Updates Dengue Fever Outbreaks Dengue Fever Outbreaks in Queensland and Florida Dengue Fever is an unpredictable disease and there are sporadic outbreaks even in industralised countries. Cairns and Townsville in Queensland were struck last year in the worst outbreak for more than half a century. Given that the disease is a simmering problem in neighbouring Indonesia I guess that it isn’t so surprising. Now Florida has been hit. Travellers to affected regions should know that dengue is spread by day-active Aedes mosquitoes so covering up with permethrin-sprayed long clothes is the best defence.
The Aedes ‘tiger’ mosquito breeds in collections of clean water including rainwater trapped in big plants (hence you encounter Aedes in gardens of tropical hotels) and outbreaks have in the past been traced to rainwater collections in discarded tyres. Emptying containers is a useful precauton and regularly practised in Indonesia where the disease is a HUGE recurrent problem.
Dengue is not a reason to avoid travel.
I have written about the disease in Wanderlust magazine; alternatively read more but having a look at The Esential Guide to Travel Health. Rabies Updates - Rabies death in Northern Ireland It is distressing to report a further person died of rabies in the UK (December 2008). The victim had worked in South Africa in close contact with animals including dogs over the previous two years and had not been protected with the very effective vaccine. Immunisation before any bite or a course of injections after a bite would have saved this life. Anyone visiting or travelling in countries where rabies is endemic should be aware of the risk and either be protected through immunisation or should travel to a competant medical facility if bitten or scratched. Careful wound-care after any bite or scratch also helps reduce the chance of infection with rabies, tetanus and other harmful microbes. - Rabies in France Rabies was eliminated from land animals in western Europe after a cunning programme of immunising wild carnivores with meat baits. In late October 2007, however, a mixed breed Border collie was illegally imported into the French town of Gers, near Toulouse. That dog had rabies. It died in November but not before infecting at least one other dog which in turn infected a third, and perhaps others.
Health authorities warn that there could be a risk of rabies if anyone was bitten, licked or scratched by a dog in Hautes-Pyrénées after October 2007, Gers from November 2007 and in Seine-et-Marne or Calvados from mid December 2007.
The post-bite injections offer absolute protection as long as they are given before any symptoms of rabies start. It is crucial that anyone who has had even a nip from a dog in France seeks treatment promptly via their GP.
News item first published in the Independent newspaper 9th March 2008 - Beware of bats : At the beginning of a two-week holiday in Kenya a small bat flew against the face of a woman. This happened in October at a camp site between Nairobi and Mombasa, at dusk, while she was brushing her teeth. She tried to hit the animal away, but it made two scratches on the right side of her nose. The wounds, which bled, were washed with soap and cleaned with an alcohol solution. No other care was given to the woman. Local advice was that there was no rabies in bats in Kenya; the disease was thought to be a problem spread by dog bites in the region: there had never been a death from rabies recorded in Kenya that was blamed on a bat. The 34-year-old woman was admitted to hospital in Amsterdam 26 days after the brush with the bat. Her symptoms – difficulty with speech, walking and odd sensations of the skin of the face – pointed towards disease of the nervous system and rabies was suspected immediately by the Dutch doctors. All possible treatments were given to the woman but she died 23 days after becoming ill, in December 2007. Wounds sustained from bats – even in England – carry a risk of rabies. Injections are required after any such incident, and immunisation before travel gives great peace of mind. Bednet update - from the Medical Journals : The 101 edition of the Transactions of the Royal Society of Tropical Medicine & Hygiene carries some interesting research reminding us that bednets are only protective if they are impregnated with a contact insecticide such as permethrin. Bednets bought in Britain are commercially impregnated – but that protective effect needs boosting periodically. A paper by Dr. J Etang et al in the Transactions reported research done in northern Cameroon where there is resistance to pyrethroids. These researchers stated that despite the local resistance to pyrethroids, permethrin-impregnated bednets gave good protection against acquiring malaria (compared to no protection from sleeping under untreated bednets). The protection was, though, only for the first three months after the net had been treated. Studies in West Africa have shown that unprotected people are bitten 200 times a night, and I take from this new research that travellers to West Africa should reproof their bednets every three months, rather than six-monthly as is usually recommended.
This review was first published in the British Travel Health Association Journal vol X; page 62 New Vaccine update - from the Medical Journals : A short review in the current Transactions of the Royal Society of Tropical Medicine & Hygiene 102, pp 211-2 by Drs Khin Saw Aye Myint & Robert Gibbons is a useful update on hepatitis E: the other, neglected hepatitis often acquired by travellers. The disease is very like so-called infective hepatitis or hepatitis A and it is acquired via the filth-to-mouth route but hepatitis E can be much nastier, especially in pregnancy. A vaccine trial conducted in Nepal shows that the new hepatitis E vaccine based on hepatitis E capsid protein is 95.5% effective, and it has few side effects. Now it remains to be seen whether anyone will put up the money to develop this vaccine, which will be of most benefit to the poor living in regions lacking basic infrastructure.
This review was first published in the British Travel Health Association Journal vol X |