Personal details

Trips to far away destinations are increasingly popular and the lower costs plus faster transport, makes it feasible for the many. The variety of different adventurous type trips are also on the increase. This is all good news, however, with such diversity, the risk of travel to your health is increased and this makes the appointment with the nurse more complex. For example, we need to know about your travel itinerary and any significant aspects of your health in the past. These are typical questions we will be asking: • When are you departing and how long for? • Where are you going including the destinations within a country? • Are you planning on undertaking any high risk activities? • Have you taken out travel insurance and have you informed the company if you have any • If female and of child bearing age, is there any possibility you could be pregnant if we • Do you have any medical conditions – these can interfere for example with the type of malaria tablets that can be chosen if you were travelling to a country that has malaria? We need to perform a risk assessment before deciding which vaccines are recommended and the advice that will best address your needs. For this reason the appointment could take 20 minutes or even a little longer. Within this surgery we plan to give you the necessary injections within the appointment time to save you having to come back. Modern vaccines are excellent today, so if you do feel nervous, please try not to worry – people are always surprised at how easy the injections are and unlike experiences remembered from the past! It would help us greatly if you had some awareness of the travel health problems that you may be of risk from on your trip before you come for your appointment. Before you attend for your appointment please go to the following website, print off and read the information for the country you are visiting and bring it to the appointment with you: We look forward to seeing you and helping you to travel safely. Personal details
Dates of trip
Itinerary and purpose of visit
Away from medical help at destination, if so, how remote? Please tick as appropriate below to best describe your trip
Personal medical history
Do you have any recent or past medical history of note? (including diabetes, heart or lung conditions) Do you have any allergies for example to eggs, antibiotics, nuts? Have you ever had a serious reaction to a vaccine given to you before? Does having an injection make you feel faint? Do you or any close family members have epilepsy? Do you have any history or mental illness including depression or anxiety? Have you recently undergone radiotherapy, chemotherapy or steroid treatment? Women only: Are you pregnant or planning pregnancy or breastfeeding?
Have you taken out travel insurance and if you have a medical condition, informed the insurance company about this? Please write below any further information which may be relevant Vaccination history
Have you ever had any of the following vaccinations / malaria tablets and if so when? For discussion when risk assessment is performed within your appointment: I have no reason to think that I might be pregnant. I have received information on the risks and benefits of the vaccines recommended and have had the opportunity to ask questions. I consent to the vaccines being given. FOR OFFICIAL USE
Travel vaccines recommended for this trip
Travel advice and leaflets given as per travel protocol
Malaria prevention advice and malaria chemoprophylaxis
Further information


13. MEDICATION PROTOCOLS FOR CO-INFECTIONS Babesia Of all the co-infections, Babesia has the most distinct regimen of medica- tions because it is a protozoal parasitic infection, not a bacterial infection as are Borrelia, Bartonella and Ehrlichia. Until recent years, the usual treatment regimen was clindamycin plus quinine; however, this regimen has been abandoned due to the unaccept


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