1. 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

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

3. 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.

4. 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

5. Mental Health
INSURANCE
INSURANCE!!!
REPATRIATION
AIR AMBULANCE

6. 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! 

7. INSURANCE, INSURANCE, INSURANCE!!!