new travel

Stay in Luxury in Haridwar

2012-01-16T09:02:00.000-08:00

Haridwar is a temple city and the district headquarters of the Haridwar District of Uttarakhand State. It is one of the seven holiest pilgrimage sites for Hindus. Haridwar is also one of the four sites that hosts the Kumbh Mela in rotation. Haridwar is easily accessible from all regions of the country. It is within easy reach from Delhi, India's capital. The distance from Haridwar to Delhi is about 214 km.

Hari is one of the names of Lord Vishnu. Dwar means an opening or doorway. So, Haridwar is considered to be the doorway to reach the feet of Hari, or Lord Vishnu. Haridwar is a major pilgrimage center and has many options for accommodation. The following section lists two Luxury Haridwar Hotels:

Classic Residency Hotel

Hotel Classic Residency is located 1.5 km from the Railway Station. Easily accessible from the Railway Station and Bus Stop, this 3 star hotel offers fine accommodation with all modern facilities. Accommodation: Classic residency Hotel has 47 well furnished and comfortable rooms and four luxury suites. All the rooms have attached bathrooms with hot/cold running water, Direct Dial Telephone, Cable TV, Free Newspaper, purified drinking water and 24-hour room service.

Dining: The hotel has a vegetarian multi-cuisine restaurant called Aangan that offers Chinese, Continental, Mughal and Indian cuisines.

Other Facilities and Services: Parking Space, Travel Desk, Doctor-on-Call, Laundry Service, Yoga and Meditation Center, Swimming Pool, Banquet Hall, Credit Cards accepted, Gym and Internet Connection.

Ginger Hotel Haridwar

The Ginger Hotel Haridwar is located near the Railway Station, and is in the center of the city. It is very close to the Hari-Ki-Pauri Bathing Ghat which is the central pilgrimage spot of the city. The hotel offers the Ginger Hotels' trademark Smart Basics and Smart Space Features. All the rooms are elegantly fitted out and have all modern amenities.

Accommodation: The comfortable and elegant rooms are all designed to provide a pleasant hassle free-stay. The rooms come in four categories:

• Single Rooms: Perfect for the single traveler
• Twin Rooms: Separate beds for people who are traveling together.
• Double Rooms: These rooms have a huge queen size bed.
• Special Rooms: These are rooms that are designed keeping in mind the needs of the physically challenged.

All the rooms are air-conditioned and have electronic locks, STD Direct Dial telephones with voicemail, wall mounted flat panel televisions, cable connection, mini fridge, in-room safety lockers, coffee maker, work area, full length mirror and wardrobe.

Dining: The Square Meal Restaurant offers tasteful and varied fare. There are vending machines for hot and cold beverages.

Other Facilities and Services: Parking, Self Check-In, Business Center, Safety Lockers, Fitness Centers, Gymnasium, ATM, Currency Exchange, Meeting Room and Audio visual equipment.
fear of flying

Travelers with Disabilities

2011-12-22T01:26:00.000-08:00

OVERVIEW

Travelers with disabilities are defined as travelers whose mobility is reduced because of a physical incapacity (sensory or locomotor), an intellectual deficiency, age, illness, or another cause, and who may require special attention and adaptation of the transportation services that are available to all passengers. The medical preparation of a traveler with a stable, ongoing disability does not differ from that of any other traveler. The following recommendations are key to ensuring safe, accessible travel:

· Assess each international itinerary on an individual basis, in consultation with specialized travel agencies or tour operators.

· Consult travel health providers for additional recommendations.

· Use print and internet resources.

AIR TRAVEL

Regulations and Codes

Carriers may not refuse transportation on the basis of disability. By law, US air carriers must comply with highly detailed regulations that affect people with disabilities. These do not cover foreign carriers serving the United States.

All US and non-US carriers are required to file annual reports of disability-related complaints with the Department of Transportation (DOT). The DOT maintains a toll-free hotline (800-778-4838, available 7 am–11 pm, Eastern Time) to provide real-time assistance in facilitating compliance with DOT rules and to suggest customer-service solutions to the airlines. The Transportation Security Administration (TSA) has established a program for screening travelers with disabilities and their equipment, mobility aids, and devices. TSA permits prescriptions, liquid medications, and other liquids needed by people with disabilities and medical conditions. International Air Transport Association (IATA) member airlines voluntarily adhere to codes of practice that are similar to US legislation based on guidance from the International Civil Aviation Organization. However, smaller airlines overseas may not be IATA members.

