Swine Flu
update
Australia has begun the national immunisation
program against the 2009 H1N1 Influenza (swine
flu).
The vaccine is called Panvax.
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Our flu season is
basically finished, but
swine flu is likely to continue spreading in
Australia even in summer (as it has
done in the northern hemisphere).
Panvax is
recommended for persons:
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with chronic
medical conditions of chest, heart, kidneys,
blood or nervous system, or
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who are
immunosuppressed, overweight or pregnant
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who have
diabetes, asthma, or cancer
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who work in the
health care industry
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who are
travelling into the northern hemisphere –
their flu season is just beginning
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if they want to
avoid getting this strain of influenza.
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More information:
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Panvax is only suitable for
persons aged 10 and over.
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The vaccine is given in the
top of the arm.
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A
single dose only is required.
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The vaccine will last until
the strain changes (perhaps a year).
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The vaccine is a dead
vaccine so it cannot give you the flu.
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Most common side effect is a
sore arm.
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Panvax is made in the same
way as the regular flu vaccine – the seed virus is just
a different 'shape'.
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Current and ongoing trials
show the side effects are the same as the regular flu
vaccine.
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If
you have already had swine flu confirmed, you do not
need the vaccine.
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If you have had swine flu
and did not know, and receive the vaccine, it will not
hurt you (but it is not necessary).
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Panvax is available
free for all Australians who wish
to receive it. Doctors may charge a fee to
administer the vaccine, but this fee is Medicare
rebatable. Some clinics will bulk bill.
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Panvax is available in
multi-dose vials so you may need to attend the clinic at
a set time.
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Panvax can be accessed by
visiting your nearest TMA clinic. If you have doubts
about whether the vaccine is suitable for you, you
should ask the TMA doctor.
...written by Dr Deb Mills, Travel
Medical Alliance, Brisbane, Queensland
Outbreak
Information and News
Cholera in PNG
PNG
reported its first cholera outbreak ever in
early September
The outbreak was in Morobe province, near Lae (not too far
north of Kokoda track). Cholera first arrived on the shores
of Papua New Guinea at Bukawa in Nawaeb district a month
before the outbreak at Wasu in the Tewae Siassi district of
Morobe Province. Details are sketchy as surveillance and
accurate diagnosis of medical issues is problematic in PNG.
The first cases in Bukawa were not recognised as Cholera.
We do know that gastrointestinal illness is commonly a
problem in countries with poverty, corruption, and less than
ideal health infrastructure.
Travellers to Morobe province
should consider having cholera vaccine just in
case. This oral vaccine protects against cholera and ETEC (Entero
toxic E coli - the most common cause of travellers diarrhoea).
The vaccine is painless with similar side effects to placebo
- even though it does not taste great.
Take care choosing food and
drink, and frequent careful hand-washing are essential
precautions no matter where in the world you visit.
Snake bite in Papua New Guinea
As we have so many
workers going to PNG lately we thought it timely to
include some information on a different sort of
travel medicine problem
Incidence of snake
bite
The incidence of venomous snake bite in PNG is among
the highest of any tropical region in the world.
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Most data is based on studies carried out in Central
Province in PNG, where the incidence of snake bite
averages 215.5 victims per 100 000 people, and
each year 7.9 victims per
100 000 people die due to snake bite.
Snake details
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The Papuan taipan is
the most dangerous snake in PNG and is responsible for
the majority of snake bite admissions to Port Moresby
General Hospital. This snake has the
third most toxic venom of any
snake in the world. There are 5 other
dangerous snake species found throughout PNG, including
death adders, the Papuan blacksnake, the Papuan brown
snake, New Guinean small eyed snake and the Papuan mulga
snake.
The Papuan taipan lives in grasslands, savannah
woodlands to an altitude of 400m, as well as village
gardens and residential areas. It is active during the
day, especially early to late morning and mid to late
afternoon.
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Death adders also
live in a wide range of habitats, and are a major cause
of snakebite throughout PNG outside of Central Province.
Although death adders are nocturnal, bites tend to occur
during the day when the sleeping snake is accidentally
stepped on, often near pathways.
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The Black snake is
active in the day, and lives in coastal swamps,
marshland, monsoonal forests, bamboo thickets, rubber
tree groves, rainforest and sometimes savannah woodland.
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The Brown snake is
very aggressive, is active during the day and can be
found in grassland and woodlands
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The New Guinean small
eyed snake is nocturnal and lives in wet
environments, monsoonal forests, swamps, and
rainforests, as well as old overgrown coconut husk
piles.
There
are often an increased number of snake bites reported during
the wet season
(November to April).
Prevention strategies
Snake bite
first aid
First aid involves the pressure
immobilisation method. There are 2 steps.
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Pressure immobilisation
bandaging (PIB)
Firmly bandage the entire bitten limb.
First apply the pressure bandage over the bite site,
then down to toes/fingers,
followed by the rest of the limb. Apply over clothes if
required to minimize
movement of the limb.
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Immobilise the limb with
splints or slings and keep the victim still.
This reduces the movement of venom from the bite
site into the circulation.
Note: Over 95% of snakebites involve the limbs. Rarely,
bites occur on the body, neck or head. In the situation,
apply direct pressure with a firm pad of cloth over the
snake bite.
For all
bites, organise urgent transfer to hospital for assessment
and management.
Antivenom
Most
snake bites will not result in envenomation.
However, when envenomation does occur, serious illness and
death can follow. Snake venom can damage the nerves, blood
clotting system, muscles and kidneys. This may show as
droopy eyelids, difficulty speaking, swallowing and/or
breathing, paralysis; blood clotting problems and
haemorrhage.
Snake venom detection kits used within the hospital setting
can identify the snake type and allow the administration of
the specific antivenom. When kits are not available, a
polyvalent snake antivenom, covering multiple snake types,
can be administered.
Antivenom is an injection given in
the vein, which aims to neutralise the effects of snake
venom. Unfortunately, the antivenom may not be
very effective at reversing the most serious,
life-threatening effects of some snake venoms, particularly
Papuan taipan venom. Antivenom is only ever given in a
medical setting and is given to patients who become ill
after being bitten by a snake. It should never be given to
people who remain well after the bite. Antivenom is very
expensive in PNG and supplies are often limited.
Consequently antivenom administration in PNG is often
reserved for the patients who are extremely unwell.
Allergic reactions, including anaphylaxis, to antivenom is
common. Queensland law restricts antivenom use to within the
hospital setting and it cannot be dispensed outside of these
restrictions. Antivenom storage also requires strictly
controlled refrigeration. For all of the above reasons,
antivenom is not a product that travellers can carry in a
medical kit.
In summary
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Learn snake bite first aid
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Wear boots and long pants
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Look before you tread
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Have contact details for
well equipped medical services
...written by
Dr Lisa Chapman Stafford, Travel Medical Alliance
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Do you have a holiday story to
tell, especially one with a medical event?
Send it to
info@travelmedicine.com.au, and we will send
you one of our mini TMA torches to put on your
key ring - a great help when finding your lock
at night. |
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