Ordered, immediately called back and the same day delivered the order.Very pleased with the work. Thank you for prompt and accurate work doxycycline online great prices, delivered on the day of the order. Pleasant managers consult by phone.
Travel vaccine recommendations and other travel health advice for the Bike
ride you planed for later this year.
These vaccine recommendations are based on the following pieces of information
regarding the itinery:
1) Countries/destination(s): Singapore overland to KL (Malaysia); KL overland to
Phuket (via coastal road); Phuket overland to BK; BK overland to Vientiane
2) Duration of travel: 1 -4 weeks
3) Hotel/Hostel with air-cond accommodation through out the trip
4) Major activity: Bike riding
5) Month(s) of travel - November-December (ie Dry season) Vaccine recommendations
1) Hepatitis A
– consider active immunisation for all susceptible travellers,
regardless of duration of travel. The importance of protection against Hepatitis A
increases as length of stay increases. It is particularly important for those who will be
eating and drinking in rural areas of Malaysia, Thailand and Laos.
Hepatitis A vaccine is available as a monovalent vaccine (Havrix 1440 ®, Vaqta
Adult®, or Avaxim®), or as a combination vaccine combined with either hepatitis B
(Twinrix 720/20 ®) or as a combination vaccine combine with Typhoid (Hepatyrix® or
Vivaxim®). 2) Hepatitis B
– consider active immunisation for all susceptible travellers who are
undertaking physical activities that make them more prone to an injury (and therefore
placing themselves in a situation where they may be inadvertently exposed to
contaminated bloods or contaminated medical procedures) such as bike riding. In
Australia, hepatitis b is recommended for all young adult travellers irrespective or
Hepatitis B vaccine is available as a monovalent vaccine (Engerix B ® or HB -II-Vax®),
or as a combination vaccine combined with hepatitis AB (Twinrix 720/20®). 3) Jap B
- Mosquito avoidance measures should be sufficient. However vaccination
is recommended for travellers spending more than a month in rural areas of Asia,
particularly if travel is during the wet season, and/or there is considerable outdoor
activity and/or the standard of accommodation is suboptimal. The JE-vax®
vaccination course is given as 3 doses over a 4 week period - schedule: 0, 7 and 28
days. 3) Polio
– a one-time polio booster is recommended for travellers who have
previously completed a standard course of polio immunisation. If immunisation is
needed, either IPV or OPV may be used depending on preference. Additionally, polio
is now available in combination with tetanus containing vaccines such as Boostrix-
IPV ® or dT -IPV as single dose . 4) Rabies
– pre -exposure vaccination should be considered for persons staying
longer than 30 days who are expected to be at risk to bites from domestic and/or wild
animals (particularly dogs), or for persons engaged in high risk activities such as bike
riding where the movement of the b ike wheels may excite a dog to bite. Need for
vaccination is more important if potential exposure is in rural areas and if adequate
postexposure care is not readily available. The pre-exposure vaccination (Merieux
Inactivated Rabies Vaccine ®) course is given as 3 doses over a 4 week period -
schedule: 0, 7 and 28 days.
– Vaccination should be considered for persons staying longer than 30
days, adventurous eaters and those who will venture off the usual tourist routes into
small cities, villages and rural areas. Contraindications depend on vaccine type
(Typh-vax oral®, Typherix® or Typhium®). 6) All routine vaccines
(such as d iphtheria-tetanus (dT) or diphtheria -tetanus-
pertussis (dTpa ), measles-mumps-rubella (MMR), poliomyelitis, varicella, influenza
and pneumococcal) should be kept up-to-date as a matter of good health practice
unrelated to travel.
Tetanus - Bike riders should receive a booster dose of diphtheria -tetanus (dT ) or
diphtheria-tetanus-pertussis (dTpa) if more than 10 years ha ve elapsed since their
last tetanus dose (biking riding elevates the risk of an injury occurring).
Influenza – all travellers aged 65 years and over should receive annual influenza
vaccine when heading to the northern hemisphere winter, as should any traveller with
a medical risk factor.
