Yellow Fever DAYTIME biting mosquito ALWAYS check each country’s recommendations ALWAYS check whether traveller needs vaccine for personal protection and/or for certificate requirements

Malaria Stick to English Guidelines Ensure patient aware of ABCD Ensure patient knows PPM’s

Hajj 30 August – 4 September 2017 The Saudi Arabia Ministry of Health strongly recommends that the following people postpone their Hajj and Umrah in 2016, for their own safety. •The elderly (above 65 years of age). •Those with chronic diseases (e.g. heart disease, kidney disease, respiratory disease, diabetes). •Immune deficiency (congenital and acquired). •Those with malignant disease. •Those who are terminally ill. •Pregnant women. •Children (under 12 years). Conjugate vaccine - single dose to be given not more than 8 years and not less than 10 days prior to arrival in Saudi Arabia •Polysaccharide vaccine - single dose to be given not more than 3 years and no less than 10 days prior to arrival in Saudi Arabia •All arrivals from countries within the African Meningitis Belt (Benin; Burkina Faso; Cameroon; Chad; Central African Republic; Cote d'Ivoire; Eritrea; Ethiopia; Gambia; Guinea; Guinea-Bissau; Mali; Niger; Nigeria; Senegal, Sudan and South Sudan) will also be administered antibiotic treatment at the point of entry as an added precaution. •In the UK, visas will not be issued unless proof of vaccination, at least 10 days prior to the expected date of entry, is submitted with the visa application. Adults and children over the age of 2 years arriving for the purpose of Umrah or Hajj pilgrimage (or for seasonal work in the Hajj area) are required to produce a certificate of vaccination with quadrivalent ACW-135Y vaccine against meningitis. Both conjugate and polysaccharide vaccines are acceptable for certificate purposes, but use of conjugate vaccine is the preferred choice in the UK. Type of vaccine given must be specified on certificate, otherwise it will be assumed polysaccharide vaccine has been used and certificate only valid for 3 years and not 8 years.

MMR Advice for travellers Make sure up-to-date with all currently recommended UK vaccines including measles, mumps and rubella (MMR) vaccine. Two doses of MMR are needed for a person to be considered fully protected. MMR vaccine can be given from six months of age before travel to a risk country and/or where an outbreak is occurring. If you have not had measles (the illness) or if you have not had two doses of MMR, you may be at risk if visiting countries reporting cases. Especially a concern if staying with friends or family, mixing with local population or going to mass gatherings like festivals, sports events or pilgrimages. Measles is easily passed from person to person and can be a serious illness in adults (as well as children). It is never too late to have the vaccine. Consider carrying a record documenting vaccination against MMR when travelling abroad  MMR – from first birthday onwards • Doses of MMR/measles vaccine given prior to 12 months of age should not be counted • For individuals <18 months of age a minimum interval of three months should be left between first and second doses • For individuals >18 months of age a minimum of one month should be left between first and second doses • Two doses of MMR should be given irrespective of history of measles, mumps or rubella infection and/or age

Mental Health INSURANCE INSURANCE!!! REPATRIATION AIR AMBULANCE

Prescribe Acetazolamide? Altitude Sickness The presence of a headache and at least one other symptom: Poor sleep Dizziness Loss of appetite/nausea Fatigue 2,500m – 3,500m High Altitude 3,500m – 5,800m Very High Altitude >5,800m Extreme Altitude >7,500m Death Zone! ACCLIMATISATION Single MOST important fact to educate traveller on! The body will adapt to lower levels of O2 in time People adapt at different rates Those going >3,000m, must ascend SLOWLY There are different guidelines but: generally ascend 300m/daytime Walk high….sleep low…. Rest days are vital – stay 2 nights at same altitude Walking pace: able to ‘walk and talk’ ANYONE CAN GET ACUTE MOUNTAIN SICKNESS (AMS)! Regardless of age, gender, fitness There is a greater susceptibility for those who have suffered from it previously Can begin >1,500m Rapid ascent >2,000m AMS symptoms are common Most going to >3-4,000m will get symptoms For most people, AMS is a minor problem only For a few people AMS can be life threatening Prevention Tips: Maintain good fluid intake High carbohydrate diet (take favourite snacks) Avoid alcohol & caffeine Avoid sedatives of any description even OTC ones Prescribe Acetazolamide? Ask me afterwards! 

INSURANCE, INSURANCE, INSURANCE!!! https://www.youtube.com/watch?v=RnsRYA-el7M