Airlines are obliged to accept a declaration by a passenger that he or she is self-reliant. Medical certificates can be required only in specific situations (for example, if a person intends to travel with a possible communicable disease, will require a stretcher or oxygen, or if unusual behavior is anticipated that may affect the operation of the flight).

Assistance and Accommodations

When a traveler with a disability requests assistance, the airline is obliged to provide access to the aircraft door (preferably by a level entry bridge), an aisle wheelchair, and a seat with removable armrests. Aircraft with fewer than 30 seats are generally exempt. Airline personnel are not required to transfer passengers from wheelchair to wheelchair, wheelchair to aircraft seat, or wheelchair to lavatory seat. Travelers with disabilities who cannot transfer themselves should travel with a companion or attendant, but carriers may not, without reason, require a person with a disability to travel with an attendant.

Only wide-body aircraft with 2 aisles are required to have fully accessible lavatories, although any aircraft with more than 60 seats must have an onboard wheelchair, and personnel must help move the wheelchair from a seat to the lavatory area. Airline personnel are not obliged to assist with feeding, visiting the lavatory, or dispensing medication to travelers.

Airlines may not require advance notice of a passenger with a disability; however, they may require up to 48 hours’ advance notice and 1-hour advance check-in for certain accommodations that require preparation time, such as the following:

· Medical oxygen for use on board the aircraft, if the service is available on the flight

· Carriage of an incubator, if the service is available on the flight

· Hook-up for a respirator to the aircraft electrical power supply, if the service is available on the flight

· Accommodation for a passenger who must travel in a stretcher, if the service is available on the flight

· Transportation of an electric wheelchair on a flight scheduled on an aircraft with fewer than 60 seats

· Provision by the airline of hazardous material packaging for a battery used in a wheelchair or other assistive devices

· Accommodation for a group of 10 or more people with disabilities who make a reservation and travel as a group

· Provision of an onboard wheelchair to be used on an aircraft that does not have an accessible lavatory

Assessment and Preparation

With high incidence of cardiopulmonary disease and millions of people traveling by air, many people are at risk for significant hypoxia and respiratory symptoms while flying. Generally, patients with an oxygen saturation by pulse oximetry >95% do not require supplemental oxygen, and those with a saturation <92% will require it during air travel. The hypoxia altitude simulation test can identify those patients (with an oxygen saturation by pulse oximetry between 92% and 95%) who may benefit from oxygen supplementation during air travel, decreasing their risk for significant cardiopulmonary effects of induced hypoxia at higher altitudes.Internationally standardized codes for classifying disabled passengers and their needs are available in all computerized reservations systems. Passengers with disabilities should use travel agents experienced in the use of the disability coding; it is critical that appropriate codes and interairline messages are sequentially entered for all flights. The delivering carrier is always responsible for a traveler with disabilities until a subsequent carrier physically accepts responsibility for that passenger.

2011-10-24T02:11:00.000-07:00

Himalayas - The Great Snowy Ranges

In a memorable verse of the ‘Kumarsambhava’, the famous Sanskrit poet Kalidasa compares the Himalaya to a gigantic measuring rod striding the earth between two oceans. The snow-capped peaks are indeed the most impressive feature. Himalaya, a Sankrit word, which means ' The Abode Of Snow' and all other names used to describe this mountain range associate it with eternal snow - “Himvan”, “Himvat”, “Himachal” and “Himadri”.

Interestingly, a vast shallow sea, the Tethys, existed where the Himalaya stands today. The submerged landmasses on either side started pushing towards each other, giving birth to these mountains. This was a relatively recent occurrence in the geographical time frame, so the Himalaya is considered a young and fragile land formation. Scientists speculate that the whole process took five to seven million years. Fossil finds at heights of over 8,000 metres (26,000 feet) support these theories. The Himalaya has risen about 2,000 metres (6,600 feet) in the past 20,000 years and continues to rise at the rate of 7.5 to 10 centimetres (3-4 inches) a year.

