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It’s not long now to the 2018 World Cup in Russia starting on June 14 and if you’ve booked your tickets to see the Socceroos in action (or you’re about to) NOW is the time to think about getting the recommended vaccinations and advice. Most vaccines can be given at one time but a few may need to be spaced out over a month, so make an appointment for your pre-travel medical very soon.

The ten Russian cities that are hosting matches cover some 3,000kms from east to west, and nearly 2,400kms north to south: Moscow, St Petersburg, Kazan, Sochi, Rostov-on-Don, Saransk, Samara, Volgograd, Nizhny Novgorod, Kaliningrad and Ekaterinburg – the Socceroos' first 3 matches are in Kazan, Samara and Sochi.

Nearly 5 million fans have put their names in the first draw for tickets, just over half of them from Russia. Among the international fans, going by the top 10 countries for ticket requests, you can expect to see plenty of people from Germany, Argentina, Mexico, Brazil, Poland, Spain, Peru, Colombia, USA and the Netherlands1.

Crowd control

When travelling to sporting, cultural or political events or religious festivals, anywhere there are large gatherings of people from all over the world you should be aware that they carry their own set of health risks. The World Health Organization2 (WHO) has been active in supporting host cities and countries in their preparations for these packed events, including the Olympic Games in London and Sochi, UEFA championships and even the Eurovision Song Contest!

With respect to the potential for health consequences, the WHO explains that mass gathering events ‘can be settings for disease outbreaks and other health problems … All this can stress the public health system and resources of host countries and the countries where the visitors return to’.

In the planning stages, assistance is rendered to host countries by the WHO in areas such as:

- ‘travel medicine: procedures to provide updated health advice and vaccination guidance for visitors on vaccinations, food and water safety, and other information, including emergency contact numbers; and

- promotion of healthy behaviours: activities before and during mass gatherings to encourage, for example, increased physical activity, observing local laws and customs, avoiding aggressive and inappropriate behaviour, cessation of tobacco use, avoidance of excess alcohol and using safe sex practices2.’

Vaccinations for Russia

First, here’s an overview of the vaccinations we would typically discuss for leisure travel to Russia, which fall under 2 headings.
ROUTINE vaccinations such as measles-mumps-rubella (MMR), diphtheria, pertussis, tetanus, chickenpox, meningococcal disease, and seasonal influenza should be up to date for every overseas trip. (Outbreaks of measles have been common in developed and developing countries recently, while flu is the number one vaccine-preventable risk for overseas travellers. Both are a concern when lots of people come together from all points of the globe!)

RECOMMENDED vaccinations for Russia would include hepatitis A, which can be given on its own or in combination with hepatitis B. Hotel workers in Moscow have been required to get hepatitis A vaccinations in preparation for the arrival of the Cup players and fans - their vaccination checks also include diphtheria, tetanus, hepatitis B, measles and rubella3. Unlike Hep A, which is spread by eating or drinking contaminated food or water, Hep B is passed from person to person through the transfer of infected blood or bodily fluids. Vaccination is usually suggested for young singles, travellers on longer stays, those heading ‘off the beaten track’, or those who plan to travel regularly in the future (regardless of age). Typhoid fever, a bacterial disease spread through contaminated food or water, is present in Russia. The disease is usually not considered a significant risk for people on short visits staying in quality accommodation, but vaccination may be suggested if you’ll be staying on to see more of Russia after the Cup or you plan to visit other countries in the region. (Rabies is also present in Russia, but vaccination is more likely to be recommended for longer stays, especially in rural areas.4)

Traveller’s diarrhoea rates are considered moderate by international standards so following safe food and water guidelines is recommended. (A locally produced vaccine is available for the prevention of dysentery outbreaks caused by Shigella sonnei bacteria in the Russian population, but it would not be used for international Cup fans5.) Food and water precautions would also be advisable in the prevention of parasitic intestinal infections such as has occurred from time to time in Russia among people who have consumed undercooked pork or meat from other animals (bear, badger, walrus)6. Check with your travel health practitioner if a diarrhoea treatment kit would be useful for your trip – they’ll advise you on the medications you’d need.

