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Flu Vaccines Now in Stock - Sept 2011

Our supply of seasonal flu vaccine has arrived. For most people flu is unpleasant but not serious and most recover within a week. If you fall into a special risk group you may be entitled to a free NHS flu vaccine. If you do not fall into one of these groups and would like to be vaccinated we offer the vaccine to anyone aged 12 years and over.
The World Health Organisation follow patterns of influenza activity worldwide and predict what strains will affect us each year.The three strains in this years flu vaccine include the Swine Flu strain. Last year there were many tragic deaths from swine flu and demand for the flu vaccine was high with supplies in the UK running out. To avoid this situation again the year we advise you book early.
To book please call the clinic on 01273 749100. From 1st October we are offering Saturday morning clinics and we have two evening clinics a week for those unable to attend during the day.
Sussex Travel Clinic offers an on site flu vaccination service for companies with 10 or more staff. To book or discuss further please contact Helen or Jane on 01273 749100.

How to Avoid Jet Lag

Jet lag occurs when we travel through several time zones which interrupt the normal body clock and causes disturbed sleep patterns and disorientation. When you fly East to West jet lag is worse as the body finds it hard to adapt to shorter days than longer ones.

Symptoms tend to only last a couple of days until your body has acclimatised to the new time zone and include:

• Sleep disturbance - the most common symptom
• Nausea or indigestion
• Altered bowel habits :constipation and diarrhoea
• Anxiety
• Irritability
• Clumsiness
• Memory problems
• Lack of energy
• Headaches
• Generally feeling unwell

How to avoid Jet Lag

• Before you travel make sure you feel rested and try to prepare your body for the new time zone. Go to bed slightly earlier if you are travelling east and going to bed later if flying west.
• When you board your flight adjust your watch to the time of your destination. If you are arriving in the evening, try not to sleep too much during the flight so that when you are you will be able to go to bed at your destinations night fall. If your flight arrives in the morning, try and sleep as much as you can during the flight, so you can stay awake during the day. Sleeping on a flight can often be difficult, use ear plugs and eye shades to help you sleep.
• Include a stopover on the way if possible. A stopover will make it easier for you to adjust to the time zone at your final destination.
• Avoid caffeine and alcohol during the flight as these can disturb sleep. Make sure you stay well hydrated as dehydration can intensify the symptoms of jet lag.
• Taking sleeping tablets are not recommended; as it does not help your body adjust to normal sleeping patterns.
• Try to get into the local routine as soon as you arrive. Spending time in natural light helps the body adjust quicker.
• Try to get the normal amount of sleep you would in every 24 hours. Try and have a minimum block of four hours sleep, known as 'anchor sleep' this helps you adjust to the new time zone. Try and make up the rest of your normal sleep hours by taking naps during the day.
• If you trip is short (3 to 4 days or less) if possible it may be better to stay on home time as this will minimise sleep disturbance on your return.

Disease Focus - Typhoid

Typhoid fever is a disease spread through ingestion of food and water contaminated with faeces or urine from a human carrier. It is caused by gram negative bacteria, Salmonella enterica serotype typhi.

Open sewer Thailand

Signs and Symptoms

It has an incubation period of 1 - 3 weeks. Symptoms range from mild to severe and include:
Mild cases: fever, constipation or diarrhoea abdominal pain, loss of appetite, headache, myalgia and a rash can develop.
Severe cases: disseminated disease with multi organ involvement and meningitis can occur.
10-15% of all cases develop complications which can include intestinal perforation, pneumonia, fits and meningitis. With prompt antibiotic treatment case fatality is less than 1%, but can be as high as 20% in untreated cases. 1-3% of people become long term carriers after infection with typhoid fever. [1]. 


Risk for Travellers

Typhoid fever can be found worldwide, but it is predominately in countries where hygiene standards are poor. The highest risk areas are the Indian subcontinent, Asia, Africa and Latin America. 16 to 33 million cases of typhoid occur each year according to the World Health Organisation (WHO) with approximately 500,000 to 600, 000 deaths.
The risk of contracting typhoid fever depends on the country visited, the highest risk remains in travellers visiting the Indian subcontinent with 17.3 cases per 100,000 travellers reported. Risk in high income countries remains low with less than 1 case per million visits [2]. 


Prevention

If you are travelling to a high risk destination where sanitation and food hygiene is poor you should consider getting a typhoid vaccination. For country recommendations visit Fit For Travel.

