifaximin (Normix) 200mg	4x daily 3-5 days
Azithromycin (Sumamed) 500mg	1x daily 3-6 days

Single dose antibiotic therapies	Dose
Ciprofloxacin	500mg - 1gram
Norfloxacin	800mg
Co-trimoxazole	3 tablets
Azithromycin	500mg - 1gram
Rifaximin	400mg

Antiperistaltic treatment therapies	Dose
Loperamide HCl (Imodium,Loperon,Imodium plus)	4mg initially, 2mg after each loose (not to exceed 16mg)
Diphenoxylate HCl (Reasec)	5mg initially, 3-4x daily children: 300-400ug/kg/day
* Antimotility agens alone should not be used with those with high fever and/or bloody diarrhea.

Degree of diarrhea

Drug regimen

mild

Loperamide, Diphenoxylate

Diosmectitum (Smecta plv.) enteric absorbent, 2-3x daily sachet

Nifuroxazid (Ercefuryl cps.) bacteriostatic chemotherapeutics,
3-4x 1 tbl. daily.

modrerate/severe:
fever of bloody stool

Ciprofloxacin, Ofloxacin, Norfloxacin Cotrimoxazole, Trimethoprim, Rifaximin

* Recent studies suggest that the combination of an antibiotic with an antimotility agent is more effective than either used alone.

Malaria

1. Malaria chemoprophylaxis according to geographic area(updated annually by WHO)

According to consultation with doctor of travel medicine