In a tick…

Repellent, long sleeves, long trousers and some enclosed footwear are important items to pack if you plan to hit the rural or forested areas of the country - this is to avoid tick bites. The Ixodes species of tick is the vector of the viral illness, tick-borne encephalitis (TBE). This infection, which strikes the central nervous system of humans, is endemic in many European countries and causes anywhere from 5,000 to 13,000 cases each year. Russia reports more cases than any other6. (A word of warning: you can also contract TBE from consuming unpasteurised dairy products.)

The risk of tick bites occurs below 750 metres in altitude generally, but the range is increasing upwards, and the warmer months of April through to November are peak TBE transmission months – more so in the summer when ticks are most active.

A TBE vaccine is available through the Special Access Scheme, however it is generally used for travellers who will have extensive outdoor activities (camping, berry picking, hiking) in affected areas. Ask your medical practitioner for more information.

If you don’t plan on heading out of the cities and you don’t consume unpasteurised dairy products, your risk of TBE is very low indeed; however if you needed more reasons to avoid tick bites, they are also responsible for a number of other infections in Russia – Crimean Congo haemorrhagic fever, tularemia and Lyme disease8.

Guard your personal safety, too

A major sporting event held in a large stadium with often volatile fans has the potential for emotional and physical stress, as well as aggression. So it’s important to pay attention to your own security, drink plenty of water to prevent dehydration, avoid no-go areas, and don’t drink alcohol to excess.

When it comes to STIs, play defensively and BYO (condoms).

All of this is good advice for sports fans – even more critical when you’re more than 14,500kms from home.
And, our final two pre-game tips: Don’t forget travel health insurance and register your travel with Smartraveller!

For more information, call our phone information service on 1300 360 164 Monday to Friday 9am to 6pm AEDT.

1. http://www.fifa.com/worldcup/news/y=2018/m=1/news=2018-fifa-world-cuptm-tickets-impressive-figures-mark-the-closing-of-t-2927411.html

2. http://www.euro.who.int/en/health-topics/emergencies/disaster-preparedness-and-response/activities/health-planning-for-large-public-events

3. https://en.riavrn.ru/news/v-voronezhe-obsluzhivayushchiy-personal-chm-2018-privyut-ot-gepatita-a-i-dizenterii-zonne/

4. https://wwwnc.cdc.gov/travel/destinations/clinician/none/russia

5. http://iliveok.com/health/inoculation-dysentery-sonne_112492i15828.html

6. https://www.ncbi.nlm.nih.gov/pubmed/16081220

7. https://wwwnc.cdc.gov/travel/yellowbook/2018/infectious-diseases-related-to-travel/tickborne-encephalitis

8. https://www.medscape.com/viewarticle/717730_10

There’s a lot of appeal in the street markets that you come across in some developing countries – where else would you find hugely discounted products with high end brand names? And of course there is no pretence that they are the real deal - what does it matter if those items fall to pieces or stop working in a few months? The trouble is that it’s not just merchandise that’s counterfeited, it is life-saving medicines too. While most of us find it hard to believe that some person or persons would wish to make money from this miserable trade, according to the World Health Organization (WHO) it has been going on for centuries and, thanks to globalisation and the online marketplace, it’s booming.

What are we referring to?

The definition of the bogus medications has recently been expanded and it now covers those which are: substandard/ spurious/ falsely-labelled/ falsified/ counterfeit medical products (or SSFFC). The WHO places them into 3 classifications:

· ‘Substandard medical products: Also called “out of specification”, these are authorized medical products that fail to meet either their quality standards or their specifications, or both.

· Unregistered/unlicensed medical products: Medical products that have not undergone evaluation and/or approval by the national or regional regulatory authority for the market in which they are marketed/distributed or used, subject to permitted conditions under national or regional regulation and legislation.

