There are only a handful of insect-borne diseases that are preventable with medication or immunisation. This means that the only real protection against the vast majority of diseases is bite prevention. This should always be considered as the first line of defence against any insect-borne infection.

As no vaccines or medications are 100% effective, bite prevention is an added measure to preventing disease.

Dengue is endemic in South-East Asia, the Indian sub-continent, the Pacific region as far south as Queensland in Australia, the Caribbean Islands, northern and eastern parts of Central and South America, to a lesser extent the Middle East and sporadically in Africa.

Dengue develops as a feverous illness within 3 to 8 days. Painkillers and intravenous fluids are the usual treatments. In severe cases hospitalisation may be required.

At present there is no vaccine available against Dengue fever and the only protection is through insect bite avoidance.
Here at The Travel Clinic we see about 5-8 people a week who have suffered from dengue fever while away

Countries reporting outbreaks in July 2010:

Yeman, Guadeloupe, Mexico, Puerto Rico, Honduras, Brazil, Philippines, Vietnam and Singapore Dominican Republic French Guiana,, Colombia, Martinique, Thailand, Malaysia, and Myanmar

Japanese B encephalitis also spread by mosquitoes causes a fever, headache, convulsions, encephalitis and meningitis and especially cranial nerve paralysis.

Prolonged recovery and post viral debility are common. Many who recover are left with disabilities. There is no effective anti-viral therapy and treatment is symptomatic.

There are outbreaks once again in India, in Manipur state where 88 individuals are still hospitalized and Nepal. Asia is at particularly at high risk post monsoons

Vaccination should be considered for repeated visits to, or prolonged stays (e.g.: >1 month) in endemic areas in Asia and especially if staying in rural areas. Vaccination is important for infants and children who may be more likely to get serious disease. Short stays in rural parts can also pose a risk, particularly during epidemics that often follow the start of the rainy season when mosquitoes are most active. Travellers should be advised to stay in screened areas or air conditioned rooms. Where this is not possible then the use of a bed net is strongly advised. The traveller should also be given advice on bite avoidance and the use of insect repellents.

Whereas previous vaccines can induce allergic reactions and also requires three doses to complete the course, IXIARO has a much safer side-effect profile and requires only two doses.

Insect Bite Avoidance

Insect Repellents: Many different types of repellents are available. The most strongly recommended is a DEET based repellent ideally between 30 and 50% for skin use apply during the day as well as evening if at risk from day lighting biting mosquitoes.

Mosquito Net: Extremely effective recommended in a variety of circumstances. If sprayed/treated with permetherin the effectiveness of the net is greatly increased against all biting mosquitoes and other insects. Nets should either be tucked under the mattress or groundsheet to prevent access by insects.

Air Conditioning: If sleeping in an air-conditioned room, windows should be left closed to prevent access from mosquitoes. As there is no risk of contact from mosquitoes a net is not required.

Room Protection: All screens and shutters should be shut, ideally at dusk to reduce access by mosquitoes. Before sleep the room should be sprayed with a knock down spray to kill any insects that may have entered during the day. Pyrethroid products may be used such as plug-ins and coils. And or candles, coils and cones may be used.

Clothing: High necked, light coloured clothing, long sleeves and shirts, trousers or long skirts are preferable to vests, shorts and bikinis, especially after dusk.

EX4 is an Anti-Mosquito Fabric Treatment that’s new on to the market. It protects you and your fabrics from the build up of bacteria and from biting insects. By simply spraying this treatment onto fabrics and textiles, you are adding an effective layer of protection to the fibres of the fabric that can last for 32 washes or up to two years.

The Travel Clinic Ltd has a full range of anti-malarials, insect repellents and mosquito nets in stock. If you would like to find out more please contact us at enquiries@travelclinic.ltd.uk

A huge thank you goes to all those who have  supported me throughout all this challenge.

It was very scary, big winds and waves I hadn’t planned for. In fact all the training on my crawl went to nothing as the waves were too big for me to crawl and breathe!

It was quite exciting, people having panic attacks, trying to turn back. Sadly one woman died after her swim, I believe.

