Travel health

 

Medical advice for travellers abroad

Areas to be discussed
Risks from contaminated food and water
Vaccination against hepatitis A, typhoid, polio and/or cholera
Handwashing
Food hygeine
Milk and Dairy
Drinking Water
Treating/managing travellers’ diarrhoea
Swimming Hazards
Insect bites avoidance
Malaria chemoprophylaxis and treatment
Other insect-borne disease dengue fever, Japanese encephalitis, tick borne encephalitis
yellow fever
Sun Safety
Accidents, animal bites and insurance
Environmental hazards
Diseases of close association
Sexually transmitted diseases

EHIC

European Health Insurance Card (EHIC)

Travel Vaccination Tables

 

Travel vaccinations available on the NHS

Which travel vaccinations are free? NHS Choices

The situation with regard to travel vaccines and what can and cannot be charged for has not altered from the old to the new GMS contract.

Under the Red Book a limited number of travel vaccines were provided on the NHS for public health reasons. The public health agenda has not altered with the new contract and therefore those travel vaccines that were provided by practices on the NHS under the old contract shall continue to be provided by them.
The only exception shall be for those practices that opt out of the additional vaccinations and immunisations service and they will have their global sum abated by 2%. Practices opting out of the additional service will not be able to charge or provide travel vaccines which are available on the NHS for their registered patients.

Supply should normally be via FP10 (normal prescription charges apply), but some practices may wish to use FP10A.
Vaccines should be administered free of charge to patients.
Patients receiving vaccines on FP10A should not be charged for either the vaccine or administration.
Polio, tetanus and all childhood immunisations should be up to date.

Typhoid, Hepatitis A, Diphtheria, Cholera and Polio vaccines
(See fitfortravel.nhs.uk or travax.nhs.uk for specific country details)
Typhoid and Hepatitis A vaccine are often advised for persons travelling outside the UK except to Canada, USA, Australia, New Zealand, Japan and much of Europe. Poliomyelitis and Diphtheria vaccines (in addition to the normal childhood primary course) are usually advised for the Indian subcontinent and Africa and a few other areas Combined Diphtheria/Tetanus/Polio (Td/IPV) vaccine should be provided for those requiring diphtheria and /or tetanus and/or Polio vaccination.
The new ‘oral’ Cholera vaccine may be supplied on the NHS. It should be given only to those travelling to work for extended periods in situations with poor hygiene e.g. voluntary work in disaster areas.

Private Supply
The following vaccines were not previously in the “Red Book” for travel purposes. A private script can be issued and GPs may charge for both script and administration at their discretion. Since no vaccine is blacklisted, supply can be made on the NHS if the GP feels that the patient genuinely cannot or will not pay for the script or service. If supplied on FP10 or FP10A, no charge can be made except the usual prescription charge at the pharmacy. A fee cannot be charged for advice alone.
Practices opting out of the additional service will not be able to charge or provide travel vaccines which are available on the NHS for their registered patients.
Hepatitis B (Some exceptions – see the Green Book)
Meningococcal meningitis (inc ACWY)
Rabies (Some exceptions – see the Green Book)
Japanese encephalitis
Tick borne encephalitis
Yellow fever

BMA advice Nov 2011

The GPC has published Focus on travel immunisations, to explain which travel immunisations are available on the NHS and which can be charged for privately. The Red Book regulations were written to cover the immunisations available at that time and consequently do not reflect today’s clinical practice, and the subsequent new GMS contract (2004) took those regulations and carried them into the new contract as an additional service. Consequently everything in the Red Book was transferred unchanged and included in the global sum of payments rather than the previous item of service system.
The change in availability of immunisations and the nature of foreign travel has made these regulations difficult to interpret, and confusion over how they apply to current practice. This document reflects the present situation and is intended to help practices by clarifying the existing regulations as they currently stand

 

Travel vaccinations available on the NHS

Which travel vaccinations are free? NHS Choices

The situation with regard to travel vaccines and what can and cannot be charged for has not altered from the old to the new GMS contract.

Under the Red Book a limited number of travel vaccines were provided on the NHS for public health reasons. The public health agenda has not altered with the new contract and therefore those travel vaccines that were provided by practices on the NHS under the old contract shall continue to be provided by them.
The only exception shall be for those practices that opt out of the additional vaccinations and immunisations service and they will have their global sum abated by 2%. Practices opting out of the additional service will not be able to charge or provide travel vaccines which are available on the NHS for their registered patients.

