The Travel Doctor TMVC Homepage News

Salsa and Guacomole? Think twice.

Wed, 21 July 2010 15:00:00 +1100

At an International Conference on emerging infectious diseases held earlier this month the USA Centers for Communicable Diseases told participants that the rate of food-borne illnesses has more than doubled for salsa and guacamole served at restaurants during the research period 1998 – 2008.

We have in the past warned against using salsa dips which are frequently seen on tables in Central American tavernas because they are likely to be contaminated by bacteria when they have been standing around for long periods. It appears that the risk is there even in countries like the USA Both these popular items are made in good restaurants from fresh ingredients but if these ingredients and foods are not properly stored and refrigerated –especially when large batches are made - they can spoil quickly and foster bacteria, such as salmonella. Cases of cholera in Ha Noi, Vietnam have been firmly linked to shrimp paste standing on tables for a long time and it is clear that partaking of pastes, sauces and suchlike items which are likely to have been exposed for long periods without refrigeration are highly likely to carry germs causing diarrhoea.

It is obvious that it is not possible to avoid such problems completely but it is wise to be circumspect about dips and sauces that have been sitting out for communal use.

Measles brought home from World Cup

Mon, 12 July 2010 09:30:00 +1100

A 24-year-old male in Darwin has been confirmed to have measles. He had travelled to South Africa for the World Cup and had not been in any other country. He did not seek pre-travel medical advice, but "had been immunised as a child" – we do not know if this means he had one only vaccination instead of the two required (one in infancy and a booster in early adolescence).

The time sequence of the development of symptoms means that the disease was acquired in South Africa. There is a large current outbreak of measles in South Africa and he could have caught the infection in any crowded area including the World Cup matches he attended.

A 24-year-old male in Darwin has been confirmed to have measles. He had travelled to South Africa for the World Cup and had not been in any other country. He did not seek pre-travel medical advice, but "had been immunised as a child" – we do not know if this means he had one only vaccination instead of the two required (one in infancy and a booster in early adolescence).

Cat Bites (Samantha) Fox – Rabies Reminder

Wed, 7 July 2010 19:15:00 +1100

Numerous media sources have run the story over the past few days that high-profile English model and TV star Samantha Fox was bitten by a cat while holidaying in Koh Samui, Thailand and is receiving anti-rabies treatment. Apparently she had been feeding stray cats around the restaurant where she had been eating because she felt sorry for them, when one bit her. Wisely she attended a medical clinic on the island where a course of rabies vaccinations was started now continuing in the U.K.

This episode serves as a reminder to heed the advice we give to tourists - stay away from animals, don’t get friendly with them and do not feed them. There is a very real risk of being bitten and rabies is then a distinct possibility unless immediate rabies "Post Exposure" vaccination is commenced.

For further details on Rabies see the Fact Sheet on this site.

Who Can You Trust With Food

Fri, 2 July 2010 12:30:00 +1100

In a report published in USA Today and circulated through a newsletter to the travel industry, Food and Drug Administration (FDA) inspectors in the USA found food stored at incorrect temperatures, unclean equipment and mice, cockroaches and evidence of other pests in the US kitchens of three catering companies who between them operate 91 kitchens preparing 100 million meals a year for US and foreign airlines at US airports. They also claimed workers in some of the kitchens suffered from poor personal hygiene. The FDA said inflight catering was getting worse and, according to a public health official quoted in USA Today, 'posed a real risk of illness and injury to tens of thousands of airline passengers on a daily basis'.

Confirmed reports of disease outbreaks in airline passengers are rare indeed but anecdotal accounts of stomach upsets following travel are not uncommon. Catering companies have commented that they all have multi-layered quality control standards in place. Nevertheless it is well-known that infectious gastrointestinal problems can be acquired not only from eating in "poor" places but also from quality restaurants, and the FDA report suggest also sometimes from airline food.

Put simply, the cause of traveller's diarrhoea is travel. It can occur anywhere, anytime. The chances of getting it will be lessened by sensible precautions but it cannot be avoided altogether and when it does occur it is very useful to have at hand the means of immediately treating it. This is the rationale behind the provision by Travel Doctor-TMVC Clinics of the various forms of Travel Kit which our clients are encouraged to have with them when travelling, whether it be for business or pleasure.

