Health checklist before travel to Philippines

[Doc Alan]

The Foreign and Commonwealth Office has just updated travel advice ( http://www.fco.gov.uk/en/travel-and-...ia/philippines ) and most of the 95,000 reported visits by British tourists last year were trouble free
It may help to avoid trouble by having a health check list
1. Confirm what is covered by your travel insurance, take proof that you have health insurance and save the emergency number to call from the Philippines.
2. Vaccines : a. primary or booster for typhoid, tetanus, hepatitis A 2(+) weeks before travel. ( Consider also polio / cholera. You have probably had BCG ). These are FREE within the NHS.
b. Others, such as rabies, hepatitis B, influenza, Japanese Encephalitis - not usually recommended, and chargeable.
3. Malaria tablets : see separate thread. Mefloquine starting 1 - 3 weeks before travel, every week in the malarious area ; or doxycycline daily, starting 2 days before. Continue tablets for 4 weeks after return. Expect to pay 40 GBP for course.
4. Other OTC ( over the counter ) medicines :-
a. Painkillers - paracetamol or ibuprofen.
b. Travellers' diarrhoea - usually self-limiting. Reduce risk by good hygeine ( use antiseptic wipes / antibacterial hand gel ; drink bottled water and be selective where / what you eat ). Anti - diarrhoea drugs such as loperamide ( " Imodium " ) or diphenoxylate ( " Lomotil " ). IF symptoms persist and are severe, seek medical help. Antibiotics such as ciprofloxacin ( " Pharex Ciprofloxacin " in Philippines ) or metronidazole ( " Moniliasol " in Philippines ) may be needed. " Just in case " buying in UK needs private prescription, so only buy if necessary in Philippines.
c. Constipation - bisacodyl ( " Dulcolax " ).
d. Insect repellent as spray or lotion ( " Repel " from Boots ) containing 50% DEET. Spray or lotion to sooth bites.
e. Travel sickness - cinnarizine ( " Stugeron " ). Start 2 hours before travel.
f. Sunblock cream ( 50 SPF, 5* UVA , such as Boots " Soltan " ).
g. E45 cream for dry skin, athlete's foot cream.
h. Antihistamine for allergies such as sneezing, runny nose, itching eyes ( loratidine / " Clarityn " ).
5. Supply of any medicines you usually take, if necessary with a letter from your doctor explaining that they are for personal use. Keep in hand luggage if possible. Contraceptives. Condoms.
6. Basic first aid kit - plasters, bandages, scissors.
7. Note your blood group.
8. Of course there are several good travel websites, you can search the forum for relevant threads, and it's as well to visit your doctor / practice nurse several weeks before you go . There's a good chance you will know more than them about conditions where you will be visiting .

[Steve.r]

Nice list Alan thanks

[Englishman2010]

Good advice Doc

[imagine]

very good , thanks doc

[stevie c]

Very informative
Thanks for the advice Doc

[Terpe]

Good update

[sars_notd_virus]

very good advice and checklists doc,...I should also add Germolene antiseptic cream for insect bites

[Doc Alan]

Most of the 120,000 or so reported visits by British tourists each year to the Philippines are trouble free. There are a range of opinions on the Forum regarding “ jabs, tablets, and insurance “ – including “ none needed “ !

However, in the event of falling ill, treatment and repatriation could be expensive without comprehensive insurance. Insurance might also not cover an illness for which recommended precautions to avoid it had not been taken, or if a pre – existing illness was not declared . Airlines also give advice on general health requirements / exclusions.


Good advice is available from pharmacists, GPs and travel health clinics. This Forum Heath Issues section also has threads on a number of serious conditions. Visit your doctor / practice nurse several weeks before travel. Remember also to read the health checklist AFTER travelling ( http://filipinaroses.com/showthread....he-Philippines ).


It might be helpful to look at the following updated check list. Just ignore whatever doesn’t apply to you ! It’s impossible to cover every category and age group in a general thread, and this is only my opinion ( hopefully informed ! ).

CODES :-

Forum link ( use “ search “ button, top right corner of page ).