Supply should normally be via FP10 (normal prescription charges apply), but some practices may wish to use FP10A.
Vaccines should be administered free of charge to patients.
Patients receiving vaccines on FP10A should not be charged for either the vaccine or administration.
Polio, tetanus and all childhood immunisations should be up to date.

Typhoid, Hepatitis A, Diphtheria, Cholera and Polio vaccines
(See fitfortravel.nhs.uk or travax.nhs.uk for specific country details)
Typhoid and Hepatitis A vaccine are often advised for persons travelling outside the UK except to Canada, USA, Australia, New Zealand, Japan and much of Europe. Poliomyelitis and Diphtheria vaccines (in addition to the normal childhood primary course) are usually advised for the Indian subcontinent and Africa and a few other areas Combined Diphtheria/Tetanus/Polio (Td/IPV) vaccine should be provided for those requiring diphtheria and /or tetanus and/or Polio vaccination.
The new ‘oral’ Cholera vaccine may be supplied on the NHS. It should be given only to those travelling to work for extended periods in situations with poor hygiene e.g. voluntary work in disaster areas.

Private Supply
The following vaccines were not previously in the “Red Book” for travel purposes. A private script can be issued and GPs may charge for both script and administration at their discretion. Since no vaccine is blacklisted, supply can be made on the NHS if the GP feels that the patient genuinely cannot or will not pay for the script or service. If supplied on FP10 or FP10A, no charge can be made except the usual prescription charge at the pharmacy. A fee cannot be charged for advice alone.
Practices opting out of the additional service will not be able to charge or provide travel vaccines which are available on the NHS for their registered patients.
Hepatitis B (Some exceptions – see the Green Book)
Meningococcal meningitis (inc ACWY)
Rabies (Some exceptions – see the Green Book)
Japanese encephalitis
Tick borne encephalitis
Yellow fever

BMA advice Nov 2011
The GPC has published Focus on travel immunisations, to explain which travel immunisations are available on the NHS and which can be charged for privately. The Red Book regulations were written to cover the immunisations available at that time and consequently do not reflect today’s clinical practice, and the subsequent new GMS contract (2004) took those regulations and carried them into the new contract as an additional service. Consequently everything in the Red Book was transferred unchanged and included in the global sum of payments rather than the previous item of service system.
The change in availability of immunisations and the nature of foreign travel has made these regulations difficult to interpret, and confusion over how they apply to current practice. This document reflects the present situation and is intended to help practices by clarifying the existing regulations as they currently stand

 

Taking controlled drugs abroad

http://hacking-medschool.com/taking-controlled-drugs-abroad

Prescribed drugs listed in Schedule 4 Part II (CD Anab) and Schedule 5 of the Misuse of Drugs Regulations 2001 are not subject to export or import licensing.

However, patients intending to travel abroad for more than 3 months carrying any amount of drugs listed in Schedules 2, 3, or 4 Part I (CD Benz) will require a personal export/import licence.

Further details can be obtained from the Home Office website by contacting 020 7035 0467

Applications must be supported by a covering letter from the prescriber and should give details of:
the patient’s name and address;
the quantities of drugs to be carried;
the strength and form in which the drugs will be dispensed;
the country or countries of destination;
the dates of travel to and from the United Kingdom.

Applications for licences should be sent to the Home Office, Drugs Licensing, Peel Building, 2 Marsham Street, London, SW1P 4DF.
Alternatively, completed application forms can be emailed to licensing_enquiry.aadu@homeoffice.gsLgov.uk with a scanned copy of the covering letter from the prescriber.
A minimum of two weeks should be allowed for processing the application.

Patients travelling for less than 3 months do not require a personal export import licence for carrying Controlled Drugs, but are advised to carry a letter from the prescribing doctor.

Those travelling for more than 3 months are advised to make arrangements to have their medication prescribed by a practitioner in the country they are visiting.

Doctors who want to take Controlled Drugs abroad while accompanying patients may similarly be issued with licences.
Licences are not normally issued to doctors who want to take Controlled Drugs abroad solely in case a family emergency should arise.

Personal export/import licences do not have any legal status outside the UK and are issued only to comply with the Misuse of Drugs Act and to facilitate passage through UK Customs and Excise control.