The High And Mighty

The Himalaya is the world's mightiest mountain range. No other chain can boast of peaks of 8,000 metres (26,000 feet). In the Himalaya there are 14 such peaks and hundreds of summits over 7,000 metres (23,000 feet) high. The range of mountains stretches 2,700-kms (1,700 miles) across an area between Assam and Kashmir. In the east, Namche Barwa stands sentinel; the western extremity is guarded by the awesome Nanga Parbat.

Varied Instances

The snow-capped, frost-crusted peaks have posed a challenge not only to the physical prowess of adventures; they have also inspired sublime metaphysics and lyrical poetry. There are innumerable references to this king of mountains, the glistening divinity, and the noble soul.

The earliest is in the Rig Veda. Singing the praise of the supreme deity, the poet sages refer to the Himalaya: 'It is to He to whom belong these celestial mountain ranges.' These sages also describe its stretch as: 'the expanse of the two arms of the great being'. The epic Ramayana and Mahabharat, and the Puranas, describe this as the region where the Gods dwell, and the landscape is evoked beautifully in classical poetical works. According to the “Skanda Purana” notes: 'As the sun dries the morning dew so does the mere sight of the Himalaya dissipate the sins of man.'

Rivers Running Through It!

The Himalaya is the source of many great rivers of the Indian subcontinent. The Indus or Sindhu (the river rising out of a lion's mouth) rises in the trans-Himalayan Tibetan Plateau, as does the Brahmaputra. The Ganga and Yamuna, with their countless colourful Himalayan tributaries, are inextricably intertwined with local myths and legends.

Securing The Lands

For centuries, the Himalaya acted as the bulwark of Indian security, serving as the great divide between India and Tibet. The rugged terrain deterred all but the most dauntless from risking their lives on perilous journeys in the icy heights. But, difficult though many of the passes and valleys were, they did not prevent a slow penetration by determined and hardy souls for the purposes of trade and pilgrimage. It must be remembered that the Himalayan region has also served through history as a melting pot of races, religions and cultures.

The vast Himalaya is far from being a homogenous region. It is, in fact, a region of remarkable variety. 'Himachal' (steadfast snows), is the term used to denote the lesser Himalaya; the outer rim rises sharply from the foothills, which are called the 'Doars', from the Sanskrit ‘Dvar’ (gateway). The greater Himalayas themselves are referred to as the 'Himadri'. ' Uttarakhand' is a loose, general term covering all the northern territories; it also denotes Kumaon and Garhwal as a unit.

Yandang Mountain

2011-10-23T02:07:00.000-07:00

Yandang Mountain covers an area of 450 sq km, and has more than 500 tourist attractions and eight major scenic zones. Of all the scenic spots in Yandang Mountain, Lingfeng Peak, Lingyan Rock and Dalongqiu Waterfall are the most famous, known as the “three perfections in Yandang Mountain”.

Yandang Mountain features complicated landforms and abundant tourism resources. When one takes a step forward, the scenery will change; and the peaks show different shapes when they are viewed from different angles.

If one enters the Dalongqiu Waterfall Scenic Zone from the entrance of the valley along the stream, one will first see the Scissor Peak, which changes the shapes when it is viewed from different angles. Now it looks like the bud of a yulan magnolia flower ready to burst; now, like a pair of scissors; now, a woodpecker catching insects; now, a big bear holding a tree with its arms; and now, a stone pillar piercing into the sky. If one walks forward a few steps and turns one head back, one will find it resembles a sailing boat….

The scenery in Yandang Mountain is mainly composed of peaks, waterfalls, caves and steep cliffs. The main tourist attractions in the mountain include the Two-palm Peak, Double Bamboo Shoots Peaks, Scissor Pak, Lotus Peak, Heavenly Pillar Peak, Flay Display Peak, Pingxia Peak, Dalongqiu Waterfall and Xiaolongqiu Waterfall.

