Coronavirus COVID-19

What is Coronavirus, COVID-19?

Coronavirus, COVID-19 was first recognised in China in December 2019.  It is a virus which is part of a family of viruses which can cause mild illness such as the common cold to more severe illness such as SARS.

Since the start of 2020, the COVID-19 pandemic has become a global health emergency with many countries imposing travel restrictions.  Guidance for households with possible infection and individuals with any of the known symptoms is to self-isolate at home.

Coronavirus COVID-19The Foreign and Commonwealth Office (FCO) continues to advise against all but essential international travel. 

While travel to some countries and regions is permitted after 4 July 2020, not all of these destinations are currently accepting inbound travellers.  It is essential to verify local directives for your travel destination.

Travellers should be aware that this type of virus is commonly transmitted through respiratory droplets, such as saliva or droplets from the nose when a person coughs or sneezes.

It is possible that the virus can be spread through faeces, blood and urine.

There is currently no vaccine for the virus. However, there are medications to control symptoms of the disease.

What are the main symptoms of COVID-19?

The most common symptoms are:

  • the recent onset of a persistent cough, and/or
  • a high temperature, and/or
  • a loss of, or change in, your normal sense of taste or smell (anosmia) 

For most people COVID-19 will be a mild illness, and some may not display any symptoms at all.

Who is at risk of Coronavirus, COVID-19?

Anyone who is in close contact with a person already carrying the virus is at risk. 

Respiratory droplets pass airborne viruses from one person to another. This can happen through coughing and sneezing when people are in close contact (less than 1-2 metres).  The airborne virus can then land on a person’s hands, nose or mouth and then enter into the respiratory system.

How can I prevent Coronavirus, COVID-19?

To lower the risk of Coronavirus, COVID-19 the following precautions can be taken:

  • Wash your hands regularly with soap and water
  • Maintain good personal hygiene especially after being in public places and before eating food
  • Carry some antibacterial wipes for emergencies – especially when you are using public bathrooms or using public transport
  • Try to avoid touching your face including your mouth, nose and eyes
  • Do not share personal items such as toothbrushes, towels etc.
  • Maintain social distancing.  Keep a distance of at least 2m (6ft) between yourself and other people, especially if they are coughing or sneezing.
  • Avoid contact with others showing symptoms of flu-like symptoms or who appear unwell
  • Maintain good communication with those you are unable to be with due to social distancing using e-mail and telephone
  • Keep up to date with travel advisories and information from your government when moving around your own country or travelling overseas
  • Check advice when you return to your own country regarding precautions you should take if you have been to an area where cases of COVID-19 are considered high 
  • If at any time you feel unwell with mild flu-like symptoms it is important to stay at home for 10 days.  The UK Government has published a stay-at-home document with advice. For more severe symptoms a person in the UK should call NHS 111 for advice
  • Vulnerable people should follow advice to prevent COVID-19
  • You should also be remember that if you try to take a flight and are suffering from a respiratory problem you could be refused access to the flight – if you have an existing condition make sure you have a letter from your doctor!
  • Before travelling overseas to certain countries during the “flu” season it is advisable to discuss flu vaccination with your health advisor.

Those travelling should:

  • Avoid live food markets where animals and birds are sold for food
  • Maintain good food hygiene and only eat food which has been well cooked in at risk areas
  • Maintain good personal hygiene

COVID Symptom Tracker

You can help slow the spread of COVID-19 by self-reporting your symptoms daily, even if you feel well.

   

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

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

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.

West Nile Virus

In most cases the virus causes mild flu like symptoms 3-14 days after the bite from an infected mosquito. Other symptoms might include eye pain, vomiting and a rash on the skin. These symptoms usually last 3-6 days.

Only 1 in 150 infected persons can go on to develop a more severe form of the disease, with increased age (over 50) being an indicator for higher risk. Severe symptoms include fever, weakness, vomiting and a change in mental behaviour. These symptoms can eventually lead to death.

Who is at risk of West Nile Virus?

Up until 1999 this disease was mainly found in Africa, Egypt, South-east Asia and the Southern parts of France. The first recorded cases in the Western Hemisphere were reported in New York in 1999 and since 2000 many cases have been reported throughout the United States and Canada. Any person travelling to these areas is at risk of the disease.

Risk is seasonal in most places and will therefore vary at different times of the year – however those travelling to the Southern States of the United States should be aware that the risk remains all year. The CDC website can provide up to date information on currently infected areas.

