Get Vaccinated now , pertussis , pandemic flu and travel vaccinations !

Despite a strong health infrastructure and vaccination programs - Australians remain vulnerable to emerging new viruses and existing old ones!
Australia is close to South East Asia, where a combination of high biodiversity, lose contact between humans and animals and changes in agricultural systems , high population densities , migration and rapid transport have made a fertile ground for new viruses. But also declining vaccination rates in Australia, and ignorance of dangers when travelling increase the risk. Resources are still much more sparse in Asia and make response to disease and control of animal reservoirs difficult. There is no passive or active Rabies vaccine available on Bali and 180 Balines died in 2010 alone of Rabies.

A number of viruses like SARS, H5N1 (bird flu) and H1N1 (pandemic swine flu )have emerged from Asia.

While WA had a raging flu season in 2009 , the one in 2010 was back to levels of previous flu seasons. Yet the UK now has full hospitals with Flu complications and we are well aware of the pertussis ( whooping cough) endemic in WA last year. H1N1 is beginning to mutate and might now become more infectious and require modification of used pandemic vaccine. The alarming levels of influenza in the UK have exhausted available stocks of flu vaccine ,the british government now has to make available stock piles of national emergency reserved pandemic vaccine!

The highly volatile genetic set up of RNA viruses makes them so very adaptable. They mutate at every replication, giving them a vast chance to develop useful change and ability to create resistance to drugs , and vaccines and chance to affect humans in new ways. The seasonal flu vaccine has to be newly cultured and filled with particles of new virus strains every year. Viruses can so jump from one species to another examples are HIV with reservoirs in primates , flu strains from waterbirds, Hepatitis C from yet unknown animal reservoir. Destruction of habitats and encroachment of human populations increase this chance presently and in future.

What can be done? Research into reservoir animals in developed countries as Australia is constantly under way, assisted by the improvements in genetic , biologic and epidemiologic science. We can now identify all viruses, understand how they emerge and spread. The World Health Organisation and richer industrial nations need to support the establishment of global scientific infrastructure for disease surveillance particularly in geographic regions where emergence of new viruses is likely, allowing a rapid and coordinated response to any new emerging infection.

We as Australians should be aware of vaccine preventable disease and continue to increase our uptake of routine vaccines already on offer like all the childhood vaccines! All Australians should consider seasonal and pandemic flu vaccine! Every traveller should attend his GP or Travel Clinic 6 weeks prior departure to discuss health and vaccination needs! All parents and grandparents of newborn or planned children should now booster against pertussis .


Sources :
- Eddie Holme , Medicus , 12 2010
- Dr Ian Barr WHO
- Maggie Fox , Medicine today 12 2010

South African Travel Fever

"Veels geluk maatjies!" (best of luck friends/mates)

The Soccer fever has gripped the world and thousands of Australians will flock with the rest of the world to the “Cradle of Mandkind" to cheer their teams. Thousands more will just travel to experience this beautiful land, not to mention the large South African originated workforce and their families in WA, who might return for a visit to their home country this year , often falsely presuming their immunity against African grown illnesses. South Africa is one of the leading economies in Africa with Ist world facilities in all cities of the worldcup. The risk of contracting illness if restricting itinerary to major centres will therefore be low. However the consideration of a minimum prevention programme like the Seasonal and pandemic Flu vaccine , Tetanus Booster , Hepatitis A , Typhoid, oral Travel diarrhoea vaccine (Dukoral) as well as carrying of Diarrhoea medication and oral rehydration treatments would be highly commendable. Drinking of tap or even fresh water is generally not recommended if for the risk of contracting a travel diarrhoea which is your highest health risk travelling to SA, but there is also danger of contracting Hep A , in north eastern provinces even Schistosomiasis. There was a measles outbreak with 6000 cases 2009 alone in all SA provinces and the country still has one of the highest world wide incidences of TB and drugresistant TB. Rabies is common in all provinces and bites scratches by dogs , foxes , mongoose, jackals in fact all animals should be taken serious and post bite prophylaxis within 24 hours should be sought from medical centres. 18% of the countries population and 50% of sexworkers are HIV positive so safe sex practices are always adviced. Travel to northern provinces of Limpopo, Mpumalanga , North Eastern Kwa Zulu and the Kruger Park makes mosquito bite precautions ( spray , nets , long sleeve / leg shirts trousers) as well as malaria prophylaxis paramount. Have a travel health insurance in place as care in outside areas can be substandard and transport and care in centres or evacuation back to Australia might be necessary and expensive in case of acute illness or accident.
Crime rates are of the highest level in South Africa, have good personal security strategies in place and use good common sense. Avoid travel on commuter trains and Bus taxis, lock your car if travelling at all times especially in cities, (leave valuables (handbags,mobiles) locked in the trunk of your car), and (do not stop on highways to sitesee) Don’t visit townships uninvited and unaccompanied. Check out the government website http://www.smarttraveller.gov.au/ with good Travel and Health advice for SA.
Indirect Travel via other countries might make Yellow Fever vaccine for entry into SA as well as re-entry into Australia compulsory. In summary have a great time this year in South Africa and good luck to the Socceroos, but seek a health and vaccination check from your GP or Travel Clinic before you go and see your GP or ED doctor, if you develop anything more than a minor illness on your Return.

