General Considerations

Medical kit and other items

Sufficient medical supplies should be carried to meet all foreseeable needs for the duration of the trip. This kit will include:
  adhesive tape
  antiseptic wound cleanser
 bandages
 emollient eye drops
 insect repellent
 insect bite treatment
 nasal decongestant
 oral re-hydration salts
 scissors and safety pins
 simple analgesic (e.g. paracetamol)
 sterile dressing
 clinical thermometer
 Certain categories of prescription medicine should be carried together with a medical attestation, signed by a physician, certifying that the traveler requires the medication for personal use.
 All medicines should be carried in the hand luggage to minimize any risk of loss during the journey. A duplicate supply carried in the checked luggage is a safety precaution in case of loss or theft.
 Other items are needed such as dental care, eye care including contact lenses, skin care and personal hygiene.

Additional items according to destination and individual needs:

 Anti-diarrhea medication
 antifungal powder
 anti-malarial medication
 condoms
 anti-disinfectant
 other items

Travelers with pre-existing medical conditions and special needs

For certain groups of travelers, including infants and young children, pregnant women, elderly, disabled, and those who have pre-existing health problems, medical advice and special precautions are necessary. They should be well informed about the available medical services at the travel destination.

Age
 Air travel may cause discomfort to infants due to changes in cabin air pressure and is contraindicated for infants less than 7 days old.
 Infants and young children are more sensitive to sudden changes in altitude.
 Elderly people should seek medical advice before planning long-distance travel.

Pregnancy
 Travel is not generally contraindicated during pregnancy until close to the expected date of delivery, provided that the pregnancy is uncomplicated and the woman's health is good.
 Travel to high altitudes or to remote areas is not advisable during pregnancy.

Disability
 Physical disability is not usually a contraindication for travel if the general health status is good. Airlines have regulations on the conditions for travel for disabled passengers who need to be accompanied.
 Information should be obtained from the airline in advance.

Pre-existing illness
 People suffering from chronic illnesses should seek medical advice before planning a journey. Therefore, the traveler with a chronic illness (for instance cardiovascular disorder, chronic hepatitis, diabetes mellitus, chronic respiratory disease, epilepsy or other) should carry in their hand bag or luggage for the journey and for the entire duration of the trip, all:
 necessary medication
 name and contact details of their physician together with information about the medical condition and treatment,
 details of medication (generic drug names included) and prescribed doses.
 A physician's letter certifying the necessity for any drugs or other medical items (e.g. syringes) carried by the traveler that may be questioned by customs officials should also be carried.

TRAVELER CHECKLIST

Obtain information on local conditions, depending on destination

 Risks related to the area (urban or rural)
 Type of accommodation (hotel, camping)
 Length of stay
 Altitude
 Security problems (e.g. conflict)
 Availability of medical facilities
 Prevention

Vaccination
 Contact the nearest travel medicine centre or a physician as early as possible, preferably 4–6 weeks before departure.

Malaria
 Request information on malaria risk,
 Prevention of mosquito bites,
 Bed net and insect repellent.

Food hygiene
 Eat only thoroughly cooked food,
 Drink only well-sealed bottled or packaged cold drinks.
 Boil drinking-water if safety is doubtful. If boiling is not possible, a certified well-maintained filter and/or disinfectant agent can be used.

Personal kit
 Obtain a card showing blood group before departure
 Animals (beware of snakes and rabid dogs)
 Sun (pack sunglasses and sunscreen)
 Obtain prescriptions for medication according to length of stay
 Dental
 Ophthalmologic pack, spare spectacles
 Other according to specific conditions (e.g. pregnancy, diabetes)
 Subscribe to a medical insurance with appropriate cover abroad, i.e. accident, sickness, medical repatriation.

Other needed items
 Comfortable shoes
 Camera
 Passport
 Visa
 Do not leave your personal belongings behind you

TRAVEL BY AIR

Health Considerations

Health risks associated with air travel, particularly long-distance travel, can be minimized if the traveler plans carefully and takes some simple precautions before, during, and after the flight. An explanation of the various factors that may affect the health and well-being of air travelers are:

1. Cabin air pressure
Although aircraft cabins are pressurized, cabin air pressure at cruising altitude is lower than air pressure at sea level. As a consequence, the available oxygen is reduced and gases within the body expand. The effects of reduced cabin air pressure are usually well tolerated by healthy passengers.

2. Oxygen and hypoxia
O2 During all stages of flight, cabin air contains ample oxygen for healthy passengers. However, because cabin air pressure is relatively low, oxygen saturation of the blood is slightly reduced, leading to mild hypoxia (i.e. reduced supply of oxygen to the tissues).
O2 Passengers with cardiovascular or respiratory diseases, or certain disorders of the blood may not tolerate hypoxia well.
O2 Moreover, the effect of alcohol on the brain is increased by hypoxia.

3. Gas expansion
Air expands in all air-filled body cavities as a result of the reduced cabin air pressure. Abdominal gas expansion may cause moderate discomfort, which may be exacerbated by consumption of carbonated beverages and certain vegetables:
 discomfort can be alleviated by swallowing, chewing, or yawning;
 if the problem persists, forceful expiration against a closed nose and mouth will usually help. For infants, feeding or giving a pacifier to stimulate swallowing may reduce the symptoms.