Helping to green your destination

Wed, 30 June 2010 12:00:00 +1100

Increasingly in Australia we are "doing the right thing" for the environment. We recycle bottles, cans and paper, and we reduce our water and power usage. But do we forget these behaviours when we go on holidays? A recent British survey suggests we could give it some thought. Almost 90 per cent of British people surveyed said that they regularly recycle in their day-to-day life, but less than half kept up the good work while away and one in five holidaymakers admitted that they "switch off" completely when they're on a break and don't ever consider the environment.

The U.K.'s The Travel Foundation is running a national campaign urging holidaymakers to make a difference to the place they are visiting and the people that live there. The principle applies to tourists from all countries. Simple things like taking short showers, switching off air-conditioners when not needed, and reducing the amount of plastic waste can contribute significantly, and shopping in local markets for souvenirs is one of the many ways in which to help local people who depend on tourist trade. The Foundation poses a question applicable to all environmentally conscious tourists:

Why Not Do What You Do at Home?

Travel Doctor-TMVC clinics chosen to do Japanese encephalitis vaccine research in children

Wed, 30 June 2010 12:00:00 +1100

Travel Doctor-TMVC clinics in Melbourne and Brisbane have been selected to participate in a world-wide trial of a new Japanese Encephalitis vaccine in children.

The vaccine is already available in Australia for people 18 years old or above, and the manufacturers need to demonstrate the effectiveness and safety in children. While the vaccine is approved for use in adults, because it is new in children, the study must be performed, and we will be assisting in recruiting participants for this study in both Melbourne and Brisbane.

If families are considering having their children vaccinated, and the children are between 2 months and 18 years of age, they may be suitable for enrolment in the study and obtain the vaccination for free.

Further details can be obtained by contacting the study co-ordinator, via: tony.gherardin@traveldoctor.com.au

Needle–free vaccination.

Fri, 25 June 2010 15:30 +1100

Vaccination by swallowing or sniffing or skin patching?

At a World Expo's theme forum held in China's Jiangsu Province in mid-June Barry J. Marshall, West Australia's Nobel Laureate , said people might in the future be vaccinated by swallowing capsules instead of by using needles. He outlined a project he and his team are undertaking to take influenza virus genes inserted into bacteria which when ingested in a capsule stimulates the immune system and provides effective "vaccination" against influenza.

Scientists and drug companies are in fact moving rapidly ahead with several new technologies that aim to deliver vaccines and other therapies needle-free. Already an inhalable weakened live flu vaccine is available in the USA. Researchers at the University of Colorado have developed a prototype for a new generation of inhaled vaccines based in part on studies that were originally done to understand how people inhale tiny airborne droplets of air pollution. Safety and effectiveness trials of a weakened measles vaccine delivered through the inhalant powder are starting in India this year. The vaccine does not require refrigeration or other special handling, and very importantly, it is cheap.

Several groups are also working toward vaccine-patch delivery systems that would carry active ingredients through the skin using small particles. Scientists at Queensland University have been working on a "nanopatch"vaccine that utilizes tiny projections too small to feel that nonetheless penetrate the skin deeply enough to activate immune cells. Tests on mice show that it achieves the same level of immunity as injections but using about 100 times less actual vaccine. And an Austrian firm, Intercell, working with the vaccine giant GlaxoSmithKline, is developing a two-step, needle-free stick-on vaccination method using two patches which has reached the stage of human testing.

So the future looks hopeful for needlephobes.

Unsafe beaches in Europe

Tue, 15 June 2010 09:30 +1100

Based on a report issued on 10 June 2010 by the European European Environment Agency a warning was issued by the European Commission that swimmers should avoid some 500 European beaches, lakes and rivers for health reasons. A survey in 2009 of nearly 20,000 sites from the Atlantic to the Mediterranean, and the North Sea to the Black Sea showed that 96 percent of European Union coastal waters and 90 percent of lakes and rivers met minimum quality standards in 2009. However , there were 129 sites in France that failed the compliance tests, 68 in Denmark, 56 in Italy, 46 in the Netherlands, 44 in Poland, 15 in Spain, 14 in Britain and 11 in Belgium.