Food and water hygiene is equally important. You should:

• Only drink and clean teeth with bottled or boiled water
• Avoid  foods such as shellfish that may have come from contaminated water
• Avoid salads that may have been washed in contaminated water
• Avoid ice in drinks , unless you are sure it has been made with clean water
• Wash hands regularly or use an alcohol hand gel when washing facilities are not available

References

1.  http://www.nathnac.org/pro/factsheets/typhoid.htm

2.  http://www.nathnac.org/pro/factsheets/typhoid.htm

Staying safe when abroad- FCO report highlights problems Brits can encounter abroad

As a travel health nurse advisor, I tend to focus on health issues such as malaria and vaccine preventable diseases during my consultations with travellers. However, it is not just health risks that can ruin a trip abroad. Last year the Foreign Office (FCO) assisted 5700 cases of arrest abroad, a 10% drop on the year before, but despite the positive trend the report highlights that many travellers are not aware of the risks and troubles they can encounter.

Key Findings 2010/11

• 25,969 Britain’s needed assistance for lost or stolen passports
• Though down by 20%, a total of 799 drug arrests were reported
• Countries with the majority of drug arrests include: Jamaica, Argentina, Brazil, Serbia and Peru
• The highest number of arrests took place in Spain
• 347 deaths were reported in Thailand- 60% died of natural causes
• The highest number of rapes occurred in Egypt, followed by Turkey.Cases of reported rapes has almost halved in Greece since 2009/10

How the FCO can help you abroad

If you do find yourself in trouble abroad the FCO can help you with the following:

• Issue emergency travel documents, such as a lost passport
• Give you details of local lawyers, funeral directors, doctors and interpreters
• Contact your friends and family back home
• Visit you in hospital if you have been arrested
• Provide you with information about transferring money

They cannot help with the following:

• Give legal advice
• Help with entry to a country without a passport or necessary visa's
• Financial help- paying bills or giving you money
• Making travel arrangements for you
• Get you better medical help in hospital than is given to local people

Tips for staying safe abroad

• Ensure you have adequate travel insurance, declare pre-existing medical conditions to your insurer and read the small print
• Study the local laws and customs of the country you are visiting
• Make sure you have enough cash to cover any emergency situations
• Check your passport is in date and you have any required visa's
• Make copies of any documents and store securely online.
• Tell someone where you are going and leave emergency contact details with them
• If you are sexually assaulted abroad, inform the local police and contact the Foreign Office who can offer you support
• Get the necessary travel vaccinations and malaria tablets before you travel
• Understand the risks you are taking if you get involved with illegal drugs. Many countries carry harsh sentences, including the death penalty in some countries.
• If you are visiting countries in the European Economic area, apply for a EHIC card online or by phone 0845 605 0707

Watch a FCO You Tube update which focuses on drug smuggling.

References


http://www.fco.gov.uk/en/travel-and-living-abroad/about-kbyg-campaign/

Disease Focus - Hepatitis A

Hepatitis A is an infection of the liver and cases occur worldwide, although it is less common in Europe, North America, Australia and New Zealand. It is endemic in many low income countries. Around 1.5 million cases of hepatitis a occur each year.[1] It is spread through the faceal oral route, person to person spread or through eating and drinking contaminated food and water.Those working with human waste and sewage are also at occupational risk.

Signs and Symptoms

It has an incubation period of 2 - 6 weeks, but less than 10% of those infected develop symptomatic illness. Likelihood of symptomatic illness increases with age.Symptoms include mild fever, diarrhoea, nausea/vomiting and abdominal pain. Jaundice may follow and lasts up to 10 days. Recovery takes several weeks, but some patients are ill for longer. Complications can occur in those with pre - existing medical conditions or liver disease.There is no specific treatment for hepatitis a. Following infection  life long immunity occurs.

Risk for Travellers

Risk of contracting hepatitis a in high income countries is low. Non- immune travellers are at risk of contracting the disease when visiting countries where risk of infection is high. The risk of acquiring hepatitis A in high-income countries is low.  Non-immune travellers are at risk of contracting the disease during visits to countries of high or intermediate endemicity. Travellers to Africa, South East Asia, the Indian sub Continent and Latin America are at higher risk.In 2009, a total of 352 cases were reported in the UK, 61% of these where associated with travel. [2]. Although the incidence of hepatitis a infection amongst travellers is declining, it remains one of the most common vaccine preventable diseases amongst travellers. Risk is higher for those visiting friends and relatives abroad, long term travellers and those visiting countries where sanitation is poor.However, there have been cases occur in tourists staying in good quality accommodation. Many travellers think staying in a 5 star hotel puts them at lower risk, but because it can be transmitted person to person, staying in luxury accommodation in a high risk country still remains a risk.

