These are some common questions that we get asked in travel health consultations.

What is Hepatitis B?

Hepatitis B is a virus that is spread by blood and infects and damages the liver. It is the most common blood borne virus worldwide and is a major cause of chronic liver disease and liver cancer. The virus is 50-100 times more infectious than HIV. [1]

How can I catch Hepatitis B?

The virus is also present in other body fluids e.g. saliva, vaginal fluid and semen. The virus can get in through open wounds ,cuts, scratches and contaminated needles. The virus can survive outside the body for at least a week so surfaces contaminated with dried blood pose infection risk. [2]

Injecting drugs and sharing needles puts people at high risk of becoming infected, however, travel also puts people at risk if they are not vaccinated.

More than 12% of cases in the UK are thought to result from people travelling to and working in countries where there is increased risk of hepatitis b infection.  [3]

Travellers most at risk are those who suffer accidents that result in requiring medical treatments abroad where unsterile or re used equipment may be used. About 8% of travellers are sick enough to require medical treatment in developing countries.  [4]

Should I get a Hepatitis B Vaccine before travel?

The UK National Vaccination Programme does not vaccinate against Hepatitis B routinely, therefore, Hepatitis B vaccination should be considered for those travelling to developing countries .Those travellers at particular risk are those who are volunteering e.g. aid workers and those assisting with construction e.g. helping building schools. Travellers participating in school projects abroad will mix with potentially infected children in schools and may be accidently exposed to the virus e.g.  through contact sports injuries or maybe volunteering in orphanages with sick children .Other travellers that are at risk are those whose work people work abroad puts them at risk e.g. body guards/police/ and travellers who adopt risky behaviours such as unprotected sex.

Travellers with any chronic diseases are potentially going to need medical attention whilst travelling so should consider vaccination.

Hepatitis b vaccination is a course of 3 injections >There are two schedules that may be offered according to time left to the traveller before departure.

Schedule 1: Day 0 1st vaccine Day 7 2nd vaccine Day 21 3^rd vaccine

(This schedule requires a 4^th vaccine 1 year later)

Day 0 1^st vaccine 4 weeks later 2^nd vaccine 5 months later 3^rd vaccine

(This schedule requires a 4^th vaccine 5 years later)

Cost – £40 per dose.

To book a Hepatitis B vaccine please call 01273 749100 or book ONLINE

Hepatitis B vaccine does not protect you against other blood borne infections such as HIV and Hepatitis C. There are no vaccines available to prevent these infections. We recommend that you carry your own sterile needle kit for use in a medical emergency. These can be purchased in clinic or in our shop.

References

1. http://www.britishlivertrust.org.uk/home/the-liver/liver-diseases/hepatitis-b.aspx

2. http://www.britishlivertrust.org.uk/home/the-liver/liver-diseases/hepatitis-b.aspx

4. http://www.britishlivertrust.org.uk/home/the-liver/liver-diseases/hepatitis-b.aspx

4.  http://www.travmed.com/healthguide/ch1.htm

Traveller’s diarrhoea (TD) can be very unpleasant and ruin a holiday or business trip. It is estimated that as many as 60% of all travellers will experience a bout of TD when they travel overseas. Many illnesses such as Hepatitis A, Typhoid and Cholera are spread through eating and drinking contaminated food and water. Thankfully, there are vaccinations that can offer some protection against these illnesses. However, many other bacterial infections such as E.Coli and parasites such as Giardia cannot be vaccinated against. It is extremely important to follow strict food and water hygiene to avoid infection.

Advice for Travellers

• Drink bottled water. Beware of fake bottled water- in many countries seals have been tampered with and the bottle actually contains unsafe tap water.
• Avoid ice in your drinks, unless you are sure it has come from a safe supply of water.
• Don’t clean your teeth with tap water- use bottled or boiled water.
• Boiled water is safe to drink- bringing water to the boil and boiling for 1 minute is enough to purify it.
• Use chlorine tablets or a water filter if you haven’t got access to clean drinking water.
• Avoid salads that may have been washed in unsafe water.
• Avoid raw fruit and vegetables- these are ok if you can peel them.
• Avoid buffet food that may have been left out for a number of hours or been exposed to flies.
• Avoid unpasteurised dairy products such as milk, yogurt and cheese.
• Always wash your hands well before you eat and if you don’t have access to washing facilities carry an alcohol hand gel.
• Avoid street food, unless it is cooked freshly in front of you.
• Don’t assume food served in a 5* hotel will be safe- staff may not have practiced strict food. Water and personal hygiene.

Prevention

Bimuno is a pre- biotic powder or pastille that can keep your tummy healthy on a trip abroad. Clinical studies have shown it to be effective in reducing your risk of TD. It works by sustaining a healthy level of good bacteria in the gut, helping to prevent bad bacteria from becoming established.