With a high elevation, all the peaks in Yandang Mountain rise abruptly from the ground, and the 100-m-high peaks and cliffs can be seen everywhere. It is almost impossible for tourist to climb the mountain as it is so steep. Going up the mountain along the undulating paths, tourists can appreciate oddly-shaped rocks and steep peaks.

Yandang Mountain contains Dalongqiu Waterfall, Xiaolongqiu Waterfall and numerous streams. Now the streams get together to form a mirror-like lake; now they flow along the winding paths; and now they fall down, like a string of pearls scattered on the green water surface, presenting various types of white patterns.

Madagascar

2011-10-22T02:02:00.000-07:00

Montagne d'Ambre (Amber Mountain) National Park is located around 30 km south of Diego Suarez. It was established in 1958 and protects a total surface of 185km². This massif rises from the surrounding dry region forming an isolated stretch of montane rainforest covering an area of 18.200 hectares and lying at altitudes between 800 and 1.470 metres. The park offers a great biodiversity: a huge tropical forest with endemic fauna and flora, luxuriant vegetation and many waterfalls and volcanic lakes. The climate is perfect, the cool air refreshes after the heat of the lowlands. The dominant ethnic groups are the Sakavala and the Antankarana.

A big number of animal species inhabit the National Park. To begin with, 25 species of mammals, among them 6 carnivores such as the ring-tailed mongoose and the fossa, and 8 lemurs: Sanford's brown lemur, crowned lemur, lesser bamboo lemur and are five species of nocturnal lemurs. Besides these forests are the home of 75 different bird species (35 of which are endemic and even locally endemic, like the Amber Mountainrock-thrush ), 60 reptiles, such as tiny stump-tailed chameleons, leaf-tailed geckos and snakes, 35 frogs and more than 40 butterflies. the flora is very reach as well. The three principal ecosystems (montane rainforest, mid-altitude rainforest and dry deciduous forests) give shelter to more than one thousand different plants. The best time to visit the Park is between September and November. It will rain from time to time but the warm temperatures make all the animals active, so the chances of seeing them increase enormously. You should avoid a visit while the cyclone season from December to March. The reserve is certainly very worthwhile and the infrastructure very well developed. Points of interest are labelled, which increases your chances to see many different species.

All the circuits are clear and well maintained, so it not hard to explore the park by yourself.
The easiest and most visited one goes to the Sacred Waterfall (Cascade Sacree). It is a short and very rewarding walk to a waterfall falling into a pool where you have good chances to spot some lemurs and birds.
There are two more walks ending in waterfalls: The Cascade Antankarana circuit is also easy and not long, the Cascade Antomboka is a little bit harder. Other treks lead to some crater lakes. The shortest walk is to the Lac de la CoupeVerte, with nice views of the forest. For visiting Lac Grand and Lac Maudit you will need the whole day.

It is also possible to climb up to the AmberMountain itself and enjoy a spectacular view over all the forest beneath you. Most people plan a two-days-trip and camp one night at the Lac Grand, but if you are used to long treks you can do it in just one day too.

Aconcagua Mountain Travel Information

2011-10-21T02:00:00.000-07:00

Mendoza acts as the base for trips to Aconcagua whose summit is the highest in South America.

The Aconcagua Provincial Park occupies a 71.000 ha surface and hosts the majestic Aconcagua Summit.Topped with white snow it is situated 180 km from Mendoza city, its name stands for "Stone Sentinel". On-site rangers, shelters and mule rent are some of the available services to the visitors.

Several climbers crowd the slopes in summertime in their hope to conquer the challenging mountain. This is one of Argentina´s most imposing landscapes, complemented by the condor´s majestic flight, the sentinels of these impressive heights. It is located on the northeastern end of the Mendoza Province, ever challenging and imposing, dressed in its perennial snow.

The Park has a lookout allowing contemplation of the mountain in full view. Climbing the mountain requires permission, which should be previously requested upon ID presentation. It is recommended to stay in the area for a period of 25 days for the body to adjust to the climate and altitude with January and February being the best months for such an undertaking.

Climbing can be done from the trail up the Horcones River, the most widely used by tourists, who are always amazed by the green-colored waters of the Horcones Lagoon, 80 m in diameter and incredibly shallow. Plaza de Mulas is the place to begin climbing, located further along. The Park´s rangers distribute information leaflets to all climbers. Services and qualified personnel are available for those who engage themselves in this adventure.