Prevention

A every effective vaccine is available to prevent infection with hepatitis a. Two doses are required to offer long term protection ( up to 30 years) One dose will offer protection for up to 1 year, the booster dose should be given 6 - 12 months after the first dose. Ideally you should have the vaccine at least 14 days before travel, but because hepatitis a has a long incubation period it can be given at the last minute and still offer good protection. The vaccine can be given to travellers aged 1 year and over.Contraindications to having the vaccine include: acute febrile illness, previous reaction to hepatitis a vaccine and egg allergy for those receiving the brand Epaxal vaccine. Side effects to the vaccine are usually mild but can include pain and redness at the injection site, less common are mild fever, tiredness, headaches and dizziness.

Food and water hygiene is equally important. You should:

• Drink and clean teeth with bottled or boiled water
• Avoid shellfish that may have come from contaminated water
• Avoid salads that may have been washed in contaminated water
• Avoid ice in drinks , unless you are sure it has been made with clean water
• Wash hands regularly or use an alcohol hand gel when washing facilities are not available

Read our previous blog post on Typhoid, also a Food and Water borne illness.

References

1.  http://www.nathnac.org/travel/factsheets/hep_a.htm

2.  http://www.hpa.org.uk/web/HPAweb&HPAwebStandard/HPAweb_C/1195733816731

Updated Yellow Fever Requirements for South Africa

Following our previous post there have been further changes to the  Yellow Fever Vaccination requirements for entry to and from South Africa. From 1st October 2011, The South African Department of Health have confimed that a yellow fever certificate will now be required by South African authoriities for travellers coming from or travelling to Zambia. Yellow Fever vaccination requirements can be subject to change so it is always wise to check the NATHNAC website for up to date country requirements.

Advice for Travellers

There is no Yellow Fever vaccination entry requirement for travellers visiting South Africa flying directly from the UK, however, if your journey includes travel or transit through certain African countries a Yellow Fever certificate will be required.
Proof of Yellow Fever vaccination is required for all travellers age 1 year and over who enter South Africa from the following countries:

• Democratic Republic of the Congo
• Eritrea
• Ethiopia
• Kenya
• Sao Tome and Principe
• Somalia
• United Republic of Tanzania

Travellers will be required to produce a certificate of vaccination even if they passed through the above countries in transit, this includes stopping at the airport for short periods. If you are unable to have the vaccine due to a medical condition, then an excemption certificate can be issued. Speak to your GP, nurse or travel clinic.

Meningitis Recommendations for Haj and other Pilgrimages

Every year over two million Muslims from around the world make the Hajj pilgrimage to Makkar (Mecca) in Saudi Arabia. A shorter pilgrimage, Umrah can be performed at any time during the year also attracts many visitors annually. It is estimated that Hajj will fall between 4 and 7 November 2011.
The Hajj consists of several rituals that symbolise devotion to God, brotherhood and unity and all Muslims are required to perform Hajj once in their lifetime if financially and physically able.

Vaccinations

If you are travelling to Hajj or Umrah you should make sure you are up to date with all your routine vaccinations such as Diphtheria, Tetanus and Polio. It is also recommended that you check you have received 2 doses of Measles, Mumps and Rubella or had the illnesses in childhood.

All travellers are required to be vaccinated against Meningitis ACWY and a certificate of vaccination is required for entry.

Sussex Travel Clinic is partner of the Muslim Council of Britain Meningococcal (ACWY) vaccination package programme and offer the vaccine at a reduced rate of £35 per dose- please call 01273 749100 to book or discuss.

Seasonal Flu- the Ministry of Health of Saudi Arabia recommends that pilgrims should be vaccinated with the flu vaccine before travel. Flu can be easily spread in crowded conditions through coughing and sneezing. You may be entitled to a free flu vaccinated from your NHS GP or we can provide a flu vaccine at the clinic. Clinics commence in October 2011.

Pilgrims should consider vaccination against Hepatitis B. Hepatitis B is a virus that is spread through blood contact or sexual contact.All males attending Hajj must have their heads shaved and the Saudi government provides licensed barbers who will use a new blade for each pilgrim, however unlicensed barbers may not do this. Sharing razors carries a risk of contracting blood borne viruses such as Hepatitis B, Hepatitis C and HIV. It is much safer to bring your own disposable razor.

Yellow Fever vaccination - the Saudi Arabian government requires travellers who arrive from yellow fever risk countries to be vaccinated against Yellow Fever. This is not a requirement if travelling from the UK. Yellow Fever risk countries can be viewed here Yellow Fever Risk Countries.

