Outbreak Information and News
An Australian FIRST
We've had it for about a month.
Our patients love it. Australia is the first country in the
world to have access to it... What is it? It's a
new type of flu vaccine.
For the most part, its the same influenza vaccine; it
protects against three strains of influenza (including the
swine flu strain). The NEW thing is the way it is given. It
goes into the surface layers of the skin... instead of deep
into the muscle. For the person receiving the vaccine, this
means less pain! My patients say they hardly feel it.
Since the vaccine is given into the surface of the skin,
recipients will see a little more redness, but it has less
effect on the rest of the body. The vaccine works in this
way, because the surface of the skin has more of the immune
cells needed to make the antibodies we all need. So if you
are having an influenza vaccine, ask for the new intradermal
one. It is only used in persons 18-59 at the moment. A
version of this vaccine for persons 60 and over will be
available next year. Children don't have a reliably thick
enough surface layer to be given this vaccine by this
method.
PNG: Cholera
Cholera is spreading in PNG, including Port Moresby.
The risk to workers is very low as many of those affected
are locals living in difficult conditions, but it makes
sense to be careful choosing food and drink. There is an
oral vaccine available for cholera that is reasonably
effective. It must be taken at least 2 weeks before
departure. It does not taste fabulous but it gives great
protection for 2 years.
Slovenia: Measles
A resident of Ireland visited Slovenia recently, and was
hospitalised on the day after his arrival - diagnosed with
measles. After ten years of being measles free, Slovenia has
now had a mini outbreak. A hospital staff member and a
visitor to the clinic were found to have measles, suggesting
transmission in a hospital setting. Measles is contagious.
Unvaccinated persons are at risk even when walking into a
room one hour after a measles case has left!
Measles booster
is recommended for persons born 1966-1981.
More info.
Netherlands: Hepatitis A
Between 31 December 2009 and 10 February 2010, 13 patients
were infected by an identical hepatitis A virus strain not
previously detected in the Netherlands. They had not been
abroad and were widely distributed over the Netherlands.
Semi-dried tomatoes in oil were implicated as the source of
the outbreak. Moral of this story is that even visitors to
the 'so called safe' countries of Europe should
consider
Hepatitis A vaccine.
More info.
Which flight seat is best?
Not sure what seat to choose on your flight?
Check out Seat Guru for a map of your aircraft and colour
coded guide to which are the best seats to request!
...Prepared by Dr Deb Mills, Brisbane, Travel Medical Alliance
Bulgaria: Measles
So called childhood diseases
continue to pop up around the globe. Measles is by far the
most serious of these, being fatal in some people and the
most highly contagious disease on the planet. Recently
Bulgaria has had an outbreak of 18,000 measles cases with 20
deaths and they have considered closing the border to
Turkey, people with symptoms stopped at the border to
prevent more people coming in with the disease. Being spread
by droplets, anyone can catch measles anytime if they do not
have immunity. In Australia we have a large group born
between 1966 and 1980 who probably are in need of a booster
dose of measles vaccine. Unless the doctor preparing you for
you trip is aware of this you may slip through the net and
travel unvaccinated. Your holiday will be a complete write
off (or worse) if you catch measles!
Polio: Nigeria and Myanmar
New cases of polio are still
occurring, Nigeria and Myanmar to name two recent places.
Vaccination programs are making headway in these developing
countries. What is important to know is that our current
school aged children do not receive vaccination as they once
did in high school and cannot be considered fully immunised
until they do. Schools are now sending students to
developing countries and it is not unusual for this vaccine
to be overlooked. Given the nature of polio it is
imperative
that this vaccine is given if travel is to Africa or India,
these places being popular for Aid work trips organised by
our schools.
...Prepared by Dr Brian Gilbert, Adelaide, Travel Medical Alliance
Northern Territory SPECIAL BULLETIN:
Northern Territory: Murray
Valley encephalitis (MVE)
All Territorians are advised to
step up their mosquito protection after recent heavy rains
from the Top End to Central Australia. "The most dangerous
mosquito-borne disease is Murray Valley encephalitis (MVE),
which is unique to the Northern Territory, from the north
coast to Tennant Creek," Dr Krause said.
Usual symptoms of MVE disease include severe headache, high
fever, drowsiness, tremor and seizures - especially in young
children - and in some cases the condition progresses to
delirium and coma, leading to paralysis, brain damage or
death.
