Health. travellers. advice for. Vital information on. Important changes to E111

Transcription

1 Impotant changes to E111 Health advice fo tavelles Vital infomation on Avoiding health isks Planning fo healthy tavelling Obtaining emegency medical teatment Fom E111 the passpot to fee o educed-cost emegency medical teatment in most Euopean counties The Euopean Health Insuance Cad (EHIC)

2 Impotant note This vesion of Health advice fo tavelles is valid only until the end of August 2005, afte which the Euopean Health Insuance Cad (EHIC) will be intoduced and an updated vesion of this booklet made available. Fom E111s issued afte 19 August 2004 will continue to be valid until 31 Decembe Fom Septembe 2005, the EHIC will be issued by a cental agency and not by the Post Office; howeve, the new vesion of this booklet and the EHIC application fom will be available fom the Post Office and othe souces. The new booklet will explain how to apply fo an EHIC and will give advice on the changes to entitlement and the claims pocess. If you apply fo an E111 in 2005 and tick the appopiate box on the application fom, you will be sent you EHIC automatically, pio to the expiy of you E111 on 31 Decembe Euopean Health Insuance Cad The EHIC will be a moe convenient, plastic, cedit-cad-sized eplacement fo the E111. It will follow a standad fomat thoughout the Euopean Economic Aea (EEA) and will be in use thoughout Euope fom 1 Januay Each tavelling individual will need thei own EHIC.

3 Health advice fo tavelles anywhee in the wold Evey yea, esidents of the United Kingdom (UK) go on moe than 59 million oveseas jouneys. Tavel acoss the wold is now so common that it is easy to foget the health isks that can be involved and the fact that vey few counties offe such easy access to medical facilities as the UK. If you fall ill o have an accident when aboad, it could pove dangeous, even fatal. Obtaining teatment can seem complicated to UK esidents used to the National Health Sevice. And, unless you ae popely pepaed, it could tun out to be extemely expensive. Read this booklet now! Whethe you ae going off in seach of sea and sun, tavelling on business, o tekking though the wilds, this booklet is designed to help you enjoy a healthy jouney and to deal successfully with any medical emegencies that might aise. It contains essential infomation and advice on: how to avoid the need fo health cae when aboad; how to plan fo healthy tavelling; how to obtain emegency medical teatment in counties thoughout the wold; how to obtain and use Fom E111, which will povide you with fee o educed-cost necessay medical teatment in counties within the Euopean Economic Aea (EEA) and Switzeland. Medical cove aound the wold The level of emegency medical cove available to UK esidents in counties aound the wold vaies geatly. Counties fall into one of the following thee categoies: 1 Euopean Economic Aea counties The Euopean Economic Aea (EEA) consists of the membe states of the Euopean Union (EU) plus Iceland, Liechtenstein and Noway. The Euopean Community (EC) ecipocal health cae aangements apply to all of these counties and Switzeland.

4 Tavelles fom the UK, who ae eligible, ae entitled to fee o educed-cost emegency medical teatment in the othe 27 EEA counties and Switzeland in most cases on poduction of a completed Fom E111. This EC document confims the holde is entitled to all necessay teatment. A COUNTRY-BY-COUNTRY CHECKLIST OF WHAT IS INVOLVED IN OBTAINING TREATMENT IN EACH OF THE EEA STATES AND SWITZERLAND CAN BE FOUND ON PAGES OF THIS BOOKLET. An application fo the Fom E111 can be found at the back of this booklet. 2 Recipocal ageement counties Thee ae ove 25 moe counties aound the wold with which the UK has ecipocal health cae ageements that entitle you to emegency medical teatment in those counties. Recipocal ageements cove, among othes, the Channel Islands, the Isle of Man, Austalia, New Zealand, cetain Caibbean islands, and the epublics of the fome Soviet Union, including Russia itself. A COUNTRY-BY-COUNTRY CHECKLIST SHOWING THE SERVICES AVAILABLE AND HOW THEY MAY BE OBTAINED CAN BE FOUND ON PAGES OF THIS BOOKLET. Counties with no health cae ageements with the UK With the est of the wold and that means moe than 100 diffeent counties the UK has no health cae ageements whatsoeve. This includes some of the most popula tavel destinations, such as Canada and the United States, India and the Fa East, as well as the whole of Afica and Latin Ameica. If you ae tavelling to any county which is outside the EEA o Switzeland and which has no ecipocal medical ageement with the UK, you ae stongly advised to take out full medical insuance to cove the cost of teatment. Even in counties with which the UK has health cae ageements, you will need a cetain amount of insuance. Fo moe details, please see page 24 of this booklet. PREPARE NOW. AVOID EXPENSIVE EMERGENCIES LATER. PLEASE NOTE: This booklet gives guidance only. It should not be teated as a complete and authoitative statement of law.

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6 Contents Health isks aound the wold... and how to avoid them 4 6 Eat and dink... safely 7 Be safe out of doos 7 Take cae in the sun 7 Avoid insect and animal bites 8 Take cae in wate 8 Take cae on the oads 8 Hazadous spots and diving 8 No go aeas 8 Day tips 9 Majo diseases and the pecautions to take 9 Malaia 10 Rabies 11 HIV/AIDS 12 Bilhaziasis 12 Cholea 12 Dengue 13 Diphtheia 13 Hepatitis 14 Japanese encephalitis 14 Legionnaies disease 14 Meningitis 14 Poliomyelitis 14 SARS (sevee acute espiatoy syndome) 14 Tetanus 15 Tick-bone encephalitis 15 Tubeculosis 15 Typhoid 15 Yellow feve 16 Immunisation summay: what may be ecommended fo diffeent counties 18 Woldwide county-by-county disease and immunisation checklist Planning ahead 22 Consult you docto well in advance 23 Paying fo immunisations and anti-malaia tablets 23 Taking medicines out of the UK 23 Existing medical conditions and medication 23 Have a dental check-up 23 Cay a fist-aid kit 23 Emegency medical tavel kits 24 Reducing the isk of DVT duing the jouney 24 Health insuance 25 Receiving benefits while you ae away 26 Planning fo when you etun 27 Emegency health checklist

