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OTHER CONCERNS FOR TRAVELLERS

TUBERCULOSIS
Tuberculosis is a re-emerging disease which has become a significant challenge to health authorities all over the globe. At the present time, Tuberculosis is one of the leading causes of death in the world each year. Tuberculosis usually spreads by close contact from infected individuals. It can also be contracted from dairy products. Guidelines for the usage of TB vaccine are quite complicated and the benefits need to be discussed with our doctor at the time of consultation. Normally the vaccine is most beneficial in young children or in persons who are involved in some high risk exposure categories. Our doctor can make arrangements for a tuberculosis vaccination if this is required for your trip. Often a Tuberculosis test is required to determine if the vaccination is possible. There are two different types of tests – a skin test (Mantoux) or a newer blood test called Quantiferon Gold. Our staff will discuss the options available.

BILHARZIA (SCHISTOSOMIASIS)
Bilharzia is a condition resulting from contact with water containing the larvae of a type of flatworm. Although the worms may be ingested, usually Bilharzia is acquired by the direct contact of skin with contaminated water. The microscopic larvae are able to pass directly through the skin and gain entry to the body. Bilharzia occurs widely throughout Africa, Asia, the Middle East and parts of South America. Normally the parasites are found in stagnant lakes in affected areas which provide an ideal habitat for a particular type of water snail. The illness is quite commonly diagnosed in returned travellers, especially those who have done long trips to Africa. 

Untreated Bilharzia infections may result in scarring and damage to the urinary tract or gastrointestinal system. Systemic illness may also follow. Many popular destinations including Lake Malawi and Lake Kariba have significant levels of Bilharzia risk. At the time of your consultation, the doctor at our clinic will discuss how you easily can prevent this illness. If you are concerned that you may have been exposed to water containing Bilharzia, the doctor at our clinic will arrange a simple test to diagnose the condition. Bilharzia treatment for most travellers is both safe and effective.

TRAVELLER’S DIARRHOEA
Many travellers have are familiar with stories from friends or family who have visited other countries and suffered severe gastroenteritis. Careless hygiene or inattention to food and water safety can completely ruin an otherwise memorable trip. Opportunities to rest or participate in a range of enjoyable vacation activities are replaced by doctor’s visits, hospital admission or confinement to a hotel room. Important business opportunities may be missed due to illness. Never let this happen to you! Adhering to a simple regimen of food and water safety principles can minimise or even eliminate these problems. During your consultation at our clinic our doctor will specifically discuss how you can reduce your risk of developing traveller’s diarrhoea during your trip. We also supply a range of simple, inexpensive medical kits which can effectively treat illnesses like gastroenteritis. Or staff will be happy to assist you with these issues during your consultation at our clinic. 

HIGH ALTITUDE
Travellers are increasingly visiting destinations at high altitude. A few decades ago, trips to the top of Mt. Kilimanjaro or to the Himalayas were considered the domain of the hardened adventurer. In the modern era, many of these destinations are available as optional extras or even the focus of an adventure tour. There are, however, serious risks to high altitude trips and deaths still occur in the unprepared and unwary traveller. The altitude at which symptoms develop depends on many factors. 

Many unanswered questions remain about high altitude travel and its exact mechanism is very poorly understood.  For instance, certain individuals will experience symptoms on one trip and not another. Paradoxically, young and otherwise fit travellers may have worse symptoms than their older companions.  Asthmatics must be well prepared but often have surprisingly few problems at high altitude.  Answers to the intriguing mysteries of high altitude travel await us in the future. Some people notice mild altitude symptoms at about 2500 metres. The majority of travellers will experience some symptoms at 3500 metres.
 
One thing that we do understand about altitude is that the risk of problems is closely related to the rate of ascent. A sudden rise in altitude without acclimatisation greatly increases the risk of altitude problems. This has important implications in planning your trip. Sudden increases in altitude should be avoided if possible. Try to organise tour itinerary so that there is a gradual and progressive increase in altitude. If possible, allow some rest days to allow the body to adjust to the higher altitude.