The ascend up the Aconcagua is a highly complicated task, not only because of its steep and snow-covered slopes, but also due to the lack of oxygen and air humidity, coupled with low pressure areas created by the winds which act as a hindrance to climbing.

The Las Cuevas community rests 14 km before the Park´s entrance. It showcases attractive architectonic design based on Nordic-styled constructions. Taking a right turn, the road leads to the International Tunnel that links Argentina and Chile. Close to this community, just 9 km from Las Cuevas, stands the Redemptive Christ, a 10m-tall statue that marks the boundary between the two countries.

holidays in Surin Beach

2011-09-23T01:53:00.001-07:00

Surin Beach is about 15 kms north of Patong (MAP). in between Kamala beach to the south and Bang Tao beach in the north of Phuket island. Surin Beach at the moment still has a small village atmosphere, but this will change over the next few years with the on-going development, luckily due to local regulations the beach area will never be developed.

Surin beach itself is lined with casuarina trees, pandanus palms and small Thai restaurants serving fresh seafood and other Thai cuisine delights.

These restaurants were recently transformed into concrete shops along surin's beach front by the local government. The centre of the beach now is dedicated to picnic tables and chairs.

Many of the 5 star hotels at Surin Beach Phuket have now moved into the newly contructed shops and the older ones and renovated them into up-market beach clubs and restaurants.

Surfing at Surin beach is also a good option. You can rent surfboards from the Saltwater Dreaming Surf Shop.

Surin beach is also the location of the first golf course in Thailand built by the King of Thailand that is why on many afternoons you will see Thai golfers practicing their swings and chips.

A lot of new hotels guesthouses and restaurants have opened in this growing area. Guesthouses start from around 700 baht in the low season. There are no hotels on the beach here, but it is just a few minutes walk to Surin beach through the park reserve. Capri Hotel short walk to Surin Beach

holidays in Surin Beach

2011-09-23T01:53:00.000-07:00

Surin beach itself is lined with casuarina trees, pandanus palms and small Thai restaurants serving fresh seafood and other Thai cuisine delights.

These restaurants were recently transformed into concrete shops along surin's beach front by the local government. The centre of the beach now is dedicated to picnic tables and chairs.

Many of the 5 star hotels at Surin Beach Phuket have now moved into the newly contructed shops and the older ones and renovated them into up-market beach clubs and restaurants.

Surfing at Surin beach is also a good option. You can rent surfboards from the Saltwater Dreaming Surf Shop.

Miami vacation

2011-09-22T01:50:00.000-07:00

Miami is a major city in southeastern Florida, in the United States. It is the county seat of Miami-Dade County. Miami is a gamma world city with an estimated population of 404,048. Miami's importance as an international financial and cultural center has elevated Miami to the status of world city. Because of Miami's cultural and linguistic ties to North, South, and Central America, as well as the Caribbean, Miami is many times referred to as "The Gateway of the Americas." Miami in the past three decades have become one of the most visited cities in the Americas. Visitors can stay in Miami hotels or may rather decide to stay in one of Miami vacation rentals. Miami has the perfect conditions to be your next gateway vacation; it has a true tropical climate with hot, humid summers, and warm, dry winters. If you visit Miami you will never want to leave. Visitor might save their time and energy and change their hotel lodging decision to one on edge lodging condo rental in Miami. The weather is perfect, Most of the year is warm and humid, and the summers are almost identical to the climate of the Caribbean tropics. There are lots of reasons to visit Miami- the beaches and weather, business conventions, and awesome attractions to name a few.

The three most popular districts among visitors to Miami are South Beach, Bayside Marketplace, and Coco-Walk. Miami is surpassed only by New York City and Los Angeles in numbers of foreign visitors, attracting 5.3 million from Europe, Canada, and South America. Tourism is one of the mainstays of Miami's economy, and it continues to grow steadily, and Miami vacation is still one of the most popular around the world.