· Falsified medical products: Medical products that deliberately/fraudulently misrepresent their identity, composition or source.’ http://www.who.int/medicines/regulation/ssffc/definitions/en/

WHO’s keeping tabs on them

The Global Surveillance and Monitoring System for substandard and falsified medical products (GSMS) was established by the WHO four years ago, providing a central agency for the receipt and compilation of information on new and previously identified suspect products – an ‘international data exchange’. In the past this has enabled countries to cross-reference the details, and even the images, of dangerous medications which had caused harm in one country and confiscate them before more damage could be done in their own population. Another function of the GSMS is to broadcast alerts when they are notified of deficient or false products.

The Executive Summary of the GSMS report released last month stresses that the SSFFC products that they are aware of are only the tip of a very large iceberg: 1,500 cases since 2013 and ‘some cases involve millions of doses of medicines, others a single dose’. What’s more, according to the report, they cover ‘everything from cancer medicines to contraception, from antibiotics to vaccines. They are not confined to high-value medicines or well-known brand names; antimalarials and antibiotics are the two most frequently reported medicines in the database.’

What that means…

At the very least, taking a counterfeit medication will mean that you have wasted time and money.

But the consequences can be so much worse as pointed out in a WHO factsheet:

· It could result in a worsening or prolonging of the condition which caused you to take the medication.

· It can lead to drug resistance – a disaster is already unfolding as we run out of effective antibiotics and malaria treatments.

· The ingredients of the drug/ medication could be toxic and cause you harm or even be fatal.

Of course you don’t even need your passport to access some overseas medications – they can often be purchased online. In this instance we found some useful advice from the Therapeutic Goods Administration if you are considering sourcing your medications this way. But when it comes to buying medications when you are travelling overseas, Smartraveller advises: 'If you need to purchase medication at your destination, be careful not to buy imitation or counterfeit medications and prescription drugs, and always check the strength of a medication with a doctor. Be aware that packaging and labelling may be similar to those available in Australia, but the strength and active ingredients can vary from country to country.'

So, if you can, it would be so much safer and more predictable to take what you need with you (with a doctor's letter certifying the medications are prescribed for the traveller's use), or in the case of vaccines, have them here in Australia before departure through clinics such as Travelvax.

Also, be aware that some countries have limits on the importation of some types and amounts of medications. Check with the embassies or consulates here in Australia well in advance of leaving.

More information on taking PBS medications overseas can be found through the Department of Health or by calling the PBS information line on 1800 020 613. And if you would like to know more about travelling with medication, click on this link to the Travelvax website, try the Department of Human Services website or call the Overseas Drug Diversion information line on 1800 500 147.

Don Daeng & Mekong River

High on the list of up-and-coming tourist destinations for Australian travellers is the Lao People's Democratic Republic, or Laos. Now, it’s the varied and spectacular landscape and historic architecture that draw the tourists - the region is very popular with Europeans who tend to visit during their peak summer months. But not that long ago, Vang Vieng in the country’s north was popular with backpackers in search of a party. The picturesque town became (in)famous for the tragic deaths of young men and women who had taken to ‘zip-lining’ and ‘tubing’ down the Nam Song river while extremely inebriated. 

Laos is land-locked, sandwiched between Myanmar to the west, Thailand to the south-west, Cambodia to the south, China to the north and Vietnam to the west. Over two-thirds of the terrain is mountainous, crossed by the mighty Mekong River which produces spectacular waterfalls and rapids, especially during the May to October tropical monsoon season (annual rainfall ranges from 1,360mm in Luang Prabang to 3,700mm in the Bolaven Plateau). The chief arable regions, with rice as the main crop, are in the south-central plains of Savannakhét and Champasak provinces. Adjacent to the Cambodian border is Si Phan Don, an archipelago of 4,000 islands that sits in a 10km-wide stretch of the Mekong River – 3 of the islands are popular with tourists: Don Khet, Don Khon and Don Khong.