Travelling to Hajj can pose some health risks. The Hajj can be very physically demanding especially in the hot heat of Saudi Arabia so you will need to take plenty of high factor sun cream. Clean water and sanitation is harder to maintain in conditions like the Hajj, it is important to make sure you drink plenty of fluids and carry clean drinking water. A useful leaflet is available in several languages with tips on keeping healthy when travelling to the Hajj and Umrah- you can view it here.

What is Altitude Sickness?

Trekking in some of the world’s highest mountains is becoming much more common as travellers go off to destinations such as Mount Kilimanjaro in Tanzania and the Inca Trail in Peru on treks for charity or pleasure. Trekkers to these popular destinations are at risk of Altitude Sickness, though not all trekkers will experience it.

Mount Kilamanjaro, Tanzania - a popular trekking destination

What is Altitude Sickness?

Altitude sickness or Acute Mountain Sickness (AMS) is a potentially life threatening condition caused by a decrease in atmospheric pressure, which makes breathing difficult. AMS is caused when you are exposed to high altitude without acclimatising first and can occur at altitudes usually higher than 2,500 metres. At high altitudes the percentage of oxygen in the air remains the same, however partial pressure drops. This pressure drives oxygen into the blood stream and the decrease results in lower oxygen levels in the blood. The way our bodies cope with this lack of oxygen is to increase our breathing rate, which then increases carbon dioxide levels in the blood and symptoms of AMS occur. AMS symptoms usually occur 6 – 12 hours after arrival at altitude, but can begin more than 24 hours after ascent. Common symptoms include: headache, nausea, sleep disturbance, dizziness and exhaustion. If you start to experience these symptoms they will usually resolve within a couple of days if further ascent does not occur.

Am I at Risk?

It is difficult to predict who will get AMS, and being physically fit does not necessarily put you at lower risk. If a traveller has previously experienced no symptoms at altitude, they are less likely to get AMS, however even this may be unreliable. Rapid ascent is the highest risk factor. 50% of trekkers in Nepal developed AMS at altitudes of between 4,500 and 5000 metres. Another study showed that 84% of trekkers experienced AMS when they flew directly to 3,860 metres [1].

Prevention

The most important factor in the prevention of AMS is adequate acclimatisation and regular rest days. A short period of acclimatisation (1-3 days) at 3,000m should be followed by further ascent which should be gradual, with no more than a 300-500m increase in sleeping altitude per day. You should have a rest day every 3 days. If you start to experience mild AMS symptoms, no further ascent should be taken until symptoms have resolved. If you experience severe symptoms of AMS rapid descent should be immediate.

Diamox (Acetazolamide)

Diamox is used as prevention for AMS, although it is unlicensed in the UK. Diamox should not be considered as an alternative to adequate acclimatisation and gradual ascent, Diamox will hasten acclimatisation, and may help to relieve the symptoms of AMS but will not relieve symptoms immediately when taken for treatment. Symptoms usually resolve within 12-24 hours when used in treatment.
If travellers use Diamox, a trial dose of 250mg once daily for two days should be taken prior to travel.
If no adverse events are experienced, it should then be commenced one to two days prior to ascent to 3,500m and then continued for at least two more days after reaching the highest altitude.
Diamox can cause nausea, increase in urine output, and oral and finger tingling. More unusual side effects include rashes, flushing and thirst.
It is contraindicated in those with hypersensitivity to sulphonamides and anyone who has experienced an anaphylactic reaction in the past.


How Does It Work?

Put simply Diamox works by forcing the kidneys to excrete bicarbonate the base form of carbon dioxide.
It speeds up the acclimatisation process
It also stimulates breathing during the night
Lessens the symptoms of AMS


Severe Mountain Sickness

Acute mountain sickness progresses in less than 10% of cases to the more severe form where travellers experience lethargy, confusion and lack of coordination or muscle movements.
Initial symptoms include shortness of breath with exertion, and a dry cough, progressing to shortness of breath at rest. The cough may become productive with blood stained sputum.
Anyone with symptoms of severe mountain sickness should descend immediately. This can progress rapidly and death is the likely consequence if a descent is not made as soon as the symptoms are recognised.

References

1.     NATHNAC - http://www.nathnac.org/travel/factsheets/altitude.htm

Disease Focus- Bilharzia

 

So you are on holiday and Lake Malawi looks cool, refreshing and inviting, but should you swim in it? The simple answer is no. Fresh water sources such as Lake Malawi are infected with parasites that cause Schistosomiasis, otherwise known as Bilharzia and swimming should be avoided if you don't want to become infected with this parasite. So however inviting the water looks - Don't be tempted to swim in it.

The inviting waters of Lake Malawi should be avoided.

What is Schistosomiasis?