"Hamba Gashle Umgani!" (go well our friends)

http://drhelkoschenk.blogspot.com/
Geraldton 12 6 2010

Sources.:
http://www.travax.com/
http://www.istm.org/
http://www.smarttraveller.gov.au/
http://drhelkoschenk.blogspot.com/
Southafrican friends and colleagues

Pregnancy and Travel

Giving the right advice to the pregnant woman keen to travel requires appropriate mix of caution and bravery, simply as this is a phase of great risk and there is a lack of controlled studies on the effects of travel , vaccinations … on pregnant women.

It is clearly sensible to discuss travel plans well in advance (6 weeks) with your GP / Obstetrician/ Travel Medicine Doctor.


Some Contraindications to travel especially abroad are:
Obstetric Factors
- complicated present or past pregnancy
- preterm labour
- retarded intrauterine growth
- twin pregnancy
General Medical Factors
- High Blood Pressure
- Diabetes
- Cardiac Arrhythmias
- High risk of blood clots (Vein thrombosis)
Hazardous Destinations
- a good travel doctor has access to information regarding general warnings
- www.cdc.gov/travel
- www.smarttraveller.gov.au
General and pre-travel information
- Geraldton travel clinic: www.gmgn.com.au/travelclinic.html




Most international Airlines carry pregnant women up to 32-35 weeks, but require a letter stating your fitness to travel and confirming date of delivery. It is also wise to carry all pregnancy documentation, Blood group, medical history , antenatal record .
The Oxygen pressure in air plane cabins is reduced , which is generally not a problem but might become if you pregnant and also anaemic or have sickle cell disease. To prevent blood from clotting in veins hydrate well, do regular in travel exercises of legs, wear below knee compression stockings.

Vaccinations should bare some exceptions - were risk of catching the true illness outweighs the harms of vaccine - be generally avoided in pregnancy. Advice on vaccination has to be based on a thorough medical and vaccination history, up to date knowledge of destination health risks. Vaccination for Diphteria Tetanus, seasonal and pandemic Flu, Hepatitis A + B, Pneumococcus , Typhoid could be considered in pregnancy.
BCG(tuberculosis), Mumps Measles Rubella, Chickenpox – vaccines are contraindicated. Tricky is the decision on Yellow fever vaccination.
The most popular travel souvenirs are common viral infections and particularly diarrhoea and vomiting in pregnancy. Persistence with oral rehydration are important to avoid particular risk of shock , metabolic illness , preterm labour in pregnancy. (Buy oral rehydration packs from your travelclinic or pharmacy!) It is not clear if anti diarrhoea medicines like immodium are safe , but they have been used in pregnancy. Only certain antibiotics can be used in pregnancy.

Malaria is a significant risk to mother and baby, avoid travel to malaria areas if possible! Mosquitos seem to be attracted to the pregnant due to increased skin temperature and higher CO2 production. Screens , Bed-nets sensible clothing , staying indoors at night and the sparingly use of insect repellents seems advisable. DEET (the commonest repellent) particularly if applied thick to large areas of skin get’s absorbed , and even travels the placenta into the babies blood. Discuss oral antimalarials with your doctor.
Other travel issues are common ailments and discomforts of pregnancy, ready access to medical facilities, safety of national blood supplies, availability of anti D for rhesus negative mothers.


Helko Schenk
Geraldton 26 1 2010

Swine flue Myths and Common Sense

If you listened to the news in the last week , you could well have been made believe , that the biblical plagues are hitting us all at once. Now while it is reasonable to show some concern, preparation and planning, it is important to keep things in perspective .

