Natural Cures For Anxiety
Are you desperately getting a cure for your anxiety condition? Do %LINK% you will get fed up with waiting for is a result of your therapies? Do you feel like one's body is loaded with medications that do not even give signs you are cured? Do you want to stop the inside effects you have? Do you need to know very well what works coming from a long list of treatments?
One way to eliminate anxiety disorder is through the self-help program from the Linden method. This method is developed to permanently remove anxiety and also similar disorder. As a means of fact, many individuals consider this process and would like to buy the Linden method. It is proven that the linden method can stop anxiety from progressing in addition to from occurring again. There are about 150,000 folks who suffer from tried this process contributing to 97% ones have successfully eliminated anxiety disorder.
However, there are numerous natural ways in which a person can overcome this problem. The first step with the treatment solutions are positivity and optimism. We can overcome problems easily if our thoughts are positive. Negativity only pulls your situation and enhances the problem. It is better not to think about situation excessive. This can create unnecessary tension. There are many varieties of herbal treatments and medications available that can assist in overcoming the situation of tension. However, a lot of people can experience unwanted effects as a result of these medications. This type of treatment doesn't suit everyone. Thus, it is advisable to stick to many from the natural ways like exercising or doing just about any activity you prefer.
To question its reliability like a treatment solutions are but normal for all those interested in just what it does to help. The method was conceptualized by Charles Linden, an ex - sufferer of the condition himself. He began to struggle from living a positive life when he was 12 years old. It got worst when he reached his early 20's. But his hope to find cure, made him the creator with the Linden Method for panic panic disorder attacks in 1996.
Over 18 in years past, Linden was told which he had many conditions, including severe anxiety and OCD, also called Obsessive Compulsive Disorder. He was handed medications that she took as prescribed. Of course, all medications will surely have strong side effects and Linden felt more serious for the medications then before he'd taken them. Not only that, but he'd to have terrible withdrawal symptoms while he went off the meds.
Acne No More EBook by Mike Walden - Get Rid Of Your Stubborn Acne
Mike Walden has finally developed a program to treating acne permanently. His program is called Acne No More. This eBook was actually developed because Mike Walden was already frustrated using the so-called acne remedies he tried which all of them yielded failed results. Confused? Actually, Mike Walden also suffered with this sort of skin problem. His face am red and brimming with pimples that it didn't have any space left for brand spanking new pimples to be sold. As I said, he tried all the expensive drugs and treatments away from desperation, instead of one succeeded. So, he developed the Acne No More program from extensive and thorough trial-and-error experimentation and research. He used the program to treat his very own acne and now his face is blemish-free and oil-free.
About Acne No More
Acne No More is really a book authored by Mike Walden. The say experience is the best teacher, Mike has been a victim of acne for 13 a few years as everybody else with similar condition he suffered the real and mental effects of acne which prompted him to look for a long-lasting solution which he finally got and documented in their book acne forget about. In the book he gives a set of each of the medications and treatments he tried that never worked. This book is therefore something in excess of seven numerous years of learning from your errors that Mike put in clinical research about acne.
Basically, acne develops due to clogging of pores and blocking the secretion from the sebum out of the human system. Now, imagine every one of the toxins inside the sweat, combined with this oil and the dirt along with other substances within the air. When this happens, the acne buildup becomes rather nasty, and anyone being affected by this would really need to have acne no more.
These will incorporate hormonal imbalances in your system that can cause too much production of oil within your face thereby, triggering the clogging of the pores. Or there is also best product for acne the possibility that you get acne from a lot of dirt, toxins or pollutants penetrating your epidermis pores, or sometimes you have the presence of internal microorganisms like bacteria that create the blockage with the pores and therefore, the breakouts.
Also, you need to please remember these acne bacteria will surely be very stubborn. They mike walden acne no more will revisit in spite of the topical applications you're prescribed from your doctor or dermatologist. So, should it be that you're afflicted with the recurring type of acne, make sure to investigate about Acne No More, a step-by-step procedure of relieving acne manufactured by an acne sufferer himself, Mike Walden.
A Personal Review of Acer Laptops
If you have never embarked over a Juicing detoxification program,they are some of the facts you should know before getting started. To start off with, detoxification diets are meant to help the body eliminate toxins. Due to this , most of the people will experience some unwanted effects including headaches, fatigue, body odor, bad breath or skin outbreaks. While these side effects aren't pleasant, they are the main cleansing process and definately will generally disappear once you've completed rapid.
The Omega juicer is recognized for it's stable and strong mastication process; it also enables nut butters being created from the powerful grinding. Some think it over being the top juicer in the marketplace. Put any fruit or vegetable inside and the outcome is pure bliss--hearty greens are specially good through the wringer. Shot of wheatgrass? No problem. It's like having your personal juice bar in your house with the ability to get creative. Adding fresh juice with a morning smoothie is a superb approach to start the morning.
For example, you could prefer to go to a sedation dentist should you be very sensitive to dental pain, and wish to keep your dental treatments proceeds without you even noticing it. While normally a sedation dentist will simply use sedation for surgeries or cosmetic dentistry, they could discuss all sedation options along if you are extremely understanding of dental pain. They may also be able to recommend you skill to lessen that pain all on your own as time passes. Sometimes dental pain is a result of not doing our home dental care well enough, and now we is able to reduce the pain sensation we experience on the dentist by subtracting better proper care of our teeth and gums.
Being creative and intellectually active can be good for your quality of life. You will never grow old, in the event you remember like a child as soon as your hobby was important and fun, and everyday you learned a new best juicer to buy challenge. Keep your brain sharp by exercising your brain, especially since you are aging, by learning some kind of new skill, reading the sunday paper or perhaps doing puzzles.
