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Health & safety

Before you go

Further reading

To begin with, pick up a copy of Lonely Planet’s Healthy Travel Asia & India. Other recommended references include Traveller’s Health by Dr Richard Dawood and Travelling Well by Dr Deborah Mills – have a look at the website (www.travellingwell.com.au).

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Even if you are fit and healthy, don’t travel without health insurance – accidents do happen. Declare any existing medical conditions you have – the insurance company will check if your problem is pre-existing and will not cover you if it is undeclared. You may require extra cover for adventure activities. If your health insurance doesn’t cover you for medical expenses abroad, consider getting extra insurance – check lonelyplanet.com) for more information. If you’re uninsured, emergency evacuation is expensive; bills of over US$100,000 are not uncommon.

Find out in advance if your insurance plan will make payments directly to providers or reimburse you later for overseas health expenditures. Note that doctors in Taiwan expect payment in cash. Some policies offer lower and higher medical-expense options; the higher ones are chiefly for countries that have extremely high medical costs. These include places such as the USA. You may prefer a policy that pays doctors or hospitals directly rather than you having to pay on the spot and claim later. If you have to claim later, make sure you keep all documentation and receipts. Some policies require you to call (reverse charges) a centre in your home country where an immediate assessment of your problem is made.

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Internet resources

There is a wealth of travel health advice available on the Internet. The World Health Organization (WHO; www.who.int/ith) publishes a superb book called International Travel & Health, which is revised annually and is available online at no cost. Another website of general interest for up-to-the minute information is MD Travel Health (www.mdtravelhealth.com), which provides complete travel-health recommendations for every country and is revised daily. The Centers for Disease Control and Prevention (CDC; www.cdc.gov) website also has good general ­information.

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Medical checklist

Recommended items for a personal medical kit:

Antifungal cream (eg Clotrimazole)

Antibacterial cream (eg Muciprocin)

Antibiotics if you are visiting rural areas; one for skin infections (eg Amoxicillin/­Clavulanate or Cephalexin) and another for diarrhoea (eg Norfloxacin or ­Ciprofloxacin)

Antihistamine – there are many options (eg Cetrizine for daytime and Promethazine for night)

Antispasmodic for stomach cramps (eg Buscopan)

Contraceptive method

DEET-based insect repellent

Anti-inflammatory (eg Ibuprofen)

Indigestion tablets (eg Quick Eze or ­Mylanta)

Iodine tablets (unless you are pregnant or have a thyroid problem) to purify water

Laxative (eg Coloxyl)

Migraine medicine – sufferers should take their personal medicine

Permethrin to impregnate clothing and mosquito nets

Steroid cream for allergic/itchy rashes (eg 1% to 2% hydrocortisone)

Sunscreen and a hat

Thrush (vaginal yeast infection) treatment (eg Clotrimazole pessaries or Diflucan tablet)

Ural or an equivalent if prone to urine infections

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Pack medications in their original, clearly labelled containers. A signed and dated letter from your physician describing your medical conditions and regular medications (use generic names) is also a good idea. When carrying syringes or needles, be sure to have a physician’s letter documenting their medical necessity. If you have a heart condition bring a copy of your ECG taken just prior to travelling.

If you take any regular medication bring double your needs in case of loss or theft. In Taiwan it may be difficult to find some of the newer drugs, particularly the latest antidepressant drugs, blood-pressure medications and contraceptive pills.

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Recommended vaccinations

Specialised travel-medicine clinics are your best source of information: they stock all available vaccines and will be able to give specific recommendations for you and your trip. The doctors will take into account factors such as past vaccination history, the length of your trip, activities you may be undertaking and underlying medical conditions, such as pregnancy.

Most vaccines don’t produce immunity until at least two weeks after they’re given, so visit a doctor four to eight weeks before departure. Ask for an International Certificate of Vaccination (otherwise known as the yellow booklet), which will list all the vaccinations you’ve received.

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Required vaccinations

Yellow Fever Proof of vaccination is required if entering Taiwan within six days of visiting an infected country. If you are travelling to Taiwan from Africa or South America check with a travel-medicine clinic whether you need the vaccine.

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Recommended vaccinations

The World Health Organization (WHO) recommends the following vaccinations for travellers to Taiwan.

