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Health Information

OTSHealth Regulations and Health Information should not be confused... one with the other! Firstly, when travelling to, from or via Latin America, South America, Asia or Africa there will be a requirement for certain valid health certificates to be carried. Secondly, some journeys to from or via other countries throughout the world may well involve limited health risks for which vaccination or inoculation certificates are not sought by appropriate health authorities. Nevertheless, a need could still arise to seriously consider certain recommended precautions in order to safeguard your own health.

YOU ARE ASKED TO ENSURE that all members of the party or group liaise with their own doctor or practice nurse to determine

a) that the individual's general health will not prevent participation in the proposed travel plan, and
b) that vaccination(s) and/or inoculation(s) together with a programme of pills or potions as deemed necessary by the doctor or practice nurse are all arranged, as recommended, prior to departure.

The OTS office has access to a wide variety of travel manuals and information technology which clearly state the latest known health situations on a world wide basis. Do please take advantage of such a facility whilst bearing in mind that some countries may find it necessary to impose temporary vaccination requirement at short notice.. but generally against a background of considerable media coverage.

For detailed advice and recommendations relating to Travel Health please visit the Foreign and Commonwealth Office website

The information below provides details regarding some of the disease risks that exisit when travellling abroad.

Malaria (Plasmodium falciparum)

Every year, since 1999, an average of 1,800 people return to the UK with Malaria. Of these, some 70% suffer from the potentially fatal Plasmodium falciparum.

When planning your trip, make an appointment with your GP's surgery, travel clinic or pharmacy at least 2 months prior to anticipated departure … the idea being to discuss those anti-malarials presently available. Essential travel health advice can be accessed right up to the date and time of travel.. it’s never too late to seek advice.

The symptoms of malaria can be non-specific and include: fever, chills, joint pain, weakness, muscular aches, vomiting, diarrhoea and abdominal pain. Patients may not know immediately that they have contracted malaria, since the symptoms can take weeks or even months to appear.

Malaria is preventable but can be fatal if left untreated. It only takes one bite from an infected mosquito to contract this dreadful disease. Reduce your chances of suffering a mosquito bite, by following your healthcare providers advice and purchasing the recommended anti-malarial medication, mosquito net and insect repellents. An insect repellent containing 20% to 50% DEET is advised.

Keep arms, legs and feet covered and limit outdoor activities between dusk and dawn when mosquitos are at their most active. Sleep under a mosquito net impregnated with permethrin.

It is absolutely essential you are meticulous in observing the anti-malarial programme originally arranged for you by your healthcare professional. In other words, keep taking the anti-malarials as prescribed and until the prescription has run its full course.

Health Risk Map for Typhoid

Tetanus

Tetanus (bacterium Clostridium Tetani)is present worldwide in the soil and the risk of catching this disease is not particularly dictated by the area of the world you are visiting. However, travellers are very often more likely to expose themselves to the risk of catching it due to their activities whilst abroad.

Tetanus usually enters the body through a wound where it grows and produces a powerful toxin which circulates in the blood causing muscular rigidity and painful muscle contractions. Death is usually caused by respiratory problems and exhaustion. Those infected with tetanus can often not even recall the instance of when they were infected as the bacteria can enter the body through the slightest of cuts or burns.

Although vaccination has reduced the incidence of tetanus, the disease has not disappeared. If individuals are not fully immunised there is always the risk of tetanus developing in wounds contaminated by soil. The incubation period is between four and twenty one days, commonly around ten days. The first sign of tetanus is generally when an individual may notice jaw stiffness and difficulty in opening the mouth (lock jaw).

All wounds, even minor ones should be thoroughly washed with clean water and soap taking particular care to remove all dirt and loose tissue. Immunisation against tetanus is highly protective and adults and children should ensure they are in date for it. Booster doses should be given at ten year intervals.

It is advised that travellers should always ensure their Immunisation for this threat is up to date, especially if they are more likely to be exposed to the risk of flesh injuries (however minor) whilst on their travels.