The report is available online at: http://ec.europa.eu/environment/water/water-bathing/report_2010.html

Homestay in Malaysia

Thu, 27 May 2010 09:30 +1100

The Ministry of Tourism of Malaysia has launched a special program called Homestay e-Marketing Promotion, which promotes accommodation for travellers in the homes of local residents. Tourists opting for staying with the families get the opportunity to try a variety of home-made dishes as well as experiencing some aspects of rural life, and activities could include hiking in the jungle, collecting rubber, learning singing and dancing, flying kites, picking fruit and coconuts, fishing and visiting local handicraft workshops. Currently 141 families from all around the country participate in the program.. The promotion campaign announced recently by the Ministry is expected to further boost not only the number of participating families but also the amount of travellers who opt for this unconventional type of accommodation.

While this attractive option provides many opportunities for a "different" holiday it also carries with it a small but definite increased risk of being exposed to health hazards. It is essential for potential travellers to take full advice from an experienced and knowledgeable health professional as to food and water precautions, insect exposure, as well as administration of appropriate vaccinations.

Yellow Fever vaccination requirements for World Cup travellers

Wed, 26 May 2010 10:30 +1100

There is no risk of yellow fever in South Africa as it is not in an endemic zone and yellow fever vaccination is not required not is it required for Zimbabwe or Zambia. The World Health Organisation considers Kenya a country with risk of yellow fever and under International Health Regulations (2005), an International Certificate of Vaccination or Prophylaxis against yellow fever disease must be shown on entry to South Africa from Kenya. The National Institute for Communicable Diseases in South Africa has highlighted that anyone travelling to South Africa via Nairobi, Kenya for the FIFA World Cup in June 2010, must show proof of yellow fever vaccination on arrival.

However, passengers merely in transit who stay in the transit lounge and technically do not enter Kenya (and there is no entry stamp on the passport) do not require yellow fever vaccination.

Problems have very rarely been known to occur with local officials at the airport requiring to see a vaccination certificate. This can be resolved by demanding to see a senior immigration official.

World Health Organisation Influenza Update

Mon, 17 May 2010 09:30 +1100

As of 9 May, worldwide more than 214 countries and overseas territories or communities have reported laboratory confirmed cases of pandemic influenza H1N1 2009, including over 18036 deaths.

The most active areas of pandemic influenza virus transmission currently are in parts of the Caribbean and Central America, and to a lesser extent in West Africa and South and Southeast Asia. In the temperate zone of the northern and southern hemisphere, overall pandemic influenza activity remains sporadic. Seasonal influenza virus type B continues to be detected at low levels across parts of Asia, Africa, and Europe.

In Asia, the most active areas of pandemic influenza virus transmission currently are in parts of South and Southeast Asia, particularly in Bangladesh, Malaysia, and Singapore.

In Sub-Saharan Africa, limited data from several countries suggest that active transmission of pandemic influenza virus continues to decline in parts of West Africa, while low levels of seasonal influenza type B viruses continue to circulate in parts of Central Africa and to a lesser extent in East Africa.

In the northern and southern temperate regions of the Americas, only sporadic detections of influenza viruses have been reported, except in Chile, which continued to report localized areas of increased ILI activity associated with co-circulation of pandemic influenza and other respiratory viruses.

In Europe, pandemic influenza virus continues to be detected sporadically as the overall intensity of respiratory diseases remained low across the continent. Low level circulation of seasonal influenza type B virus persists in parts of southern and eastern Europe, notable in the Russian Federation and in Italy.

PNG Cholera Update

Fri, 7 May 2010 09:30 +1100

New cases of cholera have been reported in the National Capital District in coastal Motu-Koitabu villages to the west of Port Moresby. By 6th May there were 35 cases under observation and according to press reports 5 people had died from the disease. It is expected that Health Minister Sisa Zibe will be declaring a medical emergency as a result of the situation.

Cholera is spread largely through contaminated water and standard hygiene precautions will protect against the disease. Where there is doubt water for drinking should be boiled first. Such precautions are particularly important for expatriate travellers visiting or working in villages without adequate safe water supply.

Although there is an oral vaccine available hygiene precautions are paramount.