Adult diphtheria & tetanus Single booster recommended every 10 years. Side effects include sore arm and fever.

Hepatitis A Provides almost 100% protection for up to a year, a booster after 12 months provides at least another 20 years protection. Mild side effects such as headache and sore arm occur in 5% to 10% of people.

Hepatitis B Now considered routine for most travellers. Given as three shots over six months. A rapid schedule is also available, as is a combined vaccination with Hepatitis A. Side effects are mild and uncommon, usually headache and sore arm. In 95% of people three shots results in lifetime protection.

Measles, mumps & rubella Two doses of MMR required unless you have had the diseases. Occasionally a rash and flu-like illness can occur a week after receiving the vaccine. Many young adults require a booster.

Typhoid Recommended unless your trip is less than two weeks and only in Taipei. The vaccine offers around 70% protection, lasts for two to three years and comes as a single shot. Tablets are also available, however the injection is usually recommended as it has fewer side effects. Sore arm and fever may occur. Travellers should get vaccinated before they get to Taiwan.

Varicella If you haven’t had chickenpox, discuss this vaccination with your doctor.

The following immunisations are recommended for long-term travellers (more than one month) or those at special risk.

Influenza A single injection lasts for two months. Recommended for all travellers over 65 years of age and those with underlying medical conditions such as heart disease, lung disease, diabetes or a compromised immune system.

Japanese B encephalitis Three injections in all. Booster recommended after two years. Sore arm and headache are the most common side effects. Occasionally an allergic reaction comprising hives and swelling can occur up to 10 days after any of the three doses.

Pneumonia A single injection lasts five years. Recommended as per the flu vaccine.

Tuberculosis A complex issue. Adult long-term travellers are usually recommended to have a TB skin test before and after travel, rather than vaccination. Only one vaccine given in a lifetime.

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Dangers & annoyances

The following government websites offer travel advisories and information on current hot spots.

Australian Department of Foreign Affairs (1300 139 281; www.smarttraveller.gov.au)

British Foreign Office (0845-850-2829; ­www.fco.gov.uk/countryadvice)

Canadian Department of Foreign Affairs (800-267 6788; www.dfait-maeci.gc.ca)

US State Department (888-407 4747; ­travel.state.gov)

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In transit

Deep vein thrombosis (DVT)

Deep vein thrombosis (DVT) occurs when blood clots form in the legs during plane flights, chiefly because of prolonged immobility. The longer the flight, the greater the risk. Though most of the time these blood clots are reabsorbed uneventfully, it is possible for some to break off and travel through the blood vessels to the lungs, where they may cause life-threatening complications.

The chief symptom of deep vein thrombosis is swelling or pain of the foot, ankle or calf. This usually (but not always) occurs on just one side of the body. When a blood clot travels to the lungs, it may cause chest pain and breathing difficulties. Travellers with any of these symptoms should seek medical attention as soon as possible. To prevent the development of DVT on long flights you should make sure you walk around the cabin, perform isometric ­compressions of the leg muscles (ie contract and relax the leg muscles while sitting), drink plenty of fluids and avoid alcohol and tobacco.

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Jet lag & motion sickness

Jet lag is most common when crossing more than five time zones; it results in insomnia, fatigue, malaise or nausea. To avoid jet lag try drinking plenty of fluids (nonalcoholic) and eating only light meals. Once you have arrived at your destination, seek exposure to natural sunlight and readjust your schedule (for meals, sleep etc) as soon as possible.

Antihistamines such as dimenhydrinate (Dramamine), prochlorperazine (Phenergan) and meclizine (Antivert, Bonine) are usually the first choice for the treatment of motion sickness. Their main side effect is drowsiness. A herbal alternative is ginger, which works like a charm for some people.

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While you're there

Air pollution

Air pollution, particularly vehicle pollution, is a severe problem in Taipei. If you have severe respiratory problems speak with your doctor before travelling to any heavily polluted urban centres. This pollution also causes minor respiratory problems such as sinusitis, dry throat and irritated eyes. If you are troubled by the pollution, avoid downtown during busy hours and visit the suburbs instead. The air is much better in the early morning and at night.

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Insect bites & stings

Insects are not a major issue in Taiwan­, though there are some insect-borne diseases present.

