Malaria is a parasitic infection found in the tropics and sub tropics, which can be potentially fatal if untreated. Figures from Public Health England show that in 2017, there was 11% increase in the number of cases of malaria in UK travellers compared to previous years and 6 reported deaths. It is an easily preventable and treatable disease.
It is important that all travellers to malaria risk areas get medical advice and malaria prevention if required.
This is especially important if travelling to West Africa, East Africa, South East Asia and the Amazon where the malignant malaria, caused by Falciparum strain, are more common.
A new accelerated schedule has been licensed for rabies vaccination. Travellers who do not have enough time before their departure can now have the 3 doses of the rabies vaccination given over 7 days (day 0, day 3 and day 7). A fourth dose is required at 12 months for long lasting protection.
This means that travellers will be able to complete the full course even if they have less than 2 weeks before their trip.
Completely all three dose of the rabies vaccine means that in the event of an animal bite, only 1 further dose would be required for treatment instead of 4 vaccination doses. Additionally, the need for emergency Human Rabies Immunoglobulin (a blood product, which can be difficult to get hold off in many countries) is removed.
There is an ongoing outbreak of Yellow fever infection in Brazil with the popular destination of the beautiful City of Rio de Janeiro affected also. There have been 19 confirmed cases of yellow fever infection in travellers who have visited Brazil. All the cases were in unvaccinated travellers.
Yellow fever infection is a potentially fatal illness with no available treatment, but which is preventable by a highly effective vaccination. The virus is transmitted by mosquitoes that bite during the daytime hours.
A single dose of the yellow fever vaccination provides protection for life and vaccination is recommended for all travellers to outbreaks regions of Brazil, including the cities of Rio de Janeiro and Sao Paulo. Additionally, certificate for entry may be required if travelling onwards form Brazil to other South American countries.
There have been reported cases of measles worldwide, with 14,600 cases across Europe, including France, Germany, Greece and Romania.
Measles is highly infectious and travellers to countries with outbreaks who are not protected against this illness can bring back the infection to the UK leading to outbreaks.
Measles is a viral infection spread through coughing and sneezing. It is estimated to have a death rate of 1 per 5000 cases. The disease is easily preventable with vaccination. Two doses of the MMR (combined Measles, Mumps and Rubella) vaccine) provides lifelong protection against the disease. It is important before travelling to ensure that you have protection against this highly infectious and potentially life-threatening disease.
Yellow fever infection is present in regions of South and Central America as well as Africa.
Increase in disease activity was observed with outbreaks in seven countries across South America, including Colombia, Ecuador, Peru, Bolivia and Brazil between January 2016 and December 2017.
Brazil continues to suffer with new cases being reported. The risk areas for infection has now extended across the country and includes the states of Rio de Janeiro and Sao Paolo. The map below taken from the European Centre for Disease Control and Prevention shows the current situation in Brazil.
About Yellow Fever
Yellow fever is a viral infection that is spread by the Aedes spp of mosquito. The mosquito bites during the daytime.
The symptoms present after 3-6 days of contracting the infection with high temperature, muscle aches and loss of appetite. Patients can recover after this stage or go on to develop the severe (Toxic) form of the disease which consists of internal bleeding, organ failure and death. There is no treatment for the infection. Therefore, prevention is key.
Please note that although there no requirement to show proof of vaccination to enter Brazil if you are travelling from the UK, the current outbreak and risk of the disease in Brazil, means that vaccination should be considered for all travelers to risk areas to prevent acquiring this deadly infection.
In Kenya, outbreaks have occurred in the main Cities of Nairobi and Mombasa and in Zambia, the majority of cases are in Lusaka. The Zambian Authorities have now started a vaccination programme for the residents of Lusaka to prevent the spread.
Cholera is an acute diarrhoeal illness that is spread through contaminated food and water. Disease transmission is linked to poor access to clean water and sanitation facilities. As it is highly infectious, the disease can spread rapidly leading to outbreaks.
The infection can take 12 hours to 5 days to manifest following exposure and can present with profuse watery diarrhoea. The majority of people infected have mild symptoms that are easily treated with oral rehydration salts. In those who develop severe symptoms, the disease can lead to dehydration and death in a few hours of onset if treatment is not sought urgently. Over 50 percent of the most severely affected patients die within a few hours. Severe disease is more likely to occur in those with lowered immunity, pre-existing liver disease or if a high number of infecting bacteria is ingested.
Maintaining food and water hygiene is key to prevention of cholera and other infections transmitted this way, such as hepatitis A and Typhoid.
All travelers should:
Only drink boiled or bottled water-it may be necessary to use bottled water to brush teeth also.
Avoid any ice
Only eat food that has been thoroughly cooked-avoid salads, uncooked fruit and vegetables.
Avoid raw or under-cooked meat, fish and shellfish.
Vaccination is another method to reduce the risk of infection. The cholera vaccine is available as a drink and can be given to individuals from 2 years and over. It is available at all CityDoc Travel Clinics.
The vaccine consists of 2 doses in individuals above 6 years of age and 3 doses in children between 2-6 years of age.
As the vaccine is inactivated, it cannot cause the disease and nor is the vaccinated person infectious afterwards.
The vaccine should be considered if you are:
Travelling to a country with an active outbreak of Cholera
If you have an underlying condition, such as liver disease, or immune disorders that will predispose to severe infection.
If you are going to undertaking activities that may increase the risk of contracting the infection, such as Humanitarian Aid Work, voluntary work or travel o remote locations where access to clean water may be inadequate.