Typhoid

Typhoid is, in parts of the world still a high risk disease with over 22 million people a year contracting it. It is prevalent mainly in the less developed countries although there always exists a risk from contracting this disease from others, especially if they have been involved in the preparation of food.

This life threatening disease is a type of Salmonella (of which there are thousands of variants of various degrees of severity) and is contracted from the bacteria Salmonella Typhi. Transmission is usually from others who have contracted the disease and have prepared food that you eat or from contact with raw sewage contaminated with this bacteria that then gets into the water you use for drinking or washing food.

If you catch Typhoid you will usually experience a prolonged high fever coupled with stomach pains, headache and loss of appetite. Occasionally there is also a rose coloured rash as well. Failure to obtain treatment is, in about 20% of cases, fatal after a few weeks although those some people may recover but continue to be carriers who can spread the disease!

Typhoid is generally treated with antibiotics such as ciprofloxacin or ampicillin both of which are extremely effective inn treating this disease. Persons treated with antibiotics usually improve within a few days. However, relapses do happen quite frequently and, those infected may then go on to become carriers.

Vaccination is available from your doctor but having such does not entirely remove the risk so precautions should be taken if visiting areas of the world that carry a higher infection risk. Regular washing of hands is advisable as is refraining from drinking any drink other than those from sealed containers (don't forget the ice!)

Health Risk Map for Typhoid

 

Hepatitis A

Is a viral disease that causing inflammation of the liver. It occurs throughout the world and is more common in areas of poor sanitation and hygiene. Many people in developing countries are infected with the virus from an early age, usually without symptoms. Past infection with hepatitis A virus gives life long immunity.

However, in the developed world where sanitation is better, fewer people are contracting the disease during childhood and are therefore at risk when they become adults from the more severe form of the disease, which they could then catch when they travel to areas of the world where hepatitis A is more common.

Hepatitis A is generally transmitted from by faeces coming into contact with food or drink, especially in in high population areas with poor sanitation. It is quickly spread through close contact, particularly within families and institutions and is commonly associated with eating and drinking contaminated food and water. Food outbreaks are often linked to raw or undercooked shellfish and raw vegetables although almost any food that has been poorly cooked in sewage-polluted water presents a high risk.

Infectio may have no noticeable symptoms through to jaundice, liver failure and death. Unlike hepatitis B, there is no chronic carrier state for hepatitis A.

Symptoms include fever, chills, weakness, loss of appetite, nausea and abdominal discomfort, followed within a few days by jaundice (yellowing of the skin and eyes). The urine becomes dark and the stools pale. Jaundice may be severe and prolonged and complete liver failure may occur.

Hepatitis A can be prevented by vaccination. The immunisation schedule consists of a single dose of vaccine followed by a booster dose six to twelve months after the first dose to give immunity up to ten years. Again, as with most disease preventaion travellers are advised to take care as to what and where they east and drink.

Health Risk Map for Typhoid

Cholera

Cholera is a bacterial intestine infection caused by Vibrio Cholerae and is generally caught by drinking water contaminated due to improper sanitation or by eating undercooked cooked fish and especially shellfish.

Generally quite large amounts if this bacteria need to be ingested to cause cholera in normally healthy adults, although increased susceptibility can occur in those with weakened immune systems, individuals with decreased gastric acidity (as from the use of antacids etc.), or those who are malnourished. The incubation period can range from two to three days to a few hours.

The symptoms range from the mild to the severe and may be fatal. They include; diarrhoea, abdominal cramps, nausea, vomiting, and dehydration. Cholera causes the disease by producing a toxin that induces usually sudden and severe painless watery diarrhoea occasionally accompanied by vomiting, which rapidly leads to dehydration.

The bacteria are transmitted in water or food contaminated with infected faeces and the disease can occur in large-scale epidemics where sanitary conditions have broken down such as those in areas of natural disasters such as floods.

Cholera is rare amongst travellers as they tend to avoid the insanitary conditions which would put them at risk.

Medical help should be sought without delay. Cholera is treated with rehydration and antibiotics, but in severe cases, can lead to death.

Fluid replacement is essential and should be started as soon as symptoms occur. The patient should aim to drink as much non-alcoholic fluid as it takes to maintain a good output of normal looking urine (this may be as much as six or seven litres a day).