Florida's large Spanish-speaking population and strong economic ties to Latin America also make Miami and the surrounding region an important center of the Hispanic world. If you need to do business in Miami, an apartment vacation rental will be your best option. If you are a leisure traveler in group or family a villa rental in Miami will be your perfect option. Warm weather, sunshine, abundant beaches, and a wide variety of entertainment are among the elements that your family or group will enjoy.

travel with children

2011-09-21T01:37:00.000-07:00

The number of children who travel or live outside their home countries has increased dramatically. An estimated 1.9 million children travel internationally each year. Although data about the incidence of pediatric illnesses associated with international travel are limited, the risks that children face while traveling are likely similar to the risks that their parents face. The most commonly reported health problems among children are:

· Diarrheal illnesses

· Dermatologic conditions

· Systemic febrile illnesses, especially malaria

· Respiratory disorders

Motor vehicle and water-related accidents are also major health problems for child travelers. In assessing a child who is planning international travel, clinicians should:

· Review routine childhood and travel-related vaccinations. The pre-travel visit is an opportunity to ensure that children are up to date on routine vaccinations.

· Assess all travel-related activities.

· Provide preventive counseling and interventions tailored to specific risks, including special travel preparations and treatment that may be required for children with underlying conditions, chronic diseases, or immunocompromising conditions.

· Give special consideration to the risks of children who are visiting friends and relatives in developing countries. These conditions may include increased risk of malaria, intestinal parasites, and tuberculosis.

· Consider counseling adults and older children to take a course in basic first aid before travel.

Diarrhea

Diarrhea and associated gastrointestinal illness are among the most common travel-related problems affecting children. Infants and children with diarrhea can become dehydrated more quickly than adults. The etiology of travelers’ diarrhea (TD) in children is similar to that in adults.

Prevention

For infants, breastfeeding is the best way to reduce the risk of foodborne and waterborne illness. Infant formulas available abroad may not be the same as in the United States; if parents are feeding their child formula, they should consider whether they need to bring formula from home.

Water served to young children, including water used to prepare infant formula, should be disinfected. In some parts of the world, bottled water may also harbor germs and should be disinfected before consumption. Similarly, food precautions should be followed diligently. Foods served to children should be thoroughly cooked and eaten while still hot; fruits eaten raw should be peeled immediately before consumption. Additionally, caution should be used with fresh dairy products, which may not be pasteurized and may be diluted with untreated water. For short trips, parents may want to bring a supply of safe snacks from home for times when the children are hungry and the available food may not be appealing or safe.

Scrupulous attention should be paid to handwashing and cleaning bottles, pacifiers, teething rings, and toys that fall to the floor or are handled by others; water used to clean these items should be potable. Parents should be particularly careful to wash hands well after diaper changes, especially for infants with diarrhea, to avoid spreading infection to themselves and other family members. When proper handwashing facilities are not available, an alcohol-based hand cleaner can be used as a disinfecting agent. However, because alcohol-based hand cleaners are not effective against certain types of germs, hands should be washed with soap and water as soon as possible. Additionally, alcohol does not remove organic material; visibly soiled hands should be washed with soap and water.

Management

Adults traveling with children should be counseled about the signs and symptoms of dehydration and the proper use of oral rehydration salts (ORS). Medical attention may be required for an infant or young child with diarrhea who has:

· Signs of moderate to severe dehydration

· Bloody diarrhea

· Temperature >101.5°F (38.6°C)

· Persistent vomiting (unable to maintain oral hydration)

The biggest threat to the infant with diarrhea and vomiting is dehydration. Fever or increased ambient temperature increases fluid loss and speeds dehydration. Parents should be advised that dehydration is best prevented and treated by use of ORS, in addition to the infant’s usual food. ORS should be provided to the infant by bottle, cup, oral syringe (often available in pharmacies), or spoon while medical attention is obtained. Low-osmolarity ORS is the most effective in preventing dehydration, although other formulations are available and may be used if they are more acceptable to young children. Homemade sugar-salt solutions are not recommended. Adults traveling with children should be counseled that sports drinks, which are designed to replace water and electrolytes lost through sweat, do not contain the same proportions of electrolytes as the solution recommended by the World Health Organization for rehydration during diarrheal illness. However, if ORS is not readily available, children should be offered whatever palatable liquid they will take until ORS is obtained.