Bilharzia is caused by infestation by a type of flatworm, or fluke (parasite). Fluke larvae are released by freshwater snails. These larvae penetrate the human skin and mature into adults. Adult worms live for many years in mesenteric or vesicular veins. They release ova which cause scarring of the bladder and rectum.

Where can I catch Bilharzia?

Bilharzia is caught through swimming or showering/ bathing with water fresh from lakes or rivers. Bilharzia mainly affects people in developing countries Africa, South America, and less so in the Middle and Far East .People from the UK become infested only when visiting tropical countries. About half of all those who swim in Lake Malawi test positive for Bilharzia on their return.  

Symptoms

'Swimmer's itch' develops where the parasite enters the skin, and is often the only symptom noticed.

Other possible symptoms include muscle pain, headache, diarrhoea, fever, vomiting, coughing, a burning sensation when passing urine, passing urine more frequently and blood in the urine.

How can I prevent catching Bilharzia?

The infection can be avoided by not swimming, paddling, wading, washing or drinking water in tropical lakes, rivers, canals or freshwater pools (that haven’t been chlorinated) . Swimming pools that have been chlorinated and well maintained pose no risk. There is no vaccination or medication that can be taken to prevent infestation.

How is Bilharzia treated?

If exposure has occurred, seek medical advice. Infestation is treated with medication (Praziquantel ) to kill the parasite.

Untreated Bilharzia may cause life-threatening urinary system or liver damage, bladder tumours and bowel cancer.

What should I do if I have returned from a trip and been swimming in a fresh water source in an endemic area?

You should seek advice from your GP who will refer you to an infectious disease or tropical medicine specialist for treatment.

Remember, you should always seek travel advice from your nurse or GP before you plan an overseas trip to ensure you have the correct vaccinations and malaria tablets if required for your destination.

Disease Outbreaks Updates

Avian Flu Egypt - 16 June 2011
Five cases of human infection with Avian influenza (Bird Flu) have been reported to World Health Organisation (WHO) by the Egyptian Ministry of Health. All cases were aged 40 years and younger, 3 cases have died and 2 cases are recovering. All cases had exposure with poultry suspected to have Avian Flu.

Advice for Travellers: avoid visiting live animal markets and poultry farms. Avoid eating undercooked poultry. Wash hands regularly before eating or use an alcohol hand gel.

E Coli Germany 10 June 2011

Germany has reported an increase in cases of Escherichia Coli. The outbreak has been going on since May 2011 and a total of 759 cases have been reported to date. 21 cases have been fatal and a total of 2229 cases of bloody diarrhoea have also been reported. E Coli is spread through eating or drinking contaminated food or water. The most likely source of this outbreak has been through consumption of bean sprouts.  

Advice for Travellers: there is no vaccine available to prevent E Coli, therefore travellers should practice strict food and water hygiene precautions and avoid consuming bean sprouts. If you have recently returned from Germany and are experiencing E Coli symptoms: bloody diarrhoea, cramping and pain - seek urgent medical attention.

Polio Chad - 10 June 2011
65 case of wild polio virus type 1 and 3 cases of wild polio virus type 3 have been reported to date in 2011

Advice for travellers to Chad:
Make sure you have received a full primary course of Polio vaccination in childhood and if it is over 10 years since your last booster ensure you are vaccinated before travel. Polio is spread through contaminated water - make sure you drink only boiled or bottled water from a safe source.

Avian Flu Cambodia - 10 June 2011
One case of human infection with Avian influenza (Bird Flu) has been reported to WHO by the Cambodian Ministry of Health. The 7 year old child died and all 6 cases reported in 2011 in Cambodia have been fatal. The child was from Prasat village, Prasat commune Kampong Trabek district, Prey Veng Province and had been exposed to sick poultry.

Advice for Travellers: avoid visiting live animal markets and poultry farms. Avoid eating undercooked poultry. Wash hands regularly before eating or use an alcohol hand gel.

Avian Flu Indonesia - 3 June 2011
One case of human infection with Avian influenza (Bird Flu) has been reported to WHO by the Indonesian Ministry of Health. The 1 year old child from the North Jakarta District recovered. The child had been exposed to poultry when visiting a local market with her father who was buying chickens.

Advice for Travellers: avoid visiting live animal markets and poultry farms. Avoid eating undercooked poultry. Wash hands regularly before eating or use an alcohol hand gel.

References

World Health Organisation http://www.who.int/csr/don/en/
Nathnac http://www.nathnac.org/

Planning your holiday- Tips to stay safe and healthy on your travels

Vaccinations and Travel Health

When planning an overseas trip it is advisable to consult your doctor or travel clinic at least six weeks prior to your departure. Many vaccinations such as rabies and hepatitis b, require more than one dose, so allow plenty of time before your trip to complete the necessary immunisations.