7 Getting teatment aound the wold 28 Getting teatment in counties with no health cae ageements with the UK 29 Getting teatment in counties outside the EEA with ecipocal health cae ageements with the UK 30 Recipocal health cae ageements: county-by-county checklist 34 Getting teatment in EEA counties and Switzeland 34 List of counties coveed 34 Who is coveed and in which counties 35 Documentation equied 35 How to apply fo the E Validity of the E What teatment is coveed 37 Chages fo teatment 37 Claiming efunds 37 Non-emegency teatment in an EEA county o Switzeland: Fom E Inteim guidance on obtaining medical teatment outside the UK 40 Studying in anothe EEA county o Switzeland 41 Woking tempoaily in anothe EEA county o Switzeland fo a UK employe o as a self-employed peson 41 Woking pemanently in anothe EEA county o Switzeland 42 Living in anothe EEA county o Switzeland 43 EEA and Switzeland: county-by-county checklist 43 Austia 53 Latvia 43 Belgium 54 Liechtenstein 44 Cypus 54 Lithuania 45 Czech Republic 55 Luxemboug 45 Denmak 56 Malta 46 Estonia 57 The Nethelands 47 Finland 57 Noway 48 Fance 58 Poland 49 Gemany 58 Potugal 49 Geece 59 Slovakia 50 Hungay 60 Slovenia 51 Iceland 61 Spain 52 Republic of Ieland 62 Sweden 52 Italy 62 Switzeland 5 Application fo Fom E111 (pull-out) 64 How to complete the Fom E111

8 Health isks aound the wold and how to avoid them Tavelling ound the wold always bings some isk to health. Howeve, by taking cetain often simple steps, you can minimise you exposue to almost evey majo health hazad. Eat and dink... safely Wheeve you ae in the wold, be caeful what you eat and dink. Food and wate may be contaminated in a vaiety of ways and that includes the wate in swimming pools, lakes, ives and the sea, so ty not to swallow wate when you ae bathing. Tavelles diahoea is vey common, especially in hot counties. Tavelles diahoea, as well as diseases such as cholea, typhoid and hepatitis A, can be caught fom contaminated food and wate. Howeve, they can also lagely be avoided by taking simple pecautions: 6 Always wash you hands afte going to the lavatoy, befoe handling food and befoe eating. If you have any doubts about the wate available fo dinking, washing food o cleaning teeth, boil it, steilise it with disinfectant tablets o use bottled wate pefeably cabonated with gas in sealed containes. Avoid ice unless you ae sue it is made fom teated and chloinated wate. This includes ice used to keep food cool as well as ice in dinks. It is usually safe to dink hot tea o coffee, wine, bee, cabonated wate and soft dinks, and packaged o bottled fuit juices. Eat feshly cooked food which is thooughly cooked and still piping hot. Avoid food that has been kept wam. Avoid uncooked food, unless you can peel o shell it youself. Avoid food likely to have been exposed to flies. Avoid ice ceam fom uneliable souces, such as kiosks o itineant tades. Avoid o boil unpasteuised milk. Fish and shellfish can be suspect in some counties. Uncooked shellfish, such as oystes, ae a paticula hazad.

9 Be safe out of doos TAKE CARE IN THE SUN Many people tavel fom this county in seach of the sun. The sun should be enjoyed, but oveexposue can cause sunbun, leading to pematue skin ageing and an inceased isk of skin cance. It is the ultaviolet (UV) ays which cause this; even in the UK they can damage you skin, and UV is much moe poweful the neae to the equato you go. If you want to avoid touble, take cae not to bun. It is paticulaly impotant to cae fo you childen, and babies should neve be placed in diect sunlight. Stay out of the sun fo at least two hous aound midday, use what shade thee is at othe times, and cove up with a wide-bimmed hat and tightly woven but loose clothing. Potective ceams suitable fo you skin type can help potect unavoidably exposed pats of the body. Wea sunglasses that filte UV ays to potect you eyes. A sepaate isk of oveexposue to the sun is sunstoke o heatstoke, caused simply by oveheating. Avoid stenuous activity duing the hottest hous, and make sue you dink plenty of non-alcoholic liquids to balance the loss of body fluid though pespiation. What you dink must be safe eithe soft dinks fom sealed cans o bottles, o wate that has been boiled o is bottled. AVOID INSECT AND ANIMAL BITES To avoid insect and animal bites, use insect epellent pepaations and cove ams and legs when advised (page 9 gives moe details on potection against malaia). Tick-bone diseases such as tickbone encephalitis and boeliosis (Lyme disease) ae pevalent in tempeate climates. It is theefoe not only in topical aeas that one needs to take pecautions (see page 15). Animal bites can set up infections that can be seious and sometimes fatal. Be way of even appaently tame animals. Page 10 povides infomation on abies. Neve undeestimate how ill caeless exposue to the sun can make you thee is no excuse fo not potecting you childen popely. 7

10 TAKE CARE IN WATER Do not go swimming alone. Bathing will cool you but emembe that fatal accidents can happen vey easily and in the most unexpected conditions. Adults should watch each othe fo signs of touble when in the wate. Childen should always be supevised by an adult who can swim well. Young childen should neve be left unattended nea a stetch of wate, even a paddling pool. If you ae going to dive into wate, make sue that it is deep enough fo you to do so safely. Each yea, many people ae pemanently paalysed as a esult of injuies sustained fom diving into shallow wate. TAKE CARE ON THE ROADS Taffic accidents ae the majo cause of death among tavelles. Whethe you ae a dive o a pedestian, always check local taffic egulations. If you ae in a ca, always wea seat belts and put childen in a child estaint. If you ae on a moto- o pedal-bike, always wea a helmet and put childen in a child estaint. If you hie a ca o a bike, check its condition and the insuance cove. In addition, neve dink and dive. 8 HAZARDOUS SPORTS AND DIVING If you ae going to take pat in potentially hazadous spots, such as skiing, canoeing o mountaineeing, follow all the elevant safety guidance; make sue that thee ae adequate emegency medical facilities on hand; and check that you have medical insuance which coves you fully in the event of any accident. Dives should allow 24 hous between thei last dive and a flight. NO GO AREAS In many counties, thee ae aeas that ae unsafe fo tavelles to visit because of the isk of violence. Fo guidance and infomation, please use the Foeign and Commonwealth Office Advice to Tavelles telephone line: Altenatively, visit DAY TRIPS Even if you ae only going on a day tip to anothe county, accidents can happen. So please make sue you have adequate tavel insuance and a completed Fom E111 if you ae visiting a county in the Euopean Economic Aea.