For clearance in the country to be visited it is necessary to approach that country’s consulate in the uk

 

Typhoid and paratyphoid (travel)

 

Cholera (travel)

 

Hepatitis A (travel)

 

Hepatits B and travel

 

Yellow fever (travel)

 

Polio (travel)

 

Rabies (travel)

 

Japanese Encephalitis (travel)

 

Tick borne encephalitis (travel)

 

More exotic and tropical Diseases

250textbooks/exotic-disease

Viral Haemorhagic Fevers
Viral Haemorhagic Fevers Visual Dx

Mosquito Borne Viral Diseases
Mosquito Borne Viral Diseases CDC

Dengue
Dengue NaTHNaC

Chagas
youtu.be/JtLWRB0X8Gs

Ross River Virus Infection
youtu.be/uZ_c65bUxFA

Schistosomiasis
Schistosomiasis BMJ May 2011

Schistosomiasis factsheet NaTHNaC

Ciguatera
Ciguatera medscape

youtu.be/k_Y0TpVrGsc

 

Malaria (travel)

 

Malaria chemoprophylaxis

Malaria Chemoprophylaxis factsheet NaTHNaC

Health Protection Agency Advisory Committee on Malaria Prevention for UK Travellers
The ACMP prophylaxis guidelines are intended for UK-based visitors to malaria endemic areas and may not be appropriate for use by those residing in endemic areas
Whilst these guidelines deal with malaria, malaria prevention is only one aspect of pre-travel advice. An overall risk assessment-based package of travel health advice should be provided

ABCD of malaria prevention:
Awareness of risk
Bites prevention
Chemoprophylaxis
prompt Diagnosis and treatment

Emphasise that while no regimen is 100% effective, the combination of preventive measures advised will give significant protection against malaria

Chemoprophylaxis
In the 2007 guidelines, the recommendation for chemoprophylaxis has been removed for some Northern and Southern states of India, and for Central and Southern Sri Lanka. It is still important to emphasise the need for bite prevention, and remember the small risk of malaria if fever occurs after visiting these areas
Given the possibility of antimalarials purchased in the tropics being fake, travellers should obtain the medication required for their chemoprophylaxis from a reputable source in the UK before they travel. ACMP also advises against purchasing antimalarial drugs over the internet

Emergency standby treatment
for those taking chemoprophylaxis and visiting remote areas where they are unlikely to be within 24 hours of medical attention
It is intended for those travellers who believe that they may have malaria and is not a replacement for chemoprophylaxis.
It is particularly important that the individual traveller is sufficiently well briefed to be able to use standby emergency treatment appropriately, so written instructions for its use are required, not least because studies from outside the UK have reported standby treatment often being used inappropriately
Standby emergency treatment should be started if it is impossible to consult a doctor and/or reach a diagnosis within 24 hours of the onset of fever
Medical attention should be sought as soon as possible for full assessment and to exclude other serious causes of fever. This is particularly important as many illnesses other than malaria may present with fever
The traveller should complete the standby treatment course and recommence their antimalarial chemoprophylaxis 1 week after taking the first treatment dose, except in the case of mefloquine prophylaxis, which should be resumed 1 week after the last treatment dose if quinine was used for standby treatment. Antipyretics should be used to treat fever. A second full treatment dose of the antimalarial should be taken if vomiting occurs within 30 minutes of taking it (half-dose if vomiting occurs after 30–60 minutes)
The agent used for emergency standby treatment should be different from the drugs used for chemoprophylaxis, both to minimise drug toxicity and due to concerns over drug resistance
Individuals for whom emergency standby treatment is advised must be provided with written instructions for its use. In particular, they must be informed about symptoms suggesting possible malaria, including fever of 38°C and above, indications for starting the standby treatment, how to take it, expected side-effects and the possibility of drug failure

Diagnosis
Suspected malaria is a medical emergency
Consider malaria in every ill patient who has returned from the tropics in the previous year, especially in the previous three months
Fever on return from the tropics should be considered to be malaria until proven otherwise
Malaria cannot be diagnosed with certainty by clinical criteria alone. Suspected cases should be investigated by obtaining a blood film diagnosis as a matter of urgency. There is no need to wait for fever spikes before taking blood; this only delays diagnosis and the fever pattern seldom conforms to text book periodicity, especially in the case of Plasmodium falciparum

Resources for treatment advice

Notification
Malaria is a statutorily notifiable disease. The clinician caring for the patient must complete a notification form
The Malaria Reference Laboratory reporting form malaria-reference.co.uk should also be completed and should be sent to the MRL separately or along with referred specimens