Ticks can be contracted from walking in rural areas. They are commonly found behind the ears, on the belly and in armpits. If you have had a tick bite and experience symptoms such as a rash at the site of the bite or elsewhere, or fever or muscle aches, you should see a doctor. Doxycycline prevents and treats tick-borne diseases.

Bee and wasp stings mainly cause problems for people who are allergic to them. Anyone with a serious bee or wasp allergy should carry an injection of adrenaline (eg an Epipen) for emergency treatment. For other people, pain is the main problem; apply ice to the sting and take painkillers if necessary. There are warning signs over problem areas. Please heed them as some wasps in Taiwan are known to be deadly.

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There are a number of flukes (liver, lung and intestinal) that can be contracted by eating raw or undercooked seafood, meat and vegetables in Taiwan. Such dishes should be avoided ­unless eating in a top-class restaurant.

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Skin problems

Cuts and scratches can become easily infected when travelling. Take meticulous care of any cuts and scratches to prevent complications such as abscesses. Immediately wash all wounds in clean water and apply antiseptic. If you develop signs of infection (increasing pain and redness) see a doctor.

Rashes can often be very difficult to diagnose, even for doctors. If you develop a rash you should seek medical advice as soon as possible.

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Dengue fever

This mosquito-borne disease is becomingly increasingly problematic in Taiwan in both cities and rural areas. It can only be prevented by avoiding mosquito bites – there is no vaccine. The mosquito that carries dengue bites day and night, so try to avoid bites at all times Symptoms include high fever, severe headache and body ache (previously Dengue was known as ‘break bone fever’). Some people develop a rash and diarrhoea. There is no specific treatment, just rest and paracetamol. Do not take aspirin, and see a doctor to be diagnosed and monitored.

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Hepatitis A

A problem throughout the country, this food- and water-borne virus infects the liver, causing jaundice (yellow skin and eyes), nausea and lethargy. There is no specific treatment for hepatitis A; you just need to allow time for the liver to heal. All travellers to Taiwan should be vaccinated against hepatitis A.

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Hepatitis B

The only sexually transmitted disease that can be prevented by vaccination, hepatitis B is spread by body fluids, including sexual contact. People who have hepatitis B usually are unaware they are carriers. The long-term consequences can include liver cancer and cirrhosis.

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HIV is also spread by body fluids. Avoid unsafe sex, sharing needles, invasive cosmetic procedures such as tattooing and needles that have not been sterilised in a medical setting. HIV rates in Taiwan remain low by Asian standards, although infection via contaminated­-needle use is increasing. However, transmission is mainly via sexual contact in Taiwan.

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Influenza is transmitted between November and April. Symptoms include high fever, muscle aches, runny nose, cough and sore throat. It can be very severe in people over the age of 65 or in those with underlying medical conditions such as heart disease or diabetes –vaccination is recommended for these individuals. There is no specific treatment, just rest and paracetamol.

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Japanese B encephalitis

This viral disease is transmitted by mosquitoes, but is rare in travellers. The transmission season runs from June to October. Risk exists in all areas except the central mountains. Vaccination is recommended for travellers spending more than one month outside of cities. There is no treatment, and a third of infected people will die, while another third will suffer permanent brain damage. However, as mentioned earlier, this is a rare disease.

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Lyme disease

This tick-borne disease occurs in summer. Symptoms include an early rash and general viral symptoms, followed weeks to months later by joint, heart or neurological problems. Prevent this disease by using general insect-avoidance measures and checking yourself for ticks after walking in forest areas. Treatment is with Doxycycline.

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In mid-March 2003 the world’s attention was drawn to the outbreak of an apparently new and serious respiratory illness that subsequently became known as SARS. At the time of writing SARS appears to have been brought under control. Since the outbreak commenced, 8500 cases were confirmed, resulting in 800 deaths. The peak of disease activity was in early May 2003, when over 200 new cases were being reported daily in Asia. Taiwan had a significant number of cases of SARS.

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Sexually transmitted diseases are common throughout the world, and the most common include herpes, warts, syphilis, gonorrhoea and chlamydia. People carrying these diseases often have no signs of infection. Condoms will prevent gonorrhoea and chlamydia but not warts or herpes. If after a sexual encounter you develop any rash, lumps, discharge or pain when passing urine seek immediate medical attention. If you have been sexually active during your travels, have an STD check on your return home.