Another factor to think about for the new juicer choices the nuJuicers - Cleaning & Maintenancember of parts. Is putting one thing together gonna be a complete nightmare every time you have it? Think of the frequency of which you employ your juicer or simply how much you would employ it whether or not this were easier to use. The more parts that have to be utilized off for cleaning, greater parts which will need to be put back on afterward. Finding a juicer that does not have a million loose parts is definitely an essential aspect to think about.
Capsiplex Fat Burner - Important Facts
Today, everyone is discussing Capsiplex, the fantastic diet pill due to its benefits too %LINK% since the safe strategy to reduce weight to large extent. Capsiplex is manufactured in the United Kingdom but because benefits and importance it's increased industry be part of US upto large extent.
Even admitting weight accident is simpler and abiding although arresting capsiplex afterward a nutritious counterbalanced diet and assuming concrete concrete exercise making you added convalescent and stronger. Additionally, it assists you to beacon bright of billowing in regards to the pores and skin, that's archetypal appropriate afterwards actual fat reduction. Its producers are abundantly complex of their barter that they're acutely aware of abstain any exceptionable ancillary effects. Use capsiplex and hang an accomplishment to everyone your worries apropos your added weight.
The worst thing concerning the available high quality fat loss products is that there are so many from which to choose. Unless you are quite familiar with weight reduction, fat burning, exercise, diet and what those weight loss products go about doing and just how they work, you will discover it tough to find the right product in your case. You could be forgiven for believing that I am over complicating things and that if you wanted help to lose weight fast you'll simply buy any well known weight loss pill. What you should consider would be the fact certain products is sure to suit a lot of people over others.
Most credible online businesses and chain stores that offers diet-related pills market the Capsiplex line. Being helped by health studies, substantially more everyone is seeking to detect whether or otherwise the product or service range totally can give easy fat burning and health desired goals in a very extremely effective mode. Using the super star reinforcement, more everyone is expressing bigger degrees of focus in shopping the product or service bestweightlosspillshq.com with no a thoughtful overview of possible undesireable effects.
Step 2 to Lose Weight Fast Naturally - Fill Up On Fiber A easy way to lose weight fast is gone the "white" food out of your diet and change it out with fiber-rich wholemeal foods. Instead of your white bread, make your sandwiches having a wheat grains or whole fiber bread. Instead of white rice for supper, make brown rice.
Exploring Rapid Secrets Of Meratol reviews
Inside a nutshell, these critiques tout meratol being a miraculous creation that efforts to de-activate every one of the methods that can cause obesity. The grounds that tripped being overweight are actually different one of the people. It may gradually develop because of slow metabolic tempo and when you attempt to hunger suppressant pill, the obesity can't be banished completely rather you have to take therapy to perk up the metabolic procedure.Most of the obese people do not realize of the fact and also the ones who've learnt this truth begin to use multiple slimming vitamin supplements, to suppress food cravings and also to bump up one's metabolism. Does Meratol work on this kind of problems and provide a nutritious outcome? Definitely meratol could be the solitary item that can offer you overall therapy to emasculate affluent lbs. - LINK REMOVED -->Does Meratol work even for that sofa potatoes? Keep in mind all the sofa potatoes usually are not lazy ones rather many fiercely run their pc, without shifting around. Obviously, the deadly deadlines in office function glue them around the chair that they mint money because of their work, however, these people are unaware from the reality until this undesirable fats settled within your body creates more wellbeing issues that cost much more than their time in pc. But now you are able to function, with no the worry to getting obese whilst you function, as meratol terminates 310 calories if you live idle.Does Meratol assist potent components? The stock of components in meratol can be a pack of hunger suppressing and fat burning properties. Therefore enhancing the questions like does Meratol work can happen simple, nevertheless the response to show the answer might include several complex details inside.
The use of diet supplements as an help shedding weight has soured within the last several years. Nonetheless there may be some disadvantages to getting a few of these newest creations such since the damaging unintended effects they have got reportedly brought about to numerous. Well lastly there weight loss pills that work has been a weight reduction complement that is particularly developed to effectively allow you to to get rid of all of your additional weight without the destructive unwanted effects which capsule is called Meratol.
The use of fat burners as a possible help to slimming down has soured over the previous few years. Nonetheless there can be some disadvantages to by using a few of these latest creations including the detrimental uncomfortable side effects they've reportedly triggered to a lot of. Well finally there was a reduction supplement that's been particularly designed to effectively assist you to to lose your entire more weight with no adverse unwanted effects and also this pill is termed Meratol.
The actual scientific benefits of your good majority of the obtainable prescription slimming drugs are depending on short-run link between the medications. Consequently, you should are aware that many prescription fat loss medicine is made to be appropriate for short-run use mainly which usage period is normally just for a couple of weeks. Regardless of this understanding, most medical professionals normally utilize their discernment in suggesting the effective use of these weight reduction drugs on an extended period.
Among the main things featured in Meratol reviews is its difference off their fat reduction solutions. Two things are presented here; the first is that it is natural remedy, not like other sorts of products which are usually chemicals and particularly containing stimulants. These things ensures that if you utilize the pill, you do not experience effects for example sleeplessness, anxiety or irritability that most other pills cause.
Easy Products In Proactol reviews - Where To Go
Proactol Plus Proactol Plus Reviews Proactol Plu, Proactol Plus Proactol Plus Reviews Proactol review ratings Plu, Tutorial
If you have ever checked out dietary aids; you probably took a glance at over-the-counter fat loss methods. This might be something of great interest for your requirements at this time and also you would love a few suggestions on discovering the right option. Given the several distributors which are marketing they, both on and offline; it's as important as ever to be absolutely mindful of the dietary aids.
There are some brands of weight loss supplements offered in the market. You have to make some some of those brands. Before you find the perfect one, you will have to understand the details of techniques in the weight-loss therapy. This particular brand really should have every one of the positive qualities. At the same time, it needs to be safe for your customer.