11 Majo diseases and the pecautions to take MALARIA A paasitic disease, spead by the bites of infected mosquitoes, malaia poduces feve and, in some cases, complications affecting the kidneys, live, bain and blood. It can be fatal. Malaia is a majo health poblem thoughout the topics a county-by-county checklist is on pages and some foms ae paticulaly life-theatening. If you live in a malaial egion, you may build up some immunity to the disease, but this can be quickly lost. Childen bon in the UK will have no immunity at all. If you ae going to visit, tavel though, o even just stop ove, in a malaial county, even if you have lived thee befoe, take the following pecautions: Ask you docto about anti-malaial measues. Tell you docto which counties you will be visiting. Many aeas have malaia paasites that ae esistant to anti-malaia medicines. If you ae in any doubt about which anti-malaia medicines ae most suitable fo you, you docto can check with the National Tavel Health Netwok and Cente (NaTHNaC), the Scottish Cente fo Infection and Envionmental Health o othe pofessional souces of infomation. You and you childen should take the medication afte food, fo a week befoe tavelling, thoughout you stay, and fo a month afte etuning. 9 Avoid mosquito bites. Use insect epellent, pefeably one containing DEET (diethyltoluamide). Keep you ams and legs coveed afte sunset. Sleep in popely sceened ooms and employ a knockdown spay to kill any mosquitoes in the oom. Use a mosquito net aound the bed at night, pefeably one that is impegnated with an insecticide. You should ensue that thee ae no holes in it and that it is well tucked in. Nets can be bought in the UK fom tavel shops and tavel clinics, such as those un by Bitish Aiways and Tailfindes. None of these pecautions, howeve, will give absolute potection. If you develop a feve, o feel ill, while aboad o up to thee months afte etuning, it is essential to seek medical attention immediately. If you develop these symptoms afte you have left a malaial egion, tell the docto that you have been to a county whee malaia is a health isk.

12 10 RABIES Rabies is an acute vial infection of the nevous system. Its symptoms include deliium and painful muscle spasms in the thoat. Once a peson develops symptoms, the disease is usually fatal. Rabies occus in animals in Euope and Noth Ameica as well as in the less developed counties. You can contact the disease if you ae bitten by any infected animal. So be caeful not to touch any animals, whethe wild, stay o appaently tame. If you ae bitten, post-exposue teatment if given ealy enough usually pevents the disease developing. If you ae bitten by an animal while away fom the UK: Wash the wound immediately, using soap o detegent, o flush with clean wate. Apply alcohol if possible. Get medical attention fast. Go to the neaest docto o hospital. You may need a abies vaccination and the couse of injections must be stated immediately. Ask fo human diploid cell vaccine, if possible. In case of any difficulty, contact the neaest Bitish Consula official. Note the date and place of the incident, the animal s desciption and whethe it was wild o a stay. If the animal was not wild o a stay, ty to identify its owne as soon as possible to ascetain if it is aleady o if it becomes sick. If the animal can be kept unde obsevation fo two weeks following the incident, exchange names, addesses and telephone numbes with the peson esponsible fo it, and aange to keep in contact to find out whethe the animal becomes sick o dies. Find out whethe it has had the abies vaccine and ask to see the cetificate. But even if one is poduced, do not assume thee is no isk. Infom the local police. Whethe o not you eceive teatment outside the UK, consult you docto as soon as you etun. Rabies vaccine befoe tavel is only ecommended fo those who may be exposed to an unusual isk of infection o who ae undetaking long jouneys in emote aeas whee medical teatment may not be immediately available. This vaccine is not nomally povided fee fo tavelles unde the NHS. Even if you ae immunised, howeve, this does not emove the need fo ugent teatment if you ae bitten by an infected animal.

13 Remembe that the UK is still fee fom animal abies. Keep it that way. Do not bing any animals into the county without a licence. This is not only illegal and caies sevee penalties, it could also endange lives. HIV/AIDS AIDS (acquied immune deficiency syndome) has now spead acoss the wold. Thee is no vaccine o cue fo AIDS. AIDS is caused by a vius known as HIV (human immunodeficiency vius). Infection with HIV is moe common than AIDS itself. People infected with HIV emain infected and infectious all thei lives. Thee is no vaccine o cue fo HIV infection. HIV/AIDS can be passed on in fou main ways: Though unpotected sex with an infected peson. Though the use of infected syinges, medical and dental instuments, and anything else which punctues the skin, such as tattooing equipment. By tansfusions of HIV-infected blood. Fom an infected mothe to he baby, befoe o duing child-bith o though beast-feeding. HIV/AIDS cannot be passed on though eveyday social contact, o though insect bites, dity food o cockey, o activities such as kissing, coughing o sneezing. 11 To potect youself against HIV/AIDS: Do not have sex except with you usual patne. Casual sexual intecouse can be vey isky. People can be infectious even though they may not be awae of it, and even if they look and feel well. If you do have sex with a new patne, always use a condom. They ae the most effective potection against HIV/AIDS and othe sexually tansmitted diseases. Pack an adequate supply of condoms, if you think you may need them when tavelling, as they might not be easily available o of good quality in some counties. Those bought in the UK should cay the Bitish Standads Kite mak o the Euopean Standad mak. If you dink, emembe that alcohol can make it easie to foget about safe sex. Do not inject non-pescibed dugs. If you do, neve shae equipment.