But I did breast stroke all the way my time was 53 minutes, but that did include diversions and the mile was slightly shortened.

So I am very happy to sit here wearing my medal having achieved my goal.

So what next?  No idea, life seems challenging enough!

Once again, thanks for the support

I'm taking part in the 2010 Great East Swim on 03/07/2010 to raise money for Huntington's Disease Association in memory of my brother Jon, who had a very hard life and a hard death and I'd really appreciate your support.

Huntington's disease is an inherited disease of the brain, for which there is no cure.
The disease damages the nerve cells in the brain causing deterioration and gradual loss of function of areas of the brain. This affects movement, cognition (perception, awareness, thinking, judgement) and behavior.

It's easy to donate online with a credit or debit card - just go to my JustGiving page:

http://www.justgiving.com/Mary-Kedward

JustGiving sends your donation straight to Huntington's Disease Association and automatically reclaims Gift Aid if you're a UK taxpayer, so your donation is worth even more. I hope you'll join me in supporting Huntington's Disease Association.

Before Christmas I could manage to swim 2 lengths without stopping. Now I am proposing to swim a mile in a one-mile outdoor swim taking place in Alton Water reservoir, near Ipswich, Suffolk
Please support me, this is a real challenge, my aim is not to drown!!

How to get a high health score in the World Cup this year.

What vaccines should I think about?
For any trip to South Africa, you need to check you are covered for Hep A and Tetanus/Diptheria/Polio. There is an ongoing outbreak of measles in South Africa, so also important to check your cover for MMR (measles, mumps and rubella).
The World Cup is happening during South Africa’s flu season, and the Department of Health are now suggesting Influenza A H1N1 vaccine for travelers. 
Those attending matches will be exposed to large gathering of people which may increase risk of exposure to these illnesses.
Insect bites
Insect repellents containing DEET, and clothing treatments should be used to reduce the risk of a variety of insect borne diseases, including Rift Valley Fever.
Malaria is unlikely to cause a problem for those travelers only visiting the cities hosting football matches, but please remember to check if anti-malarial measures are required if traveling on elsewhere.
Animal Bites
Rabies is endemic to South Africa, and is often related to contact with dogs.  However, any mammal or bat can be affected.  It is essential to get rapid medical care in the event of any animal bite, scratch or lick to face or open wound.   Pre-travel vaccination removes the need to get the HRIG, in the event of a bite.
Sun, Sex and Alcohol
South Africa has a high incidence of Hepatitis B and HIV, so safe sex is vital, as is avoiding any contact with needles. 
Don’t forget to use sunscreen and sunhats while cheering on our team, and drink plenty of water or other non alcoholic drinks.
Please remember excessive alcohol increases risk to health and personal security.
Insurance
There is no Reciprocal Health Agreement with South Africa, so please remember to organize your travel and medical insurance, including cover for medical repatriation.

TICK BORNE ENCEPHALITIS

ATTENTION ALL WALKERS, RAMBLERS AND CAMPERS:

If you are heading off this late spring, summer, or early autumn to any of the following countries:

France, Germany, Austria, Hungary, The Balkans, Czech Republic, Slovakia, Scandinavia, Eastern part of the Former USSR extending across China, Russia, Austria, , and Northern Japan.

Be aware beware of the IXODES TICK.
If bitten by this tick, one could contract a flavivrus infection called TICK BORNE ENCEPHALITIS.

There are two types of this disease: 
1. Eastern subtype
2. Western subtype. 

TRANSMISSION
The tick lives in long grass, and whilst running or walking through the grass the infected Ixodes tick will bite the human thus transmitting the Tick Borne Encephalitis disease. The tick loves a wet spring and a long hot summer, which provides the best breeding situation, hence due to global warming the risk is spreading

SYMPTOMS OF THE DISEASE  
The incubation period for both subtypes is 3-14 days. 