Increasing awareness of an under-reported and deadly disease
About Rabies Infection
Rabies is a viral infection that is transmitted by the saliva of infected animals. The virus enters the body through a bite or lick onto broken skin. From the wound, the virus spreads to the brain and nervous system. The incubation period from infection to symptoms can range from 7 days to 1 year, but on average takes 2-3 months.
If treatment is not sought, the disease is invariably fatal. To date, the only survivors of the disease have received rabies vaccine before the onset of illness.
The disease presents as either:
Furious Rabies – the most common presentation with symptoms of agitation, hydrophobia (fear of water), which then progresses to coma and death within a few days.
Paralytic Rabies – this presents with gradual paralysis of the muscles leading to death from respiratory failure.
Children are much more vulnerable as they are more likely to approach animals and are less likely to report bites and obtain urgent lifesaving treatment. Additionally, the virus does not have far to travel from any wound to the brain so symptoms are more likely to develop leading to invariable fatality.
The Statistics (WHO data)
Rabies causes 1 death every 15 minutes worldwide
1 in 4 bites and deaths occur in children under 15 years of age
Rabies is found in over 150 countries and in every continent except Antarctica. However, 99% of the deaths occur in Asia and Africa and the majority of cases are due to dog bites
In the Americas, Western Europe and Australia, transmission is mainly through bats.
Around 29 million people seek lifesaving treatment worldwide each year to prevent rabies.
Vaccination before exposure consists of a 3 dose course given at day 0, 7 and 21 or 28 days. After completion of the three dose course, travellers have protection for 10 years, following which, single booster doses only are required.
The vaccine was first used by Louis Pasteur over 100 years ago and is safe and well tolerated. It is an inactivated vaccine and can be used for all ages from birth.
Full three dose vaccination prior to exposure or bite simplifies the post exposure treatment to a further 2 doses of the vaccine. Without pre-exposure vaccination, a 5 dose vaccination course is required as well as possible administration of Rabies immunoglobulin – a life-saving blood product which is in short supply and can be difficult to obtain in many areas.
It is very important that urgent medical attention is sought if a potential rabies bite occurs. The wound should be washed immediately with soap and water for 10-15 minutes and a disinfectant such as Iodine or alcohol should be applied. Rabies infection is 99.9% fatal without treatment, but is 100% preventable with vaccination.
Pilgrims attending Saudi Arabia for Hajj or Umrah are required to provide a certificate showing proof of vaccination against Meningitis Strains A, C, W and Y to obtain a Visa.
About Meningitis ACWY
Meningitis is caused by the bacteria, Neisseria Meningitides, of which there are several strains. The combined vaccine provides protection against 4 strains; A, C, W, and Y, which are encountered worldwide.
The infection is spread by coughing, sneezing, kissing and sharing cutlery and utensils.
Japanese encephalitis is a viral infection that is found throughout South and South-East Asia, where transmission can be seasonal (usually May-October coinciding with the rains) or all year long.
The virus is spread by the Culex mosquito (vector) and the hosts for the virus are water fowl and pigs. Humans are the end host. Consequently, the disease is mainly found in rural areas, around rice paddies, farmlands (especially pig farms). However, it is important to note that outbreaks can and do occur in urban locations.
There is no treatment for the disease and it can cause fatality or permanent disability.
Therefore, all travellers at risk of this of exposure to this illness should carry out Mosquito bite prevention, which includes insect repellent, mosquito nets, insecticide infused clothing (if necessary) and strongly consider Vaccination.
Ixiaro is the licensed vaccine against Japanese Encephalitis and it is safe to administer from 2 months of age.
Previously there was one schedule, the STANDARD Schedule, which required two doses of the vaccine given 1 month apart (day 0 and 2nd dose day 28). Full protection against the disease is only achieved 7 days after the second dose. Therefore, if you were travelling to an “at risk” destination in less than 1 month and thus, unable to get two doses, you would not be covered against the illness.
There is now an ACCELERATED schedule, which can be used for travellers who do not have enough time to complete the standard course. This is licensed for use in adults aged 18-65 years and consists of two doses given 1 week apart (day 0 and 2nd dose day 7). This schedule provides the equivalent protection 7 days after the second dose as the standard schedule.
Additionally, the Department of Health guidance advises that clinicians can use this ACCELERATED schedule “off license” in children aged 12-17 years also, if there is genuinely insufficient time before travel.
Booster doses should be given at 2 years if there will be further exposure to the illness. After this, in those between 18-65 years of age, a second booster should be given at 10 years.
News from National Health and Family Planning Commission in China.
Case Report of a man who was found to have confirmed yellow fever in Beijing, China.
The man in question had returned from Luanda, Angola with symptoms of a high fever. There is currently a large outbreak of yellow fever in Angola.
It is important to remember China has yellow fever vaccination certificate requirements for all those over the age of 9 months. Although there is no actual yellow fever in China, the risk of a potential outbreak is there, because of the presence of the mosquito vector – Aedes Aegypt. An outbreak would require first an infected individual to enter the area and then subsequently to be bitten by the vector mosquito.
Make sure you attend your local Travel Clinic for yellow fever at least ten days before departure. The vaccination lasts for life and the certificate for a minimum of 10 years.
Yellow fever is a live vaccine and there are a number of contraindications so its important you attend a registered yellow fever travel clinic for expert advice. Yellow fever vaccination is contraindicated in those with a true egg allergy.