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.