Medically validated by way of 6 special clinical researches to enable individuals lower approximately 28 percent of the fat consumption, fat burning complement Proactol is the very efficient dieting assistance for letting you drop those additional lbs, shed pounds and turn into happier.
Acai Pure: This pure acai berry extract is surely an original product through the Amazon rain forest, Brazil. This ingredient comes in the majority of the weightloss pills that work. Both CNN and WSJ have got inside the ingredient in several discussions relating its therapeutic worth. The importance of the ingredient has created so that it is the best choice to produce of a diet pill. This component assists you in managing one's body weight to some much desired level. The ingredient is appreciated for its value added quality and is also thought to be a trustworthy material in this slimming pill scenario without the adverse effect. The studies also prove the usefulness of the aspect in an eating plan program.
3. An additional good thing about buying Proactol is its capability to lessen the meat cravings. If you are the type of one who is incessantly lured by sweets, treats and fatty snacks, you may locate decrease with Proactol. The purpose is a result of the fact once you acquire and just take Proactol, it will be effortless to convey no to those forms of stuffs. The transform these weight loss programs can make in you'll be greatly visible within your surplus fat loss results.
Going Ga-Ga Over The Gaggia Classic Espresso Machine
Remember, an espresso can be extremely tough to produce, especially since these rely on the freshly-ground espresso beans. These are people who themselves are lovers of cappuccinos and espressos. Right now, the Turks say that the 1st espresso maker was a copper or brass Ibrik. This possesses a thicker consistency as opposed to coffee brewed using other methods. So if you've always considered that the most effective espresso cappuccino maker will be produced in Italy, the home in the cappuccino, then you are right.
Have you ever considered introducing specialty coffees for your menu. The machine continue its function before the this page preset amount of coffee continues to be collected. While perked coffee delivers a great flavor and drip coffee permits convenience, I can't say I like either of the a lot more than my stovetop espresso. Semi-automatic machines use a portafilter handle, single or double brew basket, has capacity to switch from brewing to steaming to trouble with some manipulation, and the boiler holds water at the same time. One name will probably be drawn randomly coming from all eligible entrants, along with the winner notified via email for mailing information.
Well for individuals who are hunting to own total management, you can uncover a handbook device. Research also says that coffee affects the emotions of an person like in case you had a disagreement using your spouse the night time before then you wanted to generate amends, coffee stimulates yet calms the nerves and it facilitates in having a nice or meaningful conversation. The more functions incorporated costs more; the fewer features included will definitely cost less. In order to hold the profits, the organization purchases substandard pinto beans then over-roasts the beans leading the way in which for bitter and burnt tasting espresso coffee. If all this gets to get somewhat overwhelming, then visit their “Resources” page to browse through comparisons, articles, videos, reviews and newsletters to create the decision easier.
The EC50 features a stainless-steel lined thermoblock as well as other stainless steel components so the water in the system never touches aluminum. Lavazza offers quite a number of blends to decide on from. The machine requires 1000 watts of their time and comes which has a warranty of one year. The Pannarello frothing device, the brewing unit, also as the adjustable drip tray can often be removed for cleaning. Then, inside the late 1770s, a two chamber coffee maker started to become used.
Even using the strong 15 bar pump this Saeco Aroma espresso machine is not any louder than any up-to-date espresso maker inside it’s class, regardless how inexperienced you're with professional class home units you may find it both nimble and leisurely to prepare splendid cafe standard espressos, lattes and cappuccinos, and using a detachable drip tray there is no mess to completely clean up afterwards. Many home espresso machines will also come having a knock box, or you can invest within your own. All you might have to accomplish is to turn the pump on or off and the device will perform the rest in your case. The Bialetti espresso machines are certainly some of the most effective espresso machines that it is possible to find, as they offer more and better features and as well you will have the option of experiencing them tailor made, if which is your desire. If you want a truly authentic taste in your espresso brew, then this coffees should be freshly ground, so you will need a coffee grinder.
MD Travel Health - Kenya - vaccinations, malaria, safety, and other medical advice
MD Travel Health - Kenya - vaccinations, malaria, safety, and other medical advice
KenyaSummary of recommendationsMedicationsImmunizationsRecent outbreaksOther infectionsFood and water precautionsInsect and Tick ProtectionSwimming and bathing precautionsGeneral adviceMedical facilitiesTraveling with childrenTravel and pregnancyMapsEmbassy/Consulate LocationSafety information
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Summary of recommendations:
All travelers should visit either their personal physician or a travel health clinic 4-8 weeks before departure.
Malaria: Prophylaxis with Lariam (mefloquine), Malarone (atovaquone/proguanil), or doxycycline is recommended for all areas except Nairobi and the highlands (above 2500 m) of Central, Eastern, Nyanza, Rift Valley, and Western Provinces.
Recommended for all travelers
Recommended for all travelers
Recommended for all travelers greater than nine months of age, except that those whose itinerary is limited to the North Eastern Province; the states of Kilifi, Kwale, Lamu, Malindi, and Tanariver in the Coastal Province; and the cities of Mombasa and Nairobi, need the vaccine only if at risk for a large number of mosquito bites.
