CHILWELL

VALLEY AND MEADOWS

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The Valley Surgery

81 Bramcote Lane

Chilwell

Nottingham NG9 4ET

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Chilwell Meadows Surgery

Ranson Road

Chilwell

Nottingham NG9 6DX

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You need to be a registered patient at the practice to receive travel advice from us.


Non NHS vaccinations such as rabies, Japanese encephalitis etc are not offered by the surgery. These can be accessed locally at private travel clinics.


We are not a yellow fever centre and do not offer yellow fever vaccination. Further Information  regarding vaccinations is available at the NHS choices travel vaccinations website


If you are travelling abroad please ensure you contact us with at least 8 weeks notice before your planned departure date. 


All completed forms should be received at the surgery a minimum of 8 weeks ahead of your departure date either electronically or printed off and handed in at reception. 


Please click here and complete the travel form which can either be submitted on line or print it off by clicking here and bring into reception. One form needs completing for each person travelling.


Once we have received your form we will then contact you to discuss your travel and arrange an appointment if you need any vaccinations. 


We will try and contact you within 2 weeks of receiving your completed travel form. 

Please ensure you have given us a correct and up to date daytime contact number. 

If we ask you to come in for an appointment you will need to bring a printout of the travel advice specific to any countries that you are visiting from the Travel Health Pro website.


The foreign and commonwealth office (FCO) is also available which has the latest advice by country for safety, security, entry requirements and travel warnings. 


If you are travelling in less than 8 weeks you can still check out the information from the above details but you will need to get specific travel advice along with any required vaccinations privately. If this is the case the practice is happy to provide you with a list of any vaccinations which you have previously received.


General travel advice


Water

Diseases can be caught from drinking contaminated water, or swimming in it. Please let us know if you are not able to access safe water. Unless you know the water supply is safe where you are staying, only use (in order of preference):

Boiled water

Bottled water or canned drinks

Water treated by sterilised agent


This does also include water to make ice cubes in drinks and water for cleaning teeth. If you are on a package holiday your travel representative should be able to tell you if ice is safe.


Swimming/Wading

Don’t swim/wade or bathe in fresh water (lakes, streams, rivers) stick to chlorinated /salt water only. This helps eliminate the risk of contracting the parasitic disease of schistosomiasis (also known as Biharzia) for which there is no vaccine.


It is wise never to go barefoot, but to wear protective footwear when out, even on the beach. Other diseases can be caught from sand and soil, particularly wet soil.


Food

Two phrases to help you remember and keep safe, if travelling with children encourage them with this slogan, COOK IT, PEEL IT OR LEAVE IT. WHEN IN DOUBT LEAVE IT OUT!

Only eat well cooked fresh food

Avoid left overs and reheated foods

Ensure meat is thoroughly cooked

Eat cooked vegetables, avoid salads

Only eat fruit you can peel

Never drink unpasteurised milk

Avoid ice-cream

Shell fish is a high risk food

Avoid buying food from street vendors’ stall as a general rule


Another source of calories is alcohol! If you drink in excess, alcohol could lead you to become care free and ignore these precautions.


Personal Hygiene

Many diseases are transmitted by what is known as the ‘faecal-oral’ route. To help prevent this, always wash your hands with soap and clean water after going to the toilet, before eating and handling food. Using hand gel is another sensible option although not as effective as soap and water.

 

Travellers’ diarrhoea

This is the most common illness that you will be exposed to abroad and there is NO vaccine against it. Diarrhoea is caused by eating and/or drinking food and water contaminated by bacteria, viruses or parasites. Risk of illness is higher in some countries than others.


You can certainly help prevent travellers’ diarrhoea in the way you behave – make sure you follow the food, water and personal hygiene guidelines already given


What is travellers’ diarrhoea?


3 or more loose stools in a 24 hour period often accompanied by stomach pain, cramps and vomiting It usually lasts 2-4 days whilst it is not life threatening, it can disrupt your trip for several days. The main danger of the illness is dehydration, and this, if severe, can kill if it is not treated. Treatment is therefore rehydration. In severe cases and particularly in young children and the elderly, commercially prepared rehydration solution is extremely useful.

Travel well prepared


A good tip is to take oral rehydration solutions, with you. These can be bought over the counter in any pharmacy, available in tablet or sachet form – for example DIORALYTE OR ELECTROLADE or DIORALYTE RELIEF. (The latter is a formula containing rice powder which also helps to relieve the diarrhoea, particularly useful in children). Prepare according to instructions. Take care regarding their use in very small children and seek medical advice where necessary.

Anti-diarrhoeal tablets can be used for adults but should never be used in children under 4 years of age, and only on prescription for children aged 4-12 years. None of these tablets should ever be used if the person has a temperature or blood in the stool.