Malaria is spread through the bite of an infected mosquito and is present in many parts of the world. If you are travelling to a malarial area you will need to take anti malarial tablets. A useful website that shows worldwide malaria maps is FitForTravel  Mosquitoes spread other diseases, such as Dengue fever and it is important to avoid mosquito bites during the day and at night. It is recommended that you sleep under an impregnated mosquito net and use a DEET based repellent on any exposed skin.

Sun Care

Sunburn and heatstroke can ruin a trip. To avoid this follow these useful tips:

• Use a high factor sunscreen 25 SPF or more and apply frequently, especially after swimming
• Avoid going out in the hottest part of the day between 11 am and 3 pm
• Use protective clothing and hats; this is particularly important for children.
• Drink plenty of fluids and be aware that alcohol can dehydrate you.

Staying safe

With all the recent unrest in many countries it is advisable to register with LOCATE. You can register your details online at LOCATE In the event that there is a natural disaster or unrest in the country you are visiting, the FCO will be aware of your presence in the country and be able to assist you in the event of an emergency.

Jane Bell RGN

Nurse Director Sussex Travel Clinic

Bimuno -Don't let travellers diarrhoea ruin your trip - It Really Works

I have just recently returned from a wonderful trip to Egypt and decided to try Bimuno, a product which we recommend and sell in clinic. I always seem to experience stomach problems when I go away and was very keen to give this product a try myself and discover what all the fuss is about. I have to say it is fantastic and for the first time ever I did not suffer from an upset tummy.
I was very worried about going to Egypt, especially after the recent troubles, shark attack and reading a recent report that Egypt in fact ranks higher than India for cases of travellers diarrhoea. Well I ate everything and experience only 1 day where I had slight cramps. For me this is a miracle as I am usually plagued all week, even in low risk destinations like Spain.
Having tried Bimuno now,  I am more than happy to continue recommending it to patients as a great product to reduce the risk of getting travellers diarrhoea.

What is Bimuno?

Bimuno is a unique second generation prebiotic Galacto-oligosaccharide formulation. It helps encourage and sustain a healthy level of your gut’s ‘good’ bacteria (Bifidobacteria) helping to prevent “bad bacteria” from becoming established. Unlike other prebiotics it also has unique anti-adhesive properties, which help the body to drive out “bad” bacteria .
It is very easy to take and comes in either a powder or pastille. I chose the Bimuno pastilles for my trip and found it very easy to take. You take 3 pastilles a day for 7 days before your trip and every day you are away. The pastilles have a pleasant taste and should be taken after breakfast every day to be most effective.

How effective is Bimuno?

In a scientific study 8 out of 10 travellers to high risk destination experienced a diarrhoea-free trip

Those travellers that did experience diarrhoea, experienced less cramps and found symptoms were reduced by half the time,  if they had taken Bimuno.

Written by:

Jane Bell RGN

MMR for Travellers - HPA urging travellers to have measles jab

A recent report on BBC news says that the Health Protection agency is urging UK travellers to ensure they are protected against measles following an increase in cases in many European destinations. With Easter nearly upon us, many families will be planning overseas holidays and many popular destinations have been reporting an increase in cases of the measles virus. The countries reporting increases include Denmark, France, Germany, the Netherlands and Turkey. France reported over 1500 cases in 2009, more than 4500 in 2010 and there were 1000 cases reported in January 2011 alone.
UK travellers are urged to check their children have had two doses of the Measles, Mumps and Rubella( MMR) vaccine. Adults who have never had the measles virus or only had one dose of MMR should also consider a booster.
Measles is a notifiable disease and is spread through droplets from the nose and mouth of an infected person.  It is highly contagious and following an incubation period of 10 -14 days symptoms appear which include fever, cough and a rash.
Measles is not only present in European countries and if you are travelling to other destinations including Africa, Asia and South America it is equally important that you ensure your are covered. Speak to your nurse or GP when planning your trip. MMR is a live vaccine and should not  be given within 4 weeks of receiving another live vaccine such as Yellow Fever. Make sure you see your nurse or GP at least 6 weeks prior to travel to ensure you can complete any recommended vaccinations.