Parasitic disease is possible Stroke Risk

Thu, 6 May 2010 17:00 +1100

There is increasing evidence that a South American infection called Chagas' Disease is a separate risk factor for paralytic stroke. The disease, also called American Typanosomiasis, is caused by a microscopic parasite conveyed by the bite of the "kissing bug" bug prevalent throughout much of Mexico, Central America, and South America.

This triatomine bug thrives under poor housing conditions (for example, mud walls, thatched roofs), so in endemic countries people living in rural areas are at greatest risk for acquiring infection. Infection can also be carried from mother to baby and also rarely through blood transfusion from an undetected infection in a donor. In very poor areas there is also a possibility the parasite may be ingested with food contaminated by the triatomine bug.

Initial symptoms are associated with the bite but after entering the blood the parasite may be inactive for many years and in fact may never cause any further problems. However, in many cases it affects the heart muscle causing problems including heart failure or digestion problems through invasion of the muscles of the oesophagus. In Spain and the USA awareness of the disease has been highlighted by the prevalence in immigrants from endemic countries especially since a childhood infection acquired under adverse living circumstances may remain silent until well into adult life. It is while stroke cases were being investigated by Spanish investigators that the presence of Chagas' Disease has been implicated as a risk factor.

Chagas' Disease is not a risk for short term travellers to South or central America but it is a possibility for adventurous travellers living under poor rural conditions for any length of time. The use of insect repellants - necessary in any case for travellers to these areas for the prevention mosquito bites- may reduce the chances of being bitten by the kissing bug as well.

Possible problem with flu vaccine and young children

Fri, 23 Apr 2010 12:30:00 +1100

Media reports today have announced a potential problem with this year's seasonal influenza vaccine use in children below 5 years of age. It appears that at least one child fell seriously ill and dozens more suffered serious adverse reactions after receiving the free vaccine in Western Australia. Thus it is possible that an increase in side-effects is emerging with the use of influenza vaccine in this age group, but the situation is not clear and requires further evaluation. In the meantime, it is recommended to avoid vaccination of children below 5 years of age with seasonal influenza vaccine.

The news agencies are reporting the following:

Australia's chief medical officer Jim Bishop says parents should not have their children vaccinated at the moment. "Until we know more we've suggested that we don't use that [seasonal flu vaccine] for the moment in children under five," he told ABC Local Radio this morning. "I'm advising all doctors today not to use it until we know a bit more. This may be part of the normal pattern once we see the whole picture, or it may be more than we would expect. Therefore I just think it's wise and precautionary not to use it in children under five."

This morning a spokeswoman for Federal Health Minister Nicola Roxon said all Australian parents were being advised not to give their children the vaccine. The spokeswoman described the measure as a "precaution".

WA's Health Department has suspended the free flu vaccination program for children under five after a spike in admissions to Princess Margaret Hospital (PMH). WA Health Minister Kim Hames says that in the past month, 45 otherwise healthy children have suffered fever, vomiting and febrile convulsions hours after receiving the vaccination. WA's chief health officer, Tarun Weeramanthri, says the department is investigating whether the reactions were caused by a particular type of vaccine or batch. "We are concerned that there's a much higher number of fever reactions than would be expected, and doctors at PMH have told us this," he said. "Now we have to work out why, whether it's related to a particular type of vaccine or particular batch."

One of the manufacturers, CSL, says it is aware of the matter and is working closely with the Therapeutic Goods Administration and Western Australian authorities.

Travel Doctor-TMVC clinics chosen to do Japanese encephalitis vaccine research in children (Apr 2010)

Fri, 16 Apr 2010 12:00:00 +1100

Pandemic (H1N1) Influenza update

Fri, 19 Apr 2010 12:00:00 +1100

The World Health Organisation reports that as of Sun 11 Apr 2010, worldwide more than 214 countries and overseas territories or communities have reported laboratory confirmed cases of pandemic influenza H1N1 2009, including over 17 798 deaths. The global total number of fatalities has increased by 847 since the previous update of 21 Mar 2010.