In an early kingdom established in what is now the province of Champasak, a temple complex was constructed which formed part of the ancient Khmer cultural landscape. This is Wat Phu and, like the structures near Siem Reap in Cambodia, it is made of sandstone that has been ornately carved to honour the deities and the rulers of the time. Both Hinduism and Buddhism have been followed at different times over the centuries. Now, around half of the Laotian population are Theravada Buddhists and the overwhelming majority of the remainder adhere to various Lao folk religions.

You can still find influences from the time when Laos formed part of the French Colonial Empire from the late 1800s until it gained self-rule in 1953. Baguettes and French restaurants are common in the capital Vientiane, but it’s the famous Laotian cuisine that is a big drawcard, featuring such delicacies as Khao Niaw (sticky rice), Sai Oua (Lao sausage) and Larb.

General health concerns are similar to those in other developing countries in the region.

Vaccinations for Laos

There are no REQUIRED (mandatory) vaccinations: Yellow fever is NOT a requirement, unless you arrive from an endemic country of Africa or South America.  
Updating your childhood vaccinations is considered ROUTINE before any overseas trip. Check with your GP and, if necessary update measles-mumps-rubella (MMR) , diphtheria-tetanus-pertussis, chickenpox, and polio. Also ensure you are protected against seasonal influenza, the most common vaccine-preventable illness among international travellers.
Heading the list of RECOMMENDED vaccinations is Hepatitis A, considered a moderate risk for all travellers, regardless of the length of stay or type of accommodation. Hepatitis B is especially relevant for young singles, frequent flyers, and those heading ‘off the beaten track’ where medical facilities are scant. There’s a moderate risk of typhoid in Laos and vaccination is recommended for even short stays, especially if planning to visit towns or villages. Cholera is not generally a risk in Laos. (Read about Rabies and Japanese encephalitis below).

Malaria and mozzies

Laos’ annual malaria data for 2014 showed that there had been 38,131 cases with 28 deaths. The capital Vientiane is the only area considered to be malaria-free and the mosquito-borne disease remains a SIGNIFICANT RISK in other areas of the country. America’s CDC ranks the overall malaria risk as ‘very low’ for travellers but warns that 65% of cases are the potentially fatal P. falciparum strain. (Adding a more dangerous dimension to the malaria risk is the multi-drug resistance that is now widespread along parts of the north-east and south-east borders.) 
Malaria medication: For Australians, the most commonly prescribed and effective anti-malaria chemoprophylaxis (started before potential exposure to prevent malaria and continued during your stay in the malarial area and for a period of time after leaving it) includes Doxycycline or Malarone. Ask your doctor which of these is most appropriate for you.
Whether or not you take medication to prevent malaria or treat it is a decision you should make after discussing your travel itinerary with a doctor, ideally one experienced in travel medicine. Your doctor will determine whether taking prevention medication or carrying a drug to treat malaria at the first sign of infection would be best for you, based on your itinerary, length of stay, and level of exposure.
Other reasons to pack repellent
Dengue fever infection is even more common than malaria in Laos, while its ‘cousins’, chikungunya and the Zika virus can occur there, too. All are spread by two species of day-time feeding mosquitoes, Aedes aegypti and Aedes albopictus. Unlike the mainly rural-dwelling mosquitoes that spread malaria, the Aedes mozzies are equally at home in the biggest cities or the smallest villages – anywhere, in fact, people live.
Two other mosquito-borne diseases that are present but much less common among travellers are lymphatic filariasis, a parasitic disease caused by thread-like worms, and Japanese encephalitis (JE). JE is thought to occur countrywide in Laos, with most human cases reported from June to September. However, JE is rare among travellers and vaccination is usually reserved for those spending an extended period in rural farming areas, those living in endemic areas, or those staying in locations where outbreaks are occurring.
BYO repellent and bed net
Effective insect repellents can be hard to obtain in Laos, so bring enough from home to last the duration of your stay. Some guesthouses and hotels don’t have mosquito nets either so, once again, if you plan to stay in budget accommodation, pack your own permethrin-impregnated net.
Beware other ‘bities’, too
Mozzie bites aren’t the only ones to be wary of. The rabies risk in Laos is rated ‘high’ although, as with Japanese encephalitis, vaccination is usually recommended for long-stay expats or those travelling in rural areas, especially if on bicycle tours, camping, or hiking etc. However we advise that you discuss rabies vaccination with your doctor, as at-risk bites are also reported in the first couple of weeks of travel.
Be prepared for traveller’s diarrhoea
The risk of traveller’s diarrhoea (TD) in Laos is rated ‘moderate’, which makes it important to follow the rules of personal hygiene – especially regular hand washing – and selecting the safer food and beverage options. TD often clears up without specific treatment, but it’s wise to keep oral rehydration fluids on hand to replace lost fluids and electrolytes. Travellers who pass three or more loose bowel motions in an eight-hour period accompanied by other symptoms of dysentery like fever, nausea, vomiting, abdominal cramps and blood in stools should consider taking a course of antibiotics. Ask about the appropriate medication and dosages during your pre-travel medical consultation. If diarrhoea persists despite therapy, see a doctor – the cause may be a parasitic infection. Learn more about traveller’s diarrhoea and how to avoid it