What can I do to prevent West Nile Virus?

There is no vaccine to prevent WNV in those travelling to high-risk areas — prevention of bites from mosquitoes is the best line of protection. Most of the mosquitoes bite from dusk to dawn and a good repellent should be used during this time, however in some areas day biters have been found so use repellent accordingly.

 


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.



Yellow Fever Virus

What is Yellow Fever?

Yellow Fever is a virus, which is spread via the bite of an infected mosquito. The disease exisits  in tropical areas of Africa and South America. While the disease is not found in Asia – the potential is there for spread due to the presence of the Ades mosquito, which is responsible for its spread.

Yellow Fever is recognised in two different forms – urban and jungle. Urban Yellow Fever occurs in the cities and is spread from mosquito to human to mosquito. In the jungle form Yellow Fever is spread from mosquitoes to monkeys and also to humans.

The disease presents itself after an incubation period of about 3-6 days with flu like symptoms, with death occurring in around 5% of those who become infected. There is no treatment for Yellow Fever, and so relief of symptoms is the primary course of action.

Who is at risk of Yellow Fever?

Any traveller to areas where Yellow Fever is endemic (that is: the infection is present in low levels) is at risk. This includes areas of Africa and South America.

How can I prevent Yellow Fever?

Travellers should obtain the necessary vaccination and a certificate of vaccination when travelling to endemic areas of the world.  This certificate is the ONLY internationally regulated certificate. The WHO recommends it for all travellers to endemic areas, as well as for those coming from an endemic area to an area of potential transmission. The purpose of the certificate is not only to protect the traveller but to also protect those in areas of the world where infection is possible due to the presence of the Ades mosquito. It is essential to ensure that the traveller plans ahead due to the shortages of vaccine at this present time.

Also see Preventing Bites.

  News and References 

  • May 2016 – Independent reports that “Yellow Fever – World on brink of global emergency over deadly outbreak, academics warn”
  • JAMA Article May 2016 – A Yellow Fever Epidemic
  • Find a Registered Yellow Fever Clinic near you

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.

Typhoid and Can you Prevent it?

Typhoid is a Bacterial Infection

Typhoid is an infection caused by bacteria.  The bacteria is similar to the one that causes salmonella food poisoning.  You can become infected with Typhoid after eating or drinking infected food and water. The time between becoming infected and the first symptoms is around 1-3 weeks.  The disease can occur in any age group.  The disease is rare in children under 2 years of age.

Symptoms usually appear over the course of a month.  Once infected you might experience headaches and tiredness. This can progresses to aching muscles and stomach pains. Some people have a ‘rose spot’ rash after the first week of infection. Constipation can occur followed by bloody diarrhoea and a high temperature. If the disease is not treated quickly it can lead to death.  After contracting the disease you can pass the infection to others for 6 weeks to 3 months.

Typhoid is Present around the World

Typhoid is mainly present in South America, Africa and areas of Asia.  Therefore there is a higher risk if you travel to undeveloped areas of the world.

It is also important to understand that Typhoid can potentially occur anywhere in the world.  This is due to the way the disease spreads and the speed of travel. Natural disasters and imported cases can allow for outbreaks in parts of the world that would normally be considered low risk areas.

Typhoid can be Treated with Antibiotics 

Antibiotics can be used to treat mild cases, if the disease is diagnosed early. However, late diagnosis usually requires hospitalisation and  carries the risk of serious complications or death.

Vaccination can help Prevent Disease

Getting vaccinated (injection or oral) is a good idea when you are traveling to risk areas, and for occupational risks. Also vaccination against both Hepatitis A and Typhoid as a two-in-one injection is also available.

As vaccination does not provide 100% protection, it is also important to avoid food and drink which could be infected. You should also wash your hands properly before eating or using the bathroom.

References and Resources


Note: This information is intended to complement and not replace the relationship you have with your existing family doctor or travel health advisor.  Please discuss your travel health requirements with your regular family doctor, pharmacist or practice nurse.

BCG Vaccination

The BCG vaccine contains a weak form of the disease

The BCG Vaccine (Bacillus Calmette-Guérin Vaccine) protects an individual against Tuberculosis.  Since vaccination began in 1953 in the UK recommendations for vaccination have changed over time. Routine school vaccination for teenagers stopped in 2005. The UK vaccination programme is now “risk based”.