Asia The predominant virus associated with influenza-like-illness in East Asia is now influenza type B which continues to circulate in China, Mongolia, and Republic of Korea. In South and Southeast Asia, the most active areas of influenza transmission are Thailand and Singapore, where pandemic H1N1 is the dominant influenza virus, with co-circulation at lower levels of seasonal influenza viruses. Overall, the intensity of transmission is relatively low. In Malaysia only Melaka state has reported pandemic H1N1 laboratory confirmed cases. In India overall pandemic H1N1 activity is very low in most states, although in western India pandemic H1N1 cases continue to be reported in low numbers.

Europe Pandemic influenza activity has continued to decrease in recent weeks and is at very low intensity in all countries. The overall proportion of sentinel respiratory samples testing positive for influenza remained low (5.4 percent), and the number of influenza type B virus detections exceeded that of influenza A.

The Americas In the northern temperate zones of the Americas, overall pandemic influenza transmission remained low as pandemic influenza H1N1 virus continues to circulate at very low levels in some areas. In tropical zones of the Americas, limited data suggest that overall influenza activity remains low with localized areas of active transmission in a number of countries. In Cuba, a slight increase of confirmed cases of pandemic virus was reported during the most recent reporting week. In Mexico, available data suggest that localized active transmission of pandemic influenza virus continues to occur around Mexico City but is very low nationally. In Peru, the number of pneumonia cases has increased over the last 2 weeks, but there is no virological information available to indicate the cause of these cases. Increased levels of influenza-like infections have also been reported across much of Brazil over the previous 2 weeks particularly in northern Brazil.

Africa In North Africa limited available data suggest that respiratory disease activity remained low. In sub-Saharan Africa, West Africa continues to see community transmission of pandemic influenza virus with Ghana currently being the primary focus of transmission (45 percent of all clinical specimens tested were positive for pandemic influenza) but smaller numbers of cases were also seen in Senegal and Niger. Pandemic Guinea has now reported their 1st cases of pandemic H1N1. In East Africa, cases of pandemic influenza H1N1 continue to be detected in Rwanda, though in declining numbers

South Pacific Vanuatu and Nauru reported an increasing trend of respiratory diseases activity for this week, but this trend was not associated with laboratory confirmed detections of pandemic H1N1 virus. In Australia and New Zealand, influenza activity continues to be low.. As at 2 April, there have been 57 confirmed cases of pandemic (H1N1) 2009 influenza reported in Australia this year , bringing the total of confirmed cases to 37,693 since May 2009. In addition, there have been 233 reported cases of influenza type A not sub-typed and 35 cases of influenza type B.

Shipboard cruise "stomach upsets" can be spread on aircraft as well

Fri, 16 Apr 2010 14:00:00 +1100

Experts from the Centers for Disease Control in the USA in a report just published in the journal Clinical Infectious Diseases have confirmed that the norovirus, responsible for a number of outbreaks of vomiting and diarrhoea on cruise ships, can also be spread among airline passengers. There have now been four such outbreaks reported in the medical literature including one from New Zealand. The norovirus remains viable for minutes to hours outside the body and is easily transmissible from person-to-person by hand contact, but the most likely way it is spread is indirectly by hand contamination of surfaces such as tap handles, door handles, armrests, tray tables or seat controls. It has been pointed out that the compact layout of bathroom facilities on aircraft hinders the good hand-washing techniques that could prevent spread of norovirus, and also poses problems for crew cleaning up after contamination from vomiting or diarrhoea.

Passengers should consider carrying their own alcohol-based hand sanitizer for use after utilising the toilet. Experts also recommend that passengers should not board a flight if they are feeling nauseated but acknowledge that there are difficulties in following such advice.

Such incidents are very rare but the report does reinforce the oft-repeated message that prevention of spread of many virus diseases involves adequate handwashing.

Dengue during dry seasons

Thu, 25 Mar 2010 10:00:00 +1100

Although the prevalence of the dengue carrying mosquito is generally thought to be increased "after the rains" when there are lots of pools of stagnant water in which mosquitoes lay eggs, the number of cases reported in the Indian state of Kerala this year indicate that there are other factors involved, In fact where there is water shortage conditions remain good for mosquito breeding because households and villages store water in containers many of which are open.

Dengue and the related mosquito-borne chikungunya fevers are an ever-present threat in any of the world's tropical regions and personal anti-mosquito precautions are essential for travellers whatever the season.

