Medical advice for Foreign Travel

FOREIGN TRAVEL.
There was a time when Travel Agents dispatched British holidaymakers to the relatively safe beaches of the Costa del Sol and Costa Brava. But all that has changed.
Foreign destinations are an attractive alternative to the British climate. With high disposable incomes and plunging air fares such opportunities provide an irresistible attraction and it is understandable why UK citizens in ever increasing numbers set out to conquer the globe.

For reasons not fully understood travel excites and the evidence for this is all too clear at any airport or ferry terminal where people are heavily pre-occupied in enjoying the dwindling pre-departure time. The important priorities for travel will have been dealt with and are directly associated with the holiday: itinerary, currency, passport, departure times, tropical clothing and all the other practicalities associated with the event. Last in the list, if it appears at all, is the personal protection that should be at the head of the list, for without it all the preparation could count for nothing if the trip is a calamity of failed preparation. Vaccination and immune status against expected endemic disease should come high on the pre-flight checks.

A first requirement should be to check the holiday destination and investigate what the health risks are in that part of the world and apply these recommendations well in advance of the departure date. There are far too many recorded cases of people departing on 'bargain' or 'budget' holiday deals, which capture the fiscal imagination, but leave a lasting legacy of wrecked health. It is essential that any vaccinations administered by the doctor are allowed the necessary time to develop immunity and this can be several weeks.

Bilharziasis
A parasitic worm (blood fluke) found in watercourses in Africa. The free-swimming worm penetrates the skin, enters the blood stream and is carried to the hepatic portal system where they mature in 1 - 3 months. On maturity it infests the intestinal tract, liver and urinary tract. The infestation can be treated but there is no vaccine. Freshwater snails are the intermediate hosts; avoid bathing in lakes, streams and rivers in countries where this parasite is present.

Cholera
An acute infection involving the entire small bowel, characterized by profuse watery diarrhoea, vomiting, muscular cramps, dehydration decreased urinary output and collapse. Caused by the organism Vibrio cholerae, it is acquired by consuming contaminated food and water and is an increasing problem in areas of poor sanitation; S. America, Middle East, Asia and Africa. Pay scrupulous attention to personal hygiene and food consumption. There is no vaccine available. The older vaccine, with boosters required every 6 months, was considered largely ineffective and has fallen out of favour. Alcohol based handwash gel, regularly used, may be an additional help to restrict cross contamination.

Dengue
This fever is endemic throughout the tropics and subtropics. It is transmitted by the bite of the mosquito. There is a severe form of the disease; 'Dengue haemorrhagic fever shock syndrome' in which almost all patients are under 10 years of age.
There is no vaccine available and absolute control of mosquitoes, by day and night, is the only preventive measure.
Diphtheria
Whereas this condition is quite rare in UK it remains a serious disease in much of the world where poor hygiene and high density living is a feature. It is caused by the toxins of the organism Corynebacterium diphtheriae which produces a membraneous growth on the respiratory tract causing characteristic breathing difficulty. It is spread in these circumstances by close contact with an infected person who will transmit it by droplet infection; coughing, sneezing and direct personal contact. For adults who have been previously immunized a special low dose vaccine is available.

E Coli
Scrupulous personal and food hygiene is required to avoid infection with this bowel organism.

Hepatitis A disease caused by a virus which infects the liver and can cause jaundice.
Hepatitis A: Contaminated food and water are the usual sources of infection. The disease can be spread person to person because the disease is present in faeces, hence where sanitation is poor the index of risk is higher and a greater degree of vigilance is necessary. Extreme care is necessary in eating and drinking and a high standard of personal hygiene is mandatory. Avoid eating raw or inadequately cooked salads, vegetables, unpasteurised milk and shellfish.
Use bottled water and be sure that it is safe to drink.
Hepatitis A: affects older people very seriously and in about 1% of cases liver failure is a possibility and there is a risk of this being terminal.
A vaccine is available for Hepatitis A. Allow time for the vaccine to provide protection.
Hepatitis B: This version of the disease is spread much like HIV; through intravenous blood transfusions and injections, inadequate sterilization of medical equipment, sharing needles or syringes and person to person (as in sexual) contact. Ear piercing and tattooing are included.
A vaccine is available and provides effective protection, but this takes up to six months to provide satisfactory immunity and is available from the GP.
Hepatitis C: This is spread as in the case of Hepatitis B.
There is no vaccine. Prevention is the correct and best procedure as in the case of Hepatitis B and HIV.

Japanese Encephalitis
A disease caused by a virus (Arbovirus) and spread by the mosquito. The disease can be life threatening. Occurs throughout S.E Asia mainly in rural areas and in the monsoon season when mosquitoes are breeding.
A vaccine is available through the private health care route and not the family GP.

