Home' Australian Pharmacist : Australian Pharmacist February 2012 Contents 124 Australian Pharmacist February 2012 I ©Pharmaceutical Society of Australia Ltd.
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Samantha and her husband are
planning their journey but do not have
a firm itinerary. However, travel health
information about destinations being
considered is beneficial as it may influence
their final choices. It is also an opportunity
to highlight important issues such as
obtaining formal travel-health assessments
at least 6--8 weeks before leaving and
the need for vaccinations, antimalarials
and other medicines. Importantly, it is an
opportunity to promote travel and public
Key topics to discuss at this stage
Altitude illness and acute
mountain sickness (AMS)32--36
Mt Kilimanjaro rises to 5,896 metres.
It does not involve a great deal of
technical climbing, but should not
be underestimated as it represents a
serious challenge, especially for older
or unfit travellers. Samantha and
her husband would need to prepare
carefully and ensure that they are
physically fit enough for the challenge.
Altitude illness is a major problem and
can prevent up to 50% of travellers
using the standard 4--5 day route from
reaching the crater rim.32 All visitors
should be advised about altitude illness
and the need to descend if symptoms
occur. Taking longer to acclimatise,
ascending at a slower rate and the use
of acetazolamide will reduce the risk of
altitude illness. There are no reported
interactions between acetazolamide
and commonly prescribed
chemoprophylactic agents for malaria
and antibiotics used to treat traveller's
Malaria is endemic to most of Tanzania
below 1,800 metres. Many travellers
will want to combine a safari with
climbing Mt Kilimanjaro so malaria
chemoprophylaxis with doxycycline or
mefloquine or atovaquone/proguanil
is recommended. As no form of
malarial chemoprophylaxis is totally
effective, the travellers should also
follow precautions to reduce the risk of
mosquito bites. In the initial interview
the need for malarial chemoprophylaxis
should be highlighted, and in
subsequent interviews (once the
destination has been confirmed and
chemoprophylaxis prescribed) they
should be counselled on the use of the
agents and how to prevent mosquito
and other insect bites.34
• Routine vaccinations
-- Ensure that the travellers are up
to date with their vaccinations for
MMR, DPT and polio vaccine etc as
stated in the NIPS.
• Recommended vaccines
-- Hepatitis A
-- Hepatitis B
-- Meningococcal disease (ACWY)
º Outbreaks are seasonal from June
to November, and immunisation
should be considered for rural
travellers, those staying long
term or those in close contact
with the local population.
-- To be considered
º Cholera and rabies vaccinations.
• Yellow Fever 34--36
-- The World Health Organisation
(WHO) and CDC do not generally
Table 6. Preventive measures for jet jag and motion sickness37,38
Preventive measures for jet lag37
Preventive measures for motion
• Exercise and eat a healthy diet and
get plenty of rest.
• Begin to reset the body clock by
retiming of sleep by 1--2 hours later
for a few days before travelling
westwards and 1--2 hours earlier for a
few days if travelling eastwards.
• Seek exposure to bright light in the
evenings if travelling westwards
and in the morning if travelling
• If possible break up the journeys
• Avoid large meals, alcohol and
• Drink plenty of water to maintain
• Wear comfortable shoes and clothing
and move around the aircraft.
• If possible, sleep during long flights.
• Avoid situations requiring critical
decision making for the first day on
• Adapt to the local schedule as soon
as possible. Eat meals at appropriate
times for the destination, drink
plenty of water and avoid excessive
quantities of alcohol and caffeine.
• Optimise exposure to sunlight after
arrival at destination.
• Take short naps to increase energy
but not to jeopardise night time sleep.
• Be aware of situations that trigger
• Optimise position that will reduce
risk, i.e. sitting in the front seat of
a car/bus or driving a vehicle instead
of riding in it, sitting over the wings
of an aircraft.
• Eat before the onset of symptoms
-- this may help gastric emptying,
but may aggravate motion sickness
in some travellers.
• Drink caffeinated drinks.
• Take prophylactic medications.
• Look at the horizon.
• Aromatherapy with mint, lavender or
oral ginger or the use of acupressure
or magnets is advocated although
in some cases the scientific evidence
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