dengue fever outbreak in USA

Prepared by TMA member Toowoomba/Brookwater

For  most travellers to the USA the risk of dengue fever would low on the list of health issues,  however the following report of a dengue fever outbreak adds a sobering reminder to practice  mosquito avoidance measures even in first world countries.

According to the Texas Department of Health, 6 laboratory-confirmed, locally acquired cases of dengue fever, the first locally acquired cases since 2005, have been reported in Cameron County in southern Texas State since early November 2013. Additionally, 23 laboratory-confirmed, locally acquired cases have been reported in Martin, St. Lucie, and Miami-Dade counties in Florida State since August 2013. Sporadic cases without sustained transmission are reported in central and southern Florida State each year. Travellers are advised to practice daytime insect precautions.

Read More »

Rabies in Congo

Prepared by TMA member Toowoomba/Brookwater

In August 2013, Médecins Sans Frontières (MSF/Doctors Without Borders) started a rabies intervention in the east of the Democratic Republic of Congo after an alarming number of people were bitten by rabid dogs, and at least 10 people died. Doctors will provide PEP to people bitten or scratched by a suspected rabid dog in the Lemera region in the province of South Kivu this hyperlink.

Rabies in Congo pic

MSF teams struggle to help in an isolated area of South Kivu

After decades of conflict and instability in the Democratic Republic of Congo, measures to control canine rabies have not been implemented, and data on the size of the problem is simply not available.

“The current rabies situation now affecting humans in Lemera is exceptional and must be urgently addressed,” said Dr Jantina Mandelkow, who is leading the MSF team. “We’re doing all we can but we urge others to recognise the severity of the situation and commit resources to its containment and resolution.”

– See more at: https://rabiesalliance.org/media/news/rabies-control-measures-implemented-in-dr-congo#sthash.8vJCL33A.dpuf

MSF teams struggle to help in an isolated area of South Kivu

Read More »

Typhoon Haiyan travel advice

Prepared by TMA member Narre Warren

It is now over a month since Typhoon Haiyan (called Yolanda in the Phillipines) struck the Philippines on 8/11/13. The worst hit provinces were Leyte and Eastern Samar, which experienced sustained winds of 270 kph, gusts of up to 312 kph, and a storm surge in coastal areas as high as 7 metres. Not all travel is for pleasure. Typhoon Haiyan travel advice is be prepared and be informed.

The official death toll from the Phillipines Government is approaching 6000, the injury toll 27000, and 1800 people as of mid December 2013 are still listed as missing. These figures are considered by most to be conservative.

Enormous international aid efforts are underway. Significant infrastructure damage has caused problems with sanitation, food supply, electricity, transportation, shelter, communications, security, and medical care.

Typhoon Haiyan Pic 1.docx

What a mess

This all has implications for people who are considering travelling with aid organisations, or in those visiting relatives and friends to help them. 

The following advice applies to both groups of travellers:

1                Take a kit with you from your travel medicine clinic to treat diarrhoea; diarrhoeal illnesses are likely to be more common after a disaster where serious flooding has occurred. Follow the usual safe food and water precautions advised by your travel clinic

2                Use mosquito repellents with more than 30% DEET to prevent mosquito borne illnesses such as Dengue Fever and Chikungunya. Mosquitos will breed in greater numbers around flooded areas. The areas worst affected by Typhoon Haiyan are the islands of Leyte, Samar and Cebu; they are not affected by malaria so malaria tablets are not required for these islands.

3                Be vaccinated for Hepatitis A and Typhoid; update your tetanus injections as debris clearing will often result in injury. Have a flu injection, and speak to your travel Doctor about other vaccines you may need.

4                Avoid injury—most deaths after a natural disaster are due to blunt trauma, crush-related injuries, and drowning. Use caution around damaged or down power lines, 

water-affected electrical outlets, and interrupted gas lines.