… and, according to individual circumstances,

Recommended

or

Not usually recommended






* Confirm what is covered by your travel insurance, take proof that you have health insurance and save the emergency number(s) to call from the Philippines .


* Vaccines :


a. FREE WITHIN NHS :- Primary or booster for typhoid, tetanus, hepatitis A ( + ) two (+) weeks before travel. Consider also polio / cholera ( ). It should be confirmed that children have received their recommended doses of MMR at 12-15 months of age and again pre-school around 3 years 6 months, while unimmunised adults who have not had the disease themselves may consider vaccination if thought to be at risk ; two doses of MMR vaccine are required to give adequate protection ( ) . Adults, but not teenagers, have probably had BCG for TB ( ) protection ; thought not to be effective if given over age of 35 ( ).

b. Others, such as rabies ( ) , hepatitis B ( ), influenza ( ), Japanese Encephalitis - not usually recommended , and chargeable. Hepatitis B is, however, much commoner in the Philippines ( despite vaccination schedule ) than UK, but a vaccination course and blood test to confirm immunity could cost 50 GBP or more.


* Malaria tablets ( ). Mefloquine starting 1 - 3 weeks before travel, every week in the malarious area ; or doxycycline daily, starting 2 days before. Continue tablets for 4 weeks after return. Expect to pay 50 GBP for course. See thread .


* Other OTC ( over the counter ) medicines :-


a. Painkillers - paracetamol or ibuprofen ( ).


b. Travellers' diarrhoea - usually self-limiting. Reduce risk by good hygeine ( use antiseptic wipes / antibacterial hand gel ; drink bottled water and be selective where / what you eat ) ( ). Anti - diarrhoea drugs such as loperamide ( " Imodium " ) or diphenoxylate ( " Lomotil " ) ( ).


IF symptoms persist and are severe, seek medical help. Antibiotics such as ciprofloxacin ( " Pharex Ciprofloxacin " in Philippines ) or metronidazole ( " Moniliasol " in Philippines ) may be needed – if needed, buy locally from trusted pharmacy ( ).

c. Constipation - bisacodyl ( " Dulcolax " ) ( ).

d. Insect repellent as spray or lotion ( " Repel " from Boots ) containing 50% DEET ; Spray or lotion, such as “ Germaline “, to sooth bites ( ).


e. Travel sickness - cinnarizine ( " Stugeron " ) ; start 2 hours before travel ( ).

f. Sunblock cream ( 50 SPF, 5* UVA , such as Boots " Soltan " ) ( ).

g. E45 cream for dry skin, athlete's foot cream ( ).

h. Antihistamine for allergies such as sneezing, runny nose, itching eyes ( loratidine / " Clarityn " ) ( ).

i. Melatonin for insomnia ( ).

* Supply of any medicines you usually take, if necessary with a letter from your doctor explaining that they are for personal use ( ). Keep in hand luggage if possible. Contraceptives. condoms ( ).


* Basic first aid kit - plasters, bandages, scissors ( check-in baggage ) ( ).


* Note your blood group ( ).

* Elastic compression stockings / travel socks for comfort and to prevent deep calf venous thrombosis ( clotting in leg veins ) ( ).



http://www.moneysupermarket.com/travel-insurance/guide/


http://www.nhs.uk/Conditions/Travel-...nisations.aspx



https://www.gov.uk/foreign-travel-advice/philippines



http://www.fitfortravel.nhs.uk/desti...ilippines.aspx




http://www.netdoctor.co.uk/travel/as...lippines.shtml


http://www.nhs.uk/Conditions/Deep-ve...revention.aspx

[stevie c]

Once again doc a super guide that you have put together a must for everyone who will be travelling to the phils
A most deserved rep coming your way

[Rosie1958]

Very comprehensive list ..... and much appreciated. Thank you Doc Alan!

[Arthur Little]

Splendid update, Alan ... one that ALL who plan to undertake travel to tropical destinations would do well to read and digest!

[Doc Alan]

AIR TRAVEL AND PREGNANCY


Most women can travel safely well into their pregnancy. It might be helpful to add one post here with links concerning this special category of travellers.


