Note: all detail are given for information only, monitoring and prescription are required to undertake a long journey.
 

Vaccinations

Vaccinations may be required (including yellow fever for some countries in Africa or South America) or recommended by country and possibly the first itinerary of the traveler.

Make a checkup with his doctor to establish a "planning" of vaccinations, some with a booster dose one year later. For travel, the international vaccination book (pictured left) is essential and the inclusion of vaccination against yellow fever is mandatory.

in France, vaccinations current, whatever the situation or the country of destination, must be updated: Tetanus, Poliomyelitis, Diphtheria, Pertussis and Measles possible.

Vaccination against yellow fever is required for a stay in an area endemic (tropical regions of Africa and of South America, even in the absence of administrative obligations). In France, the injection should be performed in a vaccination center approved by the Ministry of Health.

One injection, at least 10 days before departure, at the latest. The validation of vaccination against yellow fever is 10 years.

Vaccination against the hepatitis A is recommended for travelers to stay in a country where sanitation is precarious. One injection, 15 days before departure and a booster 6 to 12 months later. The average duration of protection is 10 years.

   
Vaccination against invasive meningococcal disease is recommended for persons traveling to an endemic area or in any other area where there is an epidemic in terms of close and prolonged contact with the local population. The current outbreaks of invasive meningococcal infections is available on the site WHO web

Vaccination against typhoid fever is recommended for travelers whose stay is extended or in poor conditions in countries where sanitation is precarious. Injection, at least 15 days before departure for a protection period of 3 years .

The Hepatitis B is a serious disease that can develop into chronic infection (cirrhosis and liver cancer). The Hepatitis B is transmitted primarily through sexual contact or blood contamination. Vaccination is currently the most effective way to protect themselves. Two injections spaced a month with a single booster 6 months later. The average duration of protection is 10 years.

Vaccination against rabies is recommended for travelers whose stay is prolonged in isolation in a high-risk countries (developing countries, except for some islands). There should be three injections on D0, D7, D21 or D28 and a booster 1 year later. Duration of protection: 5 years

Glaxo Laboratories have published on their website a brochure, in french "Partez tranquille" (quiet part) which includes vaccinations and antimalarial treatment according to each destination.
   

Mosquitoes

"Malaria is transmitted to humans by the bite of an infected female mosquito, Anopheles (left photo), also infected after biting a man infected with malaria: the female, taking the blood meal needed for its laying, injects the parasite to its host. The males do not bite. " Source www.pasteur.fr

They usually bite between sunset and sunrise. Whatever the chosen treatment for malaria, it can not be issued with a prescription. The duration of treatment (before entering a contaminated area and after leaving that area) will be decided by the doctor depending on the country visited and antimalarial treatment prescribed.

The treatment should not obscure the protection against mosquito bites (repellents, mosquito nets, etc..). For tropical destinations, it is recommended:
- To protect against insect bites with repellents for daytime activities;
- Wear light clothing impregnated and spanning (light and wide clothing, long sleeves, pants and closed shoes) for the evening;
- Sleeping under a mosquito net impregnated with insecticide. The treated net provides the best protection against mosquito bites by his nocturnal effect of both insecticide and insect repellent.
   
   

Can be purchased in pharmacies or in specialty stores already impregnated mosquito nets, or immerse yourself with impregnation kits also sold in pharmacies (the recommended products are deltamethrin and permethrin). Please ask your pharmacist, this information is communicated in 2009 and may change.

In homes, insecticide spray or diffusers can be used and, outside or in a room ventilated, smoke streamers.

Essential to have with itself a test kit for rapid detection of malaria. This kit of 10 tests is reliable, practical and efficient results in 15 minutes. Learn more

The mosquitoes that transmit encephalitis viruses like Japanese encephalitis in tropical Asia, belonging to the genus Culex and usually bite at night. The recommended protections are identical to those shown to protect against malaria.
Click on the map of risk areas - Malaria to enlarge
 
New: Malaria Prevention

The continued growth of drug resistance of malaria and very costly to some recent malaria suggest pride of place of Doxycycline in the prevention of malaria. In addition to many diseases can be prevented travel by this antibiotic.

Doxycycline (International Nonproprietary Name or INN) is a molecule of the family of cyclins used as antibiotic drug.
     

Prophylaxis of malaria may be in some cases the competence of Doxycycline.

This molecule is internationally recognized and recommended for areas of multidrug resistance (forest and border areas of South-Eastern Asia).

It has been less studied elsewhere. The French army used several years for its troops in Black Africa (several tens of thousands of prescriptions during the long time): efficacy and observance are considered excellent and side effects are very slight.
However, its use in children under eight years old, pregnant and lactating women is forbidden.

Doxycycline may cause a decline in efficiency of contraceptive pills, so extra precautions must be taken.

Warning: doxycycline can cause skin photosensitivity. Evaluate with your doctor! For a long time the doxycycline are "generic" and marketed by 13 laboratories.
 