4. Cabin humidity
The relative humidity in aircraft cabins is low, usually less than 20%. Low humidity may cause discomfort of the eyes, mouth, and nose but presents little risk to health:
 discomfort can be alleviated by maintaining good fluid intake before and during the flight,
 use a skin-moisturizing lotion,
 use a saline nasal spray to moisturize the nasal passages, and
 wear spectacles rather than contact lenses.

5. Dehydration
Measures should be taken to prevent dehydration during long flights.
 Fluid intake should consist of non-alcoholic beverages, water and fruit juices, both before and throughout the flight; as alcohol contributes to dehydration.
 Consumption of alcohol should be restricted, and preferably avoided, before and during the flight.

6. Ozone and cosmic radiation
The concentration of ozone (triatomic oxygen, O3) and the intensity of cosmic radiation both increase with altitude. Ozone is easily converted to oxygen by heat and various catalytic processes that provide pressurized air for the cabin.

7. Motion sickness
If necessary, medication may be taken to prevent motion sickness.

8. Immobility and circulatory problems
Prolonged immobility, particularly when the individual is seated, leads to pooling of blood in the legs, which in turn causes swelling and discomfort. This can be alleviated by doing:
 simple exercises at frequent intervals during the flight: exercises that stimulate the circulation, reduce discomfort, fatigue and stiffness.
 wearing properly fitted graduated-compression stockings specially designed for air travel may be helpful.
 hand luggage should not be placed where it may restrict movement of the legs and feet.
 clothing should be loose and comfortable.
 after arrival, traveler can reduce the effects of the journey by gentle exercise to stimulate the circulation.

9. Jet lag
Jet lag refers to the disruption of sleep patterns and other circadian rhythms (the body's internal clock) caused by crossing multiple time zones in a short period of time, e.g. when flying east–west or west–east. Jet lag may lead to indigestion, general malaise, insomnia, and reduced physical and mental performance. General measures to reduce its effects:
 be well rested before departure and have as much rest as possible during the flight, including short naps,
 ensure the same total amount of sleep in every 24 hours when traveling as when staying at home,
 drink plenty of water and/or juices before and throughout the flight,
 eat light meals and limit consumption of alcohol before and during the flight.

10. Psychological aspects
Air travel is frequently accompanied by psychological difficulties. The main problems encountered are stress and fear of flying. Flight phobia (fear of flying)
Flight phobia is often associated with the presence of other phobias, such as claustrophobia and agoraphobia. In addition, anxiety levels may be heightened by the presence of other stress-related factors, personality disorders or an underlying psychiatric disorder. Treatment is based on identification of the cause, and desensitization is the most commonly used intervention.

11. Pacemakers
Flying is generally safe for passengers with pacemakers.
 Unipolar-lead pacing systems may be susceptible to electronic interference during flight, and guidance on the effect of airport security screening devices should be obtained.
 Bipolar-lead pacing systems are not affected.
 However, hand-held security devices may interfere with implanted automatic defibrillators, and travelers with these may find it useful to carry a physician's letter specifying this hazard.

12. Smokers
Smoking is banned on aircraft, except by a very few airlines. Nicotine-replacement patches or chewing-gum containing nicotine may be helpful.

13. Transmission of infectious diseases
Travelers should be reassured that there is very little risk of any infectious disease being transmitted on board the aircraft.
The quality of aircraft cabin air is carefully controlled and re-circulated up to 50% of cabin air, then is passed through HEPA (high-efficiency particulate air) filters, which trap particulate material, bacteria, fungi and most viruses. Consequently, re-circulated cabin air is very clean.

14. Aircraft disinfection
This is to prevent the introduction of infection by insects inadvertently carried on board. For instance, insecticide is regularly applied to all internal surfaces of the aircraft, except those in food-preparation areas.

HEALTH ADVICE FOR TRAVELERS - LATEST HEALTH UPDATES •

3 September 2003 - West Nile Virus in the United States of America
As at 2 September 2003, there have been 1,764 reported human cases of West Nile Virus, with 31 deaths occurring in 34 states.
West Nile Virus is a rare infection spread by the bite of an infected mosquito. It can infect people, horses, many types of birds and some other animals. There is no evidence to suggest that West Nile Virus can be spread from person to person or directly from an animal to a person.
To reduce the risk of infection the following advice should be followed:
Stay indoors, or wear a long sleeved shirt and long trousers at dawn, dusk and early evening
Use an insect repellant (preferably one containing DEET) on clothes and exposed skin
Always follow the manufacturers' directions for use, use sparingly on children and avoid contact with mouth and eyes.

2 September 2003 - Severe acute respiratory syndrome (SARS) - UK travel advice
On 5th July the World Health Organisation (WHO) announced that SARS has now been contained and there are no restrictions on travel to any country previously affected by SARS.
WHO is continuing to monitor the global situation and will, if necessary, give further travel advice accordingly. The UK remains vigilant for the possible recurrence of SARS.

Symptoms
The symptoms of SARS are: high fever (>38ºC) and one or more respiratory symptoms including cough, shortness of breath and/or difficulty in breathing.

10 July 2003 - Dengue Fever in Tonga
There has been a serious outbreak of Dengue Fever (DF) in Tonga.

This is a mosquito-borne disease, so insect repellent should be worn at all times. This is especially important during daylight hours when the dengue-carrying mosquitoes are most active.
The symptoms of dengue usually start with a fever and you should seek immediate medical treatment should you suspect infection.