One-time booster recommended for any adult traveler who completed the childhood series but never had polio vaccine as an adult
Recommended for all travelers
For travelers spending a lot of time outdoors, or at high risk for animal bites, or involved in any activities that might bring them into direct contact with bats
Measles, mumps, rubella (MMR)
Two doses recommended for all travelers born after 1956, if not previously given
Revaccination recommended every 10 years
Travelers' diarrhea is the most common travel-related ailment. The cornerstone of prevention is food and water precautions, as outlined below. All travelers should bring along an antibiotic and an antidiarrheal drug to be started promptly if significant diarrhea occurs, defined as three or more loose stools in an 8-hour period or five or more loose stools in a 24-hour period, especially if associated with nausea, vomiting, cramps, fever or blood in the stool. A quinolone antibiotic is usually prescribed: either ciprofloxacin (Cipro)(PDF) 500 mg twice daily or levofloxacin (Levaquin) 500 mg once daily for a total of three days. Quinolones are generally well-tolerated, but occasionally cause sun sensitivity and should not be given to children, pregnant women, or anyone with a history of quinolone allergy. Alternative regimens include a three day course of rifaximin (Xifaxan) 200 mg three times daily or azithromycin (Zithromax) 500 mg once daily. Rifaximin should not be used by those with fever or bloody stools and is not approved for pregnant women or those under age 12. Azithromycin should be avoided in those allergic to erythromycin or related antibiotics. An antidiarrheal drug such as loperamide (Imodium) or diphenoxylate (Lomotil) should be taken as needed to slow the frequency of stools, but not enough to stop the bowel movements completely. Diphenoxylate (Lomotil) and loperamide (Imodium) should not be given to children under age two.
Most cases of travelers' diarrhea are mild and do not require either antibiotics or antidiarrheal drugs. Adequate fluid intake is essential.
If diarrhea is severe or bloody, or if fever occurs with shaking chills, or if abdominal pain becomes marked, or if diarrhea persists for more than 72 hours, medical attention should be sought.
Though effective, antibiotics are not recommended prophylactically (i.e. to prevent diarrhea before it occurs) because of the risk of adverse effects, though this approach may be warranted in special situations, such as immunocompromised travelers.
Malaria in Kenya: prophylaxis is recommended for all areas except Nairobi and the highlands (above 2500 m) of Central, Eastern, Nyanza, Rift Valley, and Western Provinces. Malaria epidemics frequently occur during the rainy season, which begins in April, but transmission occurs year-round. Either mefloquine (Lariam), atovaquone/proguanil (Malarone)(PDF), or doxycycline may be given. Mefloquine is taken once weekly in a dosage of 250 mg, starting one-to-two weeks before arrival and continuing through the trip and for four weeks after departure. Mefloquine may cause mild neuropsychiatric symptoms, including nausea, vomiting, dizziness, insomnia, and nightmares. Rarely, severe reactions occur, including depression, anxiety, psychosis, hallucinations, and seizures. Mefloquine should not be given to anyone with a history of seizures, psychiatric illness, cardiac conduction disorders, or allergy to quinine or quinidine. Those taking mefloquine (Lariam) should read the Lariam Medication Guide (PDF). Atovaquone/proguanil (Malarone) is a combination pill taken once daily with food starting two days before arrival and continuing through the trip and for seven days after departure. Side-effects, which are typically mild, may include abdominal pain, nausea, vomiting, headache, diarrhea, or dizziness. Serious adverse reactions are rare. Doxycycline is effective, but may cause an exaggerated sunburn reaction, which limits its usefulness in the tropics.
Long-term travelers who may not have access to medical care should bring along medications for emergency self-treatment should they develop symptoms suggestive of malaria, such as fever, chills, headaches, and muscle aches, and cannot obtain medical care within 24 hours. See malaria for details. Symptoms of malaria sometimes do not occur for months or even years after exposure.
Insect protection measures are essential.
For further information on malaria in Kenya, including a map showing the risk of malaria in different parts of the country, go to the World Health Organization, Roll Back Malaria, the Kenya Malaria Information Service.
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The following are the recommended vaccinations for Kenya:
Hepatitis A vaccine is recommended for all travelers over one year of age. It should be given at least two weeks (preferably four weeks or more) before departure. A booster should be given 6-12 months later to confer long-term immunity. Two vaccines are currently available in the United States: VAQTA (Merck and Co., Inc.) (PDF) and Havrix (GlaxoSmithKline) (PDF). Both are well-tolerated. Side-effects, which are generally mild, may include soreness at the injection site, headache, and malaise.
Older adults, immunocompromised persons, and those with chronic liver disease or other chronic medical conditions who have less than two weeks before departure should receive a single intramuscular dose of immune globulin (0.02 mL/kg) at a separate anatomic injection site in addition to the initial dose of vaccine. Travelers who are less than one year of age or allergic to a vaccine component should receive a single intramuscular dose of immune globulin (see hepatitis A for dosage) in the place of vaccine.
Typhoid vaccine is recommended for all travelers. It is generally given in an oral form (Vivotif Berna) consisting of four capsules taken on alternate days until completed. The capsules should be kept refrigerated and taken with cool liquid. Side-effects are uncommon and may include abdominal discomfort, nausea, rash or hives. The alternative is an injectable polysaccharide vaccine (Typhim Vi; Aventis Pasteur Inc.) (PDF), given as a single dose. Adverse reactions, which are uncommon, may include discomfort at the injection site, fever and headache. The oral vaccine is approved for travelers at least six years old, whereas the injectable vaccine is approved for those over age two. There are no data concerning the safety of typhoid vaccine during pregnancy. The injectable vaccine (Typhim Vi) is probably preferable to the oral vaccine in pregnant and immunocompromised travelers.
Yellow fever vaccine is recommended for all travelers greater than nine months of age, except for those whose itinerary is limited to the following areas: the entire North Eastern Province; the states of Kilifi, Kwale, Lamu, Malindi, and Tanariver in the Coastal Province; and the cities of Mombasa and Nairobi (see map). For travelers to the the latter areas, the vaccine should be considered only for those at increased risk due to prolonged travel, heavy exposure to mosquitoes, or inability to avoid mosquito bites. The vaccine is required for all travelers greater than one year of age arriving from a country in Africa or the Americas with risk of yellow fever transmission. Yellow fever vaccine (YF-VAX; Aventis Pasteur Inc.) (PDF) must be administered at an approved yellow fever vaccination center, which will give each vaccinee a fully validated International Certificate of Vaccination. The vaccine should not in general be given to those who are younger than six months of age, immunocompromised, or allergic to eggs (since the vaccine is produced in chick embryos). It should also not be given to those with a malignant neoplasm and those with a history of thymus disease or thymectomy. Caution should be exercised before giving the vaccine to those who are between the ages of 6 and 8 months, age 60 years or older, pregnant, or breastfeeding. Reactions to the vaccine, which are generally mild, include headaches, muscle aches, and low-grade fevers. Serious allergic reactions, such as hives or asthma, are rare and generally occur in those with a history of egg allergy.
