Updates

Rabies Update

- Rabies in France :

Rabies was eliminated from land animals in western Europe after a cunning programme immunising wild carnivores with meat baits. In late October, 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.

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.

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 :

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.

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.
First published in the British Travel Health Association Journal vol X; page 62