WHAT TO PACK

Insect repellent – Apply repellent containing an active ingredient, such as DEET (30-50% formulations for adults, or up to 30% for young children aged from 6 months), Picaridin, or oil of lemon eucalyptus when outdoors. Read more on avoiding biting insects
A treated bed net – Permethrin is an insecticide that is safe for humans, but kills insects that come into contact with material treated with it. You can buy a net that’s already treated or make up the solution and treat your net, clothing, hats etc.  
Sunscreen – To ward off the tropical sun’s UV rays, take a 50+ sunscreen and apply it to all exposed skin as directed when outdoors.
First-aid kit – In case of an accident, it’s reassuring to know you have a travel first-aid kit containing syringes, needles, sutures etc. that local medical personnel can use, along with basic first-aid items you might need from day to day. The standard of medical facilities in Laos is extremely limited, particularly outside Vientiane (Australia’s embassy has a medical clinic for nationals). Travellers are advised to avoid surgical procedures, (including dental work) due to the danger of hepatitis, HIV/AIDS and other infections from unsterile dental and medical instruments.
Finally, read more on the importance of comprehensive travel insurance, areas to avoid, and local conditions on Smartraveller, the Australian Department of Foreign Affairs’ website for Australian travellers. Warnings are in place for travellers to Xaisomboun province due to attacks in recent years and the department also advises against travelling by road between Vang Vieng and Luang Prabang, and from Kasi to Phou Khoun and Muang Nan.
Australia’s embassy in Laos is located at KM4, Thadeua Road, Watnak Village, Sissatanek District, Vientiane. Telephone: +856-353800 Facsimile: +856 – 353801 E-mail: This email address is being protected from spambots. You need JavaScript enabled to view it. Website: laos.embassy.gov.au
(In a consular emergency if you are unable to contact the Embassy you can contact the 24-hour Consular Emergency Centre on +61 2 6261 3305 or 1300 555 135 within Australia or +61 421 269 080 for SMS.)
For more expert, no-obligation advice on staying healthy on your next overseas trip, or to book your pre-travel medical consultation at a Travelvax Australia clinic, please call 1300 360 164 (toll-free for landlines).

 

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Australia has seen an increasing number of dengue notifications in recent years – the more-than-2,000 confirmed cases reported last year were the highest in 20 years. Of the 2129 notifications, around 1 in 4 were in adults aged between 25 and 34 years. So we are asking - Are Australian travellers putting themselves at risk because of the Aussie ‘you’ll be right, mate’ mind-set, or is it due to the YOLO (you only live once) attitudes of younger travellers? Or could it be a lack of awareness which is fuelling this increase in infection rates?

