Front cover – Dr Deb in Morocco ; Aït_Benhaddou

Inside back cover – add info on the app

P 16

Info on vaccines and blood donation …If you wish to donate blood, it is advisable to donate prior to vaccination or to delay donation for 3 days after receiving inactivated (dead) vaccines ( eg flu) and delay donation for one month after receiving live vaccines ( eg yellow fever).

P19/ 20

New Vaccine; Tick Borne Encephalitis vaccine – used for persons visiting Europe in the Summer

New vaccine names

Cervarix ( cervical cancer vaccine) , ,

Intanza ( influenza ),

Ixiaro ( Japanese Encephalitis )

Mention children under 9 need two doses influenza vaccine

P 21/22

update side effects of vaccines

mention research suggesting benefit of TB vaccine in melanoma reduction.

Remove mention of biken je vaccine and alcohol as no longer relevant

Recommend avoid heavy alcohol within 48 hours of vaccination

P 24/25

Add Picaridin – now approved as an option for mosquito protection along with DEET; effective repellent that some people find more pleasant to use. It is nearly odorless (mild citrus scent when initially applied), and is safe for plastics and synthetic material.

Add factory permethrin treated clothes available from www.insectshield.com and effective for 70 washes

Commercially treated clothes have fewer side effects than home treated ones.

P 50

Add mention of liver flukes … can be contracted from eating undercooked, salted, pickled, or smoked freshwater fish. These parasites can obstruct your bile ducts and even cause cancer.

Yoghurt may be hazardous depending on how it is cared for; it is easily contaminated after being cultured eg when adding flavouring or if stored incorrectly.

P 64 /65

update section on personal security/ accommodation safety and drink spiking

P 75/76 Altitude

Expand information on the drugs used to prevent altitude sickness, add theophylline

Some persons with previous radial keratotomy experience a major loss of clarity in their vision at altitude – sometimes up to 3 dioptres. This is due to lack of oxygen at altitude causing their corneal scars to change shape. It recovers on descent, but lack of vision in the mountains is a major safety hazard. LASIK surgery is not as prone to this problem.

P97-105

Fine tune description of treatment of travellers‘ diarrhoea based on patient feedback

P108

Fine tune discussion of treating colds and flu , acute bronchitis, pneumonia, cough to latest evidence based guidelines.

The treatment for colds and influenza is broadly the same. Regular antibiotics do not speed recovery. Both diseases are caused by a virus There is no good evidence for the effectiveness of over the counter cough and cold medicines. Honey and Lemon home remedies are the simplest and cheapest treatment. Most people recover fully. Persons with influenza who are at higher risk of complications may benefit from an anti-viral medication to shorten the duration of the illness by 2-3 days.

Add information on Relenza

Page 119

Add brief info on spider bites; Thankfully, most spider bites are not serious. Some people develop a rapid, serious, allergic reaction (anaphylaxis). Some spiders cause local effects, e.g. pain, sweating and tissue damage in the area of the bite. Some spiders like funnel web and black widow can poison the body and cause muscle spasm, nausea, headache, breathing difficulties, heart problems, and even coma. Observe the patient closely. Catch the spider only if you can do so safely. Seek medical advice urgently.

Page 120:

Fine tune treatment of marine bites and stings;

It is best to seek local advice regarding specific treatment. Treatment varies depending on the cause There are many dangerous marine creatures around the planet: sea wasps, jellyfish, bluebottle, stonefish, fire coral, sea urchins etc. (Australia has some of the worst.)

General principles are

1. Call emergency services, especially if you are unfamiliar with the creature and recommended treatment.

2. Monitor the casualty closely in case breathing or circulation is affected.

3. Apply local remedy;

Box Jellyfish	Douse area with vinegar for 30+ seconds. If no vinegar available, flick off tentacles with a stick. Ensure casualty does not move.
Bluebottle, Jimble, Pacific Man-o-war, Irikandji, sea anemone	Gently pick off tentacles (with tweezers if possible), apply cold pack. Do not wash with fresh water.
Fish stings, stonefish, Crown-of-thorns starfish, stingray	Remove visible spines, but do not dig around in the skin trying to ‘fish them out’. Place casualty’s foot or hand in hot water (as hot as can be comfortably tolerated)

P123

Fine tune discussion of treatment of rash to include …A creeping rash may be a dog hookworm infestation. Medical name is cutaneous larva migrans. It looks like a red, snake-like, itchy line, that moves forward over time. It is caught from sand or soil. Hookworm eggs are found in the stool of infected dogs and cats. When the eggs hatch, the resulting larvae infest the soil and vegetation. When you touch this infested soil, the larvae can dig into your skin, causing a linear rash and severe itching. It is more disgusting than dangerous, and easily treated with drugs such as albendazole. It will often eventually go away without treatment. Creeping eruption is more common in countries with warm climates eg Thailand.

P139

Update info on emergencies as per St john Ambulance Australia

Add info on management of chest pain

Add info on emergency calls ; Many countries’ public telephone networks have a single emergency telephone number, that allows a caller to contact local emergency services for assistance. Most GSM mobile phones have 112, 999 and 911 as pre-programmed emergency numbers that are always available, sometimes even if you have no credit on your phone.

The emergency telephone number differs from country to country.

Some common ones are; Canada and US 911; Europe 112; UK 999; India 108; New Zealand 111; Australia 000. It pays to find out the emergency phone number of the country you are visiting.

P146

Drug reference table

ADD SOFRAMYCIN / relenza

Relenza	For treatment or prevention of influenza	Zanamivir 5mg /disc Delivered in diskhaler device directly to lungs	Treat flu: start within36 hours of symptom onset, and inhale two discs twice a day, for 5 days Prevent flu: take two discs once daily	Do not take if allergic to lactose or milk protein, or if pregnant or breastfeeding. Care in persons with known asthma
Soframycin	Antibiotic for eye and ear infection Could also be used on wound infections.	Framycetin sulphate 0.5%= Soframycin	Instill 2 drops, 3 times per day.	Once opened packet should be discarded in 4 weeks

P162

Graphic of malaria parasite lifecycle

P173

Update info on quantiferon

P179

Add information on responsible tourism

Plus

General tidying and rewording