Currently in the UK vaccination is only given on the NHS to babies, children and adults under the age of 35 living in high risk areas of the country (including London).

  • The vaccine contains a weak form of the disease
  • The vaccine is a live vaccine
  • The vaccine does not contain Thiomersal
  • There are no preservatives in the vaccine

For those travelling overseas the BCG vaccine is only given, if required, following a full risk assessment and tuberculin sensitivity test.  Travellers under the age of 16 years living and working in a high risk area for more than three months would be considered for vaccination.

If you are travelling overseas it is important to have a full risk assessment to determine if the BCG vaccine is required.  A private travel clinic will be able to determine your risk and provide advice to help you determine if you need to have the vaccine.

Resources and information for Tuberculosis and BCG Vaccination

 


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.

Tuberculosis

Tuberculosis is spread from person to person via droplets in the air from coughing or sneezing. On rare occasions, it is spread via contaminated milk in the tropics.

Once an individual is infected they can remain without symptoms or go on to experience weight loss and general ill health. Tuberculosis most commonly affects the lungs and is accompanied by persistent coughing, blood stained sputum (phlegm), chest pain and fever.

Who is at risk of Tuberculosis?

Tuberculosis is found all over the world with China and India having the highest number of cases and Africa having the most deaths. In the UK, there has been a 25% increase in cases in the last ten years mainly among those from Asian backgrounds.

TB can only be caught from someone who already has the disease.

In the UK, routine vaccination of all school children is no longer practiced (DOH July 2005). A new vaccination programme now targets those children and adults at highest risk to the disease.

For those travelling to high-risk areas, such as Africa, Southeast Asia and parts of South America, proof of immunity is recommended.

How can I prevent Tuberculosis?

Partial protection is gained through BCG vaccination. The vaccination is only given at the presentation of a negative mantoux or heaf test. Only newborn babies are vaccinated without the test.

It is essential for all travellers going overseas to have a test and the subsequent vaccination if required. It is possible that immunity after vaccination is not lifelong and therefore all persons moving abroad to work in risk areas should consider testing, especially if the vaccination scar is not present. For advice regarding BCG, you should make an appointment with your family doctor or Travel clinic nurse.

For those with TB, treatment involves a variety of antibiotics taken over a period of months. The treatment will cure the disease ONLY if the treatment is continued until the end of the course. Because many people feel better, they stop taking the medication and this results in a recurrence of the disease.

NON-UK VISITORS TO THIS SITE:

Please note that the recommendations in other countries may differ from those in the UK and local advice should be sought.

European BCG Recommendations

Australian BCG Recommendations

American BCG Recommendations

Resources for TB

The DOH has provided answers to many common concerns about the jab

NHS Immunisation Information Service has produced multi-lingual fact sheets about TB and other vaccine preventable diseases

Amazon has a collection of books covering history and medical treatment of TB including Timebomb: The Global Epidemic of Multi-drug-resistant Tuberculosis (Paperback) £6.95

Health Protection Agency provides excellent information and reports on Tuberculosis with latest health reports and epidemiological data from the UK and abroad.

  


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.

Tick Borne Encephalitis

What is Tick Borne Encephalitis?

Tick Borne Encephalitis is a viral disease spread via the bite of an infected Ixodes tick. It can also be transmitted via unpasturised milk from infected goats or cows. Ticks bite humans when they walk through undergrowth or grasses where contact is made. Peak biting times are during the warmer months of August, or following a warm humid summer in September and October. After an incubation period of 2-28 days, symptoms begin with a fever and can progress at varying degrees. Death rates are highest in the elderly.

Who is at risk of Tick Borne Encephalitis?

Tick Borne Encephalitis is a risk for travellers going to endemic areas; that is: areas where infection exists at low rates. It is most prevalent in Europe and Asia in long grass and undergrowth, at a tick infection rate of 5%. A variation of Tick Borne Encephalitis occurs in Russia and China.

How can I prevent Tick Borne Encephalitis?

While a vaccination is available for those at high risk, travellers should try to avoid areas where the disease is prevalent. If it is essential to go walking in long grass or undergrowth, suitable clothing should cover arms and legs, with trousers tucked into socks for protection. DEET can also be used as a repellent. Those trekking can impregnate cloth with permethrin to use as a ground sheet to sit on in infected areas.

If a tick gets onto the skin, it should be removed using the correct technique of pulling it straight from the skin using tweezers or a similar instrument, not twisting.

  


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.