1. Aberdeen Grammar World Challenge visit to Vietnam and Cambodia
The Grampian Travel Health Clinic
Ken and Peter Manson
Kemnay Pharmacy

2. Vietnam Population: 90.7m Capital: Hanoi Location: South East Asia
Climate: Tropical in south; monsoonal in north with hot, wet season (May-Sep) and warm, dry season (Oct-Apr)

3. Cambodia Population: 15.4m Capital: Phnom Penh
Located: South East Asia
Climate: Tropical; wet season (May-Oct); dry season (Dec-Apr); little seasonal temperature variation

4. Vaccinations
Vaccinations are given to protect you from conditions which you may be exposed to during your trip.
The advice we give is based upon the most up-to-date information available to healthcare professionals through the travel health specialist TRAVAX and is tailored to your specific itinerary
The following vaccines would be recommended for every member of the group:

5. Vaccinations Hepatitis A and Typhoid:
Disease prevalence is deemed to be "moderate to high" for these diseases which would make vaccination advisable.
Cost: we can provide this vaccine free of charge via the NHS – this is a pioneering co-operative approach with the local surgery never previously facilitated with a pharmacy travel health clinic.
Rabies:
Thailand and Cambodia are both classified as "high risk" countries for rabies. A privately administered course of 3 vaccinations would therefore be strongly recommended.
Cost: the vaccine is £50 per dose so a full course will cost £150 - your group discount will take this down to £135. This gives 10 years protection.
Hepatitis B:
Optional vaccine - Carriage of the virus in the local population in this country is considered to be high (>8%) however transmission of this blood-borne virus occurs through blood contact and is considered where risk of physical injury is increased. A privately administered course of 3 vaccinations will give full protection (with option for single vaccine after one year to infer 10 year cover)
Cost: £25 per vaccine meaning after discount price of £68

6. Vaccinations Japanese Encephalitis:
Vaccination would be advised due to risk during trekking. Spread by mosquitos (different mosquito to malaria) active during the day and particularly at twilight
Cost: £85 for each vaccine – course of 2 after discount £153
Diphtheria and Tetanus:
Although vaccination is advised for these conditions, your national schedule vaccination programme will have inferred sufficient cover.

7. Rabies and animal bites
Infection of warm blooded animals including bats
Transmitted to humans through saliva of infected animal – usually through bite but not exclusively
You cannot tell visually if an animal has rabies
Avoid contact with animals including domestic pets
Vaccination given as course of 3 injections

8. What to do if bitten by an animal
Copious flushing with running water for as long as possible (at least 10 minutes)
Do not scrub
If alcohol or iodine are available apply after flushing
Call medical assistance
If vaccine course is given before trip then rabies immunoglobulin (derived from blood products which are best avoided) is not required
2 further doses of vaccine are sometimes given

9. Blood-borne viruses
Blood-borne viruses are transmitted through contact with blood and body fluids. Main risks include:
Unprotected sexual intercourse
Anything increasing the risk of a physical accident
Any procedures where the skin is punctured eg piercing, tattooing, acupuncture.
Any procedure where skin may be cut such as hair shaving
Attending a “bloody” injury without protection such as gloves
Close contact sports

10. Malaria Risk

11. Malaria risk
Malaria is a serious and sometimes life-threatening illness. It is spread through the bite of a specific female mosquito
Both countries are classified as “high risk” for malaria
Advised antimalarial tablets – two choices:
Doxycycline 1 daily for all of trip + 4 weeks £14
atovaquone/proguanil 1 daily for all of trip + 1 week £65
Mosquito nets – protect against mosquito and other biting insects during the night. Impregnated nets advised. We can supply high quality individual nets.

12. Basic principles for preventing malaria
No antimalarial tablet is 100% effective
A – Awareness of risk
B – Bite avoidance: using DEET, appropriate clothing and mosquito nets
C – Use chemoprophylaxis correctly: taking antimalarial tablets properly
D – Report any symptoms to Doctor and mention your travel if any flu like symptoms in next year

13. Insect repellent
DEET is the most effective and only recommended insect repellent for malarious regions
Has been used for over 50 years
50% DEET recommended for application which will give up to 12 hours cover
When applied with sun-screen: apply sun-screen first then DEET on top

14. Sun protection
The sun will be much stronger in South East Asia than in Scotland
Doxycycline increases sensitivity to sun – for anyone with a previous history of photo sensitivity or who is of particularly fair complexion the alternative, but more expensive, regime of Atovaquone /Proguanil should be considered.
Long clothing provides good cover
Using a high factor sun-screen on exposed skin – SPF30 and over advised
Reapply every two hours
Use sun protective lip-salve
Wear sunglasses that have UVA and UVB filters
Apply sun-screen before insect repellent: this allows sun-screen to be absorbed into skin

15. Heat precautions Takes time to acclimatize to hot climate
If possible stay out of direct sunlight between 11am and 3pm
Drink plenty of fluids
Dark urine an indicator of dehydration
Hand held fans can be useful when it’s not possible to escape heat
Heat exhaustions – symptoms: tiredness, dizziness, feeling faint, headache. Treat by getting out if heat when possible and rehydrating with water: rehydration sachets can be useful. Heat exhaustion can lead to heatstroke which is more serious and requires medical attention.
Prickly heat – symptoms: rash caused by sweat glands becoming congested. Regular washing will help, apply Eurax cream or lotion for symptomatic control.

16. Water purification Boiling water for 3 minutes will purify it
While allowing boiled water to cool the container should be covered to prevent recontamination
When this not possible chlorine dioxide purification drops or tablets are recommended – we can provided these from the pharmacy

17. Asthma and other conditions
Ensure that you will have enough medication for whole duration of trip
Carry a letter from the doctor or nurse outlining any conditions you have
Remember with asthma acute control may be needed more regularly in extreme heat and with activities like trekking

18. Making sensible food choices
Avoid unpasteurised milk and milk products such as cheese and ice cream
Meat should be freshly prepared, thoroughly cooked and eaten while hot whenever possible
Leftover cold food should be avoided
Vegetables should be eaten cooked when possible
Fruit should be peeled because the skin can be contaminated by insects
Salads should be avoided due to easy contamination
Avoid fish and shellfish

19. Hygiene More care and attention needs to be paid to hygiene
Wash hands prior to eating and after using the toilet
Having alcohol hand-gel and hand wipes can be useful
Use alcohol wipes to clean dishes cups and utensils if necessary

20. Travellers diarrhoea Usually self limiting
Important to prevent dehydration -rehydration sachets can be useful in replacing salts and sugars
If continues for more than 3 or 4 days or if accompanied by vomiting medical advice should be sought

21. Recommended clothing
Covering up with loose clothing protects from both sun and biting insects including mosquitoes
Light materials like cotton and linen are best
DEET 100% for spraying on clothes before trekking

22. Health insurance
Speak with your group leader to ensure that everything is in place for the health insurance of the group
No reciprocal health care agreement with the UK

23. Pharmacy products
We can prepare a group pack with all medical requirements catered for both the expedition groups as well as providing an individual kit for each member of the group – we will apply a special group discount to all products supplied.
We have an extensive selection of specialist travel products including first aid kits, high quality mosquito nets, DEET sprays, sun protection etc
In addition we can apply group discount to other products including hand-gel and hand-wipes, analgesics, antihistamines, loperamide, rehydration sachets, Eurax, and any other products required.

24. Further information http://www.kemnaypharmacy.co.uk/index.html