TRAVEL HEALTH CARE

For more inforamtion on each topic please click on the word:

Acquired Immuno Deficiency Syndrome: (AIDS)

This is a disease due to the infection with human immuno deficiency virus (HIV), which impairs our immune system and causes a whole range of illnesses. There is no vaccine available to prevent the disease. The risk to travellers come from unprotected sexual contact with a HIV positive person or from being injected with contaminated needles or being given contaminated blood products.

The incidence of AIDS in the prostitute population in many Asian and African countries approaches 50%-60%. The incidence of AIDS in hospital inmates in Zimbabwe is 50%-60%. The use of condom will reduce the chance of transfer, but it will not eliminate it completely. We recommend avoidance of causal sex or the use of condoms. If you are travelling to Africa, take along our Syringe kit or Travel kit, which contain items such as needles, syringes, IV set and sutures.

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Altitude illness:

Trekkers to destinations above 2,500m are prone to altitude illness, this includes most trekkers to Nepal and Peru. The early symptoms include headache, fatigue and loss of appetite, which come on gradually and may occur overnight after a nights sleep. If symptoms occur, either stay at the same altitude to acclimatise (which can take 6 to 48 hours) and then ascend 300m or less per day, or descend to the altitude that you do not experience the symptoms. In almost all cases of fatality form altitude illness, the trekker continued to ascend after the early symptoms of the illness. IT IS NEVER TOO LATE TO DESCEND! If symptoms are still present medical treatment should be sought.

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Cholera:

Cholera is a bacteria infection of the intestine causing profuse watery diarrhoea which rapidly leads to dehydration. The bacteria are usually spread by water and contaminated food, mainly in developing tropical countries. Prevention is by simply precaution with food and water. Please see Drinking and eating safely. A cholera vaccine is available in our centre for high risk travellers. Cholera can be simply and successfully treated by immediate replacement of fluid and salts lost through diarrhoea by using oral re-hydration solutions such as Gastrolyte, part of the Gastrokit available at Travel Health Care.

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Dengue Fever:

Dengue fever is a viral illness transmitted by mosquitoes bites. It causes severe flu-like symptoms like high fever, severe headache, muscle and joint pain. Rarely, it can lead to a fatal hemorrhagic form. Dengue fever is endemic in most tropical countries of South Pacific, Asia, The Caribbean Basin, Mexico, Central and South America and Africa.
There is no cure nor vaccine available. Travellers should take precaution against mosquitoes bite. Please see Prevention of Insect bites.

Products for mosquitoes prevention are available at Travel Health Care.

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Drinking and Eating Safely:

By drinking and eating safely during travel, one can avoid serious diseases like Traveller's diarrhoea, Cholera, Typhoid and Hepatitis A.

The following are the simple guidelines:

• Always wash your hands thoroughly after using the toilet and before eating. Brush your teeth with bottled water. Keep your mouth closed in the shower.
• Assume all water is contaminated. Either boil the water for at least 10 minutes if practical or use Iodine drops available from Travel Health Care to sterilise the water.
• Drink bottled water, canned drinks or hot drinks such as coffee or tea.
• Refuse ice in drinks, as it may have been made from contaminated water.
• Avoid salads as these are often washed with contaminated water.
• Food should be thoroughly cooked and eaten hot. Avoid foods which have been pre-cooked and reheated, as well as cold meat, raw seafood and shellfish, such as oysters, crabs, prawns and lobster. Never eat uncooked seafood.
• Milk and other dairy products should be avoided unless you can be sure they have been pasteurised and stored properly. Eat only fruit which you peel or cut. Do not eat fruit which have been peel or cut by others.
• Water can be made safe either by boiling for at least 10 minutes or use 2% iodine drops to sterilise for 30 minutes.

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Hepatitis A:

Hepatitis A is a viral illness which is frequently found throughout the developing world and is spread by poor hygiene from person to person; or by contaminated water, ice or shellfish harvested from sewage-contaminated water; or from fruits, vegetables or other food which are eaten uncooked, handled by contaminated hands.

The symptoms are loss of appetite, nausea and abdominal discomfort, followed within a few days by jaundice and dark urine. The illness can last for weeks to months, and the majority will recover with no complications. There is no specific treatment.

Prevention can be achieved by precaution with food and water. Please see Drinking and Eating safely. A specific and effective Hepatitis A vaccine is available for travellers from age 2 and above from Travel Health Care.