World TB Day - 24th March 2011

Today is World Tuberculosis (TB) Day. World TB Day commemorates the day when in 1882 when Dr Robert Koch announced he had discovered the cause of tuberculosis. The goal of the Stop TB Campaign is to inspire innovation in TB research and care in the fight for TB elimination worldwide.
TB can affect any part of the body but the most common type is pulmonary TB. Pulmonary TB infection is  spread through inhalation of droplets from an infected person. These are passed on through coughing and you usually have to have prolonged contact with an infected person to contract TB yourself. Tuberculosis is responsible for nearly two million deaths each year, mainly in  Africa, South and South East Asia. The majority of cases occur in Bangladesh, India, Indonesia, Myanmar and Thailand.(1) Those infected with HIV are more at risk of death as TB can enhance progression of HIV and visa versa.

Do I need a TB Vaccine for travel to infected areas?

This is a question we get asked often in travel clinic. The UK introduced  a BCG vaccination programme in 1953 to inoculate children of school leaving age. The programme has undergone several changes since then and in the UK routine vaccination against TB is now not offered to school leavers. Studies have shown that the vaccine  is less effective in preventing respiratory disease, which is the more common form in adults and so guidance has changed accordingly. The Department of Health Guidance now recommends only the following people should be vaccinated:

• all infants (aged 0 to 12 months) living in areas of the UK where the annual incidence of TB is 40/100,000 or greater*
• all infants (aged 0 to 12 months) with a parent or grandparent who was born in a country where the annual incidence of TB is 40/100,000 or greater
• previously unvaccinated children aged one to five years with a parent or grandparent who was born in a country where the annual incidence of TB is 40/100,000 or greater. These children should be identified at suitable opportunities, and can normally be vaccinated without tuberculin testing
• previously unvaccinated, tuberculin-negative children aged from six to under 16 years of age with a parent or grandparent who was born in a country where the annual incidence of TB is 40/100,000 or greater. These children should be identified at suitable opportunities, tuberculin tested and vaccinated if negative (see section on tuberculin testing prior to BCG vaccination)
• previously unvaccinated tuberculin-negative individuals under 16 years of age who are contacts of cases of respiratory TB (following recommended contact management advice – see National Institute for Health and Clinical Excellence (NICE), 2006)
• previously unvaccinated, tuberculin-negative individuals under 16 years of age who were born in or who have lived for a prolonged period (at least three months) in a country with an annual TB incidence of 40/100,000 or greater.
BCG is not usually recommended for people aged over 16 years, unless the risk of exposure is great (e.g. healthcare or laboratory workers at occupational risk). If you think you may need a BCG vaccination discuss it with your doctor or nurse. References 1. Nathnac http://www.nathnac.org/pro/factsheets/TB.htm

Call for boys to be vaccinated against Human Papilloma Virus (HPV)

There has been a lot in the media this week suggesting that boys should now be vaccinated against the human papilloma virus (HPV) after a study found that 50% of boys are infected with the virus. The study was carried out by researchers in Florida and the results published in the medical journal, The Lancet.
HPV causes 99% of all cervical cancers. Cervical cancer is cancer of the cervix (the entrance to the womb) and the HPV vaccine has been shown to prevent pre- cancerous legions caused by HPV types 16 and 18. The UK currently has a vaccination programme for girls age 12 - 18 years, but boys are not included in the current campaign. This new study has raised the debate on whether it is cost effective for the NHS to include boys in the National Vaccination programme.
A few weeks ago there was a very interesting documentary on the BBC presented by actress Jaime Winstone. The programme highlighted the increase in throat cancers caused by infection with HPV through oral sex.Again the HPV vaccine was discussed and Professor Stanley on the programme suggested the vaccine should be available to both men and women. However, David Salisbury, Director of Immunisation, said the government had no current plans to extend the scheme.
In our clinic we have recently seen an increase in the numbers of enquiries about the HPV vaccine from both men and women aged over 18 years who are not included in the NHS vaccination programme. Sussex Travel Clinic offers the Gardasil vaccine. Gardasil is the only cervical cancer vaccine that helps protect against 4 types of papillomavirus: 2 types cause 70% or cervical cancer cases, and 2 more types that cause 90% of genital warts cases. The vaccine is given on day 0, 1-2 months later and a booster dose at 6 months.
Gardasil is licensed for use in women up to the age of 45 and for use in boys age 9 - 15 years.

Rabies Death Toll Continues to Rise in Bali

Travellers visiting Bali, Indonesia should consider getting a course of Rabies vaccinations. Since 2008 there has been an on going rabies epidemic on the island and more recent reports suggest it is now present in the surrounding islands of Nusa Penida, which include the islands of Nusa gede, Nusa Cenningan and Nusa Lembongan. These islands were considered rabies free until the recent deaths of 2 residents.
Reports from the International Society for Infectious Diseases ( ISID)  suggest that the death toll from the outbreak of rabies in Bali is continuing to rise, despite mass immunisation of  dogs on the island, with at least 5 people known to have died in 2011. This takes the official death toll from rabies to 119 since the outbreak began in 2008.The Indonesian Authorities now confirm there are no longer any areas that are free from the disease.
Rabies is nearly always fatal and is spread through the bite, scratch or lick to an open wound from an infected animal.
Unvaccinated travellers need to have immediate treatment with rabies immunoglobulin which is currently unavailable on the island. Having a course of pre exposure rabies vaccines eliminates the need for rabies immunoglobulin.

