Malaria
Malaria in pregnancy is dangerous for both the mother and the foetus. Pregnant women should avoid travelling to malaria endemic areas if possible. Because no antimalarial agent is 100% effective, they should use personal protection measures if they travel to malaria endemic areas. Pregnant women should remain indoors during dusk and dawn as there is highest likelihood of getting bitten. If they are outdoors at night, they should wear light-coloured clothing, long sleeves, long pants, and shoes and socks. They should sleep in air-conditioned quarters or use screens and permethrin-impregnated bed nets.

Immunisation
Because of the theoretical risks to the foetus from maternal vaccination, the risks and benefits of each immunisation should be carefully reviewed. Ideally, all women who are pregnant should be up to date on their routine immunisations. In general, pregnant women should be advised to avoid live vaccines and to avoid becoming pregnant within 3 months of having received one. While the risks to the foetus from maternal vaccinations are small, it is best avoided

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Traveller's Diarrhoea
To avoid diarrhoea, eat only well cooked meat and pasteurised dairy products. Drink only boiled water and avoid uncooked food, ready-made fruits and salads.
A pregnant traveller should also bring her own supply of clean water and food if necessary.

Oral rehydration is very important in treating diarrhoea. Medicines such as Kaolin and Pectin can be used. Antibiotics can also be taken if prescribed.

Cosmic Radiation
The risk to the foetus from cosmic radiation during air-travel is minimal. Effects are also dependent on flight time, route taken and state of pregnancy.

Venous thrombo-embolism
Also known as Economy Class Syndrome, it can affect pregnant travellers regardless of the mode of transport. This is due to long periods of immobility/sitting and dehydration.

To avoid venous thrombo-embolism, keep well hydrated, i.e. a glass of water every hour and avoid alcohol. Put on firm socks or stockings. Get an aisle seat, stretch your legs, extend and flex ankles and walk about. Sit near the toilet and nearer the front of the plane for a less bumpy ride.

Travelling Kids - It's a Small World

Parents should consider the following factors before deciding to bring their children overseas with them:

Prepare your Children for Travel

Dr Helen Oh, Senior Consultant, SGH

Destination:
Does the country have adequate facilities to deal with child emergencies? Will the host country have the medicines your children need? In most instances, you will be better off bringing what your children need.

Prescription Medicines:
Check to be certain that all medicines you will be bringing are allowed. Just because a drug is legal in Singapore does not mean it is also legal abroad. Japan, for example, bans the import of certain non-drowsy type cold and allergy medicines, because an ingredient in them is a controlled substance.

Immunisation:
If you have travel plans for your children, you may need to consider modifying your child's routine immunisation schedules. In addition, you might have to administer travel-related vaccines, such as Hepatitis A or typhoid. This might lead to a need to administer the routine and travel-related vaccines simultaneously, provided of course that the child is fit for immunisation. Parents should seek travel health advice at least 6 - 8 weeks before departure to give ample time for administration of more specialised travel vaccines.

Sexually Transmitted Diseases and Travel

Dr Colin Kwok, Consultant Dermatology, CGH

Sexually transmitted diseases (STDs) are caused by different infectious microorganisms including bacteria, viruses and parasites, which are transmitted through semen, vaginal fluid, blood or other body fluids during sexual activity.

STDs occur worldwide. Some are easily cured, but others, if not treated or if incurable, can have serious effects on your health. Possible consequences include infertility, ectopic pregnancy, cirrhosis of the liver, birth defects in children and cancer. Some STDs, such as HIV/AIDS, can be fatal.

At this time, Hepatitis B is the only STD for which a licensed vaccine is available. The Hepatitis B vaccines are usually given as a series of three injection doses over six months, and are considered safe and effective.

While travelling or after your return, if you think you may have a STD (ie. you have symptoms), or you have engaged in activities that may have put you at risk for a STD (ie. you have no symptoms), seek medical attention.

General symptoms
Some people with a STD have few or no symptoms at all; others have obvious symptoms. Be aware of any changes in your health while travelling and after return, such as:

• different or heavier discharge from the vagina;
• discharge from the penis;
• burning feeling when urinating;
• sores, particularly in the genital or anal areas;
• itching feeling around the genitals or anus;
• appearance of a rash;
• swollen glands in the groin;
• sudden onset of flu-like symptoms.
  These symptoms might appear alone, or in combination.

Travel Medicines - Don't leave home without it

Ms Chow Lynn Whui, Pharmacist, CGH

Jetlag
Jet lag occurs because changes in time zones confuse the body's 24-hour inner clock.

Melatonin, an over-the counter product, is being touted as the new miracle "jet-lag pill". It is a substance naturally produced in humans at night. Supposedly, it tricks the body into resetting the natural sleep/awake cycle. If taken in the morning, it delays your body clock and allows you to stay up later. If taken at night, it encourages sleep. Some people also use short-acting sleeping pills to help them sleep during the flight.

For convenience, buy a pre-packed travel kit from a pharmacy.

If possible, take a day flight so that you can arrive at your destination at your bedtime or book an overnight flight so that you can sleep on the plane. Avoid heavy meals before the flight, but keep yourself hydrated. Exercise, both in the air and upon arrival, will circulate your blood and help you feel rejuvenated.