14 12 Do not have a tattoo, acupunctue, o you eas pieced, unless you can be sue that the equipment is steile. Since some counties do not have the same standads of medical and dental hygiene as the UK, needles and othe equipment may not be adequately steilised, no blood sceened fo the pesence of HIV o hepatitis B o C, so: ty and ensue that any medical teatment, paticulaly a blood tansfusion, is absolutely necessay; make sue that any medical equipment used is feshly steilised o is taken fom a sealed pack; if you need a tansfusion, ask fo sceened blood. If you ae going to an aea whee the availability of steile needles and syinges fo medical teatment is in doubt, conside taking a special kit with you. (Please see page 23.) Some counties have intoduced HIV-antibody testing fo visitos, o equie an HIV-antibody test cetificate. If in doubt, check with the Embassy o High Commission of the county concened. BILHARZIASIS This is a paasitic disease caused by a wom that is most common in wateways in Afica. The wom penetates the skin and can cause damage to the intestines, the live and the uinay tact. The disease can be teated but no vaccine is available. Visitos to aeas whee bilhaziasis is pesent should avoid wading o bathing in steams, ives and lakes. CHOLERA Cholea is an intestinal infection that can cause sevee diahoea, which may lead to dehydation and ultimately death. It is caught fom the consumption of contaminated food and wate. An inceasing poblem in aeas of poo sanitation in South Ameica, the Middle East, Afica and Asia, it is elatively uncommon among tavelles. It can be avoided by scupulous attention to food and pesonal hygiene. No vaccine against cholea is cuently available (the old one was not effective) and no county now equies cholea immunisation as an official condition of enty. DENGUE Dengue and its moe sevee fom, dengue haemohagic feve occu thoughout the topics whee they ae inceasing in many counties. They ae tansmitted by the bite of an infected mosquito. Thee ae no vaccines against the diseases. Pevention is by avoiding mosquito bites by day as well as afte dusk (see page 9).

15 DIPHTHERIA Diphtheia emains a seious disease thoughout much of the wold, especially in topical counties whee thee is ovecowding and poo hygiene. It is caught though having close contact with an infected peson. Until the 1930s, it was one of the biggest causes of childhood death woldwide, but the mass immunisation of childen since the 1940s has effectively eadicated the disease in developed counties. Howeve, immunisation pogammes have to be continued if the disease is to be kept at bay. Fo unimmunised adults, a special low-dose vaccine is available. HEPATITIS Vial hepatitis is an infection of the live that can cause jaundice. Thee ae seveal foms of the disease, including hepatitis A, sometimes called infectious hepatitis, hepatitis B and hepatitis C. Hepatitis A Usually caught by consuming contaminated food o wate, this can also be spead fom peson to peson, since the vius is pesent in faeces. Tavelles to places whee sanitation is pimitive need to be especially awae of the isk of infection. The main pecautions ae cae ove what you eat and dink, and washing you hands afte going to the lavatoy and befoe handling food. Thee is a vaccine against hepatitis A. Hepatitis B This occus woldwide and is spead in the same ways as HIV/AIDS, that is though: intimate peson-to-peson contact; shaing contaminated needles o syinges; tansfusions of contaminated blood o the use of inadequately steilised equipment in medical teatment, tattooing and ea-piecing. Thee is a vaccine, which gives good potection against the disease. Howeve, it can take six months to become effective. The best way to pevent infection is to avoid the high-isk activities listed above and also to take a tavel kit fo use in medical emegencies (see page 23). Hepatitis C This is being inceasingly ecognised woldwide and is spead in the same way as HIV/AIDS and hepatitis B. Thee is no vaccine. The best way to avoid infection is to take the pecautions ecommended against HIV/AIDS and hepatitis B. 13

16 14 JAPANESE ENCEPHALITIS A vial inflammation of the bain that, in some cases, can be lifetheatening, this occus thoughout South-east Asia, mainly in ual aeas and duing the monsoon season. A vaccine is available and is ecommended fo tavelles who ae staying in isk aeas fo a month o moe. Howeve, the vaccine is not nomally supplied unde the NHS and you will have to pay a fee. LEGIONNAIRES DISEASE Legionnaies disease is an uncommon fom of pneumonia that occasionally occus in holiday-makes. It is spead though wate vapou containing the legionella gem, usually though pooly maintained cooling towes o ai-conditioning systems. It is teatable with antibiotics. Thee is no vaccine. MENINGITIS Meningitis is an inflammation of the membanes coveing the bain and spinal cod. It paticulaly affects childen and young adults and can esult in death. Meningococcal meningitis is moe pevalent in some aeas of Afica and Asia than in the UK, and a vaccine is available. This vaccine, howeve, does not cove the stain most common in the UK. Saudi Aabia equies the immunisation of all those going on hajj, the geat annual Muslim pilgimage. POLIOMYELITIS Polio is a vial infection that can cause paalysis of the muscles. Eveyone tavelling outside Noth and Westen Euope, Noth Ameica, Austalia and New Zealand should have up-to-date polio immunisations. Peviously unimmunised people should eceive a full couse of thee doses of vaccine. Those immunised moe than ten yeas ago equie a booste dose. SARS (sevee acute espiatoy syndome) SARS is a sevee espiatoy infection that stated in southen China in Novembe 2002 and subsequently spead in East and Fa East Asia and to many othe counties. In July 2003, SARS was declaed contained but it is not cetain whethe it may ecu. If you develop a high feve with one o moe espiatoy symptoms (fo example, cough, shotness of beath, difficulty in beathing) within ten days of tavelling in an affected o peviously affected aea, you should contact you docto fo advice. TETANUS Tetanus is a dangeous disease, which causes sevee and painful muscle spasms, and is caught by the intoduction of bacteial spoes into the body though even a slight wound. The spoes ae found woldwide, mainly in soil and manue. Tetanus is paticulaly dangeous whee medical facilities ae not available fo immediate teatment. Eveyone should be potected by immunisation, especially those who tavel to emote aeas. If you wee immunised as a child, ask you docto about a booste. If you wee not, you will need a couse of thee injections.