Advice to travellers

• Avoid contact with animals on the island.
• Consider having a pre exposure course of rabies vaccine before your trip. This is given on day 0, 7 and 21 or 28. Discuss this with your doctor or nurse at least 6 weeks before your planned journey.
• Certain activities such as cycling put you at higher risk.
• If you do get bitten seek immediate medical attention, even if you have had pre exposure rabies vaccination.
• Check your insurance covers you for medical evacuation in the event you do get bitten and need to fly home for treatment.

Do I need a Cholera Vaccination?

Cholera is spread through drinking contaminated water . It can also be caught through eating contaminated shellfish or food. Cholera is present in many countries in Africa, India, South East Asia and some countries in South America and the Caribbean. Click here to see a map of countries reporting Cholera  in 2009.

Am I at risk?

Cholera in travellers is rare and vaccination is not normally required. However, if you are working in slum regions or refugee camps in countries with cholera outbreaks your doctor or nurse may recommend you have the cholera vaccine before your trip. Having access to clean drinking water and avoiding contaminated food is essential to avoid getting infected with cholera.

Cholera Vaccination

The Cholera vaccine is given orally and two doses are required. You need a second dose 1-6 weeks after the first dose has been administered. You should not eat or drink for 1 hour before or 1 hour after having the vaccination. The vaccine is suitable for adults and children aged 2 years and over. A booster is required every 2 years if you are at continued risk of exposure to cholera.
Side effects: most people tolerate the vaccine very well, common side effects reported are headaches and stomach upsets.

Tips for avoiding contaminated food and water

• Ensure you only drink clean water. Boiled water or bottled water is fine but check the seals to ensure it has not been filled with tap water.
• Clean your teeth with bottled or boiled water.
• Canned drinks and hot drinks are usually ok to drink.
• Avoid ice in your drinks.
• Consider using a sterilising agent such as chlorine if you are unsure if the water is safe or not.
• Eat only well cooked fresh food.
• Avoid left over or reheated foods
• Avoid salads that may have been washed in contaminated water.
• Never drink unpasteurised milk
• Avoid ice cream, if made from unpasteurised milk.
• Wash your hands regularly or use an alcohol hand gel.

The Importance of Travel Insurance- Are you covered?

So you've booked your holiday but have you purchase an insurance policy? Many people travel abroad uninsured and find that when things go wrong it can be very costly, running into thousands if you need to be repatriated to the UK.

Following the recent political unrest in Tunisia and Egypt it is vital all travellers check what their insurance policy actually covers them for. The FCO says that 60% of travel policies now cover terrorism, but most will not cover you for political unrest.

 European Health Insurance Cards (EHIC)

A recent report in the Journal of BTHA[i] states that holidaymakers in Europe could have their insurance claims rejected if they do not have a valid EHIC card. These cards allow you to access state-provided healthcare in all of the European Economic Area (EEA) countries and Switzerland at a reduced cost or sometimes free of charge. It should not be used as a substitute for private travel insurance as it does not cover things like mountain rescue or repatriation to the UK. You can apply online and the card last up to 5 years. If you are due to travel to Europe soon apply or check yours is in date today. Children need their own card.

What happens when things go wrong?

holidaytravelwatch.net shows many examples of what can happen when things go wrong. The one that drew my attention was the importance of having travel vaccinations. A couple had to cancel their holiday to Egypt as they had been told by their travel agent that inoculations were not required for travel to Egypt. Whilst there is no entry requirement for vaccinations to Egypt, vaccinations are recommended for your own protection. This couple had to cancel their holiday as their insurance would not cover them as they had not had their vaccinations. Speak to your doctor, nurse or travel clinic for advice when travelling.

What to look for when taking out insurance?

·         Shop around for travel insurance, the cheapest policy may not be the best – always check what is excluded.
·         Check your policy covers you for sports such as skiing, white water rafting or water skiing for example.
·         Check the cancellations section carefully – what are you covered for?
·         Always tell your insurance company about pre- existing medical conditions. If you fail to reveal a medical condition it may invalidate your insurance.

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[i]  Journal of the BTHA, Volume XVI, 2011