• Tell your health professional ( GP, midwife, obstetrician ), confirm your general health, normal pregnancy, and expected date of delivery. Any medical conditions which may complicate pregnancy ( anaemia, other illnesses, recent surgery ) ?


• Check with airline and insurance company about conditions for travelling while pregnant, and whether a letter confirming medical clearance is needed – before booking ! Airlines’ main concerns are with risk of labour developing, lack of appropriate care providers and facilities, with resulting disruption or diversion of flight.



The second trimester is the best time to travel – risk of miscarriage has decreased, and there is low risk of complications like pre-term labour. ( First Trimester: starts with the first day of your last menstrual period (LMP) and ends with the last day of the 13th week thereafter.
Second Trimester: starts at the beginning of the 14th week after your LMP and lasts through the 27th week of pregnancy.
Third Trimester: starts at the beginning of the 28th week after your LMP and ends with labour ).




• If there are risk factors for pre-term labour like multiple pregnancy, women should not fly after 32 weeks and in any case within 4 weeks of expected delivery date.



• As for any travel, destination, season, length of stay, planned activities, and medical facilities once there, are important.


• Vaccinations – avoid “ live “ vaccines ( such as for yellow fever, not required anyway for Philippines ; and MMR / mumps,measles, rubella ), although others ( “ inactivated “ viruses, bacteria and “ toxoids “ ) – the majority - are considered safe, but take advice.



• Antimalarials – may well not be necessary for most parts of the Philippines, but of the two drugs usually recommended, doxocycline should NOT be taken in pregnancy, and take advice about mefloquine ( probably safe in second and third trimesters ). Pregnant women do seem to be attractive to mosquitoes, so insect repellents are vital.


• Body scanners – no information to suggest that a pregnant woman should avoid security scans.



• Common sense precautions during flights become even more important if pregnant :-

book an aisle seat; drink plenty water ; do calf exercises and wear supportive stockings ( increased risk of thrombosis / “ DVT “ ) ; wear comfortable clothing and adjust seatbelt.


• Helpful links :-


http://www.nhs.uk/chq/Pages/927.aspx...oryID=54#close


http://www.nursingtimes.net/nursing-...069439.article


http://www.rcog.org.uk/files/rcog-co...0Pregnancy.pdf

[Doc Alan]

Since the last update here, various Forum threads have been posted on health / medical / travel insurance with good advice, including :- http://bit.ly/1WC0v2w .


This thread is not about insurance for those living in the Philippines, although a good link was given for " backpackers " here :- http://bit.ly/1sueaw2 .


Life expectancy is improving worldwide. Healthy life expectancy is a few years less ( http://bit.ly/1X70WBV ).


Travel insurance claims - and premiums - increase with age. Those aged 61-65 make more than twice the claims of 26-30 year olds.


Personally I have annual multi-trip policy with Saga ( http://bit.ly/1OapPtH ). Not all companies will even consider insuring senior citizens. Moneysupermarket.com will search / quote for travel insurance ( http://bit.ly/N1Y3Bf ).


Information in #8 of this thread is unchanged, except that IF malaria prophylaxis is thought necessary for Philippines, British National Formulary ( https://www.bnf.org/ ) recommends chloroquine with proguanil, NOT mefloquine ( because of recent concern about possibly serious psychiatric reactions ).


For travel in countries within the European Economic Area ( EEA includes EU countries ; Iceland, Liechtenstein and Norway ; also Switzerland ), European Health Insurance Card is free ( http://bit.ly/1nNAA7B ). Travel insurance is also needed.


Whether or not you agree with UK Government travel advice ( http://bit.ly/1v5lo7W ), insurers DO note their recommendations. Insurance may be invalid if advice is not taken from UK Foreign and Commonwealth Office, and/or the government of the country of destination.


Existing health problems should always be declared before taking out insurance.


Most travel insurance policies should include :-

* emergency medical treatment costs, including hospital charges and ambulance fees

* return home following medical treatment abroad if original ticket can’t be used

* temporary emergency dental treatment

* " reasonable " additional expenses for a close relative or friend to give support / escort if needed

* 24 hour assistance helplines

* See http://bit.ly/1U4e5YQ .