17 TICK-BORNE ENCEPHALITIS An inflammation of the bain contacted fom the bite of an infected tick, tick-bone encephalitis occus in foested pats of Austia, Nothen Euope and Scandinavia, especially whee thee is heavy undegowth. It is moe commonly caught in late sping and summe. When walking o camping in aeas whee the disease is pevalent, you should wea clothing that coves most of the skin and use insect epellents as well. A vaccine is available but not fee of chage unde the NHS. TUBERCULOSIS Tubeculosis (TB) is inceasing woldwide. If you o you family have not been immunised against the disease, and you ae going to stay fo moe than a month in Easten Euope, Asia, Afica, Cental o South Ameica, you should discuss the need fo BCG immunisation with you docto pefeably at least two months befoe depatue. You will need a skin test fist. Immunisation is paticulaly advisable fo those who will be tavelling, living o woking closely alongside the indigenous population, and fo membes of ethnic goups visiting thei county of oigin. It is not necessay fo shot visits if you ae staying in intenational-style hotels. Once immunised, eimmunisation is unnecessay. TYPHOID Typhoid feve is caught though the consumption of contaminated food o wate. Those tavelling to places whee sanitation is pimitive should conside immunisation against the disease. It is also essential to take scupulous cae ove food and wate. YELLOW FEVER Yellow feve is caught fom the bite of an infected mosquito and occus in pats of Afica and South Ameica. Some counties equie a vaccination cetificate fo enty (please see pages 18 21). The vaccine can only be given at a designated Yellow Feve Vaccination Cente you docto will be able to advise you. It is not available fee of chage on the NHS. The cetificate itself is valid fom ten days afte vaccination fo a peiod of ten yeas

18 Immunisation summay: what may be ecommended fo diffeent counties FOR ALL AREAS If you have not peviously been immunised against diphtheia, polio o tetanus, this is an ideal oppotunity to have the vaccinations. Booste doses of tetanus, diphtheia o polio may be ecommended fo some aeas. FOR ALL AREAS EXCEPT NORTH AND WESTERN EUROPE, NORTH AND SOUTH AMERICA, THE CARIBBEAN, AUSTRALIA AND NEW ZEALAND Poliomyelitis FOR AREAS WHERE STANDARDS OF HYGIENE AND SANITATION MAY BE LESS THAN IDEAL Hepatitis A Typhoid FOR KNOWN INFECTED AREAS (Please check with you docto o a tavel clinic) Anti-malaial tablets and pecautions against insect bites Yellow feve (compulsoy fo some counties) 16 IN CERTAIN CIRCUMSTANCES (Please check with you docto o a tavel clinic) Meningococcal meningitis Rabies Tick-bone encephalitis Hepatitis B Tubeculosis Diphtheia booste Japanese encephalitis Measles/MMR

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20 Woldwide county-by-county dis Please note, these ae geneal guidelines; advice See also page 16 fo additional immunisations that may be ecommended. 18 This alphabetical list shows fo each county: E = Immunisation is an essential equiement fo enty to the county concened and you will equie a cetificate. E1 = Immunisation essential except fo infants unde one yea (but note the advice above). E2 = Immunisation essential (except fo infants unde one yea) unless aiving fom non-infected aeas and staying fo less than two weeks. The UK is a noninfected aea, but if tavelling via equatoial Afica o South Ameica, seek medical advice. E3 = Immunisation essential if the tavelle aives fom an infected county o aea (this will not apply if you jouney is diect fom the UK). The lowe age limit vaies. E4 = Immunisation essential if aiving within six days of having visited an infected county. E5 = Immunisation essential fo enty to the county fom endemic aeas, tavelling to Easte Island. = Immunisation o tablets ecommended fo potection against disease, but note that fo yellow feve, pegnant women and infants unde nine months should not nomally be immunised and theefoe should avoid exposue to infection. D = Check immunised against diphtheia. M = Meningitis, depending on aea visited and time of yea. MI = Meningitis ACWY, equied fo those visiting Saudi fo the pupose of Hajj o Uma. a) = Depends on aea visited. b) = Recommended fo all tavelles going to Chiapas, Daién and San Blas. c) = Cetificate also equied if leaving Paaguay to go to endemic aeas. d) = Applies only to tavelles to the Azoes and Madeia. e) = Depends on season. f) = Cetificate may be equied fom tavelles leaving Sudan. No special immunisations ae equied fo those Euopean counties not listed. Hep. A Yellow Meningitis County Typhoid* Malaia feve ACWY Afghanistan a) e) E3 Albania E3 Algeia E3 Ameican Samoa E3 Angola E3 M Anguilla E3 Antigua/Babuda E3 Agentina a) Amenia e) Austalia E4 Azebaijan a) e) Bahamas E3 Bahain Bali (see Indonesia) E3 Bangladesh E4 Babados E3 Belaus Belize E3 Benin E1 M Bemuda Bhutan a) E3 M Bolivia a) E3 a) Boneo (see Malaysia/Indonesia) a) E3 Bosnia/Hezegovina Botswana a) e) E3 Bazil a) E3 a) Bunei E4 Bulgaia Bukina Faso E1 M Buma (see Myanma) Buundi E3 M * Immunisation against typhoid may be less impotant fo shot stays in fist-class conditions.

21 ease and immunisation checklist should be taken fo an individual itineay Hep. A Yellow Meningitis County Typhoid* Malaia feve ACWY Cambodia E3 Cameoon E1 M Canada Cape Vede E3 Cayman Islands Cental Afican Republic E1 M Chad a) M Chile E5 China a) E3 Colombia a) Comoos Congo E1 Cook Islands Costa Rica a) Coatia Cuba Cypus Czech and Slovak Republics Democatic Rep. of Congo (fomely Zaïe) E1 M Djibouti E3 Dominica E3 Dominican Republic East Timo Ecuado a) E3 a) Egypt a) e) E3 El Salvado a) E3 Equatoial Guinea E3 Eitea E3 M Estonia Ethiopia a) E3 M Falkland Islands Fiji E3 Gabon E1 The Gambia E3 M Geogia Ghana E1 M Geece E3 Geenland Genada E3 Guadeloupe E3 Guam Guatemala a) E3 Guiana, Fench E1 Guinea E3 M Guinea-Bissau E3 M Guyana E3 Haiti E3 Honduas E3 Hong Kong (China) India E4 Indonesia a) E3 Ian Iaq a) e) E3 Isael Ivoy Coast E1 M Jamaica E3 19 This list is coect at the time and date of pinting.