Polio immunization is recommended, due to the persistence of polio in sub-Saharan Africa. Any adult who received the recommended childhood immunizations but never had a booster as an adult should be given a single dose of inactivated polio vaccine. All children should be up-to-date in their polio immunizations and any adult who never completed the initial series of immunizations should do so before departure. Side-effects are uncommon and may include pain at the injection site. Since inactivated polio vaccine includes trace amounts of streptomycin, neomycin and polymyxin B, individuals allergic to these antibiotics should not receive the vaccine.
Hepatitis B vaccine is recommended for all travelers if not previously vaccinated. Two vaccines are currently licensed in the United States: Recombivax HB (Merck and Co., Inc.) (PDF) and Engerix-B (GlaxoSmithKline) (PDF). A full series consists of three intramuscular doses given at 0, 1 and 6 months. Engerix-B is also approved for administration at 0, 1, 2, and 12 months, which may be appropriate for travelers departing in less than 6 months. Side-effects are generally mild and may include discomfort at the injection site and low-grade fever. Severe allergic reactions (anaphylaxis) occur rarely.
Rabies vaccine is recommended for travelers spending a lot of time outdoors, for travelers at high risk for animal bites, such as veterinarians and animal handlers, for long-term travelers and expatriates, and for travelers involved in any activities that might bring them into direct contact with bats. Children are considered at higher risk because they tend to play with animals, may receive more severe bites, or may not report bites. A complete preexposure series consists of three doses of vaccine injected into the deltoid muscle on days 0, 7, and 21 or 28. Side-effects may include pain at the injection site, headache, nausea, abdominal pain, muscle aches, dizziness, or allergic reactions.
Any animal bite or scratch should be thoroughly cleaned with large amounts of soap and water and local health authorities should be contacted immediately for possible post-exposure treatment, whether or not the person has been immunized against rabies.
Tetanus-diphtheria vaccine is recommended for all travelers who have not received a tetanus-diphtheria immunization within the last 10 years.
Measles-mumps-rubella vaccine: two doses are recommended (if not previously given) for all travelers born after 1956, unless blood tests show immunity. Many adults born after 1956 and before 1970 received only one vaccination against measles, mumps, and rubella as children and should be given a second dose before travel. MMR vaccine should not be given to pregnant or severely immunocompromised individuals.
Cholera vaccine is not generally recommended, even though cholera is reported, because most travelers are at low risk for infection. Two oral vaccines have recently been developed: Orochol (Mutacol), licensed in Canada and Australia, and Dukoral, licensed in Canada, Australia, and the European Union. These vaccines, where available, are recommended only for high-risk individuals, such as relief workers, health professionals, and those traveling to remote areas where cholera epidemics are occurring and there is limited access to medical care. The only cholera vaccine approved for use in the United States is no longer manufactured or sold, due to low efficacy and frequent side-effects.
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Two cases of polio were reported from Dadaab, Kenya, in May 2013. These are the first wild poliovirus cases confirmed in Kenya since July 2011. Dadaab is the site of a major refugee camp, which houses people from across the Horn of Africa, including Somalia. Thirteen cases of polio were reported from Kenya betgween 2008 and 2011, including three cases in the Kamagambo area of Rongo District, Western Province, in September 2011 (see the World Health Organization). A one-time polio booster is recommended for any adult traveler who received the recommended childhood immunizations but never had polio vaccine as an adult. Children should be fully immunized against polio before traveling to Kenya.
An outbreak of dengue fever,a flu-like illness sometimes complicated by hemorrhage or shock, was reported from Mombasa in May 2013. Several cases were reported in travelers. In October 2011, a dengue outbreak occurred in Mandera, northeastern Kenya, causing at least 5000 cases and four deaths. Dengue is transmitted by Aedes mosquitoes, which bite primarily in the daytime and favor densely populated areas, though they also inhabit rural environments. No vaccine is available at this time. Insect protection measures, as below, are advised.
Two cases of African trypanosomiasis (sleeping sickness) were reported in early 2012 in travelers who had visited the Masai Mara game park: a German tourist in January 2012 and a Belgian tourist in February 2012 (see ProMED-mail). Several other cases have recently been reported among visitors to game parks in East Africa (see Emerging Infectious Diseases). African trypanosomiasis is a potentially fatal parasitic infection transmitted by the bite of the tsetse fly. The best means of prevention is to avoid areas infested with tsetse flies, which are usually known to local inhabitants. Travelers at risk should wear long sleeves and long pants of medium weight fabric in neutral colors that blend with the environment. Also, travelers should avoid riding in the back of open vehicles, since dust may attract tsetse flies, and should take care not to disturb bushes (where tsetse flies rest) during the warmer parts of the day. Insect repellents are ineffective. For further information on personal protection measures, go to Health Canada.
An increased number of cases of visceral leishmaniasis (kala-azar) have been reported from northeastern Kenya since 2000. An outbreak was reported from Wajir District in March 2008, resulting in more than 180 cases as of August (see ProMED-mail; August 6, 2008). In July 2006, a leishmaniasis outbreak was reported from Isiolo District, Eastern Province, leading to the admission of more than 30 children to the local hospital in neighboring Wajir District (see IRIN). Visceral leishmaniasis is transmitted by the bite of infected female sandflies. The disease is characterized by fever, weight loss, anemia, and enlargement of the liver and spleen which may develop over months to years. The infection may be especially severe in those with HIV disease. To prevent sandfly bites, follow the same precautions as for mosquito bites, except that netting must be finer-mesh (at least 18 holes to the linear inch) since sandflies are smaller.
