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Tularaemia Disease (Tularemia)

Tularaemia Disease (Tularemia)

What is Tularaemia Disease?

Tularaemia (Tularemia) is an infectious disease.  Humans can become infected following a bite from an infected tick or animal contact.  The bacteria enters the body through an area of broken skin however, it can also be breathed  in through the nose or mouth.

The symptoms include a high fever, generalised aching and swollen glands.  The symptoms of Tularaemia can last over a period of a few weeks although it is not possible to catch the disease from other infected humans.

Who is at risk of the disease?

When visiting areas where the disease is endemic (that is: the infection is present in low levels) there is a risk. There have been recent outbreaks in all states in the USA, with the exception of Hawaii, and Netherlands.  Hunters and those trecking through land where infection exists in animals and ticks are also at risk.

How  Tularaemia be Prevented – also know as Tularemia?

Currently there is no vaccine available in the UK to prevent tularaemia.  Travellers should be careful to ensure their surroundings are kept clean, so as not to encourage rats and other potential carriers. Any water should be boiled if used for personal consumption or food preparation. Any food should be protected from animals and cooked thoroughly. Dead animals should not be handled.

A good insect repellent to prevent tick bites should be used.  Ticks should be carefully removed using tweezers.

Note: This information is designed to complement and not replace the relationship that exists with your existing family doctor or travel health professional. Please discuss your travel health requirements with your regular family doctor or practice nurse.

Travel Advice on Zika Virus Disease

Travel Advice on Zika Virus Disease

What is Zika Virus?

Zika Virus has been declared a “Public Health Emergency of International concern” (WHO).  It is a disease spread by mosquitos. This is not a new disease. The first human case was recognised in 1952. It is usually a mild illness which can occur up to seven days after a bite from an infected mosquito.  The illness usually lasts up to a week.  Symptoms include fever, rash, conjunctivitis, joint pain, headache.

Cases of Zika virus have recently been reported in Africa, Pacific Islands, Caribbean, Brazil and Southeast Asia.  In recent years there has been a rapid increase in cases of the disease. Due to the nature of the disease it continues to spread globally – therefore it is best to check with your doctor or travel clinic for latest updates especially if you are a pregnant traveller.

Who is at risk of Zika Virus?

Any traveller to areas of the world where the disease exists is at risk. Due to the mild nature of the illness a traveller might not even realise they have had the disease.

Experts believe that the biggest risk of this disease is for the unborn child.  There is growing evidence that Zika virus can cause birth defects.

Pregnancy and Zika Virus

Women travelling to areas where they will be at risk of Zika virus are advised:

  • In Pregnancy – postpone non-essential travel until after the pregnancy
  • If travel cannot be avoided bite prevention is essential
  • Avoid getting pregnant while away and for 28 days on return

How can I prevent Zika Virus?

There is currently no vaccine to prevent Zika virus, although trials are underway. The best method of prevention is bite prevention.  It is important to remember that the Ades mosquito bites during the day.

Evidence also suggests the disease can be passed sexually. In order to prevent transmission:

  • When a partner is pregnant a condom should be used during travel and for 28 days on return
  • If a partner is planning or could become pregnant condom use is recommended
  • A male partner with symptoms of the disease following travel is recommended to use a condom for 6 months

Countries where the virus is endemic will be the same countries that other mosquito borne disease can be spread such as Dengue and Chikungunya.

References and Further Information

Sun Safety – Being Safe in the Sun

Sun Safety – Being Safe in the Sun

To be safe in the sun we should have an understanding of how to prevent of skin cancer.  It is also important to know the early signs of skin cancer.

Understanding suncream

Suncream is often applied too thinly – to cover the whole body about an eggcup amount is needed every 2-3 hours. It should also be applied at least 30 minutes before going out into the sun. You should never stay in the sun for excessive periods of time.  Suncream does not offer unlimited protection.

The higher the SPF factor on your cream, the greater the protection against UVB rays which Sun cream should be used regularlycause burning. Sun cream should be used regularly and in proper proportions, especially in a tropical climate. A high SPF factor will only help prevent burning – it will not always protect against UVA rays, which are not taken into account when calculating the SPF. UVA protection is usually rated separately between 2 and 4.