Special groups (medical conditions)
Smoking cessation

Chloroquine or mefloquine should not be used in those taking bupropion hydrochloride SR as the chances of seizure may be increased
Pregnancy
Pregnant women are advised to avoid travel to malarious areas. In the event that travel is unavoidable, the pregnant traveller must be informed of the risks which malaria presents and the risks and benefits of antimalarial chemoprophylaxis
Pregnant women have an increased risk of developing severe malaria and a higher risk of fatality compared to non-pregnant women
Diagnosis of falciparum malaria in pregnancy can be particularly difficult as parasites may not be detectable in blood films due to sequestration in the placenta
Expert advice is required at an early stage if malaria is suspected in a pregnant woman. Complications, including severe haemolytic anaemia, hypoglycaemia, jaundice, renal failure, hyperpyrexia and pulmonary oedema, may ensue. The result may be miscarriage, premature delivery, maternal and/or neonatal death
Congenital malaria is rare, but occurs more commonly with Plasmodium vivax than with the other malaria parasites of humans
Avoidance of mosquito bites is extremely important in pregnancy as pregnant women are particularly attractive to mosquitoes. Ideally, pregnant women should remain indoors between dusk and dawn. If they have to be outdoors at night they should adhere rigorously to bite precautions
DEET should be used in a concentration of not more than 50%. DEET has a good safety record in children but ingestion should be avoided. Nursing mothers should wash repellents off their hands and breast skin prior to handling infants
Chloroquine and proguanil: safe in all trimesters of pregnancy. Their major disadvantage is the relatively poor protection they give in many geographical areas due to the presence of drug-resistant P. falciparum. Pregnant women taking proguanil should receive supplementation with 5 mg folic acid daily
Mefloquine: caution advised
Doxycycline: contraindicated in pregnancy
Atovaquone/proguanil: lack of evidence on safety in pregnancy

Chemoprophylaxis prior to conception
If a female traveller is planning to conceive during a visit to a destination with a high risk of contracting chloroquine-resistant falciparum malaria, expert advice should be sought
Time to allow after finishing a course of an antimalarial before attempting to conceive:
mefloquine: 3 months
doxycycline: 1 week
atovaquone/proguanil: 2 weeks

BreastfeedingMefloquine: experience suggests safe to use during lactation
Doxycycline: contraindicated (do not use)
Atovaquone/proguanil: not recommended because of the absence of data however, can be used when breast-feeding if there is no suitable alternative antimalarial
Nursing mothers should be advised to take the usual adult dose of antimalarial appropriate for the country to be visited
The amount of medication in breast milk will not protect the infant from malaria. Therefore, the breastfeeding child needs his or her own prophylaxis, which for children of breastfeeding age will be either chloroquine plus proguanil or mefloquine. Atovaquone/proguanil may be used if the child weighs 11 kg or more

Anticoagulants
Travellers who take anticoagulants should ensure their INR is stable prior to departure
Patients on warfarin may have underlying cardiovascular disease and may be on cardiovascular medication. Interactions with other medication together with the individuals’ medical history should be taken into account when deciding on appropriate malaria chemoprophylaxis
Chloroquine: no interaction between warfarin and chloroquine documented in the BNF, although there is a caution in the SPC for nivaquine
Proguanil: an isolated report of an enhanced effect of warfarin when taken together with proguanil
Mefloquine: not considered to be a problem for those taking warfarin. The manufacturer states that ‘although no drug interaction is known with anticoagulants, effects of mefloquine on travellers should be checked before departure.’
Doxycycline: the anticoagulant effect of coumarins (including warfarin) is possibly enhanced by tetracyclines
Atovaquone/proguanil: unknown whether there are interactions between atovaquone/proguanil and warfarin, although there have been isolated reports of an enhanced effect of warfarin when taken together with proguanil (see above under proguanil)
Advice for travelers needing malaria chemoprophylaxis who are taking warfarin:
travellers should start taking their malaria tablets more than 1 week (and ideally 2–3 weeks in the case of mefloquine) prior to their departure
a baseline INR should be checked prior to starting chemoprophylaxis, and re-checked after 1 week of taking chemoprophylaxis
if a traveller is away for a long period of time the INR should be checked at intervals at the destination. (However, the sensitivity of thromboplastin reagent used by some laboratories in different countries may vary
once chemoprophylaxis has been completed, the INR should be checked again to re-stabilise anticoagulant therapy