An apparently complete new strain of influenza virus, with characteristics only shown in other human, bird, and pig viruses seems to be behind a flu outbreak originating from Mexico. This new modification of the already known H1N1 virus gets transmitted by droplets between humans and causes the usual flu symptoms of fever , runny nose, congestion, sore throat or cough. There has been so far only a single death outside Mexico in a toddler travelling from Mexico, a significant number of deaths attributed to swine flue in Mexico were propably due to alternative causes, there hasn’t been a single case confirmed in Australia so far, most cases of flue outside Mexico have been reported as mild. The virus is responsive to Tamiflu and Relenza (medications), which both are stockpiled sufficiently in Australia. More so simple hygienic measures, would help to contain the spread of the virus, should he hit Australia. Currently you are only at risk if you have travelled to Mexico, USA and Canada during the last 7 days or have been in close contact with confirmed and or propable cases of swine flue. Should you develop above mentioned flu symptoms and be at risk:
- stay at home keep your social distance to others , wear a mask when around others. , (Masks seem to work - even surgical ones!)
- talk to a medical professional ideally over the phone, before you go and see them, this helps reduction of spread
- Make yourself known on arrival to reception staff, so you can be issued a mask and kept at a distance.
- Rest , drink plenty of fluids , take simple analgesics and over the counter medicines
- Keep cough and sneezing etikette (cover up)
- Wash your hands regularly, clean surfaces regularly

Pending circumstance and local situation, there will be different pathways to access tests and treatment ,via an extra set up flue clinic next or through our public health unit or local GP clinics and a combination of above. Antivirals , which have arrived in Geraldton, will be distributed only where indicated, following strict clinical guidance on a need basis and only under the supervision of our local public health unit. This is currently indicated for confirmed cases as well as close contacts of cases within 48 hours of sympoms or contact only..
Find Further information :
- Swine Influenza Hotline 18 02 007
- Health Direct: 1800 022 222
- www.health.gov.au or www.flupandemic.gov.au
Seasonal Flue vaccine remains recommended ,even though the new virus is likely not covered by it.
It remains safe to eat pork and drink corona , well within safe recommended limits, that is.
Sources:
- Dr Maris Giles from Public Health Geraldton- Dep. Of Health WA
- Australian Medical Association on Swine Flu
- Above websites
- Interview with Prof Raina Mcintyre on ABC Health

Helko SchenkGMG
4 5 2009

Flue shots need higher uptake

Influenza or common flu is lurking around the corner. Not long to go til june when the annual flue season starts and brings sudden onset fever , severe headache, sore throat , runny nose , fatigue, general aches and pains , congestion in lungs, nose and throat and even death for some of us. Not forgotten yet the disastrous flu season 2007, when we had the lowest vaccination uptake yet in Australia followed by the most severe influenza season since national reporting was started in 2001 Everybody remembers the death of the 4 west Australian toddlers. So now is the time to get vaccinated. Vaccines have arrived to pharmacies and GP surgeries. Free vaccines are available for the 6 month to 4 year old ones as well as the pensioners over 65 years and indigenous adults over 50 years of age and indigenous adults 15-45 years of age. Vaccination is also recommended for anybody else with underlying significant health problems (Asthma , Bronchitis, Heart disease, Cancer, Immuno-supression like HIV), Pregnant women, who’s IInd and IIIrd trimester falls into the flue season June til September, Parents and families of high risk children under the age of 2.
But also everybody else benefits much like the community as a whole from being vaccinated against the flu. 80% of the over 65 year old population is taking the flu shots up every year, they are aware of the usefulness of the vaccine and have tolerated it well over the years. Only 20 % of the lower risk general population between 4 and 65 is having the jab every year. 50% of which have it just because their employer pays for it or pays for their time needed to get it. A wise and very smart move from these companies, as it keeps their sick days down and saves bucks later during the season. Why do the rest don’t have it? , it costs money (about 20 $ for the script, and most GP’s bulkbill costs for prescribing/giving the shot anyway). Some feel it might give them the flu, not possible as the flue vaccine is a dead virus material vaccine. I’m to healthy to get the flue – sure thing til it hits you one season, and anyway there is clear evidence that countries with a higher general uptake of flu vaccine have a lower sick rate in the general and lower death rate in the elderly population.
So come on Midwest get vaccinated these 2 months!

Important Facts:
- Vaccination is required yearly as the virus changes
- Side effects and allergic reactions are rare
- Soreness redness at injection site in 20 %
- Flue like illness for a day or so in 1 % only
- Current Minor illness is not a reason to avoid vaccine

How can you avoid getting the flu?:
- cover your face if coughing and sneezing
- chew with your mouth closed
- use a paper tissue to wipe your nose
- wash your hands regularly especially before preparing food
- stay at home til signs of illness settle( runny nose , cough, fever)
- avoid mixing with large crowds of people if influenza is about
- Young children and people with chronic conditions should see their doctor early with illness

Sources:
- www.abc.net.au/health
- Australian Family Practitioner 10th October 2008 “INfluenca”
- www.patient.co.uk “influenza immunisation
- www.public.health.wa.gov.au leaflets for diseases A-Z