In a survey carried out on over 1,000 Australian travellers by the pharmaceutical company Sanofi, 40% of them admitted to a YOLO attitude when travelling. The survey also exposed a lack of homework before eating food from street vendors and security lapses through falling asleep outdoors. What’s more, over 40 % of travellers said they did get sick, 50% didn’t have the recommended vaccinations and more than 60% didn’t consult their GP or a travel medicine specialist clinic prior to travel!

But back to dengue fever…

Dr Cameron Webb, University of Sydney-based medical entomologist and clinical lecturer, said recently that ‘dengue fever cases were increasing globally and travellers are bringing the disease back to Australia’ as a result. Unfortunately, many popular holiday destinations are also prone to outbreaks of dengue. The opportunities to be infected are most certainly there: In June last year, there were 824,300 short-term resident departures from Australia and many of the top 10 tourist destinations (Indonesia, Thailand, Singapore, Fiji and India) are dengue endemic countries. Western Australia was in number one spot across the country last year with 533 dengue notifications - maybe that’s because cheap air fares to (dengue-affected) Bali make it a popular travel destination.

Dengue, like other mosquito-borne diseases caused by Zika and chikungunya viruses, is transmitted by Aedes aegypti and Aedes albopictus mosquitoes. The mosquito vectors are both aggressive day-time feeders that breed and bite in urban locations and prefer cool, shaded places. They are found in areas close to people, their favourite source of the blood meal the females need to lay eggs. 

While only about 25% of people infected with dengue viruses actually get symptoms, those that do fall ill can experience fever, headache, pain behind the eyes, rash, and severe aching of muscles, joints, and bones (and this is the reason why dengue also has another more evocative name, ‘breakbone fever’).

Dengue isn’t just a problem for travellers, it’s one of the most significant mosquito-borne viral diseases globally with a worldwide public health burden estimated at around 50 to 390 million infections, including dengue fever and the potentially fatal dengue haemorrhagic fever (DHF) and dengue shock syndrome (DSS). The mounting disease presence across the globe is believed to be due to climate change, the expansion of dengue vectors to new geographic regions, increasing human movement across borders, global trade and urban migration.

Our advice to avoid dengue?

Before you ask, there isn’t a dengue vaccine ... or at least not yet for tourists. A vaccine has been developed and is currently registered in 11 countries – but they are all countries with a significant dengue burden, and this is where the vaccine will be most useful. It is expected to reduce the levels of severe dengue illness and the resulting hospitalisations through its actions in the 9 to 45 years age group. 

For many travellers staying at major resorts, there will be mosquito control programs in place that substantially reduce the risks of dengue. Perhaps this is why fewer older Australian travellers are returning infected with dengue. However, even if staying in a resort with minimal risk, be aware that day trips to local villages or towns may bring with them a risk of exposure to mosquitoes, so take steps to avoid these bites.

Minimise mosquito bites and you reduce the risk of infection

Dr Webb says Australian travellers can reduce their risk of being bitten by following these measures:
– The mosquitoes that spread dengue viruses bite during the day. This means travellers must be actively avoiding mosquito bites during the day, not just in the afternoon and evening. Wearing loose, long-sleeved shirts and long pants outdoors together with topical insect repellents will provide the best protection.
–The most effective insect repellents are those containing DEET, Picaridin or extract of lemon eucalyptus oil. It is always best to take insect repellent with you from Australia as it may be difficult to find suitable formulations at your holiday destination. See here for the range of repellents that Travelvax stocks. 
– Where possible, ensure where you’re staying is air conditioned and has screened windows and doors.
– Get rid of any standing water around your accommodation, including pot plant bases and other containers that collect water.
– If you are using sunscreen, apply it first BEFORE your insect repellent.
– If you’re likely to be consistently exposed to insect bites, soak your clothing and bed net (if your room is not screened) with permethrin. This contact insecticide repels mosquitoes and other insects, and also kills them when they come in contact with the treated material. (Permethrin shouldn’t be applied directly to your skin.) Read more about permethrin and how to protect yourself against insect bites
– Mosquito coils and “plug-in” devices can also assist in reducing mosquito bites around your accommodation
The fewer times you get bitten, the lower the risk of infection. Don’t get bitten and there’s absolutely no chance at all.
No excuse for the lack of awareness now.

