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