"Those most at risk of MVE are
people with no prior exposure to the virus, including
babies, young children, and tourists. However, cases have been reported in long-term
residents of the Territory," Dr Krause said.
"People experiencing the early symptoms of MVE should seek
urgent medical attention."
The single best precaution is to
avoid being bitten. Recognise and avoid areas that are prone to high biting
activity.
Northern Territory: Kunjin
(KUN) virus disease
Kunjin (KUN) virus disease is
also found only in the Territory. MVE and KUN, as well as
Ross River virus (RRV) and Barmah Forest virus (BFV) disease
have an increased occurrence across the NT following heavy
rainfall, cyclones and floods.
KUN virus disease is milder and usually non-lethal, causing
fever and severe headaches.
The single best precaution is to
avoid being bitten. Recognise and avoid areas that are prone to high biting
activity.
Northern Territory: Ross River
or Barmah Forest virus
Traditionally known as Epidemic
Polyarthritis, both Ross River (RRV) and Barmah Forest (BFV)
disease are caused by viruses which are transmitted to
humans through the bite of mosquitoes.
Symptoms include painful or swollen joints, particularly in the hands, ankles
and knees, and sore muscles, aching tendons, skin rash,
fatigue, fever, headache and swollen lymph nodes. Symptoms
can last from a few weeks or months, with some people
experiencing symptoms up to 6 months.
In the Northern Territory so far in 2010 there have been 141
cases of RRV compared to 430 in total last year in 2009. Qld
has the highest number of cases in 2009 being 2154 and in
2010 so far 1380. When you compare the notification rate per
100,000 the NT is 191.2 versus Qld 48.9 for 2009.
Interestingly in Central Australia we had our annual
rainfall in the month of January 2010 (>400mm) and in
February we had a total of 200ml for the month. Compare this
for March and April where it was approximately 35ml for each
month. It has been predicted that due to the above average
rainfall we will have a peak in arboviral infections this
year. So far our clinic with approximately 5000 active
patients has identified only 8 new cases of RRV in 2010.
Again, the single best precaution is to
avoid being bitten. Recognise and avoid areas that are prone to high biting
activity.
Northern Territory: Meloidosis
The number of meloidosis cases
for this wet season has exceeded the
second highest season (36 in 2008/20090. There have been 72 cases and 10 deaths
since 1st October 2009 and there are still cases presenting
in early May 2010. The average number per wet season over
the past 5 years is 20.
Prevention is possible,
ensuring protective footwear, gloves
and clothing when working with the soil, by covering and
keeping wounds clean, and if camping during the wet season
using adequate shelter and ground cover.
...Information on the NT prepared by Dr Deborah Mitchell, Alice Springs, Travel Medical Alliance
Rare Spiny Amoeba causes blindness in Kokoda trekker
Just a reminder to
keep ones head OUT of the surface water
when travelling in remote parts of the world.
More info; check out
Dr Deb's
Blog.
TMA in
the News:
Filthy Airport Toilets
Pose Health Threat to Passengers
The profusion of germs at
airports can cause travellers to fall ill with colds and
flus, a top Aussie travel doctor has warned.
According to Dr Deborah Mills, from the Travel Medical
Alliance, several people believe airconditioning on planes
spreads illness, but actually the airport toilets are a hotbed of
germs.
Read more ...
More
about Meliodoisis (or Nightcliff Gardener's Disease)
The 2009/10 wet season has seen
a record 72 cases including 10 deaths from Meliodosis
infection compared to the average 20 to 30 cases per season.
Meliodosis, or Nightcliff Gardener's Disease, is caused by a
saprophytic, gram-negative bacillus Burkholderia
pseudomallei and is hyperendemic in the Top End of the
Northern Territory, tropical Queensland and South-East Asia.
Deep within the soil during the dry season,
this bacteria
comes to the surface during the wet, hence those that are in
prolonged contact with soil, mud and pooled water - like the
poor old gardeners in Nightcliff - are at an increased risk
of infection. Those with immune suppression, diabetes,
kidney disease and alcohol dependence are not only more
vulnerable of acquiring meliodosis but are more likely to
present with more severe and fatal infections. Surprisingly
people with HIV are not overly represented in those
affected. Transmission is by inhalation or subcutaneous
inoculation through cuts and sores rarely by ingestion and
person to person through blood or body fluids. The
incubation period ranges from a few hours to a few weeks.