5                 Avoid stray or frightened animals. Seek medical help immediately if you are bitten or scratched by an animal and wash out the wound. Consider rabies vaccination before you go, or seek rabies vaccination within 48 hours of any animal bites.

Typhoon Haiyan Pic 2.docx

 

Read More »

Decompression Sickness ( The ‘ Bends ‘ )

Prepared by TMA Member Boronia 

Decompression Sickness (DCS)  is also known as Acute Decompression Illness (ADI) or, more colloquially, as the ‘bends’ (because the pain involved can bend a person).

DCS in the setting of scuba diving or deep-sea diving, refers to an illness caused by an overly rapid ascent to the water’s surface.

During a scuba dive, the diver absorbs additional quantities of oxygen and nitrogen into the blood and tissues.  The nitrogen is dissolved into the bloodstream, where it remains during the dive.  Once a diver begins their ascent,  the surrounding water pressure decreases. If this transition occurs too quickly, the nitrogen does not have sufficient time to leave the bloodstream and be exhaled via the lungs.  Instead, nitrogen bubbles form in the bloodstream which can enter tissues throughout the body.  

Factors increasing risk of DCS

 

  • Increasing Age
  • Being female
  • Poor fitness
  • Obesity
  • Dehydration
  • Alcohol / hangover state
  • Fatigue / sleep deprivation
  • Sickness
  • Heart muscle defects
  • Ventricular wall defects
  • Airways disease (eg. asthma)
  • The rate of ascent
  • Flying after diving
  •  Repetitive dives
  • Exercise after diving

 

Symptoms of DCS

 Approximately fifty percent of divers with DCS develop symptoms within 1 hour after surfacing, 90 % within 6 hours and 98 per cent within the first 24 hours.

Generally, the sooner the symptoms develop, the more serious the DCS is likely to be.

DCS symptoms vary significantly because nitrogen bubbles can lodge in different parts of the body.  The symptoms experienced are largely determined by the where the bubbles ultimately lodge. eg.  bubbles that lodge in the joints will cause joint pain; bubbles under the skin can cause a blotchy rash/itching; bubble formation in the spine may lead to limb weakness/ paralysis, etc.

 

  • Joint pain (most common).
  • Dizziness.
  • Headache.
  •  Nausea.
  •  Vision disturbance.
  •  Skin changes (blotchy rash, itching).
  •  Disorientation.
  •  Extreme fatigue.
  •  Loss of consciousness.
  •  Hearing problems.
  •  Difficulty breathing, coughing.
  • Tingling/numbness.
  •  Muscle weakness.
  • Paralysis.

 

Early Management of DCS

Seek medical treatment as soon as any symptom of DCS  is noticed.  If available, apply 100% oxygen by mask ASAP to help relieve some symptoms and reduce oxygen-deprived tissue injury. Treat dehydration, maintain blood pressure and prevent shock.

Hyperbaric oxygen therapy in a high pressure chamber reverses the pressure changes that cause the nitrogen bubbles to form. The bubbles redissolve and can then be exhaled by the lungs.

Decompression Picture

 

Prevention of Decompression sickness 

Avoid flying within 24 hours after diving (increasing altitude during a flight will further decrease pressure in the bloodstream, hence potentially increasing bubble formation and exacerbating injuries).

  • Avoid alcohol before diving.
  • Maintain good hydration.
  • Be well rested prior to dive.
  • Avoid diving when sick/weak 
  • Dive within the limits set out in the diving tables. (Be wary of fudged diving tables.)
  • Avoid hot baths, spas and saunas soon after diving.
  • Choose dive destinations where hyperbaric chambers can be reached rapidly.
  • Know the location of the nearest hyperbaric chamber.

 

Divers’ Emergency Service (DES)

This is a free phone consultation service for diving-related medical emergencies. They can also provide the location of the nearest hyperbaric chamber.