As with all my health - related posts, they are for information, rather than to give advice .

In most cases it’s neither possible nor wise to advise Forum members, most of whom I don’t know personally.

See disclaimer : - " Anything posted in this section is the poster's own opinion and may not be accurate. Please seek professional advice. "

[Steve.r]

Thanks for the update Alan

[Doc Alan]

Thanks for the update Alan

Thanks in turn for your response, Steve - hopefully this is also of help to other members

[Michael Parnham]

Very useful Alan, reminds me that I'm due for my ten year boosters this year

[Terpe]

Thanks a lot Alan for your appreciated update

[Doc Alan]

Thanks in turn Michael and Peter

As this is a " sticky " / permanent thread, information here should be easily found.

[ssbib]

Hi all. I'm off back to the Philippines in the new year for the wedding. I'm really excited. I went to the doctors to get a booster of my vaccinations and this time they are recommending I get rabies and Japanese Encephilitis vaccinations too. These cost over £300!! They say it's to do with the legth of time I will be there more than anything else. Have any of you lot had them when going for a longer trip?

[Ako Si Jamie]

The rabies injection is not a preventative. You'll still need more if you do get bitten. It just gives you time to get the necessary treatment required.

[Steve.r]

Never had any for the Philippines before. But I got boosted up for a job in Ethiopia that never actually happened a few months ago, so I am pretty much covered.

[grahamw48]

I just got a repeat prescription for Viagra.

[Steve.r]

I just got a repeat prescription for Viagra.

That appeared to work just fine Graham.

[ssbib]

The rabies injection is not a preventative. You'll still need more if you do get bitten. It just gives you time to get the necessary treatment required.

Yeah, that's what I was told about rabies also. I don't see the point, vaccine or no if you get bitten by an animal you go straight to the hospital surely? My fiancé says that in February there aren't any mosquitos (which is how you get Japanese encephalitis) so I might just keep my £300.

[Doc Alan]

I have never been vaccinated against rabies or Japanese encephalitis, nor taken anti-malarial tablets ( there is no available vaccine against malaria ).
This may well be the case for most, if not all, other members. However, circumstances vary for each individual, depending on where they are visiting or living in the country.


There is much free advice available on the internet and one’s own doctor ( GP ), before considering private travel clinics.


While vaccinations ARE also usually free for conditions including cholera, diphtheria, polio, tetanus, hepatitis A ( perhaps combined with hep B ), and typhoid, others are NOT ( such as hepatitis B, rabies and Japanese encephalitis ; also antimalarial tablets ). Costs do vary, so it’s worth " shopping around " - preferably a couple of months before travelling.


Sensible precautions should STILL be taken to reduce risks of illnesses from food, water, insects ( especially mosquitoes ), animals and other humans, even if vaccinations / tablets are up to date. Full insurance cover is only valid if recommendations in the policy are followed.


Rabies is " 100% fatal but also 100% preventable " - causing around 200 deaths / year in the Philippines ( usually following dog bites ). Although it’s possible to have a course of vaccines ( " pre-exposure prophylaxis " ) it IS still necessary for urgent medical attention after any animal bite. Further vaccination / immunoglobulin is needed, and should be given to cure the patient, before any symptoms appear. There are nation-wide treatment centres in the Philippines.


Japanese encephalitis is mosquito-borne, most infections don’t have symptoms, but in a few there may be serious brain inflammation. There is an effective vaccine, but it’s not ( to my knowledge ) included in the schedule for children in the country.


Malaria ( see post #68 ) - for most travellers the risk is not usually considered high enough to recommend antimalarial tablets.

[Steve.r]

Good post Alan.

I think it is, like you say, best to just be aware of what 'could' happen. Prevention is the key.
For me, having lived there, I find mosquitos are always there year round. I always sleep under a mosquito net bought in the UK, it's a double so big enough to hang off the ceiling to below the mattress so it can be tucked in. I am not worried about malaria, but if I get bitten, I get large itchy lumps come up which are not pleasant. For bites like that get your girlfriend to buy a bottle of Apickacine oil, it does relieve the itch.
Watch out for red ants, these make nests in the ground, and if you stand in the wrong place they will climb over your foot and bite...
Advice for rabies is to stay clear of any dogs, even if friendly. We have our dogs vaccinated against rabies (free in our Brgy) but best not to take risks. We keep a few dogs at our house, but I am not a real dog person. Cats are also one to watch as they can bite too or scratch. I do have house cats at home, but I still go careful.