EASTERN SUBTYPE
When infection is evident it results in the following:
• Sudden onset of severe headaches
• Fever
• Photophobia
• Nausea

And in severe cases can lead to the progression of Encephalitis (inflammation of the brain), and mortality at this stage is approximately 20% of those who have contracted the disease.  At this time, the symptoms are the following:
• Headaches
• Stiff necks
• Photophobia
• Convulsions
• Altered mental state

WESTERN SUBTYPE
The patient has a flu-like illness for a few days, and potentially a third of the infected could develop the symptoms as above.

TREATMENT 
There is no specific treatment available

PREVENTION 
It is strongly suggested that one wears long trousers, long thick socks, no shorts and uses insect repellent.  Attempt to avoid tick bites and if bitten remove tick immediately.

Tick removers are available from the CLINIC for £7.00.

The vaccination is available at this clinic for children and adults, and is a course of three vaccines for adults and children from the age of 1 year over 5-9 months

Available from The Travel Clinic Ltd

What vaccines do I need?
Staying healthy abroad is not just about having a vaccination or taking a few tablets it's about fully appreciating the associated risks and avoiding them as far as possible, all of which we discuss at The Travel Clinic.
It is impossible to say what vaccines are needed, as it is not known what diseases you will encounter when away. So that is why a risk assessment is required. One needs to know how diseases are spread, before you think about immunising
Travel checklist The main risks for travellers fall into three categories:
1. Vaccine-preventable diseases
2. Insect-borne diseases
3. Gastrointestinal illnesses, such as diarrhoea, which is caused by contaminated food and water
This may be misleading, the major cause of preventable deaths in travellers is injuries.
In any case, preventive measures can reduce the possibility of all these problems -- from making sure one's vaccines are up-to-date to drinking only bottled water.
If business travellers are more at risk than the average traveller, it is because they are less likely to take the necessary precautions.
Traveller's health is mostly common sense - Bugs, Bites and Bowels as written in Dr Jane Wilson-Howarth memorable book who practices here at The Travel Clinic Ltd
http://www.travelclinic.ltd.uk/publications.aspx
While specific health risks may vary, recommended travel precautions include:
• Before the trip, assess the potential health risks for the country the person is visiting. These will vary depending on what parts of the country they will visit, the time of year, and the kind of accommodation they will stay in.
• Ensure that you bring previous records of vaccinations with you

Most children recover well from a bout of chicken pox, It is not usually a life threatening disease. They may be off school for 7-10 days and have up to 250-500 itchy red blisters and spots; they recover well and have just a few scars.
Varicella or chicken pox is highly infectious. It spreads rapidly through households, and is very common with infection of up to 90% of vulnerable individuals who come into contact with the virus

 However occasionally severe complications such as meningitis and pneumonia occur especially as one gets older. The rate of admissions to hospital for treatment of varicella is 900% higher in adults although 90% of are people affected before adolescence.

10-20% of people who had had chickenpox will eventually develop shingles (a condition characterised by numbness, itching, or severe pain that may last for many weeks and may reoccur.

In pregnancy there is a fear of severe damage to the developing baby as well as complications with the mother
It is a course of two vaccines with about 6 weeks between doses

Until recently it was recommended that children should just have one vaccine, with the over twelve years and adults having two injections. The Department of Guidelines were changed in February 2010 so here at The Travel Clinic Ltd we are recalling all children to have their second dose of varicella vaccine
Later this Spring 2010 a vaccination against shingles will be released, the DOH are looking at vaccinating elderly people with the vaccine first as they are extremely vulnerable, this vaccine will be available from The Travel Clinic Ltd as soon as it is released.
 
http://www.patient.co.uk/doctor/Chickenpox-(Varicella).htm is a useful source of information

The raising and consumption of dog meat has been linked to the transmission of rabies to humans with two reported cases in China, one in Vietnam, and two deaths reported in the PhilippinesAlso, workers processing the meat from a rabid dog can easily become infected with rabies.

Recently a child in the Philippines has died after eating dog at a family party.