Did you know you can get no-obligation, country-specific advice on insect-borne diseases and other potential health risks of your next overseas destination by calling Travelvax Australia’s travel health advisory service on 1300 360 164 (free to landlines)?

 

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Snow is falling along with the mercury as winter bites in the southern states of eastern Australia.
If you are heading for the snowfields, we’ve got some advice to keep you healthy and safe on the slopes.

1 - Invest in quality eyewear

Snow can reflect as much as 80% of the sun’s rays – much higher than the reflection off sand, water, or cement – and it comes into your eyes from all angles. The higher the elevation, the less atmosphere there is to filter out harmful UV rays.
Your snow eyewear should:
– Provide 100% protection against both UV-A and UV-B radiation.
– Fit your face snugly from above your eyebrows to the middle of your cheeks
– Wrap around your face so UV rays and wind can’t reach your eyes from the side.
Eyewear that meets Australian Standard AS1067 is a guarantee that it will block at least 95% of UV radiation. Glacier goggles (or glacier sunglasses) are the best option: They fit like sunglasses but screen out light from the sides. Your optometrist can also fit prescription lenses.

2 – Be aware of snow blindness

Goggles also protect you from a very painful corneal injury (UV solar keratopathy or ‘snow blindness’). Essentially it is sunburn of the eye’s surface.
Snow blindness feels like sand or grit in your eyes. Its symptoms include watering of the eyes, bloodshot eyes, and uncontrollable twitching of the eyelid. If you experience the symptoms you should:
– Remove contact lenses if you’re wearing them.
– Lie down in a darkened room.
– Cover your eyes with a cool compress or dark cloth.
– Refrain from rubbing your eyes.
Happily, almost all cases of snow blindness heal spontaneously over a few days.

3 - Don’t forget the sunscreen

Vacations that involve snow skiing (or mountain climbing or high-altitude trekking) have the potential for sunburn because of increased levels of UV. UV radiation exposure increases by 4% for every 300m of elevation above sea level.
Even on a cloudy day, sunscreen should be applied at a rate of 2mg per square centimetre of exposed skin. Properly applied, a sunscreen with an SPF of +15 will protect you from 93% of UVB radiation; while SPF +30 protects against 97% of UVB; and SPF +50 offers protection against 98% of UVB.
SPF 30+ is the recommended sunscreen for fair-skinned people who burn frequently and rarely (or never) tan. For those with light-intermediate, olive, brown, or black skin who tan easily and rarely (if ever) get sunburned, SPF 15+ offers sufficient protection.
It’s worth remembering that all UV damage lasts a lifetime and potentially fatal melanomas can occur anywhere on the human body – even in the eye. If you damage your eyes or skin, the long-term effects may only become apparent years – even decades – later.

4 – Respond to hypothermia

Even experienced skiers, snowboarders and alpine hikers can get caught out by a sudden change of weather that sends the mercury plummeting. So, it pays to be aware of two other potential risks on the snowfields, hypothermia and frostbite.
Hypothermia can occur if your body temperature falls just a couple of degrees to less than 35°C. The initial signs include feeling cold and shivering with pale skin, which can progress to feelings of fatigue or exhaustion, drowsiness, confusion, slurred speech, and memory loss.
There are steps you can take to help someone with hypothermia until medical help arrives:
- Get them to a warm space out of the wind and remove any wet clothing.
- Raise their core temperature by wrapping their head, neck, chest, and groin in a blanket (electric, if you have one) or warm them with skin-to-skin contact under blankets or sheets.
- If conscious, encourage them to sit up to drink warm, non-alcoholic beverages, such as tea or coffee.
- After raising their core temperature, keep them wrapped in a warm blanket – including their head and neck.