22 20 Please see key on page 18 and also page 16 fo additional immunisations that may be ecommended Hep. A Yellow Meningitis County Typhoid* Malaia feve ACWY Japan Jodan E3 Kazakhstan E3 Kenya E3 M Kiibati E3 Koea (Noth & South) Kuwait Kygyzstan Laos E3 Latvia Lebanon E3 Lesotho E3 Libeia E1 Libya E3 Lithuania Macau (China) Macedonia Madagasca Madeia E3 d) Malawi E3 Malaysia a) E4 Maldives E3 Mali E1 a) M Malta E3 Mashall Islands Matinique Mauitania E2 Mauitius a) E3 Mayotte Mexico a) Miconesia (Fedeated States of) Moldova Monaco Mongolia Montseat E3 Moocco Mozambique E3 M Myanma (Buma) E3 Namibia a) E3 M Nauu E3 Nepal a) E3 Nethelands, Antilles E3 New Caledonia E3 New Zealand Nicaagua E3 Nige E1 a) M Nigeia E3 M Niue E3 Nothen Maiana Islands Oman a) E3 Pakistan E3 Palau E3 Panama b) Papua New Guinea a) E3 Paaguay a) E3 c) Peu a) E3 a) Philippines a) E3 Pitcain Island E3 Poland Polynesia, Fench (Tahiti) E3 * Immunisation against typhoid may be less impotant fo shot stays in fist-class conditions.

23 Hep. A Yellow Meningitis County Typhoid* Malaia feve ACWY Potugal E3 d) Pueto Rico Qata La Réunion E3 Romania Russia a) Rwanda E1 M St Helena E3 St Kitts and Nevis E3 St Lucia E3 St Vincent and Genadines E3 Samoa E3 São Tome and Pincipe E1 Saudi Aabia a) E3 MI Senegal E3 M Sebia and Montenego a) Seychelles E4 Siea Leone E3 M Singapoe E4 Slovenia Solomon Islands E3 Somalia E3 M South Afica a) E3 Si Lanka E3 Sudan f) E3 a) M Suinam E3 Swaziland E3 Syia a) e) E3 Taiwan Tajikistan a) e) Tanzania E3 M Thailand a) E3 Togo E1 M Tokelau Tonga E3 Tinidad and Tobago E3 a) Tunisia E3 Tukey a) e) Tukmenistan a) e) Tuks & Caicos Islands Tuvalu Uganda E3 M Ukaine United Aab Emiates Uuguay USA Uzbekistan Vanuatu Venezuela Vietnam a) E3 Vigin Islands Wallis and Futuna Islands Yemen E3 Yugoslavia Zambia a) M Zimbabwe a) e) E3 21 This list is coect at the time and date of pinting.

24 Planning ahead Befoe you set out to tavel anywhee in the wold, check the health equiements fo you destination. Look at the potential isks and plan the pecautions you need to take both befoe you go and once you ae away. These will depend not only on the counties you may be visiting, but which pats, fo how long, at what time of the yea, and whee you will be staying. Camping, fo example, pesents diffeent potential health poblems to staying in a hotel. And thee may be special immunisation equiements if you plan to ente a Euopean Economic Aea (EEA) county fom a non-eea state. You can get moe infomation on all these points fom you tavel agent, the Embassy o High Commission of the counties concened, o fom a specialist tavel clinic. Consult you docto well in advance 22 You should consult you docto well in advance (pefeably at least two months) of you depatue, fo advice and to aange immunisations. Some of these cannot be given at the same time. Some take time to be effective. Immunisation against hepatitis B, fo example, can take six months to give full potection. Howeve, see you docto even if you ae going at shot notice some potection may be bette than none. Tell you docto whee you ae going, if you ae o may become pegnant, and if you ae taking childen with you. This is paticulaly impotant if they have not had thei full couse of childhood immunisations. If you need anti-malaia medication, you docto will advise on which is most appopiate. You should stat taking the medication a week befoe depatue. If you equie pescibed medicines while aboad, check on thei availability at you destination since you docto can nomally only pescibe a limited quantity unde the NHS. If the medication cannot be obtained whee you ae going, you will have to puchase supplies in the UK.

25 PAYING FOR IMMUNISATIONS AND ANTI-MALARIA TABLETS Some immunisations ae fee unde the NHS. Fo othes thee may be a chage. Doctos can chage fo signing o filling in a cetificate. Some anti-malaia tablets ae available fom phamacists without a pesciption. TAKING MEDICINES OUT OF THE UK If you want to take any sot of medicine with you eithe pescibed o bought fom a phamacist find out if thee ae any estictions on taking it in and out of the UK o the county you ae visiting. Ask the elevant Embassy o High Commission o the Home Office Dugs Banch (Tel: /8446). Always cay medicines in a coectly labelled containe, as issued by the phamacist. Othewise, take a lette fom you docto o a pesonal health ecod cad giving details of the dug pescibed in case you need it to get you though Customs. Remembe, some medicines available ove the counte in the UK may be contolled in othe counties, and vice vesa. EXISTING MEDICAL CONDITIONS AND MEDICATION Keep a witten ecod on you peson of any medical condition affecting you, such as angina pectois, diabetes and haemophilia, and the pope names not just the tade names of any medication you ae taking. HAVE A DENTAL CHECK-UP If you have any doubts about you teeth, o you plan to be away fo a long time, see you dentist. It may be difficult and expensive to obtain dental teatment at you destination. CARRY A FIRST-AID KIT A packet of adhesive dessings, some insect epellent, antiseptic ceam and wate-steilisation tablets will take up little space and could be useful. EMERGENCY MEDICAL TRAVEL KITS These contain a vaiety of steilised and sealed items of equipment, such as syinges, needles and sutue mateials, and may be puchased though a phamacist, pivate medical cente, o fom a numbe of othe supplies. They should nomally be handed to a docto o nuse fo use in a medical emegency in a county whee the safety of such items cannot be assued. A typical kit should contain: 2 x 5ml syinges 5 x needles (pefeably two sizes) 1 dental needle 1 intavenous cannula 1 skin sutue with needle 1 packet skin closue stips 5 alcohol swabs fo skin cleansing 5cm x 5cm and 10cm x 10cm non-stick dessings 1 oll sugical tape 23