Cholera outbreaks are regularly reported from Kenya. The most recent were reported in May 2010 from West Pokot district (Rift Valley province) and Kilifi district (Coast province); in March 2010 from Coast, Eastern and Rift Valley provinces (particularly affecting Kajiado District and Pokot Central district in Rift Valley Province); in November 2009 from the Coast province, Central province, and Eastern province; in September 2009 from Turkana in northwestern Kenya and from Laisamis, Marsabit; in December 2008 from western Nyanza province, causing 4000 cases and 89 deaths by July 2009; in March 2009 from Moyale town, in the extreme north of Eastern Province; in December 2008 from the three districts of Mandera, causing more than 1400 cases and 13 deaths; in September 2008 from the Nandi hills area in Rift Valley province; in June 2008 from the Rachuonyo, Migori and Kisumu East districts of Nyanza Province and the Busia and Samia districts in Western Province; in April 2008 from the western province of Nyanza and from the town of Naivasha in Rift Valley province; in February 2008 from Mandera district in the Northeastern province, near the Somali border; in January 2008 at a center hosting victims of post-election violence in Nandi in Rift Valley province; in July 2007 from Siaya District in Nyanza province, in southwestern Kenya; and in April-May 2007 from West Pokot and Turkana districts in Rift Valley province, in the western part of the country bordering Uganda; from the town of Mandera in Northeastern province, near the border with Somalia and Ethiopia; and from Kisumu and Siaya districts in Nyanza province (see ProMED-mail). In December 2006, a cholera outbreak was reported from Northeastern province after flooding. A small flood-related outbreak was also reported from Mombasa in November 2006. In September 2006, a cholera outbreak was reported from Vanga Village in Kwale district, apparently related to contaminated well water (see ProMED-mail (September 29, 2006). A cholera outbreak was previously reported from this area in 2004. In December 1998, a major cholera outbreak occurred in Nyanza, Eastern, Rift Valley and Nairobi provinces, resulting in over 1000 cases and 25 deaths.
The main symptoms of cholera are profuse watery diarrhea and vomiting, which in severe cases may lead to dehydration and death. Most outbreaks are related to contaminated drinking water, typically in situations of poverty, overcrowding, and poor sanitation. Most travelers are at extremely low risk for infection. Cholera vaccine, where available, is recommended only for certain high-risk individuals, such as relief workers, health professionals, and those traveling to remote areas where cholera epidemics are occurring and there is limited access to medical care. All travelers should carefully observe food and water precautions, as below.
An outbreak of an intestinal infection was reported in January 2008 among British tourists who had been staying at the Sun'n Sand Hotel in Kikambala. Some of the cases were reportedly confirmed as salmonellosis. For further information, go to ProMED-mail (January 15, 2008).
An outbreak of Rift Valley fever was reported in December 2006, causing 684 cases and 155 deaths by May 2007. The outbreak began in flooded areas in North Eastern Province, especially the districts of Garissa, Ijara, and Wajir. Cases were also reported from Coast Province (districts of Kilifi, Tana River, Malindi, Isiolo, and Taita Taveta), Central Province (districts of Kirinyanga and Maragua), and Rift Valley Province (Kajiado district). 684 cases including 155 deaths (case-fatality ratio, 23%) of RVF was reported in Kenya. See the International Federation of Red Cross and Red Crescent Societies, World Health Organization, MMWR, IRIN News, NATHNAC, and ProMED-mail for further information. The human cases occurred at the same time that outbreaks were occurring among sheep, cattle, and goats in the area. In February 2010, seven additional cases, one fatal, were reported from the Free State and Northern Cape.
Rift Valley fever is a viral infection that primarily affects domesticated animals. The disease is usually transmitted by mosquitoes, but may also be acquired by direct exposure to infected animals or their tissues or by consumption of raw milk. Aerosol transmission has been documented. Most cases occur in those who work with livestock. The incubation period ranges from two to six days. Initial symptoms may include fever, chills, muscle aches, backache, headache, nausea, vomiting, and light sensitivity. Most people recover uneventfully in four to seven days, but the course may be complicated by loss of vision (retinitis), liver inflammation (hepatitis), kidney failure, excessive bleeding (hemorrhage), inflammation of the brain (encephalitis), or death. Travelers to affected areas should follow insect protection measures, as below, and avoid direct contact with livestock.
Cases of Rift Valley fever reached epidemic levels in late 1997 and early 1998 after torrential rains and severe flooding, causing at least 170 deaths. Cases were confirmed in the North Eastern, Eastern, Central, and Rift Valley provinces. The chief risk factors for infection were direct contact with sheep body fluids and housing livestock indoors. See "An Outbreak of Rift Valley Fever in Northeastern Kenya, 1997-98" in Emerging Infectious Diseases, and "An outbreak of Rift Valley Fever, Eastern Africa, 1997-1998"(PDF) inWeekly Epidemiological Record, Vol. 73, 15 1998.
Outbreaks of Chikungunya fever, a mosquito-borne illness characterized by fever and incapacitating joint pains, occurred in coastal Kenya (Lamu, then Mombasa) in 2004, followed by sporadic cases, including an American traveler who spent three months in Kenya and Somalia in 2005 (see MMWR). Symptoms of Chikungunya fever include fever, joint pains, muscle aches, headache, and rash. The disease is almost never fatal, but may be complicated by protracted fatigue and malaise. Rarely, the infection is complicated by meningoencephalitis, which is usually seen in newborns and those with pre-existing medical conditions. Insect protection measures are strongly recommended, as described below. Because of the risk of mother-to-child transmission, pregnant women need to take special care to protect themselves from mosquito bites.