DO seek medical assistance if the affected person has:

A temperature

Blood in the diarrhoea

Diarrhoea for more than 48 hours (24 hours in children)

Becomes confused

Women taking the oral contraceptive pill may not be fully covered for contraception if they have or have had diarrhoea and vomiting and will need to take extra precautions, it is important to refer to your pill patient information leaflet. If using condoms as protection it is important to take a safe supply of these from the UK with the CE approved mark on the packet ensuring they are in date – always remember never use baby oil with a condom as this diminishes the condoms efficacy.


Hepatitis B and HIV infection –

These diseases can be transmitted by:

Blood transfusion

Medical procedure with non-sterile equipment

Sharing of needles e.g. tattooing, body piercing, acupuncture and drug abuse

Sexual contact – STIs sexually transmitted infections are also transmitted in this way – important to note is not just on penetration.


Ways to protect yourself:

Only accept a blood transfusion when essential

If travelling to a resource poor country, take a sterile medical kit

Avoid procedures e.g. ear and body piercing, tattooing and acupuncture

Avoid casual sex, especially without using condoms


Remember excessive alcohol can make you care free and lead you to take risks you otherwise would not consider.

 

If you feel you may be at risk during your travel after reading the above please let us know.


Insect bites


Mosquitoes, certain types of flies, ticks and bugs can cause many different diseases. E.g. malaria, dengue fever, yellow fever and zika virus. Some bite at night, but some during the daytime so protection is needed at all times.

Avoid being bitten by:

Covering up skin as much as possible if going out at night, (mosquitoes that transmit malaria bite from dusk till dawn). Wear loose fitting clothes, long sleeve and trousers or long skirt.

Use insect repellents on exposed skin. (deet containing products are the most effective. A content of up to 50% DEET is recommended for tropical destinations). Clothes can be sprayed with repellents too or clothing specific sprays e.g. permethrin. Check suitability for children on the individual products. If using sun screen always apply first, followed by insect repellent on top.

If room is not air conditioned but has a screen, close shutters early evening and spray the room with knockdown insecticide spray. In malarious regions, if camping or sleeping in unprotected accommodation always sleep under a mosquito net (impregnated with permethrin). Avoid camping near areas of stagnant water, these are common breeding areas for mosquitoes etc.

Electric insecticide vaporisers are very effective as long as there are no power failures!

There is no scientific evidence that electric buzzers, savoury yeast extract, tea tree oil, bath oils, garlic and vitamin B are effective – mosquitoes are said to be adverse to lemon scents so using lemon scented toiletries whilst away may be of benefit.

Homeopathic and herbal medications should never be used as an alternative to conventional measure for malaria prevention.


Malaria

Malaria is a disease spread by mosquitoes, there is no vaccine yet available. If you are travelling to a malarious country, this will be advised at the beginning of this letter.

Remember malaria is a serious sometimes fatal disease. If you develop flu like symptoms, including fever, sweats, chills, feeling unwell, headaches, muscle pains, cough, diarrhoea – you must seek immediate advice and state you have recently travelled abroad. Remember the ABCD of malaria prevention advice:


Awareness of risk

Bite Prevention

Chemoprophylaxis – ensuring if tablets are required you are taking them correctly

Diagnosis – knowing the symptoms of the disease so you can 5


Animal Bites/Rabies

Rabies is an infectious viral disease that is almost always fatal, once symptoms appear. Rabies is one of the deadliest diseases that can be passed to humans from animals. Worldwide, there are tens of thousands of human cases of rabies each year. Rabies is found in all continents, except Antarctica.

Rabies can affect both domestic and wild animals and is spread to people by animal bites or scratches, usually via saliva. Typically, symptoms do not appear immediately, but two to three months after exposure. However, this can vary from a week to a year, depending on the location of the bite/exposure and amount of virus present

In the United Kingdom (UK), no human rabies cases acquired in the UK from animals (apart from bats) have been reported since 1902. Between 1946 and 2017, there were 25 human deaths from travel-related rabies in the UK. Five of these cases occurred between 2000 and 2017. None of the cases were known to have received pre-or post-exposure rabies treatment. An additional case has been reported in a UK traveller during 2018


Advice for travellers: Rabies is spread by contact with saliva from any infected wild or domestic animal (including bats) usually by a bite, scratch or a lick to an open wound. It is usually fatal, once symptoms are present. A course of rabies vaccination can prevent infection and death


Before travel: Rabies risk increases with longer trips and activities such as cycling or running. Certain jobs: vets working overseas, animal control, conservation or wildlife work and volunteering in animal sanctuaries may be very high risk.

Children are at greatest risk, as they are most likely to touch animals, and may not report being bitten, scratched or licked, if they are very young or are worried about getting into trouble.