26 Additional items such as an intavenous-giving set and a blood substitute solution may be advised fo jouneys to emote aeas. You docto will be able to povide moe infomation. Emegency medical tavel kits should cay sufficient identification to ensue thei acceptance by Customs officials, but the contents should not be opened until needed. It is also unwise to cay loose syinges o needles unless you have a docto s lette explaining thei pupose if, fo example, you ae diabetic. REDUCING THE RISK OF DVT DURING THE JOURNEY Polonged immobility on long jouneys, whethe by plane, tain o ca, can lead to deep vein thombosis (DVT a blood clot in the leg). Move you feet aound, o get up and walk aound egulaly if you can. And avoid dehydation take egula non-alcoholic dinks. If you have eve had a DVT o clots in you lungs, have a family histoy of clotting conditions, have had majo sugey, especially a hip o knee eplacement in the last thee months, o suffe fom heat disease, cance o have eve had a stoke, you may be at inceased isk. Ask you docto fo advice. Health insuance 24 Health insuance is vey often one of the last items on a tavelle s checklist, yet it is pehaps the most impotant of all. People fom Bitain tend to foget that they may have to pay thousands of pounds in medical costs if they fall ill o have an accident outside the UK. This is tue even in counties, such as EEA states, with which the UK has mutual health cae ageements because, even in such cases, the aangements may not cove all the expenses you can incu. And the cost of binging a peson back to the UK, in the event of illness o death, is neve coveed, even unde the ecipocal aangements. Befoe you tavel, always aange health insuance adequate fo you destination. Talk to you tavel agent, insuance company o bank. Use the county-by-county checklists on pages and to see what level of fee o educed-cost necessay medical teatment you can expect in any paticula county. Then make any appopiate exta insuance aangements. If you have a pe-existing condition, always tell you tavel insue. Othewise, you may not be coveed by the policy you buy.

27 Even if you ae visiting a county with a ecipocal health cae ageement with the UK, bea in mind that in an emegency you might be sent acoss the bode fo teatment in a county whee no such aangement exists. Make sue you tavel insuance allows fo that. Some cedit and chage cads povide health insuance fo tavelles. Check that it is adequate fo you needs. If not, take out exta cove. If you ae tavelling on business, you company will pobably aleady have insuance that coves you. But check whethe the cove is adequate. If it is not, take out additional insuance. If you ae diving in any county outside the UK and you have an accident, you may not be coveed fo medical o hospital expenses. Consult you insuance company o a motoing oganisation befoe leaving the UK to make sue that you ae fully insued. No matte whee you ae going to tavel, ALWAYS check that you insuance cove is adequate to meet whateve expenses you ae likely to incu. Always examine the small pint of the policy. And talk to you insue if in any doubt. Receiving benefits while you ae away If you ae eceiving a cash benefit except a etiement pension tell the Depatment fo Wok and Pensions (DWP) office that pays you that you ae going aboad. Some benefits can be paid while you ae away. Howeve, you should find out about the ules fo obtaining benefits aboad well befoe you leave. State Retiement Pensions If you ae eceiving a State Retiement Pension, you must tell you local Jobcente Plus/Social Secuity office, if you ae going aboad fo moe than six months at a time. Claiming Incapacity Benefit o Statutoy Sick Pay while away If you ae taken ill while tempoaily in anothe EEA county, you employe in the UK geneally pays you fo the fist 28 weeks of illness, but not fo the cost of medical teatment. Let you employe know about you illness as soon as possible. If you ae self-employed, claim Incapacity Benefit as soon as possible o you may lose money. Contact the Jobcente Plus/Social Secuity office neaest you home in the UK o wite to:

28 The Depatment fo Wok and Pensions The Pension Sevice Intenational Pension Cente Tyneview Pak Whitley Road Newcastle-upon-Tyne NE98 1BA O, fo Nothen Ieland: Social Secuity Agency Incapacity Benefits Banch Castle Cout Royal Avenue Belfast BT1 1UB When you tavel, take these addesses, and the addess and telephone numbe of you local Jobcente Plus/Social Secuity office with you. Planning fo when you etun As fa as health is concened, you must plan not just fo you jouney but also fo what to do when you etun home. If you wee given any medicines in anothe county, it may not be legal to bing them back into the UK. If in doubt, declae them at Customs when you etun. 26 If you wee taking anti-malaia tablets on you jouney, emembe to continue taking them fo a month afte you etun. If you developed diahoea when away o shotly aftewads, and you wok involves handling food, tell you employe as soon as possible. If you become ill on you etun, do not foget to tell you docto that you have been out of the UK, and what counties you have visited o tavelled though. Even if you have eceived medical teatment in anothe county and feel well on you etun: if you have been bitten by an animal o isked catching a sexually tansmitted disease, always consult you UK docto; if you ae a blood dono, always tell the blood tansfusion staff if you have tavelled outside Euope o if you have had medical teatment in any county outside the UK. If you had medical teatment aboad, claim on you insuance as soon as possible when you etun. Holdes of Fom E111 should put in a claim fo a efund befoe etuning. If you did not have time, please see the instuctions on page 37.

29 Emegency health checklist This checklist is designed to help emind you of some of the impotant things to do to help you deal with any health poblems when tavelling. Make sue that you have all the documents you need befoe seeking teatment: you passpot; a valid Fom E111, whee appopiate even if you ae only going on a day tip; poof of UK esidence, such as a dive s licence o NHS cad; vaccination cetificates. Whee you ae eligible fo fee o educed-cost teatment, these will help pove you entitlement. Read you insuance document befoe teatment so that you know what you insues will pay fo. Read pages and of this booklet to see if you ae entitled to fee o educed-cost emegency medical teatment. Contact the epesentative of you tavel company, if that is applicable Tell any pactitione you consult if you ae taking any medication and povide its geneic name as on the pesciption label not just the band name. Tell any pactitione you consult if you have visited anothe county befoe becoming ill. Keep all eceipts, special poofs of puchase, pice tags and labels fo all payments made fo teatment o dugs if you intend to claim a efund o claim against you insuance. Keep the names and addesses of fiends and elatives with you passpot so that Bitish Consula officials can contact them if thei help is equied. Contact Bitish Consula officials if you need to etun to the UK quickly. They may be able to aange this fo you. But emembe, you will have to bea the costs.

