COMMON SENSE, awareness, vaccination and avoidance is the self-evident message. Knowing your own blood group could be useful. Taking needles and syringes and having a good travel insurance are important.

VACCINATION should be taken against Tetanus, Diphtheria, Polio, Typhoid, Hepatitis A and Yellow Fever. Vaccination against Hepatitis B, Rabies and Meningitis A & C may be indicated for longer term travellers and backpackers. Cholera vaccine is not very effective.

MALARIA has no effective vaccine so anti-malarial tablets must be taken. Three regimes are suggested: a) chloroquine 2 tablets weekly and paludrine 2 tablets daily (75% effective); b) mefloquine 1 tablet weekly (90% effective); c) doxycyline 1 capsule daily (75% effective). There is a lot of publicity surrounding mefloquine (Lariam) but it was our choice for a recent trip. Side effects are quite rare and usually show early, so start 3 or 4 weeks before going to see how you tolerate it.

PREVENTION OF BITES is also vital. Mosquitoes bite at night and prefer sweaty feet! Use screens and a pyrethrum impregnated sleeping net. Cover exposed areas. Use DEET insect repellent. Avoid sluggish water (Schistosomiasis) and fast running water (river blindness) so, no swimming, except in the ocean! Wear walking boots (snakes, bites, blisters).

TRAVELLERS DIARRHOEA is extremely common. It is normally self limiting with full recovery within a few days. Wash your hands, avoid untreated water, ice cubes, ice cream and raw fruit and vegetables unless they have been peeled. The mainstay of treatment is taking plenty of clear fluids (bottled drinks, clear soup) but powdered proprietary preparations of salt and sugar for reconstituting in boiled water are best (e.g. Dioralyte). The anti-biotic Ciprofoxacin is effective in helping most causes of the problem. Loperamide (imodlum) is a good anti-diarrhoreal.

Michael and Jo Nelki

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