Rabies may be transmitted if dog meat is not well cooked, or eaten raw The most familiar form of eating dog meat is in the form of spiced chunks cooked in a hot-pot stew, but this is hardly the only form. Approximately 100 different dishes may be made from a single dog, depending on the local dog-cooking conventions, and not all of them are cooked. Sometimes the brains, tongue, and/or testicles are eaten raw. Sometimes uncooked "cold cuts" are eaten in sandwich wraps

It may be an issue for travellers who unknowingly may eat a stew containing dog meat, it is advised to have well cooked meat at all times.

Rabies vaccine is recommended for all travelers who may be unable to access prompt medical aid and the fast acting vaccine immunoglobulin, which is given within 24-48 hours of the bite or contact.

Infections with rabies occur when the virus is first inoculated into the victim and then absorbed into a susceptible cell where it multiplies. The virus then enters nerve endings. The virus will migrate to the brain and once the virus has then entered the brain, rabies symptoms begin to occur. Rabies is almost universally fatal afterwards. The term rabies refers only to when the person has the fatal condition.

The average incubation time before the development of symptoms is 90 days, although is has occurred is as little as 7-10 days to greater than a year. Rarely only a few days resulted in rabies and 1 case was over 6 years.

Children tend to develop symptoms faster because bites are closer to the brain (the virus have less to travel towards the brain), and often more severe.

Pre-exposure vaccination is giving the rabies vaccine to people who might be exposed to rabies.

The vaccine is given in three doses with a booster at 1 year and every 3- 5 years after. It eliminates the need for post exposure immunoglobulin treatment after a rabid bite, which may not even be available in certain countries.

The Department of Health has rolled out a programme to protect girls and women against cervical cancer.

News from the makers of Gardasil, Sanofi Pasteur MSD, shows in studies that the vaccine is protective in women up to the age of 45. The decision to vaccinate a woman should take into consideration her risk for previous HPV exposure and her potential benefit from the vaccine.

This vaccine protects against cervical cancer and precancerous cell changes in the cervix caused by HPV viruses. Cervarix guards against the two strains of the HPV virus which cause 70% of cases of cervical cancer, the second most common cancer in women worldwide and Gardasil which also protects against four strains of the HPV virus, also protects against genital warts.  Both are courses of three vaccines given over 6 months, they are not interchangeable. Both are available from The Travel Clinic for girls and women who will not be included in the DOH target groups

The vaccine has been made available to girls aged 12-13 years old from September 2008, the vaccine will also be delivered to girls up to 18 years in a two year catch-up programme.

This means that girls leaving school from 2010 will be protected by the vaccine.

Worldwide, cervical cancer affects more women under 45 than any other malignancy apart from breast cancer.  So it’s surprising that the disease, known also as cancer of the cervix, is in most cases unknown by women. 

Despite the positive impact cervical cancer screening has had in managing this disease, cervical cancer continues to have a high prevalence.  However, a feeling of optimism is emerging as for the first time, revolutionary vaccines will make it possible to prevent most cases of this disease

In the UK there are around 2,800 new cases and 1,100 cervical cancer deaths a year.  While in the US there are 10,000 new cases and 3,700 deaths per year.  Around the world, every two minutes a woman is dying of cervical cancer.

Cervical cancer commonly strikes women early, often in their mid-thirties, at an age when they are in the prime of their lives.  Many affected women will be caring for young children and extended families, so one death from cervical cancer can devastate the lives of many people.

Unlike the vast majority of other cancers, the cause of cervical cancer has been narrowed down to a single agent; the human papilloma virus (HPV).  This common, highly infectious virus, spread via sexual activity where penetrative intercourse is not necessary, will infect the majority of women at some point in their lives and 80 per cent of women will acquire a genital HPV infection by the age of 50.  

Nearly half of these infections will be by a strain of HPV which has the potential to cause cervical cancer – although experts stress that only a small percentage of women infected will go on to develop the disease as, in most instances, infections of this nature tend to clear naturally.

You can book your HPV vaccination at either of our Travel Clinics (Cambridge or Ipswich) for £140 per dose

Call us now on 01223 367 362 or 01473 2170592 to arrange an appointment

At the Travel Clinic, we have the answers!

Watch this space!