24 Hour Hotline:

ph: 1800 088 200 (toll free from within Australia)

618 8212 9242 (if calling from  outside Australia

 

 

Read More »

Sri Lanka

Sri Lanka

by Dr Jonathan Barrell, TMA Member Daylesford, Victoria

The Democratic Socialist Republic of Sri Lanka, is an island country in the northern Indian Ocean off the southern coast of the Indian subcontinent in South Asia; known until 1972 as Ceylon. Sri Lanka has maritime borders with India to the northwest and the Maldives to the southwest.

Sri Lanka has a documented history that spans over 3000 years. Its geographic location and deep harbours made it of great strategic importance from the time of the ancient Silk Road through to World War II. Sri Lanka is a diverse country home to many religions, ethnicities and languages. It is the land of the Sinhalese, Sri Lankan Tamils, Moors, Indian Tamils, Burghers, Malays, Kaffirs and the aboriginal Vedda. Sri Lanka has a rich Buddhist heritage, and the first known Buddhist writings were composed on the island. The country’s recent history has been marred by a thirty-year civil war which decisively but controversially ended in a military victory in 2009.

We visited central and southern Sri Lanka in 2011 for 4 weeks. The people and cuisine and seaside villas such as www.ambalamavilla.com near Galle and www.kadjuhouse.com near Tangalle are fabulous.
Highlights included the tiny tea country mountain village of Ella www.mountainheavensella.com, the very slow train to Nuwara Eliya,, and climbing the rock at Sigiriya just north of Kandy.In Colombo I would recommend  www.gallefacehotel.com  and www.mountlaviniahotel.com, the latter being a fabulous venue for wedding party photo shoots that last for days.Travellers to Sri Lanka do need to seek medical advice about their trip as diseases such as hepatitis A, typhoid, rabies and dengue do occur and are largely preventable click here to find your nearest TMA clinic


Springs Medical Centre

You can give us a call on (03) 5348 2227 or visit our clinic website click here

Read More »

Permethrin – a secret weapon against mosquitoes

Permethrin is a special insecticide that enables clothing to kill or repel mosquitoes

Wearing treated items will significantly decrease the number of bites you get. Treated bed nets have been shown to be four times more effective than untreated nets. When you wear treated clothes, you still need to use repellent on exposed skin. You can buy items pre-treated (especially bed nets) or treat items yourself with commercially produced permethrin packs. Follow the treatment instructions carefully to ensure the best effect. Do not throw any unused solution down the sink. It is toxic to fish. Follow the disposal instructions on the pack.

Treated articles which are immediately stored in a sealed plastic bag, will retain effectiveness for 12 months until usage is begun. A permethrin impregnated mosquito net is effective for 3-6 months of regular use. The solution wears off as well as washes off. Treated clothes are said to be active until the fourth normal wash. Do not iron treated clothes.

Is permethrin safe?
Yes. Permethrin is related to the naturally occurring pyrethrum from the flowers of a type of Chrysanthemum. Once the fabric is treated and dried, permethrin has no vapour action and nets can be used safely, even around sleeping children. Should a young child suck the net, they will not suffer any ill effects. Treated items are not more flammable. There are rare reports of persons developing a minor skin rash after wearing treated clothes.

Did you know …

The Defence forces wear permethrin treated uniforms to help keep mosquito diseases at bay. Now travellers can do the same – treat their clothes at home before they head off overseas. This will deter mosquitoes from biting through the clothes. The clothes will remain effective for up to four washes. Self Treatment Permethrin Soak packs are available from your nearest TMA.

Read More »

Mosquito Avoidance

Dr Deb Mills

Moisture, warmth, carbon dioxide and odour all attract ‘mozzies’, and some unlucky people seem to be genetically more delicious to mosquitoes.

Cover up – long sleeved, light coloured clothes
Try and avoid being outside when they are biting. If you are outside between dusk and dawn, wear treated, long sleeved shirts, long pants, and long socks. Light coloured clothes are best. Dark colours attract mosquitoes. Strong scents also attract them, so avoid perfumes etc.

