Whether you are travelling overseas, or you are assisting others to travel overseas, this update will provide you with information on some of the important travel health news for that month. Please feel free to forward this to anyone who is interested. New people can sign up here.

To make an appointment with your nearest TMA clinic ring 1300 42 11 42, or click here.

IMPORTANT BULLETIN
Swine Influenza (Swine Flu) 26/4/09

A new type of influenza known as swine flu has just been reported in several countries - first in Mexico, with subsequently some confirmed cases in different parts of the USA. A New Zealand school group recently returned from a language trip to Mexico, have symptoms of influenza and are being kept in isolation with their family members, whilst further tests are undertaken.

In Mexico, surveillance began detecting cases of influenza-like-illnesses starting on March 18th, 2009. The number of cases rose steadily through April and as of April 23rd, there were more than 854 cases of pneumonia from the capital. Of those, 59 have died. It is not yet known how many of these are confirmed to be due to swine flu. Some reports from Mexico say 1300 are sick and 80 have died. (Not all these cases are confirmed to be swine flu.) All the confirmed swine flu cases in the USA to date are mild and no one has died. The suspect cases in New Zealand school group are also reported to be only mildly sick.

In Mexico, bars and nightclubs, schools, gallery openings and sporting events were cancelled until further notice. Authorities advised people to wash their hands regularly and avoid the customary greeting of kissing on the cheek. The government has issued a decree giving the Health Ministry power to enter people's homes, close public events, isolate patients, and inspect travellers and their baggage.

The symptoms of swine flu in people are similar to the symptoms of regular human flu and include fever, cough, sore throat, body aches, headache, chills, and fatigue. Some people have reported diarrhea and vomiting associated with swine flu.

The World Health Organisation (WHO) is taking this matter very seriously.

On 25April the director-general of WHO determined that the current events regarding swine flu constitute a public health emergency of international concern, under the WHO regulations.

This flu is important because:

• Person-to-person transmission is suspected (People do not normally get swine flu. Rare human cases typically involve people who have had direct contact with pigs)

• It has occurred at multiple sites (confirmed cases in Mexico, California, Kansas and Texas)

• It has affected healthy age groups (not just the very old or very young)

• There is no vaccine that is specific for swine flu

The antiviral drug oseltamivir is effective against this strain.

It is safe to eat pork, you cannot catch swine flu by eating properly prepared pork.

Influenza is thought to spread mainly person-to-person through coughing or sneezing of infected people. There are many things you can to do preventing getting and spreading influenza:

There are everyday actions people can take to stay healthy

• Cover your nose and mouth with a tissue when you cough or sneeze. Throw the tissue in the trash after you use it.

• Wash your hands often with soap and water, especially after you cough or sneeze. Alcohol-based hands cleaners are also effective.

• Avoid touching your eyes, nose or mouth. Germs spread that way. Try to avoid close contact with sick people.

• Influenza is thought to spread mainly person-to-person through coughing or sneezing of infected people.

• If you get sick, it is recommended that you stay home from work or school and limit contact with others to keep from infecting them.

Vaccination is an effective way to prevent the commonly circulating strains of human influenza.

This is especially important for travellers. Studies have shown about 1% of travellers are exposed to influenza on their journey. Many workplaces have free flu vaccines for staff as this has been shown to decrease absenteeism and improve productivity in a work setting. Many travellers report that travel time is more precious than work time.

FURTHER INFORMATION

• Information on swine flu for travellers to Mexico

• World Health Organisation (WHO) swine flu update page

...prepared by Dr Deb Mills, Travel Medical Alliance, Brisbane, Queensland

Our doctors recognise that for some people, having an injection can be a very fearful event. We respect these concerns and use our many years of experience at giving immunizations to ensure the experience is as painless as possible. We can even provide anaesthetic patches to numb the skin beforehand. (Click here for video on how to use EMLA patch)

Hypertension (High blood pressure) at High Altitude

Should travellers with hypertension adjust their medications when travelling to high altitude?

A recently published article (High Alt Med Biol. 2009;10:11-15.) showed the great majority of patients with hypertension do not need to change their medication when they travel to or stay at high altitude because blood pressure increases modestly or not at all. As it is impossible to identify the few in whom blood pressure will increase markedly, it seems sensible to encourage travellers with poorly controlled or unstable high blood pressure to monitor blood pressure and to have a plan of action if the pressure were to rise above defined levels.

Malaria affects 109 countries worldwide - yet 35 countries suffer 98 percent of the global malaria death toll. Just five of these - Nigeria, the Democratic Republic of Congo, Uganda, Ethiopia and Tanzania - account for 50 percent of global deaths and 47 percent of all malaria cases.

There are also medications travellers can take during their journey to protect themselves from malaria, these are also available from your local TMA clinic.

(One of the worries about climate change is that it may expand the territory of the malaria mosquito - for more info see Doctors for the Environment website).

Wearing treated items will significantly decrease the number of bites you get. It is especially useful for long sleeved shirts. (When you wear treated clothes, you still need to use repellent on exposed skin.) Treated bed nets have been shown to be four times more effective than untreated nets at keeping mosquitoes away.

Treated clothes should not be ironed. Most people will not experience any ill effects from wearing treated clothes, although there are rare cases of persons developing a slight skin rash if clothing is worn close to the skin.

It is most useful to treat outer clothes, e.g. an overshirt. This means you can readily wash the undershirt, and do not need to wash the overshirt as often, so the permethrin impregnation will last longer. Once treated, the clothes are said to remain effective until at least the fourth wash.

View a video demonstrating how to treat your clothes with permethrin.