Ask your nurse about water purification products – Bimuno, Chlorine Tablets and Water Filters or purchase online in our shop.

In our third question and answer post we look at a common question we get asked when travelling to the Gambia.

Q: Do I need to take malaria tablets for a holiday to The Gambia?                             

 A. Yes malaria tablets would be recommended for a trip to The Gambia. Between October and December 2011 18 cases of malaria were imported into the UK and found to be associated with travel to The Gambia. 7 of these cases were in holidaymakers. Malaria is spread through the bite of an infected mosquito and can be fatal. The preventative steps to be taken to avoid mosquito bites include using a Deet based insect repellent, sleeping under a mosquito net and covering up as much skin as possible with loose clothing.  Appropriate anti -malarial medicines can be obtained by consulting with your travel health nurse . You need to take these before, during and after travel. Your nurse will advise which tablets will be most suitable and explain any potential side effects. It is important to know that malaria is not entirely preventable so all travellers should seek immediate health advice if they become unwell following a holiday to a malaria risk area. Symptoms of malaria can be any of the following; diarrhoea, flu like symptoms headache and fever.

You should also ensure you have had all of the recommended vaccinations for travel to The Gambia.

To book an appointment at Sussex Travel Clinic call 01273 749100 or book ONLINE

Over the coming weeks I will be posting some common questions that we get asked at the Travel Clinic. This week’s post looks at vaccinations required for travel to Egypt.

Q: I am travelling to Egypt for a 2 week holiday, do I need any vaccinations or malaria tablets?

A: Egypt is becoming an increasingly popular destination for UK travellers. The year round climate makes it the perfect choice for those wanting to escape the UK weather for some guaranteed sunshine all year round. Many people who book a holiday to Egypt do not realise that any vaccinations are required.

The recommended vaccinations for travel to Egypt are Diphtheria, Tetanus and Polio, Hepatitis A and Typhoid. Protection against food and water-borne diseases such as Polio, Hepatitis A and Typhoid are very important as you could become infected through eating or drinking contaminated food or water. Staying in a 5* hotel does not reduce your risk, as the people preparing your food may live in areas where sanitation is poor and could pass on these diseases whilst preparing your food.  

Malaria tablets are generally not required for Egypt, as malaria is not present in the popular tourist destinations. However, there will still be lots of mosquitoes around, so you should take a good DEET based insect repellent to apply on your skin and help you avoid bites. Book an appointment with your travel clinic, ideally at least 2 weeks before departure, to get your vaccinations and to get further travel health advice on food and water hygiene and mosquito bite avoidance.

Egypt is a high risk destination for traveller’s diarrhoea. Bimuno has been shown to reduce your risk of getting diarrhoea- Available to purchase in clinic.

To book an appointment at Sussex Travel Clinic call 01273 749100 or book ONLINE

The rabies virus is spread through the bite or scratch of an infected warm –blooded animal, most commonly dogs, and is nearly always fatal.  The virus attacks the central nervous system, causing paralysis, encephalitis and coma.

The World Health Organisation estimate that, more than 3 billion people are at risk of contracting rabies in at least 85 countries worldwide, with the annual number of deaths worldwide caused by rabies is estimated to be between 50,000 and 60,000. [1].

In this weeks post we look at countries reporting rabies in 2011.

 Countries Reporting Rabies cases in 2011 (June – December)

Angola

Angola is reporting an increase in rabies in animals during 2011. 405 people have been bitten by potentially rabid animals with 12 deaths since the beginning of the year.

Australia

A women from Brisbane in Queensland, Australia received rabies post-exposure prophylaxis following an attack by three foxes or fruit bats while she was on her balcony.

Bhutan

In 2011 it has been reported that five people have died from rabies in Bhutan. Dogs accounted for 39% of the cases, while the main transmitters of rabies in Bhutan are cattle 55%

Bolivia

Bolivia had reported at 60% increase in cases of canine rabies in 2011. There have been 208 confirmed cases of canine rabies with three human deaths reported in 2011.

China

In Shanghai  it has  been reported I that during 2011 there has been an increase of dog attacks on residents.40,000 people have been bitten by a pet, a 40% increase from 2010. In 2010 there was 1 case of rabies, this year 6 cases have been reported. Beijing reported six human deaths from rabies in the first six months of the year and in Chongqing in Southern China there were a total of 38 deaths from rabies in the first half of the year.

Ecuador

A total of nine human deaths from rabies were reported by the ministry of Health of Ecuador on 28 Nov 2011. An on-going mass vaccination programme is being conducted in the affected communities in canton Taisha, Morona-Santiago.