30% DEET is the best
‘DEET’ (Diethyl toluamide) is clinically proven to be the most effective mosquito repellent to apply on your skin e.g. Repel™ or Rid™. Repellents work by blocking the receptors on the mosquitoes antennae. A concentration of 30% DEET is recommended for adults under conditions of intense mosquito exposure. Concentrations greater than 50% DEET are usually not recommended. In field trials, DEET products on the skin have been found to be more effective than coils, ‘mozzie plants’, citronella candles, sonic repellers, and UV light lures. DEET can damage plastics, synthetic fabrics, leather and painted or varnished materials so be careful with eye glasses, cameras etc. DEET has no effect on cotton, wool or nylon or skin(!) DEET has been on the market for 45 years and side effects are rare if used properly.

Apply regularly
Apply regularly as per instructions on the bottle (for 30% DEET usually every 4-5 hours). Don’t forget your neck and ankles. Use just enough repellent to lightly cover your skin. You do not need to saturate your skin. Never use repellent over cuts, wounds or inflamed skin. After application, wipe or wash the repellent off your palms to avoid inadvertent contact with your eyes, mouth and other sensitive areas. Don’t apply repellent to children’s hands if they are likely to put their hands in their mouth. Ideally, wash off the repellent when you no longer need it.

Sleeping precautions
Sleeping in air-conditioned or well-screened rooms is the ideal. Use a ‘knock down spray’ if necessary to remove stray mosquitoes. The next best plan is to sleep under a permethrin-treated mosquito net. Check there are no holes in the net, and tuck the edges under the mattress. If mosquitoes are already inside the net, spray them with insecticide before you go to bed. As a last resort burn mosquito coils, cover exposed skin in insect repellent, and sleep next to a fan.

Did you know … mixing sunscreen and repellent?

When sunscreen is required, apply sunscreen first, wait 20 minutes and then apply repellent. Combination products are not as effective.

Read More »

Splitting tablets?

Dr Deb – TMA member in Brisbane  

A recent study looking at the accuracy of tablet splitting, found large variations in dose in some of the splits. Some tablets are easier to split than others, and some drugs are more dangerous than others if you get the dose slightly wrong.

The major finding of the study was this “Based on our results, we recommend use of a splitting device when splitting cannot be avoided, for example when the prescribed dose is not commercially available or where there is no alternative formulation, such as a liquid.”

Tablet splitters can be purchased from most pharmacies. More info.

 

Read More »

Spain

  prepared by Dr Joan Chamberlain, TMA member in Rockhampton.

Generally we felt reasonably secure but all bags must be held close and be closed firmly. Pick pockets do well. Loose items disappear quickly. We let our guard down in the last 15 minutes before leaving the conference hotel (5 star) and were rewarded with one of our bag being stolen: Camera, chargers for phones, power converters, medical kit and coats. Take care with your goods.

Madrid is more metropolitan and Spain’s largest city. You can taste all of the flavours of Spain here. We found the smaller places of good value and with a very large variety of good wholesome, well priced food. We found free Flamenco bars where the passion was as strong as the alcohol in the beverages. Parks open at 10am and people are flooding in at 8-9pm while the daylight still shines.The bigger cities come alive from 9pm onwards. 

The art word reigns supreme in Madrid, followed closely by the History of Spain in both Museums and architecture. There are amazing shops that sell genuine armoury still made in the famous Toledo factory. Cross bow 25E, just don’t expect to get it through customs. Your local shopping mall has the men’s section complete with underwear, suits and leather coats, selection of fishing gear, knives for hunting as well as a full Gun collection. Everything a real man needs.

Central Spain. We had a brief one day visit to Avila and Segovia. The change in foods, wine and scenery was incredible. You first pass near the highest mountains in Spain, complete with ski resorts, then along amazing cliffs and ravines. Out from here lies the fertile central Spanish plains. Central Spainproduces some of the most amazing wines in Spain, re-noun especially for their Red wines, the whites are not to be dismissed. Their suckling pig, plethora of hams, cheeses and extensive variety of Horticultural produce is impressive.