Pneumococcal – All travellers 65 years and over should have received a single dose
of 23-valent pneumococcal polysaccharide vaccine.
Measles-mumps-rubella (MMR) - for all adults aged 18 -36 years who does not have
2 d ocumented doses of MMR since childhood (Australian recommendation). Other considerations: 1) Malaria
– According to the current itinery the risk of malaria is low risk. Risk of
malaria is determined by where the travellers sleep at night-time. There is no risk in
Singapore or KL. Coastal tourist areas of Malaysia and Thailand are free of malaria.
There is no risk in the interior of Thailand, nor in the cities and main tourist areas of
Thailand. For Laos, the risk exists throughout the country except there is no risk in
the city of Vientiane.
Therefore, mosquito avoidances measures only should be sufficient especially
understanding that travel is to occur in the dry season and that the bike riders will be
sleeping in air-conditioned accommodation , and the ride finishes in Vientiane . 2) Dengue
- low risk. mosquito avoidance measures only. 3) Mosquito avoidance measures
– wear protective clothing (long cotton sleeve
shirts and pants); airconditioning deters mosquitoes and windows that can be shut
tight or at least with flywire screens can help decrease the number of mosquito bites.
Use of DEET (N,N diethyl metatoluamide)-containing mosquito repellent. It is
important that you purchase a product that has between 25-50% DEET. Simply look
on the side of the product under ingredients to make sure it contains DEET and to
find the correct percentage. 4) Adequate oral Rehydration
with boiled/bottled water 5) Sun cream, sun glasses & hat/cap
6) First aid kit
7) Antidiarrhoeal medications.
Examples of medication to include in your gastro -kit
are Loperamide (Gastrostop, Imodium), Norfloxacin, Tinidazole (Simplotan or
8) Travel insurance*****essential
This advice should not replace or prevent obtaining advice from a qualified family
physician or travel medicine specialist as every individual has different requirement
and medical needs that need to be taken into account.
Things to remember while you Travel (Carry with your travel documents)
Don’t Get Diarrhea.
, you cannot wash them enough, especially before eating (substitute
alcohol based hand sanitizers like Purell or Aavanguard if more convenient).
Foods to avoid:
Raw or undercooked meats, seafood, and fish; untreated milk or
cheese; lettuce and raw vegetables. Fruits should be prepared in a clean manner. Water and milk
can be made safe to drink by bringing to a boil and letting cool
down. Commercially bottle drinks are usually safe.
If you have one or two loose stools a day use only medicines to help with symptoms,
if lots of watery stools, especially with blood in the stools, pain, or fever, take an
MEDICATIONS For diarrhea
To help with symptoms: loperamide (“Imodium”)
Take two tablets to start, then take one pill after each stool (do not take
more than 8 in 24 hours). Don’t use this medicine in babies, young children or when
you are pregnant.
To treat an infection: Antibiotic:
Your doctor or nurse will give you an antibiotic to take with you that you
can take if you get bad diarrhea. Make sure you understand how to use this before
leaving the office. The names of some common antibiotics are Azithromycin
(Zithromax), Ciprofloxacin, Norfloxacin, and Rifaxamin.
The new england journal of medicineWithdrawal of Long-Term Cabergoline Therapy Annamaria Colao, M.D., Ph.D., Antonella Di Sarno, M.D., Ph.D., Paolo Cappabianca, M.D., Carolina Di Somma, M.D., Ph.D., Rosario Pivonello, M.D., Ph.D., and Gaetano Lombardi, M.D., Ph.D. b a c k g r o u n d Whether the withdrawal of treatment in patients with nontumoral hyperprolactinemia, From the Department
SamenOud: elke huisarts een eigen OuderenzorgTeamA. de Groot MSc, S.L.W. Spoorenberg MSc, drs. R.J. Beukema, drs. R. Mustafa en dr. K. Wynia1specialist ouderengeneeskunde en hoofd medische en paramedische dienst Zorggroep Meander, Veendam2projectleider SamenOud en promovendus, afdeling Gezondheidswetenschappen, UMC Groningen en RijksuniversiteitGroningen, Groningen5onderzoeker Integrated Care,