Consider having a pre-exposure rabies vaccine course, especially if you are travelling to a high risk country, undertaking activities that might put you at greater risk of an unexpected animal encounter (e.g. cycling, running) and/or visiting remote areas, where medical care and rabies post-exposure treatment may not be available.

Get comprehensive travel insurance that covers all medical evacuation costs.


During travel: Avoid contact with any wild animals (including bats) and domestic animals/pets:

Do not approach any animals

Do not pick up ill or unusually tame animals

Do not attract stray animals by being careless with litter or offering food

Remember certain activities, like cycling or running can attract dogs


If you are bitten or scratched by an animal, or if an animal licks open skin, you must immediately flush the wound/area under a running tap for several minutes, then thoroughly wash with soap/detergent and water to remove saliva. Apply a disinfectant like a 70% alcohol or iodine solution, and cover the wound covered with a simple dressing. If you have an animal saliva exposure (usually by spitting) to your mucous membranes such as eyes, nose or mouth, wash thoroughly with clean water as soon as possible

Get urgent medical help, even if the wound or incident seems very trivial. Prompt post-exposure treatment is needed, even if you have already had a full pre-exposure vaccine course, as further vaccine doses are necessary. 6


If you did not have or did not complete a rabies vaccine course before travel, you may need treatment with a blood product called rabies immunoglobulin, as well as a full vaccine course after a potential exposure. In some parts of the world, both rabies immunoglobulin and vaccines may be unavailable. However, getting rabies vaccine (a different product to immunoglobulin) is critical in post exposure treatment and should be started as soon as possible, whether or not immunoglobulin is available. You may need an emergency flight back to the UK or a nearby country for appropriate treatment and vaccines.

Ask for a written record of any post exposure treatment you receive overseas. If you do not feel comfortable with the advice you have received at the time of your consultation overseas, you should contact your medical insurance company.


After travel: If you had any potential exposure, however minor, get medical advice immediately on your return to the UK. This is important, even if your received post exposure treatment abroad and the bite/exposure was weeks before, as you may need to continue a course of rabies vaccines in the UK. If you have a record of any treatment given, remember to bring this with you.

Reference

https://travelhealthpro.org.uk/news/359/worldwide-rabies-risk--reminder-for-travellers  

Further info

https://www.nhs.uk/conditions/rabies/

https://www.nhs.uk/conditions/rabies/vaccination/


Accidents

Major leading causes of death in travellers abroad due to accidents, predominantly road traffic accidents and swimming/water accidents. You can help prevent them by following sensible precautions.

Precautionary guidelines:

Avoid alcohol and food before swimming


Never dive into water where the depth is uncertain


Only swim in safe water, check currents, tides, sharks, jellyfish etc.


Avoid alcohol when driving especially at night


Avoid hiring motor cycles and mopeds – ensure that your holiday insurance covers you for such activities including water sports.


If hiring a car, rent a large one if possible. Ensure tyres, breaks and seat belts are in good condition.


Use reliable taxi firms, know where the emergency facilities are


Personal Safety and Security

The foreign commonwealth office (FCO) provides excellent up to date information about this. They have information for many different types of travel and also advise on travel to specific destinations in times of political unrest and natural disasters. Please go to their website for more information at:

http:www.gov.uk/government/organisations/foreign-commonwealth-office 7


Insurance Cover

Take out adequate insurance cover for your trip. This should possibly include medical repatriation as without it, this service is extremely expensive if needed.

If you have pre-existing medical conditions, make sure you inform the insurance company of these details and check the small print of your policy throughout

Check if you are entitled to an EHIC card at – www.gov.uk/european-health-insurance-card


Air Travel

It is sensible on any long haul flight to be comfortable in our seat Exercise your legs feet and toes while sitting every half hour or so and take short walks whenever feasible. Upper body and breathing exercises can further improve circulation. Drink plenty of water and be sensible about alcohol intake which in excess leads to dehydration. Further information with more specific advice and information on travel related deep vein thrombosis can be obtained from the websites enclosed.


Sun and Heat

Sun burn and heat stroke cause serious problems in travellers but in the long term can be a serious cause of skin cancer. There is no such thing as a safe suntan, but the following advice should be taken.

Precautionary guidelines:

Increase sun exposure gradually, with a 20 minute limit initially

Use sun blocks which contain both UVA and UVB protection and sufficient sun protection factor (SPF) and a minimum of SPF 15. Children under 3 years should have a minimum of SPF 25 and babies under 6 months should be kept out of the sun at all times. Reapply often and always after swimming and washing. Always read manufacturer’s instructions.

Always apply sunscreen first followed by insect repellent spray on top

Wear protective clothing, sunhats, t-shirt and sunglasses

Avoid going out between 11am-3pm, when the sun’s rays are strongest

Take special care of children and those with pale skin/red hair

Drink extra fluids in a hot climate