In this issue:

Swine flu Update

I know this has been discussed in previous newsletters but we are in the midst of a pandemic so it is worth keeping up to date. Australia has left the CONTAIN phase of pandemic and is PROTECT phase. This means the illness is widespread in the community and no one is keeping count on new cases except [sadly] the number of swine flu deaths [88 to date August 12].

For Travellers

The implications for the traveller are they may well be in contact with the virus prior to leaving, during their journey or at their destination.

One should follow the Top 10 Swine Flu Tips mentioned in the last newsletter and can obtain a script for an antiviral agent [tamiflu or rulenza] from their doctor prior to leaving - this is not subsided by the government and cost around $60. In many developing countries this medication will be unavailable. The downside of self treatment is other illnesses e.g. malaria, dengue fever can be 'flu-like' so expect a rapid response to anti-flu medication and consult a medical practitioner as soon as possible.

Of note and I realise this is anecdotal only but I have seen few if any patients with swine flu who have had the flu vaccination - the ordinary 'flu' affects 1% of travellers in the tropics per month.

...prepared by Dr John Kenafake, Travel Medical Alliance, Sunshine Coast, Queensland

Adventure travel

The phrase conjures up different images to different people. The adventure traveller seeks excitement, a challenge, doing something a bit out of the usual whereas the Travel Doctor is thinking HIGH RISK. Now this of course doesn't mean the adventure shouldn't be carried out and or would or should be discouraged by the Travel Doctor. In fact, quite the opposite as most of the TMA doctors are participating in such activities e.g. climbing Kilimanjaro [see last month with Dr Stan Khoo-Perth], trekking in Tibet-rewriting the 'Motor cycle Diaries in South America' [Dr Paul Davey-Geelong] and Dr Deb Mills-Brisbane [just about everywhere] just to name a few. It does mean, however, maximum precautions to minimise risk.

I am preparing for the www.tourdetimor.com - a 5 day mountain bike race around Timor Leste - and have a number of fellow competitors as patients. The physical requirements of the race and the conditions of racing in tropical climate seem well understood. Hydration, electrolytes and sun protection for Australians are well known but others issues must be carefully considered. As well as being up to date with routine vaccinations [especially tetanus] and the 'standard' recommended measures like hepatitis A and typhoid, a more 'comprehensive' approach is needed. Remember a new vaccination exists for Japanese Encephalitis not normally recommended for a week stay, say in resort in Phuet, but for adventure travellers maybe.

Similarly rabies needs to be discussed and strongly considered for cyclists which are good targets for dogs in rural villages.

Japanese Encephalitis (JE), a mosquito-borne viral disease in humans and animals, is a major public health problem in the East and Southeast Asia. Mosquitoes may transmit the disease to humans after feeding on infected animals such as domestic pigs and wild birds. Sporadic cases of JE occurred very infrequently in Hong Kong over the past two decades while five local cases were reported in 2004.

Mosquito protection is important in the tropics but doubly so when sleeping out in rural areas. This means maximal personal protection - 30% DEET on skin exposed areas, protective clothes and nets/tents soaked in permethryn [Permethrin treatment of clothes www.drdeb.com.au] and anti-malarials are essential. Medication exists to help prevent [dukarol] and treat [antibiotics e.g. norfloxacin] travellers diarrhoea.

To do well [or even finish] an endurance event the bike needs an engine [you] working well!

Chikungunya

This illness is slowly spreading across Asia from west to east. Travax report an outbreak in Malaysia with 2876 cases. The same day I read this report I treated a 15 year old girl who had been trekking and camping in the national park. She initially had fevers, headache and rash then generalised aches in her joints. She was improving by the time she arrived back in Australia though still needed a week off to recover. Her father [a local GP] and I weren't too surprised when the blood tests confirmed the diagnosis.

I believe Chikungunya will be an increasingly common finding for travellers to Southeast Asia. Though rarely fatal it causes the affected person moderate distress which tends to be worse with age. Those pesky mosquitoes again - no vaccine but personal mozzie protection.

Aedes Mosquito [Chikungunya]

Travel Medicine Alliance - annual conference Adelaide 2009

News headlines

• 2 billion people people infected with hepatitis B world wide - 'Vaccine not required as long as everything goes swimmingly' [Dr Jill Benson]

• a single vaccine shot for Japanese Encephalitis will be here 'soon'

• up to a third of travellers seek pre-travel medical advice on the internet and need to be cautious when becoming a member of GOOGLE UNIVERSITY

• don't forget primaquine for malaria in certain circumstances - an oldie but a goodie

• next years fluvax can be given by an intradermal method i.e. tiny needle so even less excuses for not vaccinating

• rabies intradermally is effective and relatively affordable

• tick borne encephalitis vaccine should be considered for travellers who spend significant time in European forests

• Dr Brian Gilbert makes very good white wine in the Adelaide Hills