India

In Chennai at least 20 people have died of rabies in the first half of 2011. General hospitals in Tamil Nadu reported 12 deaths due to rabies in 2010. In Visakhapatnam, sea port on the south east coast of India a rabies death was reported in July 2011 and a boy died in the Khammam district. also in July 2011.

Indonesia

The rabies epidemic continues in Bali, as of June 2011, over 100 deaths caused by rabies have been reported. In Borneo at least 858 rabies cases have been reported, including one death. In east Nusa Tenggara a total of 800 dog bites have been reported this year.  An on-going shortage of rabies vaccine has been reported in Kab Sikka regency and in other areas of the province.

Kazakhstan

In July 2011 a 10-year-old boy was hospitalized in the KyzylordaOblast with suspected rabies.

Pakistan

Rawalpindi city has reported an increase of dog attacks on residents.  Every month more than 100 dog-bite cases are being with the number continuously on the rise.

Peru

In 2011 a total of 20 human rabies cases have been reported so far. Of the 20 deaths 19 were in natives of the Amazonas region who were bitten by bats. In a remote village in the Atalaya province a rabid cattle had to be slaughtered and a total of 87 people consumed the infected meat in November 2011. All persons involved received rabies post-exposure prophylaxis.

Russia

In the first nine months of 2011 in Russia ten people contracted rabies, of which three cases were reported in the Tverskaya province. In 2010 there were 17 cases of human rabies in the Russian Federation.

Svalbard and Jan Mayen (Norway)

Three reindeer were reported to have tested positive for rabies on 27 Sept 2011.

Ukraine

Ukraine has reported 5 cases of human rabies in 2011. 100,000 – 120,000 people seek medical treatment for animal bites every year in the Ukraine.

USA

There have been reports of rabies cases in racoons in Florida in 2011 and in Texas they are reporting a rise in the cases of animal rabies with 591 reported in the first six months of the year. In Jul 2011, a 73-year-old woman tested positive for rabies. She was bitten by a dog in her native Haiti in Apr 2011. Animal rabies was also reported in Illinois and New York.

Vietnam

In June 2011 an outbreak of rabies amongst domestic dogs in the Si Ma Cai District of northern Lao Cai Province was reported.

 Zambia

In October 2011 an outbreak of rabies was reported in Mansa district with 14 cases. One human death was reported in Mwang’uni , the person had become infected after being bitten by a dog.

Advice for Traveller’s

If you are travelling to country where rabies is present for 4 weeks or more, or if you are likely to be more than 24 hours away from a reliable source of vaccine and treatment, then you should consider having a course of rabies vaccines pre travel. Many countries do not have a supply of rabies immunoglobulin, the treatment you need if you have not had any rabies vaccines, so you should consider having the vaccine before you go.

To book a rabies vaccine please call 01273 749100 or book ONLINE

References

1. www.nathnag.org

Follow our top 10 Tips to ensure you have a safe and healthy trip abroad.

Before your Trip

• You should consult with your travel clinic at least one month before your departure to ensure you get the necessary vaccinations, travel health advice and malaria tablets. Some vaccinations such as rabies and hepatitis b, require more than one dose, so make sure you book well in advance so that you can complete the course.
• Get all your documents in order- passports, visas etc and make copies of these and store them electronically in case they get lost or stolen on your trip.
• If you take regular medication see your doctor to make sure you will have adequate supplies for the length of your trip. Remember to carry all medication in your hand luggage.
• Take out comprehensive travel insurance and check it covers you for all the activites you plan to do.

During Trip

• Take precautions against malaria when you visit risk areas. Make sure you have malaria tablets, a mosquito net to sleep under and plenty of insect repellent to protect you from mosquito bites. Remember malaria can be fatal so if you feel unwell with fever or flu like symptoms seek urgent medical advice.
• Road safety – many accidents occur when abroad. Always wear seat belts when travelling in cars or coaches and always wear a helmet when riding a bike or motorcycle.
• Avoid casual sex or practice safe sex to prevent HIV and other sexually transmitted infections. Take an adequate supply of condoms for your trip.
• Eat and drink sensibly- avoid drinking the water abroad, drink only boiled or bottled water to avoid traveller’s diarrhoea. Take diarrhoea treatment or Bimuno which helps prevents traveller’s diarrhoea with you.
• Avoid excessive sun exposure and use a high factor sunscreen. The sun can be very hot abroad and over exposure of the sun can lead to skin cancer.
• Avoid touching animals when abroad. In many countries rabies is high risk so if you get bitten or scratched by any animals seek immediate medical attention.

Remember if you feel unwell during or after your trip seek urgent medical help.

Have a safe trip!

To book an appointment for travel vaccinations or malaria tablets call us on 01273 749100 or use our online booking system