Going on a trip to the tropics?

In some tropical countries, you can contract nasty and dangerous diseases. Think of
diarrhoea, malaria, skin problems and sexually transmitted infections (STIs). Read in this
leaflet which precautions are important.

You will also read about what you can do if you do contract an illness. Children are more vulnerable than
adults. Therefore, this leaflet provides information on children separately.

Vaccinations and medicines
Vaccinations or taking tablets can help you prevent diseases such as hepatitis and malaria.
Discuss your trip with a knowledgeable traveller's advisor at least four weeks before departure. The
healthcare at your travel destination may not be as good as in the Netherlands. The adviser will keep
take into account your health condition, purpose of travel, duration and itinerary. On the website of the
Landelijk Coördinatiecentrum voor Reizigersadvisering (LCR) lists where you can find a
expert traveller advisers can find.

Hygiene
Wash your hands thoroughly with soap. Always do this after using the toilet and before eating. Wash your
hands as well before cooking. Keep persons suffering from stomach ache and/or diarrhoea out of the kitchen.
Work with well-cleaned kitchen materials and use clean tea, hand and dish towels.
In (sub)tropical countries, it is often hot and humid. In this environment, your skin is more sensitive to
inflammations. It is important to clean small wounds as well. This can be done with lukewarm drinking water.
Diseases such as hepatitis B can be transmitted by unhygienic materials. For example
to having a piercing or, tattoo, sharing razor blades (including at the hairdresser's) or
non-sterile medical instruments.

Food and drink
Be careful what you eat and drink. Food - especially raw food - is often not safe. Therefore, do not eat raw meat,
raw fish or shellfish. This also applies to raw milk or milk products.
Food spoils faster at higher temperatures. To kill germs, food must be sufficiently
are heated. Eat fruit only if it has been peeled by you. Do not eat unpackaged ice cream.
In many countries, water from the tap is not drinking water. Ice cubes, diluted drinks (lemonade) and
washed salads are a risk if tap water has been used for this. Water from sealed bottles and
Boiled tap water is safe to drink. Water can be purified with a water filter.
Chemicals such as iodine or chlorine can also be used. These are available in
outdoor sports shops. Iodine and chlorine kill bacteria, viruses and, to a lesser extent, parasites. Caution:
Iodine should not be used in thyroid problems or pregnancy.

Children
When travelling, breastfeeding is the safest food for your baby. For food preparation and
bottle feeding, the same advice applies as for adults. Use only cooked or
pasteurised milk

Diarrhoea
About 40% of travellers experience temporary diarrhoea. By applying
hygiene measures you limit the risk of diarrhoea. Diarrhoea usually goes away on its own after a few days
again. It is not always necessary to take medication for diarrhoea. However, it is important to
Keep drinking enough. Drink two to three litres of fluid a day, for example mineral water, tea or
broth. Oral Rehydration Solution (ORS) is a special salt-sugar solution that helps prevent dehydration
prevent. In healthy adults, ORS is recommended only in cases of water-thin diarrhoea.
For water-thin diarrhoea, a stopping agent containing loperamide (Imodium®, Diacure®, Diarem®) can
be used. Be cautious about this; overuse can lead to constipation.
Never use a stopping agent in diarrhoea with blood or mucus, or diarrhoea with fever. Do not use
activated carbon for diarrhoea. It reduces the effect of other drugs, such as
antimalarial drugs or the contraceptive pill.
ORS and loperamide are available at drugstores and pharmacies without a prescription. Use these
means according to the instructions for use.

Consult a doctor in case of:
- diarrhoea with fever higher than 39 degrees;
- diarrhoea with blood and/or mucus;
- diarrhoea lasting more than 3 days.

Children
Children can dehydrate more quickly due to diarrhoea. For them, ORS is always recommended in case of diarrhoea.
Stoppers such as loperamide should not be given to children under 2 years of age. Be
caution with these agents in children under 6 years of age, as they can quickly become constipated by them
touch. Also for children: never use a stopping agent in diarrhoea with blood or mucus.

Consult a doctor in case of:
- diarrhoea longer than one day in children up to 1 year of age;
- longer than three days in children ≥1 year;
- In case of poor drinking and persistent vomiting.
- diarrhoea with fever higher than 39 degrees;
- diarrhoea with blood and/or mucus;
- signs of dehydration, such as drowsiness or, on the contrary, strong irritability, and reduced urination.

Mosquitoes and insects
In many (sub)tropical countries, diseases such as malaria, yellow fever and Zika are transmitted by
mosquitoes. The malaria mosquito mainly stings after sunset. The mosquito that causes chikungunya, dengue, yellow fever or Zika
transmits stings during the day. Other insects such as ticks and sandflies can also transmit diseases
transmit. Insect bites usually produce itchy or painful bumps, which are easy in the (sub)tropics
become inflamed.

Some measures against mosquito and insect bites are:

• Protect yourself with covering clothes. Wear long sleeves, long trousers and closed
  shoes with socks. Feet, ankles, lower legs, forearms and neck are favoured
  puncture sites for insects.
• On uncovered body parts, use an insect-repellent lotion or spray containing DEET. In
  the leaflet 'Mosquito repellent when travelling' you will find information on how to use it.
• Sleep under a mosquito net (mosquito net).
• Sleep in an air-conditioned room, this will protect you from mosquitoes while you sleep
• Anti-malaria tablets are advised for some areas. Discuss this with your
  traveller's advisor.