Using clothing to protect you in the sun

It is important when travelling to understand the risks associated with too much sun exposure. This is true not only on the beach. Snow, sand and water will also reflect the sun’s rays. Our choice of clothing can play a part in protecting our bodies.

Wear clothes that will protect you in the sun – sunglasses, clothing of tightly woven fabric and a sun hat covering the neck, ears and back of the neck.

Protection through lifestyle

Here in the UK we still consider a good tan to be “fashionable” and let’s face it who doesn’t feel better about themselves when they have developed a tan! However simple lifestyle changes as well as “everything in moderation” can help us lower our risk of skin cancer.

Staying in the shade between 11.00 and 15.00 hrs you can help prevent burning and overexposure. Too much exposure even in the UK can eventually lead to skin cancer, ageing, wrinkles or sunburn. When you arrive at your destination don’t sit out in the heat all for the whole time on the first day – gradual exposure to the sun is far safer, increasing your time as you get used to the sun.

Drink plenty of non-alcoholic drinks to prevent dehydration. If you are on any medication check with your doctor before you go away as some medications can make you more sensitive to the sun.

Keep an eye on those moles when you have been in the sun

Always consult with your Doctor or Nurse if you notice any unusual changes in your skin or your moles. Any moles which become itchy or bleed, or change in colour, shape or size should also be reported to your doctor.

Resources


Note: This information is designed to complement and not replace the relationship that exists with your existing family doctor or travel health professional.  Please discuss your travel health requirements with your regular family doctor or practice nurse.

EHIC – European Health Insurance Card

EHIC – European Health Insurance Card

EHIC covers basic healthcare on short trips around Europe and is available free of charge 

The European Health Insurance Card (EHIC / formerly E111/ not EH1C) allows European Nationals in the European Economic Area (EEA) to obtain healthcare when travelling.  The healthcare may be at a reduced cost or in some cases for free.  The EHIC card is provided free of charge to United Kingdom residents.

ehic

The card provides free or reduced cost healthcare cover for short-term trips around Europe and Switzerland. It only covers the basic national healthcare as received by local residents of the country visited. This scheme will not cover those living permanently outside of the UK. It will cover the card holder in the EEA and Switzerland. The EHIC is valid for 5 years and only available to United Kingdom residents. The EHIC card does not replace the need for travel insurance.

One EHIC Card for each Family Member includes non-emergency care for existing/chronic conditions

Each member of a family will need a separate, individual insurance card – including all children.

Those travelling with a chronic health condition can also receive essential non-emergency care for the length of stay.  The care received will be the same as provided to locals of the country visited. Not all EEA countries provide completely free healthcare and some countries might still charge for healthcare at a reduced rate.

EHIC does not cover already planned treatment in home country

The card will not cover any treatment a patient is awaiting for in his or her own country, nor treatment that can wait until return home.

Travellers still need Travel Insurance

The EHIC will cover emergency treatment and support for chronic conditions. However it is essential that all travellers still obtain travel insurance as the EHIC card will not cover:

  • Transport home (repatriation) is not covered under this scheme
  • Expenses for relatives – such as accommodation costs are not covered
  • It will not cover loss of luggage or other personal items

It is also important to remember that any treatment provided will be the same as that received by locals, which can vary among EEA member states.

Applying for a Free European Health Insurance Card

You can apply for the EHIC free of charge via the NHS website . Note that some companies offering to do the application for an individual on-line will charge for this service.  To obtain the card for free you must access the service via the NHS website.You will need the following information in order to apply for a free EHIC:

  • Full name
  • Current Address
  • Date of birth
  • National Insurance or NHS number (England and Wales)
  • CHI number (Scotland)
  • Health and Care number (Northern Ireland)

Renewal of a European Health Insurance Card

The EHIC card is valid for 5 years.  It can be renewed free of charge on-line if your personal details have not changed.  A renewal can be made six months before the old card expires. More details about renewals, address changes, name changes and lost cards can be found on the NHS website

Brexit – What next for the EHIC?