Lessons learned on the Trip:

  1. Be prepared and know the area you are going to. You will appreciate better what you see and find.
  2. Many of the best experiences are not far away or too expensive. But be prepared to pay for inside knowledge when needed.
  3. Most people will help you and appreciate you making the effort to speak at least a few basic words in Spanish eg hello, thank you, please, good buy and their name.
  4. Never leave your possessions unattended and be vigilant.
  5. It’s a long way to fly from Australia to Spain.

 

 

Read More »

Tran Siberian Express

Prepared by TMA member Gold Coast

Travel Health Doctors Gold Coast clients, Kate and Matt experienced the longest and arguably one of the most fascinating train journeys of all time – the Trans Siberian Express. The couple boarded the train in Frankfurt then onward to Warsaw and St Petersburg. The official journey then commenced in Moscow. From there Kate said she was amazed by the diversity of the landscape.

“It was so brilliant to see the unexpected variety in the landscape – such eye catching scenery from European forests through to Siberian forests, snow and desert” she said

Also what surprised them was, although not travelling in the height of the winter, the Gobi desert was covered mostly in snow and when it wasn’t snowy, the land was mostly rocky instead of sandy -only a small percent of the Gobi desert is actually sand. Throughout these rocky regions of the desert, a huge number of dinosaur relics can be found.

 

As self adventurers, highlights for Matt and Kate along the way included a three day horseride along the Mongolian step which proved a real eye opener for them.

“It was fascinating to see nomadic families move to greener and warmer pastures – just packing up their lives and livestock and moving in groups of three or four families to an area more sustainable” Kate said.

Away for nine weeks but spending three weeks touring Mongolia, Matt also lent a hand helping a farmer herd cattle along the way. To show their gratitude, the farmer insisted Matt and Kate accompany him home where he offered his “best yoghurt” – from a bucket just sitting outside. They thought for sure the yoghurt would render them sick for days but surprisingly were okay!

Travelling throughout Mongolia the couple do recommend employing local guides.

“Due to snow and the movement of nomadic tribes to let areas grow over with grass, the roads are ever changing and you would get hopelessly lost without a guide” Kate said.

At one stage they were blocked by a huge snowdrift and had to physically dig their way out before help arrived in the form of a local landrover which pulled their car to safety.

After this, the locals again extended their hospitality insisting on bringing them home to taste their proud home brew of warm, salty camel’s milk.

“Outside of the cities especially, the locals are so appreciative, interested in us and super friendly..

“We enjoyed tasting the local food, although you never really knew what you were ordering – one cafe had dishes called “Horse and Cart” and “The Merchant’s Daughter” ..which in fact was chocolate pancakes” Kate said.
Health wise the couple left prepared and were grateful not to experience any health issues as sometimes they were nearly three days’ drive to anywhere which could remotely help them.

Travelling for nine weeks, it’s difficult to condense such a life changing trip, but both Matt and Kate were amazed and humbled by the beauty and culture they experienced.

Travelling in September/October at the end of the tourist season, proved ideal with temperatures reaching -15 at night… instead of -40 which can occur in the Winter.

Considered the longest train journey in the world, the most extended stretch Matt and Kate spent on the train non-stop was 60 hours. Their tip is that you book both an upper and lower bunk instead of just upper bunks so you have more space to relax during the day.

“The train journey was ever-changing and we so enjoyed meeting some amazing people and glimpsing cultures and experiencing adventures we could only dream about” they said.

 

 

This report has been prepared by Travel Health Doctors, Southport.

Read More »

Travel Health Information

Creative Commons License
This work by Dr Deb The Travel Doctor Pty Ltd (ABN 75 624 360 247) is licensed under a Creative Commons Attribution-NoDerivatives 4.0 International License.
Permissions beyond the scope of this license may be available at http://www.thetraveldoctor.com.au/website_terms_conditions.htm.

Website Terms and Conditions | Governing policy

Website Developed by Big Blue Creative