Altitude affects our body in several ways. Most importantly our tissues receive less oxygen as a consequence of the altitude. The lowered air pressure also plays a role. Individuals who suffer altitude symptoms normally experience breathing difficulties and an accumulation of fluid in the lungs (High Altitude Pulmonary Oedema – HAPE). This results in breathlessness, a cough and sometimes frothy sputum. There may also be some symptoms arising from fluid accumulation in the brain (High Altitude Cerebral Oedema – HACE). Usual HACE Symptoms include confusion, unsteady walking and poor judgement. 

There are several important aspects of high altitude travel that will help you to experience an enjoyable and safe journey.

  • Take time to acclimatise if possible at about 2500 metres.
  • Maintain a steady fluid input to remain hydrated.
  • Limit ascent to about 300 metres each day (‘Climb high, sleep low).
  • Add rest days to your itinerary to allow additional acclimatisation.
  • Do not use alcohol or sleeping tablets.
  • Treat mild symptoms with ‘Diamox’ (Acetazolamide) 250mg tablets. 
          Normally the dose of Diamox is 125mg (i.e. ½ tablet) taken twice daily. Our             clinic doctor will discuss the suitability of these tablets for your trip and their             correct usage to ensure best results. Another tablet called Dexamethasone              is sometimes used to relieve effects of altitude but does not speed                           acclimatisation (4mg dose every 6 hours).
  • Commencing Diamox 2-3 days before ascent is believed to speed acclimatisation.
  • Remember severe altitude sickness can be fatal – if you are severely affected you must descend to a lower altitude.
  • Some tour operators carry a portable recompression (Gamow) bag for emergencies.
  • Avoid flying straight to high altitude destinations from sea level (e.g. Lhasa in Tibet or La Paz in Bolivia). 

DEEP VENOUS THROMBOSIS
In recent years there has been considerable attention devoted to the risk of deep venous thrombosis in travellers on long haul plane flights. Awareness has significantly increased but many unanswered questions remain. The risk to most travellers is quite low but blood clots have serious consequences and you must take steps to reduce your risk. A number of very important things are known about DVTs in travellers.

  • Certain individuals have increased risk – if you have a past history of clotting or a family history of similar events.
  • Smoking and those taking the oral contraceptive pill are at greater risk.
  • Longer flights are more risky – some recent studies have shown even a 4 hour flight increases your risk of DVT above the baseline. The risk may also persist for several days after the trip.
  • Recent hospitalisation (within 3 months) increases risk
  • Lower limb immobilisation (e.g. a cast) is associated with increased risk.
  • Other risk factors include obesity, pregnancy, history of cancer and age over 40.
  • Aspirin does not lower DVT risk on long haul flights. It does work however for heart attacks and strokes.
  • Specially-designed travel stockings make a real difference if fitted appropriately.
  • If you have unexpected pain or swelling on a leg after a long flight you must get checked up – usually clots can be easily diagnosed with a type of ultrasound.
  • The risk is not greater in economy class. It depends on other factors.

What can you do to reduce the risk of DVTs on long plane trips? Several things make a real difference. There is a clear link between risk and immobility. Take regular short walks around the cabin and perform in flight exercises as suggested. Some short walks in the days after you arrival are a good idea too and may help you overcome the effects of jet lag. A pair of properly designed, well-fitted travel socks significantly reduces your DVT risk – they are comfortable too! About 20mm of compression is recommended by most experts.

Certain high risk individuals will require blood-thinning medication to travel safely. There are two different types, an injection called Clexane and a tablet called Warfarin. If you think you may have an elevated risk of DVT, discuss this with our clinic doctor at the time of your consultation and we will be able to provide appropriate advice.  


Phone  (02) 9891 4850
Travel Health, Medical and Vaccines
   Sydney Travel Vaccines