Following the United Kingdom exit from the European Union it important to remember that the EHIC is still valid – until it isn’t… Cards should still be renewed as normal when they expire.  Check your card expiry date.  Travellers to Europe can still renew cards using the NHS Website.  The service is free of charge – you do NOT have to pay to renew the card – please be aware that there are website charging for this service.  


Note: This information is designed to complement and not replace the relationship that exists with your existing family doctor or travel health professional.  Please discuss your travel health requirements with your regular family doctor or practice nurse.

DVT – Deep Vein Thrombosis

DVT – Deep Vein Thrombosis

What is Travel Related Deep Vein Thrombosis (DVT)?

dvtA Deep Vein Thrombosis (DVT) is a clotting of the blood in any of the deep veins.  This clotting is usually in the calf. If a clot develops, it usually makes its presence known by an intense pain in the affected calf. Medical attention should be sought immediately if this occurs, especially after a long journey. In some cases this can be fatal. If the clot breaks off and makes its way to the lungs it can then affect the lung’s ability to take in oxygen.

What are the symptoms of DVT – How will I know it is a DVT?

A DVT can occur days or even weeks after a trip. In most situations the person will have no symptoms. In many cases through normal movement the clot will break up.

If the clot is larger it can cause an obstruction and prevent the blood flowing through the veins. When this happens a person might experience pain, redness and swelling in the affected area.  The affected part of the body might also ache and the skin might be warm to touch.  The pain might also feel worse when walking or standing. If these symptoms are experienced urgent medical help is required.

Complications can occur if the cot breaks off and travels to the lungs. If a clot breaks off and travels to the lungs the flow of blood can become blocked. Breathlessness and chest pain can occur hours or days after the clot has formed. This is a potentially fatal condition and urgent medical attention is required.

Who is at risk of DVT?

We  have a lot of information from hospital research specific to DVT. We already know that immobility for an extended period of time can increase the risk of DVT with the following factors being added risk factors:

  • A personal or family history of DVT
  • Active cancer or cancer treatment
  • Recent surgery or leg surgery
  • Existing clotting abnormality
  • Obesity
  • Hormones or the oral contraceptive pill
  • Inflammatory bowel disease
  • Varicose veins
  • Pregnancy or 2 months post-partum
  • Existing Cardiac problems or a history of cardiac problems or stroke
  • Dehydration
  • Severe infection
  • Aged over 60

How many people get a DVT?

It is hard to establish just how many people are affected by DVT after travel related activities, as no official records are kept. However it is important to be aware that it is a potential problem for those with risk factors.

How can I prevent DVT when travelling?

Those in a high-risk category should see their travel health advisor or doctor before they travel and discuss prevention.

Those at risk should try to exercise at least every hour on long journeys. Exercise the calf muscles by rotating your ankles, or making use of the commercially available exercise equipment. The risk applies to any form of travel where you are routed to one place for hours at the time.

Good compression hosiery will encourage circulation. However it is important that you do not wear clothing that will cause a restriction of circulation. Any compression hosiery should be measured properly to ensure a suitable fit.

For long flights wear loose clothing. Due to the change in atmospheric pressure in a plane, parts of your body can expand due to increased gas! In the dry environment of a plane, it is a well-documented fact that too much alcohol, tea and coffee on flights can add to the problem of dehydration. It is therefore very important to remain hydrated during a long flight by drinking plenty of water and fruit juices.

Always remember to buy your travel insurance before travel. For travel within Europe (EEA and Switzerland) you can also get a free European Health Insurance Card.  When planning a trip take a look at the Pre-Travel Advice to ensure you are fully prepared for a healthy trip.

In-Flight Stockings, Compression Hosiery and DVT Socks

With much attention given over the potential risks associated with Travel Related Deep Vein Thrombosis, it is not surprising that many people are looking for products, which will offer protection. Research has shown that correctly fitting anti-thrombosis stockings or DVT socks increase blood flow, thus lowering the risk of DVT in those at risk. Advice related to stocking/socks should apply to all forms of travel when a passenger is sitting still for a long period of time.