Travellers are recommended to avoid possibly contaminated food and water, especially raw or undercooked seafood from polluted water.

There is a new vaccine now available (Dukoral) for immunisation against cholera for people travelling to highly endemic or epidemic areas, particularly emergency relief and health workers in refugee situations. The vaccine may be considered for the following..

  • People working in areas where there are known cholera outbreaks (e.g. aid workers)
  • Travellers staying for long periods in known high risk areas and/or where close contact with locals is likely, and who do not have access to medical care
  • Travellers to risk areas who have an underlying gastro-intestinal disease or immune suppression

The vaccine is taken as a raspberry flavoured drink and can be used in adults and children over 2 years.

Health Risk Map for Typhoid

Rabies

Is a viral infection that is acquired from the saliva of an infected animal, usually a dog or cat. In most cases infection results from a bite but even a lick on an open cut or sore may be enough. Symptoms start with itching and tingling at the site of the healed bite and then rapidly progresses to include headache, fever, spreading paralysis, confusion, aggression and hydrophobia (fear of water).

Sympptoms may take weeks or months to develop although the morm is two to eight weeks. Animals may be infectious for up to a week before they develop any symptoms.

If you suspect that you may have been bitten or cratched by a rabid animal immediately clean all bites with soap and water and do not allow the wound to be stitched. Limited bleeding should be encouraged and apply an alcohol solution if possible.

If available human immunoglobulin (HRIG) should be given especially for bites to the head or face. The disease can almost always be prevented, even after exposure, if the vaccine is administered without delay. In the event of a bite, your body's responses could be quickly activated by booster doses of vaccine. There are rarely any side effects or discomfort from the new type of vaccine unlike the old types.

If you feel that there is a risk that you may have been infected seek medical advice immediately and have a course of 5 injections of Purified Chick Embryo Cell Vaccine (PCEC) or Human Diploid Cell Vaccine (HDCV). This can be difficult to obtain abroad and if necessary the British Embassy or consulate should be contacted for a supply.

Prevention: Never approach or handle animals you don't know, particularly if they are acting strangely.Pre-exposure immunisation against rabies is available for long-stay travellers who intend to travel to rural and remote areas.

Health Risk Map for Typhoid

Tuberculosis

Three million people a year still die from this disease and whilst there is little risk on contracting this disease within most developed countries. Tuberculosis is generally spread through infected sputum but there is also a form spread through milk from infected cows.

TB is generally caught from inhaling microscopic droplets that have come from a person infected with TB. When coughing, speaking or sneezing, these droplets are expelled into the air which quickly dry out but the bacteria can remain airborne. However, the tuberculosis bacteria are killed when exposed to ultraviolet light, including sunlight.

Symptoms take the form of a general infection where the subject may feel a little unwell but these symptoms may go unnoticed until the disease takes effect sometimes a number of years later.

There is a vaccination against TB which can give a valuable degree of protection, particularly in children.

Those who have not received BCG Immunisation are advised to do so and if for travel purposes, at least six weeks before departure to ensure a protective level of immunity.

Health Risk Map for Typhoid

Other Traveller's Health Risks

Whilst travelling we are more suspectable to diseases, especially when visiting less developed areas of the world where we may not have the same immunity as the local inhabitants. The obvious advice is to take care with regards to general hygiene and also show caution to what you eat and drink but do be aware of the slightly less obvious risks that may exist due to many factors such as..

  • The effects of excessive alcohol!
  • The riding of often poorly maintained Motorcycles on strange roads in countries where the traffic laws we are used to do not exist.
  • Sexually Transmitted diseases. Do remember that many parts of the world have Aids epidemics. The steps to be taken to not need to be explained further here!
  • Swimming with Dolphins! This may sounds an attractive and harmless activity but frequently the water in which these creatures are kept may not meet the required standards for bathing!
  • The effects of the sun! Many trips undertaken are to much hotter climes and there will often be a strong risk of sunburn, even on a cloudy day. Dehydration can also happen, especially if involved with strenuous sporting activities

 



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