A sad travel story ... with a
lesson
On 24 October 2007, at the start of a two-week
holiday trip through Kenya, a small bat had flew against
the face of a 34 year old woman. While she was hitting
away the animal, it made two bleeding scratches on the
right side of her nose. The incident took place in a
camping site between Nairobi and Mombasa, at dusk, while
she was brushing her teeth. The wound was washed with
soap and cleaned with an alcohol solution. The warden of
the campsite and medical personnel of the neighbouring
health centre said no further action was needed.
The woman and her husband continued the holiday.
On 19 November 2007, she was admitted to the hospital
in the Netherlands with trouble speaking, loss of
sensation of both cheeks and unsteady gait, all of which
started the day before. She had also experienced
dizziness, nausea and general tiredness for three days.
Despite all possible medical efforts, the lady died
of rabies on 8 December, 23 days after the onset of
illness.
This fatal incident shows that in a rabies endemic
area, any bite or scratch from a mammal has to be taken
very seriously indeed, and do not necessarily believe
the local medical advice.
Australians are particularly at risk of rabies and
other exotic disease as they have very poor knowledge of
such things as rabies.
We live in such a safe environment!
If this woman had been properly briefed about rabies
and insisted on vaccination immediately after the
exposure, she would have lived.
Travel Medicine is not just needles - it is
information about how to stay safe. That is why it is so
important that travellers consult doctors who specialise
in Travel Medicine before going overseas - to get the
right advice.
If possible, obtain the name of a competent physician
and medical facility in the country that you are
visiting, or at least always carry the Travel Insurance
Hotline number that you receive as part of your travel
insurance policy.
Injury and death resulting from road
traffic accidents
85% of all road traffic deaths occur in low and middle
income countries
Gap year? Volunteer? Eco-tourist? Many travellers are
spending longer periods overseas and immersing
themselves in local culture and activities. Many of them
have been informed of health risks from mosquitoes, food
and water and exotic diseases. But unfortunately, many
of them ignore or underestimate a much more common risk:
injury and death resulting from road traffic accidents.
This is a global problem of truly horrendous
proportions.
Annually, 1.2 million people die and an additional 50
million people are injured in road collisions, many with
severe and permanently disabling injuries. More than 85%
of all road traffic deaths occur in low and middle
income countries. And these are of course the areas
where young, adventurous travelers are to be found.
What can travellers (and their parents) do to reduce
these risks?
Consider the following suggestions:
- Choose the safest form of transportation in each
country.
- Avoid night travel in countries with poor safety
records and/or mountainous terrain.
- As a pedestrian: be aware of traffic patterns
and be alert to driver behaviour that jeopardizes
pedestrian safety.
- When renting a car
Check that the vehicle is equipped with safety
features, such as seat belts, and daytime running
lights; check tyres, ask about latest inspection of
brakes and headlights and obtain information
regarding roadway and traffic patterns; learn
highway hazards and driving conventions specific to
the country in which you are travelling.
- When travelling by bus
Avoid overcrowded buses and minivans; be alert
for reckless driving; follow local tourist bureaus'
advice to travel by night only in countries with
good safety records. If possible, obtain the name of
a competent physician and medical facility in the
country that you are visiting.
- Avoid motorcycle travel whenever possible. If
you choose motorcycle travel, insist that you be
provided with a helmet if you do not bring one with
you.
- Spend some time reviewing recent global
campaigns;
www.makeroadssafe.org; initiatives from WHO
www.who.int and
www.globalroadsafety.org.
Don't forget your Travel Kit
(even in Australia)
I travelled to Central Australia and the 'top-end'
with my adult daughters in July 2007. My girls grew up
in Zambia and Mozambique and we have travelled widely in
southern Africa. We found it quite an intense and at
times moving experience to camp in the desert and view
some of the great Australian tourist icons. We had an
Aboriginal guide in Arnhem land and learnt an amazing
amount about bush foods, native animals and cultural
history. It was a wonderful experience and especially
thought-provoking since it occurred at the time of the
Northern Territory 'intervention'.
I developed an upper respiratory tract infection
while travelling and spent about 10 days coughing up
productive sputum. Not particularly serious, but I won't
leave home again (even in Australia) without a
reasonably comprehensive
travel kit that includes antibiotics.
... from Christine Aus, Chromis
Travel Medicine, Maitland, NSW
Handy Travel Product
Keeping clean on the road is not always easy. Public
transport can be grimy, markets are dusty and
hand-washing facilities are few and far between. All
travel medicine practitioners emphasize the importance
of hand hygiene, especially before eating, as an
important activity to prevent the dreaded traveler's
diarrhoea.
Well, alcohol based hand sanitizer is a fantastic
product to solve these problems. The gel-type wash is
used without water and is in fact more effective at
killing microbes than soap and water. It is now
recommended for use in most health care settings in
place of hand washing by staff.
Travelers can obtain compact sizes (50 ml) of these
products from many TMA clinics. However, you must ensure
that the product has a minimum of 60% of the active
alcohol ingredient (many supermarket products have less
than this) to be effective.
... from Christine Aus, Chromis
Travel Medicine, Maitland, NSW
Pills
for malaria?
We don't have a vaccine for malaria yet.
Malaria pills often get a bad name because some
people experience side effects, however, without them,
malaria could be a serious problem.
A study was recently published of 38
Australians who trekked the Kokoda Trail in Papua New
Guinea.
-
Two trekkers did not take any malaria
prevention pills for the trip - they both got
malaria.
-
Twenty four stopped their pills too soon
after they got home - four out of that twenty four
developed malaria.
-
Twelve participants took their pills as
recommended - none of them came down with malaria.
The pills do work when taken as recommended.
Outbreak
Information
Yellow fever in Brazil
Brazil has recently issued an international alert
about yellow fever in the light of the 2nd death of a
Brazilian from yellow fever in Brasilia, the capital.
Both cases were infected outside the capital, but
hospitalized in the city in the acute phase.
Tourist agencies will be warned, and leaflets
distributed at Brazil's airports and bus stations,
advising all tourists, international and national, to
get vaccinated. The Ministry of Tourism emphasizes that
coastal Brazil, the part most visited by tourists, is
"practically free" of yellow fever.
... source PRO> ProMED Digest V2008
#15
New vaccination requirements for travelers to
Bolivia from USA
Released: December 21, 2007
Effective December 1, 2007, the Bolivian Consulate
General in the U.S. has advised that all persons older
than 12 months traveling to Bolivia must have a valid
International Certificate of Vaccination or Prophylaxis
(ICVP) to ensure protection against yellow fever. If a
physician decides that for health reasons, a person
cannot receive a yellow fever vaccine, a medical waiver
may be issued. A medical waiver includes the completed
medical waiver section of the ICVP and a letter from the
physician. The physician's letter must be translated
into Spanish. The traveler must submit both the ICVP and
the translation of the letter to the Bolivian
Immigration Authorities.
... source
www.cdc.gov
Chikungunya fever spreads to Taiwan
Taiwan Centres for Disease Control (CDC) identified 2
imported cases with chikungunya fever on 28 and 30 Dec
2007. One of these patients is an Indonesian worker; the
other is also an Indonesian, who came to visit his
relatives.
This is yet another example of rapid movement of
chikungunya virus infected individuals into distant
areas where competent vectors are present (Taiwan
reported dengue transmission in 2007).
See previous TMA newsletters with Chikungunya
discussion
here (January 2007).
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