Assess your risk of DVT

  • Before buying any products assess your personal risk factors and obtain advice from your own doctor regarding fitness to fly. If you are in a high-risk category you should seek advice from your doctor and consider postponing your travel plans

Get measured properly by a professional

  • It is important that any DVT stocking/sock purchased be fitted properly by a professional. A stocking that is too tight and worn by a traveller with existing circulation problems can do more harm than good — cutting into the skin on a long flight and potentially causing ulceration and increased risk of DVT
  • Never guess the size stocking or sock you require – ask to be measured properly. A good flight sock will come in a variety of sizes allowing for measurement from the knee to the ankle as well as the foot size. If a stocking is too tight around the knee it will prevent essential venous return causing the blood to pool around the knee.
  • When buying your DVT compression hosiery make sure they are comfortable with your chosen footwear for travelling. Some flight stockings can be slightly thicker than normal leg covering and can be potentially restrictive with tight foot wear.
  • Do not think that if you wear tight knee-highs during a flight you will save some money. Any clothing or tight shoes cutting into the skin around will prevent normal blood flow and increase the risk of travel related DVT.
  • Wear your stockings around the house prior to travel to ensure you have a good, comfortable fitting. On the morning of your travel put them on when you get dressed, especially if you are travelling a distance to the airport. Hurriedly put on stockings in the airport lounge can cause no end of travel related anxiety!
  • Flight socks and stockings are just one-way to help prevent travel related DVT – take advice from your doctor as well as preventative advice related to travel.

What can your Doctor, Nurse or Pharmacist do to help?

Your Health professional will be able to help you determine your risk factors and provide you with both advice and written information. They will also be able to guide you as to the best time to travel after an illness or operation.

Other Resources




Note: This information is designed to complement and not replace the relationship that exists with your existing family doctor or travel health professional.  Please discuss your travel health requirements with your regular family doctor or practice nurse.

Pre-travel Questionnaire

Pre-travel Questionnaire

It is essential that you visit your NHS Practice or TravelHealth Clinic or Travel Health trained Pharmacist well in advance of travelling abroad. They will be able to advise you personally regarding vaccinations, malaria prevention and general health issues you should consider for your destination.

To help you have all the right information at hand, print off this form, complete the details, and take it along with you when you visit for your GP Surgery / Travel Clinic for your travel health consultation.

Pre-Travel Questionnaire

 

Malaria Lifecycle and How Malaria Spreads

Malaria Lifecycle and How Malaria Spreads

The following pictorial diagram shows the lifecycle of the mosquito responsible for the spread of malaria. This diagram has been provided and reproduced with permission from GlaxoSmithKline.

malaria life cycle
Pictorial Diagram showing how Malaria spreads

Note: This information is designed to complement and not replace the relationship that exists with your existing family doctor or travel health professional.  Please discuss your travel health requirements with your regular family doctor or practice nurse.

Research References

Research References

The following sources have been useful in compiling the information for TravelHealth.co.uk

Dawood R. Traveller’s Health 1999 3rd Edition, Oxford press, Oxford

HEA BCG Vaccine Sheet 1997 Department of Health, London

HEA Polio Vaccine Sheet 1997 Department of Health, London

HMSO Immunisation against Infectious Disease 1996, DOH London

Kassianos G. Immunisation – Childhood and Travel Health 1998 3rd Ed. London Blackwell Science

Walker E. Williams G. Raeside F. Calvert F. ABC of Travel Health 1997 5th Edition, Cambridge BMJ Publishing Group