Legionnaires Disease
A bacterial disease cause by Legionella pneumophila and which can occur where people gather in groups - such as holiday makers - causing a form of pneumonia. The organism is water borne; usually in poorly cleaned cooling towers, shower heads and the like. The disease is treatable with antibiotics. There is no vaccine.

Malaria
A parasitic disease caused by any one of four types of malarial parasite (plasmodium) and spread by the bite of an infected Anopheles mosquito. The complex life cycle of the parasite causes a variety of symptoms and the disease remains life threatening. It is essential to follow strict rules to prevent mosquito bites during the day and night-time by using well dressed mosquito netting at night, avoiding water areas during the day and using insect repellent (preferably containing diethyltoluamide - DEET) and keeping the body as covered as possible. Malaria remains a most dangerous disease and absolute protection is not possible. Consult the GP before travelling, take anti-malarial treatment before departing and for at least a month after returning. Such measures are necessary even when stopping over or passing through a malarial country.

Meningitis
This is an inflammatory disease of the covering of the brain (meninges) caused by a number of bacteria but primarily the organisms: Neisseria meningitidis (meningococcal), Haemophilus influenzae and Streptococcus pneumoniae.
A vaccine is available for the meningococcal variant and the GP should always be consulted ahead of travel to areas of risk and especially if children are in the party.

Poliomeyelitis
A viral disease that causes paralysis. Anyone travelling beyond Western and Northern Europe should ensure they have up to date poliomyelitis immunisation. There are two types of vaccine available; live (Sabin) vaccine and inactivated (Salk). Sabin is an oral vaccine and is the one used in UK. People who are un-immunised should obtain a full three course dose of vaccine and those whose immune status is over ten years require a booster dose. No adult should remain un-immunised against polio.

Rabies
Rabies is an encephalitis, or brain disease, which is caused by the rabies virus. It is caused by being bitten by an infected animal, usually a rabid dog or a bat. There is a vaccination against the disease, but once symptoms of rabies have developed the condition is almost always fatal - and the few people who have survived have suffered serious long-term disabilities.
Avoiding animals whether stray, wild or domesticated is the best policy.
The vaccine is delivered in various doses and takes time to develop immunity.

HIV / Aids
This subject is covered in a wider context under 'STD' via the egohealth website portal for users of the health screening programme.

Sars
This is a newly recognised disease that emerged in the Far East early in 2003, first in southern China, then spreading to Vietnam, Singapore, Hong Kong, Canada and vary many more countries. Its name is Severe Acute Respiratory Syndrome.
It is believed to be caused by a new strain of Corona virus - a family of viruses which has been linked to the common cold. There is no vaccine for the disease but a diagnostic test has been introduced.

Tetanus
Caused by the organism Clostridium tetani, a spore bearing organism found in soil and wound contamination is the usual entry point. Everyone should ensure that they are up to date with their anti-tetanus vaccine. Gardeners should wear gloves.

Tick-borne Encephalitis
An inflammatory brain disease caused from the bite of an infected tick. The tick is most common in forested areas of Austria and other areas of Northern Europe and Scandinavia. It is more common in late spring and summer. In these areas clothing that covers most of the skin is the best avoidance and the use of insect repellents. A vaccine is available but is not free on the NHS

Tuberculosis
This disease is making a resurgence word wide and immunisation is recommended. It is prevalent in deprived areas of the world where humans live in closely confined conditions. It is spread by 'droplet infection'; coughing, sneezing and spitting. Discuss with the GP the status of immunity and whether the BCG (Bacillus Calmette - Guerin vaccine) is necessary in the particular case. Resistant strains of the Tubercle bacillus are prevalent in Asia, Eastern Europe, Africa and Central or South America.

Typhoid
Typhoid vaccine is available and indicated for travellers to countries where the disease is endemic but the vaccine is no substitute for personal precautions. Food should be freshly prepared, cooked and hot. Uncooked vegetables and salads should be avoided. Only fruits which can be peeled should be eaten. Only boiled tap water, bottled water or water treated with sterilizing tablets should be used for drinking purposes. This information also applies to Cholera (See 'Cholera'). A vaccine is available for Typhoid but not for Paratyphoid and other diarrhoeal diseases including 'Traveller's diarrhoea'.

Throughout the information in this section the important point to remember is to check the destination country, be aware of the countries being travelled through, any stop-over time being included and to check with the family GP the individual immunized status and what is necessary for protection. Always provide sufficient time for immunity to develop well ahead of departure time. Children travelling in such circumstances require exceptional care and protection.

Prevention is always better than cure, if cure is available at all.

Brought to you by:
Egohealth Limited
Tel. 01562 753107
Drayton Court, Drayton Road, Solihull, West Midlands, UK, B90 4NG.

www.egohealth.co.uk