Epilepsy
Proguanil alone (200 mg daily) is recommended for malarious areas without chloroquine resistance. For areas with a high risk of chloroquine-resistant malaria, such as sub-Saharan Africa, doxycycline or atovaquone/proguanil can be used
Chloroquine: unsuitable
Mefloquine: unsuitable
Doxycycline: half-life may be reduced by phenytoin, carbamazepine, and barbiturates, so in theory its dose should be increased for patients taking these drugs. However, there is currently no direct evidence that this is necessary

Glucose 6-phosphate dehydrogenase deficiency
Chloroquine: theoretical risk of haemolysis in some glucose 6-phosphate dehydrogenase (G6PD)-deficient individuals. Haemolysis does not appear to be a problem when chloroquine is given in the dose recommended for malaria chemoprophylaxis so there is no need to withhold chloroquine prophylaxis from those known to be G6PD-deficient. This risk is acceptable in acute malaria and G6PD levels are not usually checked before using chloroquine in treatment doses
Primaquine: not currently recommended as a first line agent for malaria prevention in UK travellers, but may be considered in special circumstances on expert advice. There is a definite risk of haemolysis in G6PD-deficient individuals. The traveller’s G6PD level must be checked before primaquine is prescribed: G6PD deficiency contraindicates its use for prophylaxis

Sickle cell disease
Presence of the sickle cell trait confers some protection against malaria, though individuals with the sickle cell trait still require antimalarial prophylaxis
For those with homozygous sickle-cell disease, malaria is regarded as a significant cause of morbidity and mortality, producing further haemolysis against the background of that due to sickle-cell disease itself. Therefore, it is essential that individuals with sickle-cell disease travelling to malaria-endemic areas receive rigorous antimalarial protection

Immunocompromised travellers
Risks for transplant patients:
a review on the prevention of infection in adult travellers after organ transplantation recommended that ciclosporin levels should be monitored if chloroquine is co-administered
Risks for those with HIV/AIDS:
all of the HIV protease inhibitors (PIs) in current use, as well as the nonnucleoside reverse transcriptase inhibitors (NNRTIs) delavirdine and efavirenz, interact with the same liver enzymes which metabolise most drugs used for malaria prophylaxis and treatment. This can result in altered metabolism of antimalarials or antiretrovirals, though the extent of this and the clinical significance is often unclear. The prescriber should check on an individual agent basis
the extra risk of increased severity if malaria is contracted by an HIV-infected traveller is unclear. Most reported studies have been done in those living in endemic areas where HIV infection increases the risks for contracting and developing severe malaria and increasing immunosuppression reduces treatment success although this varies by area
co-infected pregnant women are at risk from higher parasite density, anaemia and malarial infection of the placenta
children born to women with HIV and malaria infection have low birth weight and are more likely to die during infancy. It is unclear whether malaria during pregnancy increases the risk of mother-to-child transmission of HIV

Liver disease
Severe liver disease: all antimalarial drugs are contraindicated, with the possible exception of atovaquone plus proguanil
Moderate impairment: proguanil, or atovaquone plus proguanil or mefloquine may be used
Mild impairment: chloroquine, or proguanil, or chloroquine plus proguanil, or atovaquone plus proguanil or mefloquine may be used. Doxycycline should be used only with caution
The choice of chemoprophylaxis should be made after discussion with the patient’s specialist, who will be able to assess their degree of hepatic impairment. The Child-Pugh classification is often used for grading liver function and can be found at http://www.emea.europa.eu/pdfs/human/ewp/233902en.pdf

Renal impairment
Chloroquine: dose reduction for prophylaxis is required only in severe renal impairment
Proguanil: should be avoided or the dose reduced. Not to be used in patients receiving renal dialysis
Atovaquone/proguanil: not recommended for patients with a creatinine clearance of less than 30 ml/minute. Not to be used in patients receiving renal dialysis
Doxycycline or mefloquine may be used in severe renal failure. There is no need to reduce the dose of mefloquine in renal dialysis

Splenectomy
Those who have no spleen or whose splenic function is severely impaired are at particular risk of severe malaria and, where possible, should avoid travel to malarious areas
If travel is essential, every effort should be made to avoid infection by rigorous use of antimosquito precautions and strict adherence to appropriate chemoprophyaxis. If the traveller becomes unwell during or after their visit, medical attention is required as a matter of urgency, as malarial parasitaemia in asplenic individuals may rise rapidly to very high levels (e.g. greater than 50% with P. falciparum)

Acute porphyrias
Doxycycline is unsafe in porphyria so should not be used for antimalarial chemoprophylaxis in patients with acute porphyria

 

Fitness to fly

 

Venous thromboemblism (air travel)

On commercial flights, regardless of aircraft type, many passengers sit in smaller spaces than in the home environment and may have reduced opportunity to get up and walk about. The potential for the development of travellers’ thrombosis , particularly on long haul flights, should be borne in mind and the use of lower limb exercises may be of value in improving the venous return.