An outbreak of dysentery was reported in May 2006 from the Kotulu area in El Wak division of Mandera District in North Eastern Province. As of May 16, a total of 13 children had died. The outbreak appeared to be related to contaminated drinking water obtained from a local pond. See IRIN and ProMED-mail (May 12, 2006) for details.
A measles outbreak was reported in April 2006 from North Eastern, Nyanza, Rift Valley and Nairobi provinces. See the International Red Cross for details. As of the end of 2006, the outbreak appeared to be waning. All travelers born after 1956 should make sure they have had either two documented measles immunizations or a blood test showing measles immunity. This does not apply to people born before 1957, who are presumed to be immune to measles. Although measles immunization is usually begun at age 12 months, consider giving an initial dose of measles vaccine to children between the ages of 6 and 11 months who will be traveling to Kenya. Measles vaccine should not be given to pregnant or severely immunocompromised individuals.
A meningococcal outbreak was reported in February 2006 from four divisions (Alale, Chepareria, Kachelila and Kasei) of West Pokot, an area bordering the epidemic districts of Uganda. As of February 26, a total of 74 cases and 15 deaths had been identified. See the World Health Organization for details. Meningococcal vaccine is recommended for travelers to this area.
A leptospirosis outbreak was reported in June 2004 from a high school in Bungoma district, resulting in 141 suspected cases and 6 deaths as of June 17. Cases have also been reported from a nearby elementary school. See the World Health Organization for further information.
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Schistosomiasis may be acquired from exposure to bodies of fresh water. In 1984, acute schistosomiasis developed in a group of 15 American students traveling in Kenya, two of whom became paraplegic from transverse myelitis (inflammation of the spinal cord due to deposition of schistosomal eggs.) (See Acute Schistosomiasis with Transverse Myelitis in American Students Returning from Kenya, MMWR August 10, 1984 / 33(31); 445-7). Swimming and bathing precautions are strongly advised (see below).
Marburg fever was reported from Kenya in 1980 and 1987.
HIV (human immunodeficiency virus) infection is reported, but travelers are not at risk unless they have unprotected sexual contacts or receive injections or blood transfusions.
Other infections include
Cutaneousand diffuse cutaneous leishmaniasis (transmitted by sandflies)Crimean-Congohemorrhagic feverKenyantick typhusPlague(outbreak involving 44 people occurred in 1990, and foci of diseaseare believed to persist in rodents; any traveler at risk for exposureto wild rodents or their fleas, whichtransmit the plague, should bring along a bottleof doxycycline, to be taken prophylactically if exposureoccurs)O'nyong-nyong fever (cases reported from the Coast Province in December 2004; see ProMED-mail, December 16, 2004, for details)Anthrax (outbreaks reported from Embu District in Eastern Province in January 2009 and from Meru Central District in January 2006; those who work with farm animals are at highest risk; see ProMED-mailBrucellosis(low incidence)
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Food and water precautions
Do not drink tap water unless it has been boiled, filtered, or chemically disinfected. Do not drink unbottled beverages or drinks with ice. Do not eat fruits or vegetables unless they have been peeled or cooked. Avoid cooked foods that are no longer piping hot. Cooked foods that have been left at room temperature are particularly hazardous. Avoid unpasteurized milk and any products that might have been made from unpasteurized milk, such as ice cream. Avoid food and beverages obtained from street vendors. Do not eat raw or undercooked meat or fish. Some types of fish may contain poisonous biotoxins even when cooked. Barracuda in particular should never be eaten. Other fish that may contain toxins include red snapper, grouper, amberjack, and sea bass.
All travelers should bring along an antibiotic and an antidiarrheal drug to be started promptly if significant diarrhea occurs, defined as three or more loose stools in an 8-hour period or five or more loose stools in a 24-hour period, especially if accompanied by nausea, vomiting, cramps, fever or blood in the stool. Antibiotics which have been shown to be effective include ciprofloxacin (Cipro), levofloxacin (Levaquin), rifaximin (Xifaxan), or azithromycin (Zithromax). Either loperamide (Imodium) or diphenoxylate (Lomotil) should be taken in addition to the antibiotic to reduce diarrhea and prevent dehydration.
If diarrhea is severe or bloody, or if fever occurs with shaking chills, or if abdominal pain becomes marked, or if diarrhea persists for more than 72 hours, medical attention should be sought.
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Insect and Tick Protection
Wear long sleeves, long pants, hats and shoes (rather than sandals). For rural and forested areas, boots are preferable, with pants tucked in, to prevent tick bites. Apply insect repellents containing 25-50% DEET (N,N-diethyl-3-methylbenzamide) or 20% picaridin (Bayrepel)to exposed skin (but not to the eyes, mouth, or open wounds). DEET may also be applied to clothing. Products with a lower concentration of either repellent need to be repplied more frequently. Products with a higher concentration of DEET carry an increased risk of neurologic toxicity, especially in children, without any additional benefit. Do not use either DEET or picaridin on children less than two years of age. For additional protection, apply permethrin-containing compounds to clothing, shoes, and bed nets. Permethrin-treated clothing appears to have little toxicity. Don't sleep with the window open unless there is a screen. If sleeping outdoors or in an accomodation that allows entry of mosquitoes, use a bed net, preferably impregnated with insect repellent, with edges tucked in under the mattress. The mesh size should be less than 1.5 mm. If the sleeping area is not otherwise protected, use a mosquito coil, which fills the room with insecticide through the night.In rural or forested areas, perform a thorough tick check at the end of each day with the assistance of a friend or a full-length mirror. Ticks should be removed with tweezers, grasping the tick by the head. Many tick-borne illnesses can be prevented by prompt tick removal.
To prevent sandfly bites, follow the same precautions as for mosquito bites, except that netting must be finer-mesh (at least 18 holes to the linear inch) since sandflies are smaller.
