Dengue is a mosquito-borne infection that has become a major international public health concern in recent decades. Caused by the bite of a mosquito infected with a Dengue virus, a mosquito can acquire the virus by biting an infected person and then be able to transmit the virus to another person. The mosquito remains infectious for the rest of its life.

Dengue is usually found in tropical and sub-tropical regions including South East Asia, India, the Carribean, South and Central America and Africa. Most cases of Dengue reported are associated with travel to South East Asia and India. Thailand, Vietnam, Singapore and Malaysia have all reported an increase in cases. The World Health Organization (WHO) estimates there may be 50 million Dengue infections worldwide every year.

After being bitten by a mosquito carrying the virus, the incubation period ranges from 3 to 14 days before symptoms may appear. Some people who contract Dengue do not have any symptoms at all, with young children often having a fever with a rash, but other symptoms being minor. Older children and adults may have mild symptoms; however they are more likely to experience a sudden onset of high fever and the following symptoms:

• severe headache (especially behind the eyes)
• muscle and joint pain (ankle, knees and elbow)
• flushing of face and neck
• unpleasant metallic taste in mouth, loss of appetite, sickness, vomiting and diarrhoea
• a bumpy red rash which starts on the chest, back or stomach and spreads towards the limbs and face.

There is currently no vaccine to protect against Dengue. To control and prevent yourself from Dengue (see fact sheet):

• elimiate mosquito breedint sites (e.g.: tyres, buckets)
• wear insect repellent
• spray insect surface spray in dark and shady places where mosquitoes like to hide.

If any symptoms of Dengue are experienced, apply insect repellent and see a doctor immediately.

For more information view the World Health Organization (WHO) fact sheet, visit the Queensland Health Department website or discuss with your Travel Clinic East Perth travel doctor.

Rabies is caused by a virus that attacks the nervous system. The virus is secreted in saliva and is commonly transmitted to humans through a bite from an infected animal. Less commonly, rabies can be transmitted when saliva from an infected animal comes into contact with an open cut or wound.

You should seek medical attention for any animal bite and wash the wound vigorously with soap and lots of water. Prompt and appropriate treatment after being bitten and before the disease develops can stop infection and prevent the disease from developing.

The period between infection and the first symptoms (known as the incubation period) can be anywhere from one week to more than a year. The closer the bite is to the head, generally, the shorter the incubation period. Most people first develop symptoms of pain, tingling, itching or shooting from the bite or virus entry site. If the bite is not treated in time, they may experience flu-like symptoms including fevers, chills, fatigue, muscle aches and headaches; and then progress to involve the respiratory, gastrointestinal and/or central nervous system. Gradually, if left untreated, people with rabies will be come extremely ill, developing a variety of symptoms including high fever, confusion, agitation and eventually seizures and coma. The primary cause of death is usually respiratory insufficiency.

Wound cleansing and immunizations, done correctly and as soon as possible, can prevent the onset of rabies in virtually 100% of exposures. Once the signs and symptoms of rabies begin to appear, there is no treatment and the disease is almost always fatal.

For more information view the World Health Organization (WHO) fact sheet or discuss with your travel doctor.

Symptoms of Dengue Fever

Typical symptoms of dengue fever include:

• fever
• headache
• sore muscles
• nausea
• vomiting
• rash

Treatment for Dengue Fever

The main treatment for dengue fever is to encourage the intake of food and especially fluids. This may be supplemented with intravenous fluids if necessary.

Dengue Fever Vaccine

There is no clinically proven vaccine available for the prevention of dengue fever. It is therefore important that travellers to high risk areas take precautions to prevent infection.

Prevention of Dengue Fever

As there is no vaccine available to prevent dengue fever, people in high risk areas are advised to protect themselves against infection by avoiding mosquito bites. Mosquitos carrying dengue fever typically bite during the day, especially at dawn and dusk. Avoid getting bitten by wearing clothing which protects the skin and by using insect repellents on exposed skin. It is also recommended to remove all potential breeding sites for mosquitos such as still water found in containers, pots, and old tyres.