If if you have a weak stomach only drink bottled water, or soft drinks from cans/bottles, these are safe. If your gf's house has water from the water district you can drink that fine too. Well water for you I would stay away from, although I drink from ours but my stomach is quite strong and I have never had problems. What you must watch is if you go to someone's house where you can't regulate what you are given, so your gf is going to have to watch that for you, ice etc etc.

Sure you will be fine, just take some Imodium tabs with you just in case, some Jungle Formula roll on or spray and just enjoy yourself.

[ssbib]

I have never been vaccinated against rabies or Japanese encephalitis, nor taken anti-malarial tablets ( there is no available vaccine against malaria ).
This may well be the case for most, if not all, other members. However, circumstances vary for each individual, depending on where they are visiting or living in the country.


There is much free advice available on the internet and one’s own doctor ( GP ), before considering private travel clinics.


While vaccinations ARE also usually free for conditions including cholera, diphtheria, polio, tetanus, hepatitis A ( perhaps combined with hep B ), and typhoid, others are NOT ( such as hepatitis B, rabies and Japanese encephalitis ; also antimalarial tablets ). Costs do vary, so it’s worth " shopping around " - preferably a couple of months before travelling.


Sensible precautions should STILL be taken to reduce risks of illnesses from food, water, insects ( especially mosquitoes ), animals and other humans, even if vaccinations / tablets are up to date. Full insurance cover is only valid if recommendations in the policy are followed.


Rabies is " 100% fatal but also 100% preventable " - causing around 200 deaths / year in the Philippines ( usually following dog bites ). Although it’s possible to have a course of vaccines ( " pre-exposure prophylaxis " ) it IS still necessary for urgent medical attention after any animal bite. Further vaccination / immunoglobulin is needed, and should be given to cure the patient, before any symptoms appear. There are nation-wide treatment centres in the Philippines.


Japanese encephalitis is mosquito-borne, most infections don’t have symptoms, but in a few there may be serious brain inflammation. There is an effective vaccine, but it’s not ( to my knowledge ) included in the schedule for children in the country.


Malaria ( see post #68 ) - for most travellers the risk is not usually considered high enough to recommend antimalarial tablets.

Thanks for all the information Alan. Have you ever been to the Philippines for any significant length of time? I'm asking because you said that you have never been vaccinated. Also, why bother ever having a rabies injection? If you get bitten from an animal you go straight to the hospital and get treatment so why bother having the rabies vaccine just to "have extra time to get to the hospital" as my GP put it? For me it is simply the cost of these vaccinations puts me off. I just simply can't afford it.

Good post Alan.

I think it is, like you say, best to just be aware of what 'could' happen. Prevention is the key.
For me, having lived there, I find mosquitos are always there year round. I always sleep under a mosquito net bought in the UK, it's a double so big enough to hang off the ceiling to below the mattress so it can be tucked in. I am not worried about malaria, but if I get bitten, I get large itchy lumps come up which are not pleasant. For bites like that get your girlfriend to buy a bottle of Apickacine oil, it does relieve the itch.
Watch out for red ants, these make nests in the ground, and if you stand in the wrong place they will climb over your foot and bite...
Advice for rabies is to stay clear of any dogs, even if friendly. We have our dogs vaccinated against rabies (free in our Brgy) but best not to take risks. We keep a few dogs at our house, but I am not a real dog person. Cats are also one to watch as they can bite too or scratch. I do have house cats at home, but I still go careful.

If if you have a weak stomach only drink bottled water, or soft drinks from cans/bottles, these are safe. If your gf's house has water from the water district you can drink that fine too. Well water for you I would stay away from, although I drink from ours but my stomach is quite strong and I have never had problems. What you must watch is if you go to someone's house where you can't regulate what you are given, so your gf is going to have to watch that for you, ice etc etc.