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Swimming and bathing precautions
Avoid swimming, wading, or rafting in bodies of fresh water, such as lakes, ponds, streams, or rivers. Do not use fresh water for bathing or showering unless it has been heated to 150 degrees F for at least five minutes or held in a storage tank for at least three days. Toweling oneself dry after unavoidable or accidental exposure to contaminated water may reduce the likelihood of schistosomiasis, but does not reliably prevent the disease and is no substitute for the precautions above. Chlorinated swimming pools are considered safe.
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Bring adequate supplies of all medications in their original containers, clearly labeled. Carry a signed, dated letter from the primary physician describing all medical conditions and listing all medications, including generic names. If carrying syringes or needles, be sure to carry a physician's letter documenting their medical necessity.Pack all medications in hand luggage. Carry a duplicate supply in the checked luggage. If you wear glasses or contacts, bring an extra pair. If you have significant allergies or chronic medical problems, wear a medical alert bracelet.
Make sure your health insurance covers you for medical expenses abroad. If not, supplemental insurance for overseas coverage, including possible evacuation, should be seriously considered. If illness occurs while abroad, medical expenses including evacuation may run to tens of thousands of dollars. For a list of travel insurance and air ambulance companies, go to Medical Information for Americans Traveling Abroad on the U.S. State Department website. Bring your insurance card, claim forms, and any other relevant insurance documents. Before departure, determine whether your insurance plan will make payments directly to providers or reimburse you later for overseas health expenditures. The Medicare and Medicaid programs do not pay for medical services outside the United States.
Pack a personal medical kit, customized for your trip (see description). Take appropriate measures to prevent motion sickness and jet lag, discussed elsewhere. On long flights, be sure to walk around the cabin, contract your leg muscles periodically, and drink plenty of fluids to prevent blood clots in the legs. For those at high risk for blood clots, consider wearing compression stockings.
Avoid contact with stray dogs and other animals. If an animal bites or scratches you, clean the wound with large amounts of soap and water and contact local health authorities immediately. Wear sun block regularly when needed. Use condoms for all sexual encounters. Ride only in motor vehicles with seat belts. Do not ride on motorcycles.
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For a guide to physicians, dentists, hospitals, pharmacies and ambulance services in Kenya, go to the U.S.Embassy website. Adequate medical care is available in Nairobi, though facilities are limited elsewhere. Most doctors and hospitals will expect payment in cash, regardless of whether you have travel health insurance. Serious medical problems will require air evacuation to a country with state-of-the-art medical facilities.
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Traveling with children
Before you leave, make sure you have the names and contact information for physicians, clinics, and hospitals where you can obtain emergency medical care if needed (see the U.S. Embassy website).
All children should be up-to-date on routine childhood immunizations, as recommended by the American Academy of Pediatrics. Children who are 12 months or older should receive a total of 2 doses of MMR (measles-mumps-rubella) vaccine, separated by at least 28 days, before international travel. Children between the ages of 6 and 11 months should be given a single dose of measles vaccine. MMR vaccine may be given if measles vaccine is not available, though immunization against mumps and rubella is not necessary before age one unless visiting a country where an outbreak is in progress. Children less than one year of age may also need to receive other immunizations ahead of schedule (see the accelerated immunization schedule).
Because yellow fever vaccine is not approved for use in children less than nine months of age, children in this age group should not in general be brought to Kenya.
The recommendations for malaria prophylaxis are the same for young children as for adults, except that(1) dosages are lower; and (2)doxycycline should be avoided. DEET-containing insect repellents are not advised for children under age two, so it's especially important to keep children in this age group well-covered to protect them from mosquito bites.
When traveling with young children, be particularly careful about what you allow them to eat and drink (see food and water precautions), because diarrhea can be especially dangerous in this age group and because the vaccines for hepatitis A and typhoid fever, which are transmitted by contaminated food and water, are not approved for children under age two. Baby foods and cows' milk may not be available in developing nations. Only commercially bottled milk with a printed expiration date should be used. Young children should be kept well-hydrated and protected from the sun at all times.
Be sure to pack a medical kit when traveling with children. In addition to the items listed for adults, bring along plenty of disposable diapers, cream for diaper rash, oral replacement salts, and appropriate antibiotics for common childhood infections, such as middle ear infections.
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Travel and pregnancy
Because of the risk of malaria and yellow fever, pregnant women should not in general travel to Kenya. Yellow fever vaccine is not approved for use during pregnancy, because it contains live virus. Malaria may cause life-threatening illness in both the mother and the unborn child. None of the currently available prophylactic medications is 100% effective. Mefloquine (Lariam) is the drug of choice for malaria prophylaxis during pregnancy, but should not be given if possible in the first trimester. If travel to areas with malaria and yellow fever is unavoidable, insect protection measures must be strictly followed at all times. The recommendations for DEET-containing insect repellents are the same for pregnant women as for other adults.
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Helpful maps are available in the University of Texas Perry-Castaneda Map Collection and the United Nations map library. If you have the name of the town or city you'll be visiting and need to know which state or province it's in, you might find your answer in the Getty Thesaurus of Geographic Names.
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(reproduced from theU.S. State Dept. Consular Information Sheet)
Americans living in or visiting Kenya are encouraged to register at the Consular section of the U.S. Embassy in Kenya and obtain updated information on travel and security within Kenya.
The U.S Embassy is located on United Nations Avenue, Gigiri, Nairobi, Kenya; telephone (254)(20)363-6000; fax (254)(20)363-6410. In the event of an after-hours emergency, the Embassy duty officer may be contacted at (254)(20)363-6170. The Embassy's international mailing address is P.O. Box 606, Village Market 00621, Nairobi, Kenya. Mail using U.S. domestic postage may be addressed to Unit 64100, APO AE 09831. The Embassy home page is http://kenya.usembassy.gov.
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For information on safety and security, go to the U.S. Department of State, United Kingdom Foreign and Commonwealth Office, Foreign Affairs Canada, and the Australian Department of Foreign Affairs and Trade.
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