5 – Know some frosty first-aid

Frostbite is any injury caused by freezing; usually the nose, ears, cheeks, chin, fingers, or toes. Severe frostbite can lead to permanent tissue damage – even amputation – especially in people with poor blood circulation.
Tell-tale signs of frostbite include reddened skin progressing to a white or greyish-yellow colour that may also feel unusually firm or ‘waxy’, along with numbness and blistering. With more advanced frostbite, the skin may darken and turn black.
Victims of frostbite also need urgent medical treatment from a trained professional, but there are simple steps you can take to provide initial first-aid:
- Get them into a warm space.
- Immerse the affected areas of skin in warm water (not hot) or warm the affected area using body heat.
- Don’t massage the affected areas – it could cause more damage.
- Arrange transportation to medical help. Walking on frostbitten feet or toes may increase the damage, particularly as the thawing and re-freezing of feet after they’ve been warmed will increase the tissue damage.

6 – Take care out there!

With dozens of people of wildly varying skill levels likely to be on the slopes at any one time, safety is everyone’s responsibility.
Off-piste collisions with trees, rocks and covered obstacles can result in serious injuries that may require urgent evacuation. It’s one domestic travel situation when it is important to have travel health insurance that suits the type of activity you’re undertaking.
Finally, it’s always a good idea to take a pre-travel course in first-aid and emergency resuscitation (CPR). The knowledge will give you the confidence to provide what help you can.
Before you travel, call Travelvax Australia’s telephone advisory service on 1300 360 164 (toll-free from landlines) for country-specific advice and information. You can also make an appointment at your nearest Travelvax clinic to obtain vaccinations, medication to prevent or treat illness, and accessories for your journey.

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Whether you’re heading to Brazil for the Games in August or just taking a short winter break in Fiji, the last thing you’ll want to bring home is dengue, chikungunya or Zika.
With no vaccines available to travellers for these nasty viruses, avoiding infection means dodging mosquito bites.
But, what really prevents bites from the aggressive, day-time biting Aedes species that transmit all three diseases, or other biting insects?

A new US study published in Consumer Reports compared the effectiveness of insect repellents. It confirmed what we knew: Products containing any of 3 active ingredients — DEET, Picaridin, or oil of lemon eucalyptus — work well against Aedes and Culex mosquitoes and Lyme disease-carrying deer ticks, while those marketed as ‘natural’ offered little protection, especially against Aedes mozzies.
But, the active ingredient’s concentration is just as critical. Repellents containing 15% - 30% DEET provide long-lasting protection against mosquitoes and ticks, while others with 7% DEET didn't work well against Aedes mozzies. (DEET is safe for children, and pregnant and lactating women, too.) 
A product containing 20% Picaridin was the study's top overall repellent, but one containing a 5% concentration of Picaridin scored far lower. Oil of lemon eucalyptus was the only naturally occurring compound to do well in the tests: Other plant oil-based products containing cedar, citronella, lemongrass, or rosemary provided little protection and often failed within 30 minutes. Once again, they were particularly ineffective against Aedes mosquitoes.

What works, what doesn't

A recent article by Beth Skwarecki neatly sums up the state of play as to what works and what doesn’t when it comes to products that claim to repel insects:
Wristbands and pricey gadgets don’t prevent mosquito bites. A wristband protects only your wrist, while ultrasonic devices don’t work at all.
Clip-on devices. They protect you from bites, but only if you sit still.
Some plants are natural repellents. But, planting them nearby isn’t enough.
Insect traps can be problematic. They may attract more mosquitoes than they kill.
Candles provide partial protection. There is some benefit – depending on which way the wind is blowing. Citronella candles don’t seem to work any better than plain candles.
Insecticide-treated clothing is worth the trouble. But, treated clothing works best with long sleeves and pants, and used in conjunction with an effective topical repellent applied to all exposed skin.

So, for now at least, the proven options are still the best – regardless of the maker’s claims, or how convenient or appealing the flashier gimmicks might appear.
But, select the repellent right for you (including kids) and read the label closely.