Research both in pharmacology for treatment that vaccination for prophylaxis are at a pace more accelerated thanks to sponsors like the Malaria Vaccine Initiative, which aims to develop a vaccine for the decade 2010-2020, or NGOs such as MSF (Doctors Without Borders).

Source Astrium - Institut Pasteur - Esculape - Agence de la santé publique du Canada.

The mosquitoes that transmit dengue virus and chikungunya virus belonging to the genus Aedes and usually bite during the day. To protect themselves from mosquitoes that bite during the day, you should use repellents skin. These products contain an active ingredient that repels insects without killing them. They are applied to all parts of the body with little or no coverage. It is necessary to comply with the instructions of use (application, duration of protection, ...)

Ticks can transmit disease through bites, such as Lyme disease. Ticks can hang on humans when he moves in infested areas (especially forest). It is therefore imperative to search for ticks on themselves after any walk outside and quickly remove the tick. For this, we can use a fine-tipped (schema on right). The wound must be disinfected after the removal of the tick.
 
Generally, it is recommended not to touch animals and / or plants that are not known. It may be poisonous plants or animals carrying rabies.
User manual (pictured right): Insert the hook on the side of the tick (1). Turn slowly without pulling (2) until the tick detaches.
   

Traveler's diarrhea

This is usually a benign acute diarrheal phase, resolved spontaneously within 1 to 3 days. More often linked to consumption of solid food beverage, traveler's diarrhea or turista, is mostly due to infections or toxic bacterial infections.

Preventive measures:

- Wash hands
- Avoid beverages at risk, pressed fruit, local water bottles and non-encapsulated and ice cube.
- Avoid ice cream.
- Do not eat that meat, fish, shellfish well cooked and hot.
- Wash and peel fruits and vegetables.
- Do not consume raw milk or dairy artisan
- Avoid cooked foods that are left at room temperature too long.
- Avoid food sold on the sly in the street.

It should drink lots of water, rehydration is essential (oral rehydration solution (ORS) or if Coca-Cola without bubbles).

Milder forms of the adult can be reduced by taking anti-diarrheal. Before departure ask your doctor to explain the difference between an anti-diarrheal Anti-secretory (type Racecadotril as Tiorfan ®) and anti-diarrheal (such as Loperamide Imodium ®), and in any case take the one or the other.
   
Acute mountain sickness

Relates excursions and hiking at altitude (8,000 feet). A rule: "do not go too fast, too high."

AMS (acute mountain sickness) occurs most often from 3500 m. The MAM regresses with acclimatization and disappears immediately on the descent. It is advisable to seek expert medical advice before departure. He may recommend a test of hypoxia. For us in the Paris region this test is performed at the hospital in Bobigny (service doctors and Richalet Rathat in 2009)

The symptoms of high altitude are related to the hypoxia, resulting in lower partial pressure of oxygen. They arise especially as the ascent is rapid. It should leave a few days for the body to adapt to these environmental conditions.

The symptoms of AMS are headache, insomnia, anorexia, nausea, peripheral edema.

This condition can progress to two serious complications involving life-threatening pulmonary edema and cerebral edema high altitude.
   
Prevention: Make acclimation levels - regularly drink in small sips, but in large quantities, at least 3 liters a day - do not go over 300 to 400 m per day between 3000 and 4500 meters above sea level - lower than sleep maximum altitude reached during the day.

We have read many comments on treatment of altitude sickness (as some preventive, curative or by other useless): acetazolamide (Diamox). We are neither doctors nor specialist to high altitudes, we note just for information. Your turn!
 
Consult your dentist for a check a few weeks before leaving. A cavity can always ruin a trip!
   

Aid kit

Your doctor and pharmacist are there to advise you. Do not forget your usual treatment. Ask a prescription with the drug's name but also the name of the molecule or INN: International Nonproprietary Name. The International Nonproprietary Names facilitate the identification of pharmaceutical substances or active pharmaceutical ingredients. It was designated by the World Health Organization to be used without ambiguity in many languages. Know your INN medicines: here

Here are some suggestions, but it's of your doctor  to prescribe the medication best suited to each patient because he knows the each history (allergic terrain ..):

- Analgesic and antipyretic (paracetamol is preferred) - Anti-diarrheal
- Intestinal plasters - anti-secretory
- Rehydration sachets (ORS) - Antiemetic (anti vomiting)
Broad spectrum antibiotic (acts on many bacteria) - Antiallergic
- Urinary antiseptic - Antiseptic skin in single dose
- Antihistamine - Local anti-inflammatory
- Cons itching ointment (bites mosquitoes) - Preventive antimalarial use (if necessary)
   

Other non-medical products - Provide a certificate bilingual French / English for customs controls, including syringes.

