p17/19: information about the new Japanese Encephalitis

Vaccine - it is a two dose course instead of three dose

p24: refine information about DEET insect repellent

'DEET' (Diethyl toluamide) is clinically proven to be the most effective mosquito repellent to apply on your skin. Repellents work by blocking the receptors on the mosquitoes antennae, so they cannot find you. A concentration of 30% DEET is recommended for everyone over 2months of age. It should give protection for 4-5 hours. Higher concentrations protect for longer. Above 50% DEET the duration of protection is said to plateau. However ‘sticky’ products with higher DEET (e.g. Bushman 80%) may be useful in conditions such as the Kokoda track where persons are sweating profusely. In field trials, DEET products on the skin have been found to be more effective than coils, citronella candles, sonic repellers, UV light lures, and ‘mozzie plants’. E.g. Citronella protects for less than 20 minutes and wristbands average 12 – 18 seconds. DEET can damage plastics, synthetic fabrics, leather and painted or varnished materials so be careful with eye glasses, cameras etc. DEET has no effect on cotton, wool or nylon or skin(!) DEET has been on the market for 45 years and side effects do not occur if used according to the directions.

p27: only need to test doxy/ lariam / (not malarone)

p26: chloroquine not readily available in australia

p28: mention blisters from doxy

p29: Primaquine added for prevention of malaria

This drug is only rarely used for prevention of malaria, mainly because of the necessity for a G-6-P-D blood test before taking this medication. If an individual has an abnormal G-6-P-D test and takes primaquine, their blood cells will haemolyse (explode) which can cause a very dangerous anemia. Primaquine can also cause more common side effects e.g. abdominal cramps and pains, nausea, vomiting, dizziness & headache.

p35: PBS Medicines

These are medicines where the Australian Government has subsidised the cost of the prescription. Sometimes the subsidy may be a hundred dollars per script. Many persons are not aware their medicines are PBS subsidised. Ask your pharmacist. In Australia, it is illegal to take PBS medicine overseas unless that medicine is for the personal use of the carrier or or someone travelling from Australia with them. Illegally exporting PBS medicine can attract a penalty of up to two years imprisonment and/or a $5,000 fine.

p40: Travellers over 60

If visiting hot climates, consider air conditioned accomodation and keep well hydrated. Ideally travel with a companion. Perhaps book slower paced trips e.g. 2-3 nights in one place rather than one night. Check travel insurance and if it covers pre- existing illness. A collapsible trekking pole may be useful for trekking, walking on uneven ground around ruins or slippery marble floors. Dont forget extra batteries for hearing aids if relevant, and perhaps spare reading glasses. Compression stockings are recommended for flights over 12 hours. Extra vaccines may be recommended e.g. for flu, pneumonia and shingles.

p42: food related clock in the brain

fasting for 16 hours then eating when you land may help you adjust to new time zone more quickly

p49: how to wash vegetables in dev countries

p51: betadine and steripen for water purification

p52: comment on solar disinfection of water if have nothing else for water purification

p66: Time Zones .... and the Pill

If you are happy to change your regular time of pill taking, you can keep a watch or phone on home time, and continue to take the pill at 24- hour intervals. To enable you to take your pill at your preferred time ( morning or night), you should shorten the interval between two pills but not lengthen it. This may mean adding an extra active pill. If you wish to keep the days in sync with what is written on the pill packet, this extra pill should be taken from a spare packet so that the Tuesday pill continues to be taken on the Tuesday etc.

Forgetting .... and the Pill

When travelling out of the usual routine, it is easy to miss a pill. A late pill is now defined as being up to 24 hours late. A missed pill is defined as being more than 24 hours late. The active pills closest to the sugar tablets are the most risky to miss as they prolong the pill free interval and increase the chance of break through ovulation ( egg release). Seven consecutive active pills are sufficient to suppress ovulation after which 7 pill free days are needed for ovulation to occur. This means .... If a pill is less than 24 hours late (less than 48 hours since the last pill taken ) then take the most recent missed pill as soon as you remember, and continue taking the remaining pills at the usual time. No additional contraceptive protection is required. If a pill is more than 24 hours late, take the pill when you remember, continue taking pills at the usual time, and use other means of contraception until you have taken 7 active pills in a row.

p67: Malaria tablets ... and the Pill

Chloroquine, Maloprim, Malarone, and mefloquine (Lariam) do not interfere with the oral contraceptive pill. Doxycycline may interfere by temporarily decreasing gut bacteria and therefore changing the way the pill is metabolised in the body. This effect only occurs in the first 3 weeks of taking doxycycline, so women need to use other means of contraception for the first 3 weeks on the doxycycline only. After that the gut flora have recovered and the no further precautions are needed.

p78: encourage safe waste disposal during a trek

p92: primaquine and g6pd test

p98: brief mention blastocystis as a cause of diarrhoea symptoms in some persons

p111: add use of azithromycin as option for chest infection

p136: add mention of trichonosis as cause of muscle pain

p138: change to single dose morning after pill - postinor 1

p140: new cardiac compression rate 100/min

p149: cease noroxin if getting tendon pain

p152: avian influenza now in alphabetically correct spot

p165: Norovirus as a cause of travellers diarrhoea

p171: Tick encephalitis added

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