30 Getting teatment aound the wold Use this booklet; take advice fom you docto and tavel agent; and obtain infomation fom the Touist Office, Embassy o High Commission of you destination county to ensue that befoe you set out fom the UK, you fully undestand what obtaining emegency medical teatment in that county might involve. You can aely expect to be teated in such a staightfowad manne as unde the National Health Sevice. You may find youself dealing with vey unfamilia official systems that can involve a geat deal of time and effot on you pat. Above all, in most counties aound the wold you will have to pay often lage amounts fo what may seem to be elatively mino teatment. 28 The following sections tell you about obtaining health teatment aboad. Thee diffeent sets of ules apply: Getting teatment in counties with no health cae ageements with the UK; Getting teatment in counties outside the EEA with ecipocal health cae ageements with the UK; and Getting teatment in EEA counties and Switzeland. Getting teatment in counties with no health cae ageements with the UK Fewe than 60 counties woldwide have any sot of health cae ageements with the UK. The vast majoity do not including Tukey; Canada, the United States and Mexico; most of the islands in the Caibbean; all the South Ameican nations; evey county in the Middle East and Afica; and most of Asia, including India, Thailand, Japan, Hong Kong and the whole Pacific egion, except fo Austalia and New Zealand. To secue even basic medical cae in these counties, you ae stongly advised to take out compehensive medical insuance. And in the case of the United States, fo example, you should cay a vey high level of cove. You tavel agent o insuance boke will be able to advise you on the amount of insuance to take out, depending on you destination.

31 Getting teatment in counties outside the EEA with ecipocal health cae ageements with the UK The UK has ecipocal ageements with cetain counties fo the povision of ugently needed medical teatment eithe at educed cost o, in some cases, fee. The counties and the sevices available ae listed on the following fou pages. Only ugently needed teatment will be povided and you will be teated on the same tems as esidents of the county in question. The ange of medical sevices may be moe esticted than unde the NHS, and if chages ae involved, these cannot be efunded by the Bitish Govenment. You should cay sufficient insuance to cove them. In ode to obtain teatment, you will nomally have to poduce you passpot o some poof of UK esidence, such as a diving licence o medical cad. Requiements vay fom county to county and ae shown in the list on the following pages. WHO IS COVERED In geneal, you and you dependants ae entitled to emegency medical teatment on the tems shown if you ae a UK national and live in the UK. Even if you ae not a UK national, you may still be entitled to teatment in some of the listed counties if you nomally live in the UK. 29 If you ae going to live o wok in one of the ecipocal ageement counties, the aangements in this booklet may not apply. Please wite fo details to: Inland Revenue Cente fo Non-Residents Room BP1301 Benton Pak View Newcastle-upon-Tyne NE98 1ZZ Tel: Fom outside the UK: If you ae a membe of the Amed Foces seving in any of the ecipocal ageement counties, you and you dependants should geneally not use the local health sevices but the medical facilities of HM Foces. You standing odes will tell you what facilities ae available.

32 Recipocal health cae ageements: Counties outside the Euopean Documents needed County to get medical teatment What is nomally fee Anguilla Poof of UK esidence Mino emegency teatment. (e.g. NHS medical cad o UK diving licence). Austalia Poof of UK esidence Public hospital teatment (this includes (e.g. UK passpot o enal dialysis, but you must make NHS medical cad) advance aangements befoe leaving and tempoay enty the UK. Please ask you NHS enal pemit. unit fo futhe details). 30 Babados UK passpot (o NHS Hospital teatment. medical cad if not a Teatment at polyclinics. UK national). Ambulance tavel. Pescibed medicines fo childen and the eldely. Bitish Vigin Poof of UK esidence Hospital and othe medical teatment Islands (e.g. NHS medical cad o fo pesons aged 70 o ove and UK diving licence). school-age childen. Bulgaia UK passpot and NHS Hospital teatment. medical cad. Othe medical and dental teatment. Channel Islands Poof of UK esidence On Guensey/Aldeney: if staying less (e.g. diving licence o Hospital in-patient teatment. than thee NHS medical cad). months On Jesey: Hospital in-patient and out-patient teatment. Ambulance tavel. Falkland Islands Poof of UK esidence (e.g. medical cad o UK diving licence). Hospital teatment. Dental teatment. Othe medical teatment. Pescibed medicines. Ambulance tavel. Gibalta UK passpot. If you ae GP and medical cae and dental up to 30 not a UK national, teatment unde the local Medical days stay show you Fom E111. Scheme is available at the Health Cente. Hospital teatment in public wads. Isle of Man No documents needed. Teatment simila to UK National Health Sevice.

33 County-by-county checklist Economic Aea What you pay chages fo Hospital in-patient and out-patient teatment. Hospital accommodation. Dental teatment. Pescibed medicines. Ambulance tavel. Teatment at most doctos sugeies. Pescibed medicines. Ambulance tavel. Dental teatment. Dental teatment. Pescibed medicines. Othe infomation Family-docto-type teatment is available at out-patient clinics. A chage is made. You will need to enol at a local Medicae office, but this can be done afte you get teatment. Some doctos chages may be patially efunded by the Medicae scheme. Claim at the local office befoe you leave. UK visitos ae chaged fo all sevices at ates applicable to esidents. Medicines supplied by public phamacy. Some pescibed medicines. Accident and emegency hospital teatment. Emegency dental teatment. GP and othe medical cae. Ambulance tavel. Teatment at a docto s sugey. Dental cae. Pescibed medicines. On Sak: All medical teatment. Recent changes suggest that only a vey limited state health cae secto (some hospitals only) now exists. Pending futhe claification, pivate medical insuance cove is stongly ecommended. No out-patient depatment at Guensey Geneal Hospital. Fee teatment at a family-docto-type clinic is available most weekday monings at the Jesey Geneal Hospital. Hospital teatment povided in Guensey. 31 Nominal fee payable fo house calls. Small chage fo each item of medicine pescibed unde the scheme. Pivate dental teatment. Nominal fee fo a limited emegency sevice at the Pimay Cae Cente. Dental teatment. Pescibed medicines. You ae not coveed if you go to Gibalta expessly fo teatment of a condition that aose elsewhee, e.g. in Spain. If you ae a UK State Pensione and go to live in Gibalta, you will be povided with any medical teatment you need by the Gibalta authoities, without having to pay insuance contibutions. You will have to pay pesciption chages.