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Hepatitis B:

Hepatitis B is a viral illness primarily transmitted through activities which result in exchange of blood or body fluids, or through sexual activities with an infected partner. Incidences are particularly high in Asia, Africa and South America. People working overseas in health field or travellers with long stay in these areas are at higher risk.

The symptoms are loss of appetite, nausea, abdominal discomfort, jaundice and dark urine. The illness can last up to a months. Some people can develop long term complication leading to liver cancer years after the initial infection. There is no specific treatment.

Prevention is by avoiding the risky behaviour mentioned above, or having a course of Hepatitis B Vaccine which is available from Travel Health Care.

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Japanese Encephalitis:

Japanese Encephalitis is a virus illness transmitted by mosquitoes that causes a severe flu-like illness with headache, neck stiffness, confusion and coma. Death rates may be up to 30%, and long term brain damage is common. The disease occurs mostly in rural areas of many parts of South East Asia, China, Korea, Northern India and Nepal.

There is no specific treatment. Prevention is by avoidance of mosquito bites. Please see Prevention of Insect bites. A specific three course vaccine is available for high risk travellers from Travel Health Care.

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Jet Lag:

Jet lag is a features of flying long distances east-west or west-east through several time zones causing the travellers routine daily rhythm of activity and sleep to get out of phase. The main symptoms are exhaustion,disorientation, poor concentration, insomnia, loss of appetite, weakness, headache and dizziness.

Some factors will affect the jet-lag. Noise of the aircraft, sitting still for prolonged period, lack of sleep during the trip, overeating and excessive alcohol during the flight.

A few simple hints can help to ease the jet lag. Before the flight, plan a stopover if possible, and plan to fly into the night. Ensure a good sleep the night before flying.

During the flight, the followings can be done:

• Avoid alcohol and coffee. Drink plenty of non-alcoholic drinks especially water.
• Eat only when hungry. It do no harm to skip a meal.
• Wear loose ,comfortable clothes and shoes.
• Try to sleep on longer section of the flight. Close the blinds and wear special eye masks.
• Try to take regular walks around the aircraft and exercise at stops. Keep your feet up when resting.

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Malaria:

Malaria is an illness caused by a parasite that is transmitted by the bite of a female anopheline mosquito. The risk of malaria depends on the traveller's itinerary, the duration of travel, and the place where the traveller will spend the evenings and nights. These factors will assessed during the consultation.

Symptoms of malaria include fever, chills, headache, muscle ache and malaise. It can be up to 12 months before symptoms appear. Specific anti-malarial medication can treat the malaria but death can occur if treatment is given too late.

Effective prevention can be achieved by using preventive anti-malarial medications, which are available from Travel Health Care. Avoiding mosquito bites between dusk and dawn is very important. Please see Prevention of insect bite. A malaria prevention kit which contain mosquito net and special mosquito repellent is available from Travel Health Care.

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Prevention of Insect Bites:

Insects, especially mosquitos, carry diseases such as Malaria, Dengue fever, Yellow fever, and Japanese encephalitis are commonly encountered while travelling overseas.

The following is the basic advice to avoid insects bites, and thus the diseases:

• Most insect borne disease are seasonal. Change the itinerary if possible may reduce the risk.
• Avoid outdoor activities during twilight periods at dawn and dusk as the mosquitoes and insects are most active at these times.
• Wear long-sleeved shirts, long pants and hats to minimise exposed skin.
• Avoid dark clothes, perfume and after shave as these attract mosquitoes and insects.
• Use insect replants containing DEET , which is available from Travel Health Care.
• Use mosquito nets when staying in accommodations that are not air-conditioned or adequately screened. Different size nets are available from Travel Health Care.
• Use premethrin containing repellents to treat the mosquito net, clothing and shoes. This is available from Travel Health Care.

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Rabies:

Rabies is a viral illness of animals which may be transmitted to human through bites from infected animals, usually dogs , cats or monkeys. Travellers should assume all mammals are rabies carriers especially in high endemic areas like SouthEast Asia, Mexico, Central and South America.

Symptoms of rabies are muscular paralysis and spasm with bizarre behaviour leading to delirium and convulsion and death. There is no specific treatment available. Prevention can be achieved by using a specific rabies vaccine which is available in Travel Health Care.

Travellers suffering from animal bites should seek medical advice immediately for cleansing of the wound and consider post-exposure immunisation.