Cleveland Clinic Journal Medicine Feb 2011

 

Air travel in pregnancy

RCOG Air Travel and Pregnancy guidelines

 

Air Travel: hypoxic contraindications

Within 7-10 days of an acute MI for shorthaul flights and 14 days for longhaul flights
Within 3 days of acute CVA
Patients with uncontrolled cardiac failure within the past 3 weeks; even compensated cases of cardiac failure may decompensate ataltitude
Patients needing supplementary oxygen at sea level should be weaned off it before air travel; these patients will need to travel with supplementary oxygen (enough to provide a flow of 2 I/min) and may need to be accompanied by a medical professional
Patients who cannot walk for more than 50 metres on the flat without oxygen (although flying may be possible with supplementary oxygen)
Severely anaemic patients (Hb <7.5 gldl), particularly if of acute onset
Patients with sickle cell disease may have a crisis.

Physiology of flight GPCSG
Contrary to popular belief, modern aircraft are not pressurised to sea level equivalent, and fly with a cabin altitude between 5,000 and 8,000 feet. This results in reduced barometric pressure and a concomitant decrease in the partial pressure of alveolar oxygen (PaO2).
Few aircraft fly for any significant period of time at the upper limit of cabin altitude of 8,000 feet, where the barometric pressure is approximately 565 mm Hg with an alveolar partial pressure of O2 of approximately
75mm Hg. However, due to the shape of the oxyhaemoglobin dissociation curve (Figure 1), this only results in a fall of oxygen saturation to around 90%. This fall is well tolerated by most healthy travellers and is compensated by the normal physiologicalresponse.
However, this decrease in saturation needs to be taken into consideration for those with cardiac, pulmonary conditions or anaemia.
Contrary to what is believed by many, the aircraft cabin environment does not result in dehydration, as there is no evidence of any change in osmolality. However, the cabin has a low humidity, usually in the range of 10% to 20% compared to that in buildings, which is in the order of 40% to 50%.
This is particularly noticeable in the mucous membranes, especially if wearing contact lenses and also in the skin.

Cardiovascular disease
Hypobaric hypoxia, i.e. that due to a lowered oxygen pressure at altitude, is an area of concern for travellers with cardiovascular disease. The decrease in oxygen saturation may have implications for passengers with cardiac disease who wish to travel.
Patients compensate to an extent for this relative hypoxia by increasing their ventilation and by developing a mild tachycardia, which may result in increased myocardial oxygen demand.
In patients with limited cardiac reserve, the use of supplemental oxygen may be required and most commercial airlines will supply this when requested in advance although a charge maybe levied.

 

@@@ Air Travel: hypobaric contraindications

The decrease in ambient pressure in the cabin, compared to ground level, will cause any gas to expand and increase in volume by approximately 30%, which may cause problems if trapped in any body cavity, e.g. the ear, giving rise to pain and possible perforation of the ear drum.
Similar issues may occur following surgery, if gas is introduced to the abdominal cavity or the eye.

Recent craniotomy or air encephalogram
Recent chest, middle ear or abdominal surgery (within 10 days)
Recent gastrointestinal (GI) bleed
Pneumothorax without a chest drain occurring within 14 days of the flight
Acute otitis media
Acute bowel obstruction
Sinus haemorrhage
Penetrating eye injury
Deep sea diving less than 48 hours before flying; this can produce the ‘bends’
Patients who have just been fitted with a plaster cast (within 24 hours for shorthaul flights and 48 hours for a longhaul flight).

 

Diabetes Travel

Jet lag, or circadian dysrhythmia, in addition to being an annoyance for healthy travellers may complicate the timing of medication, e.g. in diabetic passengers who are treated with insulin.

Things to check out before you go Diabetes UK

 

Good samaritan acts (air travel)

hacking-medschool/good-samaritan-acts

 

Jet Lag

 

Diving Medicine

UK Sport Diving Medical Committee

 

Travellers’ diarrhoea

 

Motion sickness

 

Altitude sickness

 

Fever in returning travellers (travel)

 

Health information for Hajj pilgrims

Comments are closed.