Meliodosis presents in numerous ways from insidious
non
healing boils and prostatitis to pneumonia,
Meningoencephalitis and overwhelming sepsis, thus meliodosis
must be considered as a differential diagnosis when
practicing in the tropics or when consulting people who have
been travelling or residing in the tropics. Approximately
85% of infections are diagnosed during the wet season in
tropical regions, however the bacteria can lie latent for
decades and become reactive when the host becomes immuno-compromised
and cases have even been reported in dry, hot Alice Springs.
Diagnosis is made by culture from blood, urine, sputum and
pus samples, the indirect hemagglutination assay is the most
widely used serological test. Early suspicion allows for
prompt treatment and improves prognosis - the treatment
consists of intensive antimicrobial therapy such as
Meropenum for at least 14 days and supportive management
followed by oral trimethoprim-sulfamethoxazole, with or
without doxycycline.
Prevention is possible, ensuring protective footwear, gloves
and clothing when working with the soil, by covering and
keeping wounds clean, and if camping during the wet season
using adequate shelter and ground cover.
...Prepared by Dr Sarah Cush, Alice Springs, Travel Medical Alliance
Why see
a Travel Medicine Specialist?
In recent years there has been a
dramatic shift in Travel Medicine. There has been a number
of increasing complexities faced by medical practitioners.
An example of this is the advent of Rabies in Bali and the
general unavailability of the antidote to an animal bite
(RIG). This is making vaccination against rabies very much
more a necessity (rabies is fatal in every case, so in the
event of a bite, travellers may be advised to go home to get
the antidote!) There is also a vast difference in the
average traveller's itinerary compared to 10 years ago, with
African and South American destinations being much more
common, as well as more off the beaten track adventurers
with plans including trekking and eco-tourism. Malaria maps
have also become available to specialists in travel medicine
which are very detailed and help us tailor the medications
quite specifically for each traveller, essentially reducing
the cost to patients.
In addition, we have noted that vaccine suppliers are
continually running out of stock making it very difficult,
if not impossible, for pharmacists to get the vaccines
quickly, potentially leaving a traveller unable to obtain
vaccine even if they have a prescription, so they leave the
country unprotected! This has come to our attention with 6
vaccines in the last 12 months, and the problem appears to
be getting worse, not better.
Another example is the flu vaccine which has been pretty
much unavailable around the country for most of April.
In the best interest of travellers, we feel it is important
that you know that there are ways to get around these
problems. TMA travel clinics keep all the vaccines on site,
and keep a good supply of each vaccine. In addition, Rabies
is a complex and expensive vaccine and it is possible to
give it via a cheaper method. This is called the intradermal
method. But to do this properly time is required, ideally a
month, to give the vaccine and 6 weeks to allow for it to
work and be checked. This can save travellers over $100!
-
For example, at a pharmacy,
a rabies vial costs between $80 and $100, so a full
course would cost $240-$300. TMA clinics can save you a
lot on this price but only if there is sufficient time!
-
Other comments re Rabies: In
the past 2 years we have had travellers tell us of their
problems after a bite from a mammal. Travellers have
been given a tetanus shot, general antibiotics, told not
to worry, told the animal is ok so you will be too. They
have been given vaccine only and not told of the
antidote. They have been given incorrect scheduling of
vaccine and they have been generally unable to get
consistent advice even when calling doctors in
Australia. All of these scenarios are incorrect and
could result in a fatality from rabies. We are keen for
this not to happen!
...Prepared by Dr Brian Gilbert, Adelaide, Travel Medical Alliance
Central
Australia's "Larapinta Trek"
In Central Australia the "Larapinta Trek" is world famous as
it goes for 12 stages with a total of 240km.
Dr Deborah Mitchell, Alice Springs, Travel Medical Alliance
did the first 6 stages in June 2009 - a total of 130 km
walking with spectacular scenic views from the walk,
including Euro Ridge only 15 km west of Alice Springs so you
can see back towards the township of Alice Springs.
The sun on the Ranges |
Euro Ridge view (Alice Springs in the distance) |
The view from the end of stage 5 |
Standley chasm at stage 3 |
...photographs taken by Dr Deborah Mitchell, Alice Springs, Travel Medical Alliance
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Have you any interesting travel photos?
We would love to publish them in our
newsletter. Not only will you win fame and glory
with your name published ... if the photo is
published in our newsletter,
you will win a first aid kit valued at $35.
If you do have an interesting travel photo,
(especially those with a health theme) send it
to TMA care of
info@travelmedicine.com.au. |
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