Travel & Breastfeeding

2011-09-21T01:32:00.000-07:00

The medical preparation of a traveler who is breastfeeding differs only slightly than that of other travelers and depends in part on whether the mother and child will be separated or together during travel. Most travelers should be advised to continue breastfeeding throughout travel. Before departure, mothers may wish to carry with them a written list of local breastfeeding resources at their destination. Clinicians may be able to help breastfeeding mothers find out about available breastfeeding support experts at their destination through sources that may include:

· International Board-Certified Lactation Consultants (IBCLCs)—health professionals in approximately 50 countries who specialize in the clinical management of breastfeeding

· La Leche League Leaders (LLLLs)—trained and accredited volunteer mothers in approximately 60 countries who provide mother-to-mother breastfeeding support and help.

Mothers who plan to use a breast pump while traveling should have a back-up option available, including written instructions for hand expression; for more detailed instructions about hand expression,

Immunuzation and medications

In almost all situations, clinicians can and should select immunizations and medications that are compatible with breastfeeding. In most circumstances, it is inappropriate to counsel mothers to wean in order to be vaccinated or to withhold vaccination due to breastfeeding status.

Breastfeeding and lactation do not affect maternal or infant dosage guidelines for any immunization or medication; children always require their own immunization or medication, regardless of maternal dose. In the absence of documented risk to the breastfeeding child of a particular maternal medication, known risks of stopping breastfeeding generally outweigh a theoretical risk of exposure via breastfeeding.

Immunizations

Breastfeeding mothers and children should be vaccinated according to routine, recommended schedules; only preventive vaccinia (smallpox) vaccine is contraindicated for use in breastfeeding mothers. Administration of most live and inactivated vaccines does not affect breastfeeding, breast milk, or the process of lactation.

Special Consideration: Yellow Fever Vaccination

Whether this vaccine is excreted in human milk is unknown. However, at least 2 cases of yellow fever vaccine-associated neurologic disease have been documented in infants, presumably associated with breastfeeding transmission of yellow fever vaccine virus. No testing has been done to detect the yellow fever vaccine virus in breast milk, so it can only be said that the vaccine virus was transmitted through breastfeeding, but it has not been definitively determined that transmission occurred via the breast milk. Therefore, breastfeeding is a precaution to yellow fever vaccination, and women should be cautioned to avoid this vaccination while breastfeeding. Since risk exists and there are many gaps in knowledge, breastfeeding mothers should be discouraged from traveling to yellow fever–endemic areas. However, if travel to a yellow fever–endemic area cannot be avoided or postponed, then the mother should be vaccinated.

Medications

The American Academy of Pediatrics (AAP) 2001 Policy Statement: The Transfer of Drugs and Other Chemicals into Human Milk provides an overview of the compatibility or effects on breastfeeding of approximately 250 drugs. The pharmaceutical reference guide, Medications and Mothers’ Milk, is updated every 2 years and provides a comprehensive review of the compatibility or effects on breastfeeding of approximately 1,000 drugs, including generic and trade names, AAP recommendations, risk categories, pharmacologic properties, interactions with other drugs, suitable alternatives, theoretic and relative child dose, pediatric half-life, and many other pediatric concerns.

Special Consideration: Antimalarial Medications

Since chloroquine and mefloquine may be safely prescribed to infants, both are considered safe to prescribe to mothers who are breastfeeding. Most experts consider short-term use of doxycycline compatible with breastfeeding. Primaquine may be used for breastfeeding mothers and children with normal glucose-6-phosphate dehydrogenase (G6PD) levels. Breastfeeding mothers should not use atovaquone-proguanil when the breastfeeding infant weighs <5 kg (about 11 lb).

Pregnant Travelers

2011-08-22T01:27:00.001-07:00

Since as many as 50% of pregnancies are unplanned, women of reproductive age should consider maintaining current immunizations during routine check-ups in case an unplanned pregnancy coincides with a need to travel. Because of the decreased risk to the unborn child, preconceptional immunizations are preferred to vaccination during pregnancy. A woman should defer pregnancy for ≥28 days after receiving live vaccines (such as measles-mumps-rubella or yellow fever) because of a theoretical risk of transmission to the fetus. However, small studies of women who received these vaccines unintentionally during pregnancy have not found a definitive link between the vaccines and poor pregnancy outcomes. Therefore, pregnancy termination is not recommended after an inadvertent exposure.