Sure you will be fine, just take some Imodium tabs with you just in case, some Jungle Formula roll on or spray and just enjoy yourself.

Hi Steve, thanks for the information. Can I ask if you have had the rabies or JE vaccinations? It will be interesting to hear if you have and living out there. I will take your advice about water onboard. When I have been there in the past I just drank bottled water to be safe, I only used the tap water for brushing my teeth. I do have a weak stomach so would hate to have an episode because of the water.

Funny story actually...my weak stomach caused me quite a bit of anxiety when i first went to the Philippines to meet my girlfriend. We stayed at Hotel H2O at Manila Ocean Park. Its a great hotel and I would recommend it for everyone but the room layout is a bit weird, with an open plan bathroom/bedroom and only a frosted glass door covering the toilet. First meeting with the girlfriend and she was going to have to listen to my weak .... every time I went to the toilet. Luckily my guts were on top form that week so it wasn't an issue. She's since learnt all about my rancid guts and still loves me so now it wouldn't be an issue but by God, it caused me some sleepless nights worrying about that before my first trip.

[Steve.r]

No, never had them. Rabies was too expensive in my mind, but it is what it is. What I will say though, is that by not trying local foods, drinking water, you will never build up the strength in your stomach. As long as you have immodium, have a ball, eat drink and enjoy everything, nothing worse than worrying if you should try this and try that.... I really love street bbq.

As as for toilet habits, I am sure your gf was not shocked, you always see people on the side of the road having a pee. No closed doors in our house either lol

[ssbib]

No, never had them. Rabies was too expensive in my mind, but it is what it is. What I will say though, is that by not trying local foods, drinking water, you will never build up the strength in your stomach. As long as you have immodium, have a ball, eat drink and enjoy everything, nothing worse than worrying if you should try this and try that.... I really love street bbq.

As as for toilet habits, I am sure your gf was not shocked, you always see people on the side of the road having a pee. No closed doors in our house either lol

I'm all for trying the food over there. Actually I really liked it. The only thing I don't touch is the tap water. I don't even like tap water in England so I just stick to bottled all round. I always carry Imodium when I travel, it's essential. Interesting that you haven't had the vaccines. I'm certain I'll be ok. Just a bit frightening when you hear the gp talk about it.

My girlfriend was just as nervous as me I think about the bathroom situation but she quickly got over it. There's no hesitation for her now regarding such things for either of us.

[Doc Alan]

Thanks for all the information Alan. Have you ever been to the Philippines for any significant length of time? I'm asking because you said that you have never been vaccinated. Also, why bother ever having a rabies injection? If you get bitten from an animal you go straight to the hospital and get treatment so why bother having the rabies vaccine just to "have extra time to get to the hospital" as my GP put it? For me it is simply the cost of these vaccinations puts me off. I just simply can't afford it.

My maximum time in the Philippines has been a month or less, over several visits since 1978 ( when I worked for a year at the University Hospital in Kuala Lumpur, Malaysia ). At no time did I consider it necessary to have rabies or Japanese encephalitis vaccines, or antimalarial tablets, because of the places I visited, and my home in Malaysia was on the University campus next to the hospital.



I can’t give advice to individual members, most of whom I don’t know personally. All I can do safely is to give information based on best available evidence. It’s a matter for each person to reach a decision according to their general health, where they plan to visit ( or live ), and what they intend to do during their visit - after consultation with their doctor / nurse, and reading reliable source(s).



So-called " pre-exposure prophylaxis " ( immunisation ) is different to " post-exposure prophylaxis ". Each depends on the age and general health of the patient, and ( after a bite ) whether or not the suspect animal can be shown to have rabies.


Essentially pre-exposure involves several intramuscular injections and booster dose(s) of vaccine. Post-exposure involves not only further vaccines but also immunoglobulin for immediate " passive " immunity.


Each regime is indeed expensive, either in UK or the Philippines. Of course, once there are symptoms - after a variable incubation period of usually 1 - 3 months, rabies is almost always fatal. It is preventable ONLY by vaccination ( and immunoglobulin ).