High Risk Destinations

Dengue fever can be found in any tropical or subtropical area and is most prevalent during the warm and humid seasons. Mosquitos infected with the dengue fever virus can be found in both rural and urban areas including major cities. The highest risk is for travellers visiting South East Asia and Central and South America. In Australia, the risk is mainly confined to northern Queensland including Cairns and Townsville as well as the Torres Strait Islands.

Travel Vaccinations for Indonesia and Bali

Travel vaccination requirements and recommendations are subject to change but we currently suggest the following vaccines for travellers to the region.

Recommended for all travellers to Indonesia:

• Hepatitis A vaccine
• Typhoid fever vaccine
• Flu vaccination (for people over 50 or people with a compromised immune system)

For travellers staying for longer periods or for frequent visitors:

• Hepatitis A vaccine
• Hepatitis B vaccine
• Typhoid vaccine
• Japenese Encephalitis vaccine (especially for visitors to Bali, Kalimantan, Nusa Tenggara, Sulawesi, Mollucas, Irian Jaya, and Lombok)
• Rabies vaccine (rabies can be transmitted by monkey bites as well as from other infected animals)

Other Diseases

Malaria is of high risk in rural areas but the main cities and tourist areas, such as Bali, and generally risk free.

Diarrhoea is very common throughout the country, including with visitors staying in high end accommodation.

Other diseases to be aware of include:

• Avian Influenza (bird flu)
• Dengue Fever
• Tuberculosis
• Herpes B (can be transmitted by monkey bites)

Cholera can be life threatening if left untreated or in very severe cases but with treatment, the death rate is less than 1%.

Symptoms of Cholera

The main symptom of cholera is diarrhoea but other stomach related symptoms are often also present. Most of the symptoms are a result of severe dehydration caused by fluid loss due to the diarrhoea. Possible symptoms include:

• diarrhoea
• stomach cramps
• muscle cramps
• vomiting
• fever

Treatment for Cholera

The typical treatment for cholera involves aggressive rehydration to restore lost body fluids as well as treatment to replace electrolytes. The treatment usually consists of an intravenous injection of a salt/sugar solution.

Cholera Vaccine

The cholera vaccine is given in two doses and generally provides protection for 3 years. The cholera vaccine is not 100% effective so travellers should take care at all times when consuming food and water in high risk areas.

High Risk Destinations

Vaccination against cholera is recommended for travellers to certain high risk countries and regions where there is an immediate risk of cholera. Although any traveller to these regions may require the cholera vaccine, it is mainly administered to health care and emergency relief workers. Cholera is present in many countries such as:

• Afghanistan
• Angola
• Cameroon
• Central African Republic
• Chad
• Congo
• Côte d’Ivoire
• Equatorial Guinea
• Ethiopia
• Ghana
• Guinea-Bissau
• Iraq
• Liberia
• Madagascar
• Malawi
• Mauritania
• Mozambique
• Nigeria
• Senegal
• Sierra Leone
• Somalia
• South Africa
• Sudan
• Swaziland
• Tanzania
• Togo
• Uganda
• Zambia
• Zimbabwe

Travel vaccination advice is subject to change so please consult your doctor well before you plan to travel.

• Hepatitis A
• Hepatitis B
• Cholera
• Japanese Encephalitis
• Rabies
• Typhoid Fever
• Yellow Fever

Hepatitis A can easily be spread through personal contact, eating contaminated raw seafood or drinking contaminated water, so you may consider getting vaccinated against it no matter where you are headed.

Japanese encephalitis may be a risk for travellers to:

• Bali
• Bangladesh
• Cambodia
• China
• India
• Indonesia
• Malaysia
• Myanmar
• Nepal
• Pakistan
• Papua New Guinea
• Thailand
• Timor
• Torres Strait islands
• Vietnam

Vaccination against cholera is recommended for emergency relief and health care workers travelling to Afghanistan, Iraq, and Africa.

Travellers heading to developing countries in Asia (especially India), Africa (north and west), and Central and South America (especially Peru) may wish to get vaccinated for Typhoid Fever.

Vaccination against Yellow Fever may be necessary for travellers to certain regions in Africa, South America, Central America, and the Caribbean.