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Traveller's Diarrhoea:

Traveller's diarrhoea is the most common health condition facing travellers. Studies show that up to 50% of people travelling to developing countries will develop the problem. It is typically characterised by stomach cramps, profuse diarrhoea, sometimes with fever and blood in the motion. The cause is due to ingestion of contaminated food and water. The most common germ that causes this condition is E. Coli.

The best protection against the disease is prevention. Please see Drinking and Eating Safely. For high risk people, preventive antibiotics can also be taken.

When diarrhoea develops during travel, you should do the following:

• Rest if you feel tired and exhausted.
• Have plenty of fluids to drink, especially with oral rehydration fluid like Gastrolyte.
• Take anti-diarrhoeal medication if the symptom is mild when you need to get on a bus or plane.
• Consider taking some specific antibiotics if you have three or more bowel motions associated with vomiting and fever.
• Seek medical advice if you have blood in the stool, sever abdominal pain, or fever above 38 degree.

All the products for treating traveller's diarrhoea are contained in the Gastro kit, available from Travel Health Care.

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Travellers with High Risk:

Travelling is not without risk especially for travellers with existing medical conditions, pregnant women and small children, or people involving in higher risk activities like scuba diving, trekking, caving, etc. These people should be assessed comprehensively and individually for their vaccination requirements, fitness to fly, management of existing conditions like Diabetes, special requirements for transport and access to medical assistance. At Travel Health Care you will be provided with comprehensive and professional advice on healthy travel.

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Tuberculosis:

Tuberculosis is a global epidemic disease with one third of the world's population infected at some stage especially in developing countries. Tuberculosis is a bacterial infection contracted after spending a long time in a closed environment where the air was contaminated by an infected person who is coughing out the bacteria. Therefore it is not a major hazard for short term travellers but it can be a problem for health workers who work in high risk countries. If infected, people can develop symptoms like fever, lethargy, cough with bloodstained sputum and experience weight loss.

Prevention is by maintaining good general health and by the BCG Vaccine for high risk travellers. Treatment is available for tuberculosis, but it is a prolonged course, and sometimes requires isolation in an institution.

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Typhoid Fever:

Typhoid Fever is an acute infectious disease caused by bacteria and usually transmitted by drinking contaminated milk, water, or solid food. After a period of one to three weeks from ingestion the first symptoms are noted: chills followed by high fever and prostration. Victims may also experience headaches, cough, vomiting, and diarrhoea. The disease dies down after several weeks but in about 20 percent of untreated cases it progresses to pneumonia, intestinal haemorrhage, and sometimes death. Treatment is usually with a form of chloramphenicol and/or antibiotics.

Typhoid is prevalent in most tropical and subtropical countries in Asia, Africa, the Middle East, Oceania and Central and South America.

A typhoid fever vaccine is available from Travel Health Care and is strongly recommended for those travelling to areas with poor sanitary facilities.

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Yellow Fever:

Yellow fever is a mosquito-spread viral illness that exists in some parts of Africa and South America. The symptoms include fever, vomiting, jaundice and kidney disease. It has a mortality rate up to 60%. There is no cure for the disease. Prevention is by protection against mosquito bites and by a yellow fever vaccination available from Travel Health Care. Persons over the age of one arriving in Australia and who have visited an endemic area within the last 6 day,will need a current WHO Yellow Fever vaccination Certificate. Please see section for the Prevention of Insect Bites.

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DVT:

DVT, or Deep Vein Thrombosis is a condition where clots of blood form in the deep veins of the calves. The clots are formed when blood pools in the calves and is increased in travellers who sit for extended periods of time in cramped conditions,whoare immoblile for extended periods, who are dehydrated and who have a history of DVT or varicose vein or women on the pill.

The following measures can be done to minimise the chance of developing DVT:

• Do not take sleeping tablets on the plane unless you are in business or first class(lower risk).
• Make sure you wiggle your toes every 15 min and have a stroll every hour.
• Do not consume alcohol as this dehydrates the body and causes increased drowiness.
• Drinks adequate amounts of water or fruit juice..in excess of one litre during a 10 hours flight.
• If you have a past history of varicose veins or on the Pill, discuss th use of half an aspirin for 2 days before till 3 days after the flight with your doctor and the use of elastic supportive stockings during the flight.
• If you have a history of clots in the legs or a clotting disorder discuss the need for elastic stockings and injection of a medication (Heparin) before and after the flight with your doctor.

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