Children
Children are unable to protect themselves from insect bites, therefore protect your child
Good against insect bites by:

• Properly covering clothing.
• Use an insect repellent that contains DEET. In the leaflet 'Mosquito repellent on
  travel' you will find information on dosages for children.
• Have your child sleep under a mosquito net (mosquito net), even during the day.

Sunbathing and swimming
In (sub)tropical countries, the sun is much brighter than in the Netherlands. Even in cloudy weather and through thin
clothing can burn you. This can cause rashes, inflammation, fever and skin cancer.
Stay out of the sun between 11am and 3pm as much as possible. Protect skin with clothing in time. Use a
sunscreen with a Sun Protection Factor (SPF) of at least 30 and that UVB and UVA radiation
stops.
Sunscreen and insect repellent cannot be applied simultaneously. First
the sunscreen and then the insect repellent are applied. This reduces the
effect of the sunscreen does not.

Pathogens can occur in stagnant freshwater such as small lakes and in rivers. Also
although the water looks clear, do not swim or paddle in it. In seawater and well-chlorinated
pool water do not usually contain pathogens.
Coral reefs can cause nasty injuries that inflame quickly. Also watch out for marine animals and
freshwater animals.

Children
Children are more sensitive to sunlight. For them, therefore, the advice described above is extra
important. Use a sunscreen with a high protection factor, at least factor 30. Leave
children do not play barefoot in seawater.

Sexually transmitted infections (STIs)
STIs occur all over the world and are more often contracted during holidays. Travellers who
intend not to have sex while travelling, have occasional sexual contact anyway. Not in all countries
reliable condoms are available. It is therefore recommended to bring condoms from the Netherlands with you
take, even if sex during your trip is not your intention. A condom gives good protection
against STIs.

Rabies
Rabies occurs in dogs and cats in most (sub)tropical and Eastern European countries.
The disease can also occur in other mammals such as bats and monkeys. Rabies is
transmitted if an infected animal bites, scratches or licks you in an open wound. Therefore, do not pet animals and
Do not feed them. Do not touch sick or dead animals either. Avoid caves because bats often live there
are those that may be infected.
If you sustain a bite wound, wash the wound thoroughly with soap and water immediately. Disinfect the
Then wound with alcohol 70%. If bitten or scratched, always see a doctor immediately! To prevent rabies
occurrence may require vaccinations and antiserum (MARIG). Treatment should be given as soon
be started as possible. The antiserum is not available in some countries. Have an expert
traveller's advisor assess whether rabies vaccinations are necessary for you.

Children
Don't let children play with animals!

Tuberculosis (TB)
In some countries, there is an increased risk of tuberculosis (TB). The most common form of
TB is pulmonary tuberculosis. Patients with pulmonary tuberculosis can be infectious to other people.
Coughing releases TB bacteria into the air. Inhalation of these bacteria can lead to infection
lead. Avert your face near coughing persons, this will reduce the risk of
infection. Visit a doctor if you have persistent cough symptoms for more than 3 weeks after your trip.
When doing so, please indicate that you have been abroad. For more information, see www.tuberculose.nl

Children on the plane
Children older than seven days can join the plane. Check the rules with your
airline. Ear pain can be caused by changing air pressure during take-off and
countries. Swallowing remedies this. Therefore, give your child something to eat or drink during take-off and
countries. Children can also suffer from motion sickness more quickly. If you know your child is prone to
motion sickness is you can give tablets against motion sickness.

Side effects of vaccinations
You will usually experience little discomfort from vaccinations. The place where the injection was given may be painful and
feel stiff. Sometimes that area is red and/or swollen. A slight elevation of the
body temperature is also possible. These symptoms usually disappear within a few days.
Paracetamol may help against pain or fever. Bear in mind that not every complaint is due to vaccination
is caused. If you suspect an adverse reaction to the vaccination or malaria tablets you can
report them. This can be done at the vaccination agency, your GP or the Dutch Side Effects Centre
Lareb. You can report adverse reactions using the vaccine reporting form or the medicine reporting form
at www.lareb.nl.

Period of validity of vaccinations and vaccination schedules
Most vaccinations give years of protection. Some vaccinations need to be repeated
to give good and long-lasting protection. You can find information on the website
from the LCR: www.lcr.nl > information on vaccinations > duration of protection.

Taking medicines with you when travelling
When travelling, always take a travel pharmacy and your vaccination booklet with you. If necessary, you can take a
medicine passport with you. For information on the travel pharmacy, see the leaflet 'Travel Pharmacy'.
www.lcr.nl > disease information > traveller leaflets. For some resources, such as strong
painkillers, ADHD medication, sedatives and medicinal cannabis, is a doctor's certificate
needed. Information on this can be found at www.hetcak.nl.

In conclusion
Make sure you travel well insured. In case of persistent fever or other
health problems promptly see a doctor. Do the same when you are back in the Netherlands. Tell your
(GP) doctor in that case always that you have been abroad.

Additional information can be found on the websites:
- National Coordination Centre for Travel Advice (LCR): www.lcr.nl
- Netherlands Worldwide: www.nederlandwereldwijd.nl
- Nederlands Bijwerkingen Centrum Lareb: www.lareb.nl
- CAK: www.hetcak.nl