Travel Clinics Australia has released their latest newsletter discussing a number of topics relevant to would be travellers.

Why use a travel clinic?

It’s a scary fact that up to 50% of overseas travellers suffer illness sometimes serious diseases requiring extended hospitalisation. However, most of these illnesses can be prevented with the right advice from a travel medicine expert! Our highly skilled Travel doctors keep up with the continual changes in travel medicine, so that you can avoid incorrect advice and unnecessary vaccinations. They take the time to learn about each patient so that you can be given specific advice for your situation, taking into account important factors such as duration of stay, type of travel and accommodation, season, current health and medical history

Points to consider when choosing a travel doctor

• Travel Clinics Australia are;
• World Health Org. approved yellow fever vaccination centres
• Local experts in all aspects of travel health
• Have an online database with continually updated information not just for vaccinations but a complete travel health service (jet lag, ear problems in flight, altitude sickness, motion sickness)
• Malaria and other advice for areas at risk
• Save patients cost of vaccines partly claimable on extras health insurance cover
• One stop medical experience with everything on site

Overseas travellers, especially to Asia, Africa and South America, should seek medical advice at least 6 weeks prior to departure. Our clients receive up to date advice, a free personalised destination report, pocket guide and international vaccination certificate. Vaccinations, medications and travel health kits are all available on site at competitive rates.

Yellow Fever Vaccinations

Yellow fever is a viral disease that is transmitted by mosquitoes in parts of Africa and South America. One in seven patients develop severe, frequently fatal disease characterised by multi-organ involvement. Travellers are at risk of yellow fever in endemic areas, especially in forested and rural regions and during urban outbreaks. In addition to anti-mosquito measures, it is important to prevent yellow fever by vaccinating where there is true risk. Vaccination is also a mandatory requirement for entry into some countries even for in-transit travel.

Vaccination must take place at an approved vaccination centre and a record entered and validated in an International Certificate of Vaccination or Prophylaxis (ICVP) Yellow fever must be given at least 10 days before entering a country that requires you to have it.

Routine Vaccinations

As well as considering vaccinations for travel to specific destinations, it is important to ensure that you are up to date with your routine vaccinations for your appropriate age as according to the National Immunisation Program Schedule. Many of these vaccines are inexpensive. The total cost of any vaccine is less than the cost of a hospital stay.

Some of these vaccinations include:

Diphtheria, tetanus and pertussis (whooping cough) routinely been given to most students by the time they leave school.

One of the most common injuries while travelling is a simple cut or scrape from a fall, which may require a tetanus injection. Hence, travellers to countries where health services are difficult to access and hygiene may be of concern should consider vaccination if more than five years have elapsed since their last dose.

Poliomyelitis – Most people are vaccinated against polio in early childhood, however a booster dose should be given to travellers to areas where poliomyelitis is epidemic or endemic. This applies particularly to the Indian subcontinent, parts of Africa and the Middle East Indian subcontinent, parts of Africa and the Middle East.

Measles, mumps, rubella and Varicella (chicken pox) – The regular measles and chicken pox outbreaks that have occurred as a result of non-immunised individuals importing this disease into Australia and several European countries indicate that these childhood infections remains a significant threat to non-immune children and adult travellers. Measles in non-immune adults is more severe than it is in children and readily preventable. Measles, mumps, rubella vaccination (Priorix) is recommended before international travel for adults born during or after 1966 who do not have evidence of having had two doses of a measles-containing vaccine in the past. A combined measles, mumps, rubella, varicella vaccine is expected to become available in the near future.

Influenza – This is one of the most common diseases in travellers and is potentially fatal either from the infection itself or secondary pneumonia. Vaccination is therefore recommended for all travellers. This especially applies to those with chronic medical conditions including heart disease, asthma, diabetes and other cardio-respiratory diseases as well as those with lowered immunity.

Pneumococcal disease – Pneumonia remains one of the more common reasons for travel health insurance claims. Pneumococcal vaccination is also advised for all travellers with chronic medical conditions, especially cardio-respiratory disease or diabetes.

Dengue fever has returned to North Queensland only two months after health officials declared an end to the outbreak.

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 a deadly disease spread widely all over the world. Every year over 55,000 people die, with over 95% of the deaths occurring in Asia and Africa.

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.

Dengue fever is the most common mosquito spread disease with around 100 million cases occurring annually. It is found in most tropical and subtropical regions and is transmitted to humans by the bite of an infected mosquito. There is no evidence of person to person transmission and the disease is rarely fatal. Travellers should take precautions to avoid mosquito bites when travelling to high risk areas. See your doctor immediately if you present the typical symptoms of dengue fever.

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.

Indonesia is a developing nation and as such does not have the same level of sanitation and health care standards which we come to expect in developed nations such as Australia. Many travel related diseases are prevalent in Indonesia, including Bali, and it is therefore recommend that travellers to Indonesia consult their doctor regarding travel vaccinations well before they travel.

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 is a severe diarrhoeal disease caused by a bacteria which is generally transmitted to humans by ingesting contaminated food or water. Contaminated shellfish can also be a source of infection. Cholera outbreaks usually occur due to poor sanitation in areas where there are a large number of people in close proximity, usually due to a natural disaster, war or civil unrest. Tourists are rarely at risk of contracting cholera, even in high risk countries. However, all travellers to high risk regions should take precautions when consuming food and water.

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.

Australia is one of the safest countries in the world to travel around. You are unlikely to pick up a travel related disease while travelling here but that is not the case for many other regions in the world. High risk areas include many parts of Asia, Africa, and South America. As usual, prevention is generally better than the cure so we recommend discussing your travel plans with your doctor well in advance of your departure date. Your doctor can suggest preventative measures such as getting travel vaccinations, avoiding mosquitos, and reducing the risk of drinking contaminated water. Diseases which you can be vaccinated against include:

• 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.

Typhoid Fever is caused by a bacteria that is usually spread when the faeces or urine from an infected person contaminates food or water. It can also be spread by flying insects which have fed on contaminated faeces. When travelling in endemic areas, be especially careful when consuming:

• 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)

The Japanese encephalitis virus is one of the most common travel related diseases with around 50,000 cases per year. It is spread by infected mosquitos found primarily in South East Asia and the Far East. There is a vaccine available to prevent this potentially fatal disease, so it is advised to see your travel doctor well before travel to high risk countries.

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.

Most of us wouldn’t even think twice about the possible diseases we can contract while on holiday. Unfortunately, when we travel we find ourselves at higher risk of disease than if we had stayed at home. This is due to a number of reasons such as:

• 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.