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
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.
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).
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.
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.
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
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227g of fruit juice, 1/2 tsp of corn syrup or honey, 50g of salt
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227g of purified water, 1/4 tsp of backing soda
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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.
1. Malaria chemoprophylaxis according to geographic area(updated annually by WHO)
According to consultation with doctor of travel medicine