Other diseases to be aware of when travelling are:

• Dengue Fever
• Malaria
• Meningococcal Meningitis
• Other strains of hepatitis
• HIV/AIDS

If you require a vaccine or would like further information, contact us for an appointment. We are registered with Travel Clinics Australia to provide travel vaccinations and can help you with all your vaccination needs.

• raw fruit
• raw vegetables
• milk
• other dairy products
• seafood
• water

Symptoms of Typhoid Fever

Some people present no or very mild symptoms so it is important to see your doctor immediately if you suspect you may have Typhoid Fever. There is a wide range of possible symptoms which may or may not include the following:

• sustained fever
• severe headache
• constipation
• chills
• sore throat
• nausea
• abdominal pain
• skin rash
• loss of appetite
• diarrhoea
• enlarged liver

Treatment for Typhoid Fever

Antibiotics are used to treat Typhoid and prompt treatment reduces the fatality rate to around 1%. However, left untreated, the fatality rate is around 10% to 30%.

Typhoid Fever Vaccination

Prevention is the best cure so it is advised to avoid consuming potentially contaminated food and water in high risk, unsanitary areas. In such high risk areas, you may wish to only consume bottled water, even when cooking and when brushing teeth.

If you will be travelling to a country where the disease is endemic, you may wish to get vaccinated against Typhoid Fever. This can be achieved by a simple injection, giving you immunity for 3 years. It is important to note that the vaccine doesn’t give 100% immunity so good hygiene is essential while travelling.

High Risk Destinations

Typhoid Fever is rarely found in developed countries. High risk areas include any endemic regions where environmental hygiene is poor and drinking water is unsafe. This includes certain regions of:

• Asia (especially India)
• Africa (north and west)
• South America (especially Peru)

Infection

Japanese encephalitis is transmitted by the bite of an infected mosquito. The incubation period is generally between 6 and 16 days so it’s important to see a doctor as soon as possible after a suspected infection. Japanese encephalitis can not be transmitted from person to person.

Symptoms

Symptoms of Japanese encephalitis vary depending on the severity of the infection but may include:

• lethargy
• neck rigidity
• high fever
• headache
• disorientation
• tremors
• gastrointestinal symptoms

Treatment

There is no specific therapy to treat Japanese encephalitis. Patient care focuses on treating the symptoms displayed.

Prevention

There are two methods of prevention of Japanese encephalitis:

1. Vaccination
   Immunisation against Japanese encephalitis involves a course of vaccinations over a 30 day period. The vaccine is given on days 0, 7, and 28. A booster vaccine is required every 3 years.
   
2. Mosquito Avoidance
   If you find yourself in a high risk area and you haven’t been vaccinated, then you can follow these tips for mosquito avoidance:
   
   • Use an insect repellent.
   • Stay indoors between dawn and dusk.
   • Cover up with light coloured, loose fitting clothing.
   • Avoid strong scented soaps and perfumes.
   • When sleeping, use a mosquito net impregnated with insecticide.

High Risk Destinations

Your travel doctor can give you specifics about prevention of this virus and whether vaccination is required or advised in your case, however, the broad regions where your are most likely to find the infected mosquitos are:

• South East Asia
• Far East

Specific high risk countries vary depending on recent outbreaks. These countries may include:

• Bali
• Bangladesh
• Cambodia
• China
• India
• Indonesia
• Malaysia
• Myanmar
• Nepal
• Pakistan
• Papua New Guinea
• Thailand
• Timor
• Torres Strait islands
• Vietnam

Visit your doctor to determine the best method of prevention or treatment for you.

• being in a different climate
• being in a different environment
• having more contact and closer contact with other people
• eating in less sanitary places
• being faced with less hygienic facilities
• participating in more risking behaviour than your would at home
• being exposed to diseases which are less prevalent in Australia

Check with your doctor before departing on holiday for information on travel vaccinations which can prevent a number of the common travel related diseases. However, vaccines are not always available and other methods of prevention are required.

Top 10 Travel Related Diseases

1. Cholera
   Cholera is a disease caused by a bacteria transmitted to humans by food or water. Contamination usually occurs when untreated sewerage is released into waterways and then that water is used in the preparation of food. Symptoms include severe muscle and stomach cramps. Prevention includes sterilising water before use by boiling and/or filtering.
   