Helko Schenk
Geraldton 12 3 2009

Whooping Cough and other Vaccination Matters

Most developed countries have successfully run vaccination programmes in the last 50 years, almost eradicating former killer diseases. This is thanks to parents and health care workers, scientists who always have the safety of their children and patients in focus. Vaccinating them, helps children to fight deadly diseases.
Vaccines contain weakened virus material, triggering a response, creating antibodies and immune information, storing protection for years to come. Vaccination creates natural immunity as a normal response of our immune system, without living through the pain of real illness. Immunisation is safe and has saved millions of lives.
Why than do infections sometimes return? Immunisations work less well when vaccination rates in the community fall below certain levels, the virus survives in patient groups, might be re-imported, protection from vaccines wane over years. We have to remain forever vigilant.
One dragon raising his head is whooping cough with 315 notified cases 2008 in Western Australia (threefold rise since 2007!) This seems small numbers, but the effects of whooping cough can be 6 weeks and longer lasting excruciating cough attacks, strong enough to break ribs and make some kids go blue or even stop breathing. Adults and older children have milder illnesses, which can make outbreaks go undetected. Contacts have a 80 percent chance to get the disease. Babies under 6 months are particularly affected and there have been 16 deaths in this age group and 84000 cases of whooping cough in total between 1993 and 2005 in Australia.
The reason for this is, that whooping cough vaccine only protects for 6-12 years and enough people are missing out on the vaccination during the 1st, 4th and 15th year of age. The message is simple: get your children vaccinated in time , parents planning or just been through pregnancy and even grandparents and health care workers should be re-vaccinated. Geraldton Medical Group and Batavia are just boostering all their medical staff! Babies should be kept away from sick and coughing visitors till the first course of immunisation is completed. It pays to do a pre-pregnancy visit to the GP and to use this opportunity to have rubella and chicken pox status checked as well.
Other vaccine preventable illness worthwhile discussing with your doctor:
- Tetanus
- Mumps Measles Rubella
- Polio
- annual Influenza
- 10 yearly Pneumococcus
- Hepatitis A and B in risk groups
- Cervical Cancer

Which reminds me, that we have to urgently recall this big belly bloke Mr Claus Santa for his travel vaccine check prior the 24th of this month.

Merry Christmas 2008!
Helko Schenk

Sources:
- Special thanks to Marisa Giles (Community Health) and James Quirke (Batavia Health) for facts and ideas.
- “Pertussis in Australia today” Australian Family Physician Vol 36, 1/2007
- www.public.health.wa.gov.au website public health western Australia
- “Disease Watch” 9/2008
- www.immunise.health.gov.au

Are You Fit to Fly?

The holiday season is upon us, lots of us use this time to long-haul fly overseas, Australia remaining an island on the other side of the globe for a number of destinations. It is advisable that you see your GP or even specialist before booking a flight to help you with your travel plans. You might need a letter carrying medication onto the flight(emergency medication inhalers and heart sprays, painkillers ,sickness tablets belong into your hand luggage) or a ‘fit to fly’ certificate (certain medical conditions and pregnancy). A number of countries don’t take lightly to unconfirmed carrying of drugs of addiction. Some routine vaccinations might need boostering up and the country you fly to might require specific ones. Will you need antimalarials? (Remember you are not immune against local illness if you were born outside Australia) Travellers need bigger amounts of their usual drugs prescribed. Are there special requirements for your flight (wheelchairs?, aides ? , oxygen? ) Have a routine check (Bloods , BP , general health...)done prior departure, unless you wish to experience foreign health care inside out. Plan your flights wisely, have a stop over if you frail and easily exhausted, allow for jet lag! Are you fit for your specific travel itinerary(climate, accommodation, airports and carrying of luggage) Have you got insurance covering you and your conditions (chronic or terminal illness , pregnancy) Do you carry spare glasses, batteries for hearing aids and a first aid kit ( Anti-diarrhoeas, Anti-emetics) There are a number of no no’s to flying, your doctor can advise you on.
You might not be fit to fly or need to follow specific advice with the following conditions:
- severe or unstable heart- / breathing illness (asthma , angina)
- Acute infections if ill or in fever
- A new Stroke or blood clot anywhere
- Very recent fractures
- Recent surgery
- Middle Ear infections til able to pop ear drums, Sinusitis til resolved
- Pregnancy needs fitness to fly assessment, most airlines refuse transport after 32-36 weeks
- Acute psychiatric illness, or unstable epilepsy
- Diabetes , check dose regime and adjustment with doctor
- Renal Dialysis, check availability of dialysis ahead

Drink plenty (Fluids!! Not Alcohol!!) to prevent blood clotting, keep your calfs exercising, discuss prevention of blood clots with your doctor (especially if you have a history of clots, are pregnant , overweight or have other medical problems)

When planning your itinerary you might check out these:
www.cdc.gov/travel/
www.smarttraveller.gov.au
www.immunise.health.gov.au
www.diabetesnsw.com.au
www.globaldialysis.com

And don’t forget when all is considered, planned and packed you more than likely to have a great time if not the time of your life.