According to the American College of Obstetrics and Gynecology, the safest time for a pregnant woman to travel is during the second trimester, when she usually feels best and is in least danger of spontaneous abortion or premature labor. A woman in the third trimester should be advised to defer overseas travel because of concerns about access to medical care in case of problems such as hypertension, phlebitis, or premature labor. Pregnant women should be advised to consult with their health care providers before making any travel decisions. Collaboration between travel health experts and obstetricians is helpful in weighing benefits and risks based on destination and recommended preventive and treatment measures. Table 8-05 lists relative contraindications to international travel during pregnancy. In general, pregnant women with serious underlying illnesses should be advised not to travel to developing countries.

Preparation for travel during pregnancy

Once a pregnant woman has decided to travel, a number of issues need to be considered before her departure:

· An intrauterine pregnancy should be confirmed by a clinician and ectopic pregnancy excluded before beginning any travel.

· General health insurance policies may or may not provide coverage of pregnancy-related problems while abroad. Pregnant travelers should inquire about what their health insurance policies cover and, if needed, obtain a supplemental policy for their trip. Many supplemental travel insurance policies and prepaid medical evacuation insurance policies do not cover pregnancy-related problems, so this issue should be clarified before obtaining a policy.

· Check medical facilities at the destination. For a woman in the last trimester, medical facilities should be able to manage complications of pregnancy, toxemia, cesarean sections, and premature or ill neonates.

· Determine beforehand whether prenatal care will be required while abroad and who will provide it. The pregnant traveler should make sure she does not miss prenatal visits requiring specific timing.

· Determine beforehand whether blood is routinely screened for HIV and hepatitis B and C at the destination. Pregnant travelers should consider the safety of blood transfusions, if needed, when making plans for international travel. The pregnant traveler should also be advised to know her blood type, and Rh-negative pregnant women should receive anti-D immune globulin (a plasma-derived product) prophylactically at about 28 weeks’ gestation. The immune globulin dose should be repeated after delivery if the infant is Rh positive.

· Determine if the traveler risks influenza on this trip, and recommend influenza vaccine accordingly.

· Determine whether the prevalence of tuberculosis (TB) is high in the destination region and whether the planned itinerary will put the traveler at risk for TB. If exposure to TB is determined to be a risk, the pregnant traveler should receive skin testing before and after travel.

General recommendation for travel during pregnancy

A pregnant woman should be advised to travel with at least one companion; she should also be advised that, during her pregnancy, her level of comfort may be adversely affected by traveling.Table 8-06 lists the most serious risks that pregnant women face during international travel.

Typical problems of pregnant travelers are the same as those experienced by any pregnant woman: fatigue, heartburn, indigestion, constipation, vaginal discharge, leg cramps, increased frequency of urination, and hemorrhoids. During travel, pregnant women can take preventive measures, including avoiding gas-producing food or drinks before scheduled flights (entrapped gases can expand at higher altitudes) and periodically moving the legs (to decrease venous stasis). Pregnant women should always use seatbelts while seated, as air turbulence is not predictable and may cause significant trauma.

Signs and symptoms that indicate the need for immediate medical attention are vaginal bleeding, passing tissue or clots, abdominal pain or cramps, contractions, ruptured membranes, excessive leg swelling or pain, headaches, or visual problems.

Pregnant Travelers

2011-08-22T01:27:00.000-07:00

Preparation for travel during pregnancy

Once a pregnant woman has decided to travel, a number of issues need to be considered before her departure:

· An intrauterine pregnancy should be confirmed by a clinician and ectopic pregnancy excluded before beginning any travel.

· Determine if the traveler risks influenza on this trip, and recommend influenza vaccine accordingly.

GENERAL RECOMMENDATIONS FOR TRAVEL DURING PREGNANCY

Travelers with Disabilities

2011-08-21T01:17:00.000-07:00