Center for Disease Control (CDC) www.cdc.gov/travel

Lancaster T. The Traveller’s Good Health Guide 1999 London, Sheldon Press

Martin J. Malaria Primary Health Care June Vol. 7 no.5 1997

Travel Health On line – Shorelands www.tripprep.com/index.html

Wilson E. Personal Risks for Foreign Travellers Practice Nurse May 1996

Bell D. Tropical Medicine 1995 4th edition, Oxford Blackwell Science

CDC Hepatitis Information www.cdc.gov/ncidod/diseases/hepatitis/a/fact.htm

WHO Dengue Fever fact sheet www.who.int/inf-fs/en/fact117.html

HMSO Immunisation against Infectious Disease 1996, DOH London

WHO International Travel health page www.who.int/ith/english

World Health Organisation www.who.org

TravelHealth Books

TravelHealth Books

General TravelHealth Recommendations

  1. Top Recommendation: Traveller’s Good Health Guide by Ted Lankester
  2. Travellers’ Health: How to Stay Healthy Abroad edited by Richard Dawood – The long awaited new edition of Travellers’ Health is now available full of information and help for the traveller
  3. How to Shit in the Woods: An Environmentally Sound Approach to a Lost Art by Kathleen Meyer
  4. Bugs, Bites and Bowels (Cadogan Guides) by Jane Wilson-Howarth
  5. Rough Guide to Travel Health (Miniguides) by Nick Jones
  6. ABC of Healthy Travel (ABC) by Eric Walker

Destination Guide Recommendations

  1. The Rough Guide to Europe
  2. Central and South America (Lonely Planet Read This First) by Conner Gorry
  3. South East Asia (Lonely Planet Shoestring Guides) by Chris Rowthorne
  4. Australia (Eyewitness Travel Guides)

Travelling with Children

  1. Your Child’s Health Abroad: A Manual for Travelling Parents by Jane Wilson-Howarth
  2. Travel with Children (Lonely Planet Travel Guides) by Cathy Lanigan

Travel Planning Books

  1. The Rough Guide to Travel Online – 2nd Edition by Samantha Cook and Greg Ward
  2. The Gap Year Book: The Definitive Guide to Planning and Taking a Year Out (Lonely Planet Gap Year Guide) by Joe Bindloss and Charlotte Hindle (Paperback – 1 Jul 2005)

Books relating to Fear of Flying

  1. Ask the Pilot by Patrick Smith
  2. Flying Without Fear by Keith Godfrey
  3. Flying? No Fear! (Summersdale Self-help) by Akers Douglas

Business Travel

  1. Top Recommendation: The Survivor’s Guide to Business Travel (International Herald Tribune) by Roger Collis

Health Professional TravelHealth Material

  1. Top Recommendation: Travel Medicine and Migrant Health edited by Cameron Locke
  2. Immunization: Childhood and Traveller’s Health by George Kassianos
Considerations for Pre-Travel Gap Year Health

Considerations for Pre-Travel Gap Year Health

  1. Pre-Travel Gap Year Health – You’ve decided on a far flung destination – the first thing you need to do is make an appointment with your Travel Clinic, Pharmacist or Doctor for a Health Check. You will also need to consider what Vaccinations you will need for your trip
  2. Make sure you have the right travel insurance to cover your trip.  Good insurance will include cover for ALL of those activities you are going to take part in.  Check that everything you want to do is covered in the small print.  Sometimes you will need to pay for the extra cover to ensure you are covered for everything.
  3. Preventing Sexual Health problems can occur anywhere so best to be prepared
  4. Think through the Physical Hazards of your trip is essential to ensure you are prepared for all eventualities
  5. Retail Gap Year – Essential buys for the Gap Traveller
  6. Staying healthy through attention to Safe Food and Water
  7. Avoiding trips to the long drop – your guide to Travellers Diarrhoea
  8. Personal Safety and Security
  9. Preventing Malaria
  10. Be prepared for the Psychological issues related to travel

Pre-Travel Gap Year Health if you only have 5 minutes …?

Whether you are planning to travel the world for fun, or intending to work as a volunteer as part of an Aid Agency, you will need to take careful precautions to ensure your continuing health and safety.

Make sure you read our Gap Year Travel Health advice sheet

  


Note: This information is designed to complement and not replace the relationship that exists with your existing family doctor or travel health professional.  Please discuss your travel health requirements with your regular family doctor or practice nurse.