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Taiwan has a high rate of tuberculosis (TB) infection. While rare in travellers, precautions should be taken by medical and aid workers and long-term travellers who have significant contact with the local population. Vaccination is usually only given to children under the age of five, but adults at risk are recommended pre- and post-travel TB testing. The main symptoms are fever, cough, weight loss, night sweats and tiredness.

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This bacterial infection is spread via food and water. It gives a high and slowly worsening fever and headache, and may be accompanied by a dry cough and stomach pain. It is diagnosed by blood tests and treated with antibiotics. Though contracting typhoid is rare, vaccination is recommended for all travellers spending more than two weeks in Taiwan and travelling outside of Taipei. Be aware that vaccination is not 100% effective so you must still be careful with what you eat and drink.

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Giardia is a common parasite in travellers. Symptoms include nausea, bloating, excess gas, ‘eggy’ burps, fatigue and intermittent diarrhoea. The parasite will eventually go away if left untreated but this can take months. The treatment of choice is Tinidazole, with Metronidazole being a second-line option. Giardia is not common in Taiwan.

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Availability & cost of health care

Taiwan is a relatively well-developed country and the quality of medical care reflects this. In Taipei the quality is high, however in rural areas you cannot expect to find Western standards of care.

A recommended hospital in Taipei is the Adventist Hospital (2771 8151; 424 Bade Rd, sec.2); it has English-speaking staff.

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Traveller’s diarrhoea

Traveller’s diarrhoea is the most common problem affecting travellers – between 10% and 30% of people visiting Taiwan will suffer from it. In the majority of cases, traveller’s diarrhoea is caused by a bacteria (there are numerous potential culprits), and therefore responds promptly to treatment with antibiotics. Treatment with antibiotics will depend on your situation – how sick you are, how quickly you need to get better, where you are etc.

Traveller’s diarrhoea is defined as the passage of more than three watery bowel-actions within 24 hours, plus at least one other symptom such as fever, cramps, nausea, vomiting or feeling generally unwell.

Treatment consists of staying well hydrated: rehydration solutions such as Gastrolyte are the best for this. Antibiotics such as Norfloxacin, Ciprofloxacin or Azithromycin will kill the bacteria quickly.

Loperamide is just a ‘stopper’ and doesn’t get to the cause of the problem. It can be helpful, for example, if you have to go on a long bus ride. Don’t take Loperamide if you have a fever or blood in your stools. Seek medical attention quickly if you do not respond to an appropriate antibiotic.

Eating in restaurants is the biggest risk factor for contracting traveller’s diarrhoea. Eat only freshly cooked food and avoid shellfish and food that has been sitting around in buffets. Peel all fruit, cook vegetables and soak salads in iodine water for at least 20 minutes. Eat in busy restaurants with a high turnover of customers.

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Women’s health

In most well-developed areas of Taiwan, supplies of sanitary products are readily available. Birth-control options may be limited so bring supplies of your own contraception.

Heat, humidity and antibiotics can all contribute to thrush. Treatment is with antifungal creams and pessaries such as Clotrimazole. A practical alternative is a single tablet of fluconazole (Diflucan). Urinary tract infections can be precipitated by dehydration or long bus journeys without toilet stops: it’s best to bring suitable antibiotics.

Pregnant women should receive specialised advice before travelling. The ideal time to travel is in the second trimester (between 16 and 28 weeks), when the risk of pregnancy-­related problems are at their lowest and pregnant women generally feel at their best. During the first trimester there is a risk of miscarriage and in the third trimester complications such as premature labour and high blood pressure are possible. It’s wise to travel with a companion. Always carry a list of quality medical facilities available at your destination and ensure you continue your standard antenatal care at these facilities. Avoid rural travel in areas with poor medical facilities and transport. Most of all, ensure travel insurance covers all pregnancy-related possibilities, including premature labour.

Traveller’s diarrhoea can quickly lead to dehydration and result in inadequate blood flow to the placenta. Many of the drugs used to treat various diarrhoea bugs are not recommended in pregnancy. However azithromycin is considered safe.

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