2. Dengue Fever
   Dengue fever is caused by a virus found in the tropics. It is transmitted to humans by infected mosquitos. Symptoms include headache, muscle pain, joint pain, and fever along with a bright red rash (although this is not always present). Currently, there is no vaccine available for the prevention of dengue fever so the best way to avoid this disease to avoid being bitten by mosquitos in affected areas.
   
3. Hepatitis
   Hepatitis is an inflammation of the liver. Symptoms include joint pain, abdominal pain, loss of appetite, nausea, and jaundice. There are numerous types of hepatitis but the most common form contracted when travelling is hepatitis A. Hepatitis A can be spread through personal contact, consumption of raw seafood or by contaminated water. A vaccine is available to prevent infection from hepatitis A for life. A vaccine is also available to prevent hepatitis B.
   
4. HIV/AIDS
   HIV infection can occur by the transfer of blood, via sexual contact or by breast milk. Prevention includes avoiding unprotected sexual intercourse and contaminated needles. There is no vaccine available to prevent infection.
   
5. Japanese Encephalitis
   Japanese encephalitis is a disease spread by infected mosquitos. Travellers to Southeast Asia and the Far East are at the most risk. Sever neck rigidity, fever, and headache are symptoms of this sometimes fatal disease. See your doctor about vaccines available to prevent Japanese encephalitis.
   
6. Malaria
   Malaria is an infectious disease found in tropical and sub-tropical areas. It is generally spread by mosquitos and is particularly common in Sub-Sahara Africa. Symptoms include fever, shivering, joint pain, and vomiting. No vaccine is currently available for Malaria however, preventative drugs are available to help reduce your risk of infection.
   
7. Meningococcal Meningitis
   This disease is a bacterial infection spread by close contact with an infected person. It is more common in young people. Symptoms include headache, fever, chills, stiff neck, and a rash. A vaccine is available to prevent certain groups of the meningococcal bacteria.
   
8. Rabies
   Rabies is a virus affecting mammals, including humans. It is usually spread by the bite of an infected animal such as a dog, cat, bat or fox. Initial symptoms to appear are similar to the flu. Post exposure vaccinations are effective if administered promptly. Although Australia is rabies free, most countries are not. The vast majority of cases of rabies occur in Africa, Asia, and South America.
   
9. Typhoid
   Typhoid is a common bacterial illness transmitted by ingested food or water contaminated by the faeces of an infected person. Typical symptoms include fever, headache, and diarrhoea. You can be vaccinated against typhoid fever and vaccination is recommended for people travelling to certain areas of Asia, Africa, and Latin America.
   
10. Yellow Fever
    Yellow fever is a viral disease spread primarily by mosquitos. Symptoms include fever, headache, loss of appetite, vomiting, jaundice, and a slow pulse. Yellow fever is preventable by a vaccine which gives immunity for around 10 years. Vaccination may be necessary for travellers to certain regions in Africa, South America, Central America, and the Caribbean.

Travel vaccination requirements are subject to change. Please see your doctor for full information on vaccinations and other prevention methods well before travelling to high risk destinations.

Our doctors and medical staff have many years of experience in a wide range of fields. Although we focus on the administration of travel vaccinations, we also provide other health services including:

• Acupuncture
• Adult and child immunisations
• Audiometry testing
• Blood pressure reviews
• Breast examinations
• Contraception advice
• Cryotherapy
• Diabetes reviews
• Diving medicals
• ECG
• Executive medicals
• Fitness medicals
• General health assessments
• GP management plans
• Home visits
• HUET medicals
• Insurance medicals
• Medication management reviews
• Minor surgical procedures (such as skin cancer, skin lesion, and wart removal)
• Motor vehicle accidents claims
• On-site pathology services
• Pap smears
• Phlebotomy
• Pre-employment medicals
• Prostate screening
• Skin care checkups
• Spirometry testing
• Sports injuries
• Travel vaccinations
• Workers compensation claims

We are able to provide other services so please don’t hesitate to contact us for more information or to make an appointment.

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