- Cream for burns and sunburn - Eye lotion (single-dose packaging)
- Unbreakable thermometer - Strips (small adhesive strips)
- Dressing for blister (ampulla) - A fine-tipped
- Repellent against mosquitoes - Protection against malaria
- Disinfectants
- Dressing kit (bandages, tape, scissors, tweezers, support bandage, safety pins)
- Set of single-use equipment (needles, syringes, suture material ...)
- 3.0 suture thread, even if you do not sew, a professional will do with quality materials

For hygiene

- Toilet Paper Gel or hydroalcoholic solution for hands
- Saline

Medications should be carried away in their packaging and not in bulk (saves space in the luggage but possible source of error). Take a sheet which contains the drug name, in which case the dosage and your usual treatment

Water Treatment

The risks are especially infectious. The pathogens are mostly set on an organic or not (the importance of filtration before any water treatment). It recognizes three types of agent:

- Bacteria: E. Coli, Salmonella, Shigella, Cholera.
- Virus: real "parasite" of a living cell.As a rule they are fragile in the external environment, but hepatitis A could survive 3 months in soil and wastewater at 25 °C.
- Parasites: giardiasis, amebiasis, cryptosporidiosis. Their ability to form cysts gives them great strength in the external environment and chemical agents.

3 methods are used to decontaminate drinking water: heat, chemical (chlorine derivatives), filtration.

Our Toyota is equipped with 2 tanks light-tight, black polyethylene, for cold water. We have chosen to treat some of the water with a filter Katadyn Combi Plus filter (left) to wash vegetables and fruits to cook. Same as Combi for excursions, it also comes with a kit faucet. Ideal in our case to plug directly into the sink of Toyota. We can also unplug it and use it when hiking.

The Katadyn Combi combines a silver impregnated ceramic element and a refillable, activated carbon cartridge. It is effective against bacteria and protozoa and also reduces chemicals and bad taste.
There are other ways to treat water.

For disinfection of water (including drinking water) can also use the bleach has traditional 2.6 per cent (chlorine) in vial al ready obtained employment or after dilution berlingot recharge has rate of 6 drops (ie 0, 30ml) per liter of water and wait 10 minutes before consumption. There is a formula in dropper (DrinkwellChlore ®). In this case, allow 3 drops per liter of water 1 hour before consumption.

The use of tablets to purify water that destroy viruses, bacteria and amoebae. A simple solution since it suffices to let the pads do a few minutes to get water for consumption. But be careful to taste! And travel long runs, it must provide a large quantity.

In the range Micropur, there are several models, you see one that corresponds to your journey Micropur Forte for rapid and effective disinfection of water (use a clear water). Micropur Classic, to conserve water avoiding the proliferation of bacteria in the tanks. Micropur antichlor to remove the chlorine taste. Use after treatment with Micropur Forte.

In all cases, to obtain bottled water for drinking and brushing teeth.
   
 
The women's space

Other travelers are one of your best sources of travel information. Contact them and ask their advice.

When you travel, bring a supply of tampons and sanitary napkins. In general they are difficult to find and can be expensive. In South-Eastern Asia, you will find notices to the entrance of the premises of a religious call to women to refrain from entering if they have their periods.

If you use oral contraceptives, bring in a quantity sufficient for the journey and be sure to take a pill every 24 hours. Do not be misled by time zones.

Always bring a supply of toilet paper. In some parts of the world, this paper is very rare or too harsh. In parts of Asia or Africa, you find near the toilet a pitcher of water in lieu of toilet paper. If you're prone to vaginal infections, you'll be particularly vulnerable in hot and humid climates. Wear underwear with cotton that are further and choose a skirt rather than trousers.

In some countries, customs based on religious or moral beliefs have a significant impact on the female attire. If you openly transgress these rules would be considered irreverent and might put you at risk. Try to dress simply respecting the highest traditions of the country traversed.

There are chances that you stare openly. Be Aware. In countries where your appearance is very different from everyone else, neither men nor women seek to hide their curiosity.
 
Health insurance

We'll leave course with health insurance. Patrick is studying various options to ensure overseas for over a year. To be continued ....

In France, the group AVI offers a "Plan Marco Polo" which we can provide for a period of 2 months to 1 year (renewable). They even have a senior formula!Their performances are interesting:
- Reimbursement of actual costs of health - repatriation assistance - Liability insurance

By spending a few hours on the web pages of those who travel in time, we read on globetour.fr "To use the Marco Polo plan that we endorsed a perfect fit. No problems for reimbursements. In India we have repeatedly requested their assistance in finding a doctor or hospital. We had appointments quickly and AVI has supported the costs directly. » Rather reassuring!

For their part, insurance AXA offer the phrase "Support expatriates" for stays over 90 days out of France. There is also the IMA (Inter Mutuelle Assistance) which we often see the name appear in the forums. And why not Europ Assitance with a range of services or World Travel Assitance with a solution Globe Trotter.

Patrick will have got a lot to do !