Get all the Important information, and Emergency Card for the World Cup

Tue, 16 Mar 2010 10:45:00 +1100

One of the largest international events of the 2010 sporting calendar will be the FIFA World Cup taking place in South Africa from 11 June -11 July 2010. Thousands of Australians have already purchased tickets to attend the event. There are several useful items that can assist Aussies planning to go to this year's event.

Check out the 2010 World Cup - South Africa Healthy Fact Sheet, available on this website ( see Fact Sheets)

DFAT have developed a 2010 FIFA World Cup travel bulletin and consular card for Australians planning to attend. The pocket-size card includes advice to assist Australians in preparing for travel to South Africa and contains emergency contact numbers both in Australia and South Africa in the event of an emergency. Both the card and bulletin are posted on the www.smartraveller.gov.au website.

Cruise Ship held up by Gastro outbreak

Fri, 12 Mar 2010 19:00:00 +1100

Hundreds of passengers aboard an international cruise ship were stricken with vomiting and diarrhoea prompting a temporary quarantine of the vessel in southeastern Brazil early in March. After the first case was detected the national Agency for Sanitary Vigilance ordered the ship, which had 1987 passengers and 765 crew, to stay anchored at Buzios near Rio de Janeiro and the ship was released the following day with those who remained ill taken to hospital. This is by no means the first incident of its kind. Such outbreaks having occurred in cruise ships sporadically over the years although the number is small in relation to the number of cruises at sea at any time in diverse parts of the world. While cruise ships do have resident medical staff to deal with illnesses or accidents it is wise for passengers to have the ability to treat symptoms on their own. A such it is worthwhile consulting a health professional at one of our clinics to obtain a Travel Doctor TMVC Cruise Kit. In addition to immediate treatment for symptoms of gastroenteritis the Kit contains such items as sunscreen, insect repellants, lip balm and anti-seasickness pills. Details of the kit and other advice can be found on the Health and Cruise Ships Fact Sheet available on this website.

Rabies active on Bali and spreading - 40th death

Thu, 11 Mar 2010 10:40:00 +1100

The Bali government announced the 40th recent human death from rabies on Bali. This is a disaster for the local population as the locals who are being bitten by dogs are not recieving proper treatment due to lack of resources and slow response from health authorities. Travellers to Bali should be aware that dogs should be avoided carefully, and those spending long periods there should consider being vaccinated before arrival. Being vaccinated provides much higher protection against the disaese, as the treatment required after the bite is simpler, safer and cheaper. Unfortunately rabies vaccine is expensive, but for travellers who are unlucky enough to get a bite, it is cheap compared to the cost of treatment in the unvaccinated. The risk of rabies should be discussed with ebvery traveller to Bali, and many other parts of Indonesia.

Pandemic Flu world wide update mid February

Tue, 23 Feb 2010 10:40:00 +1100

As of 14 February 2010, worldwide more than 212 countries and overseas territories or communities have reported laboratory confirmed cases of pandemic influenza H1N1 2009, including at least 15921 deaths.

Asia
After several months of sporadic influenza activity, Thailand reported increasing respiratory diseases; however, the overall intensity of activity nationally remains low. In Myanmar and Indonesia, localized geographic spread of influenza activity, an increasing trend of respiratory diseases, but low overall intensity was reported. Activity persists in the northern and western states of India, however, overall influenza activity continued to decline or remained low in India, Nepal, Bangladesh, and Sri Lanka. In East Asia, transmission of pandemic influenza virus persists but has been steadily declining in most countries of region (China, Japan, and the Republic of Korea), with the exception of DPR Korea, where an increasing trend of respiratory diseases activity was reported.

Africa
In North Africa, pandemic influenza transmission persists but substantial declines in activity continue to be reported over the past month. In Sub-Saharan Africa, limited data suggest that pandemic influenza virus transmission may be sporadic in most areas of the continent. Several countries in West Africa continue to report increases in the numbers of confirmed cases of pandemic influenza,

Europe
Pandemic influenza virus continues to circulate across central and southeastern Europe, but the overall intensity of activity remained low in most places; only Greece, Bulgaria, Turkey, Slovakia, the Republic of Moldova, and the Russian Federation reported a moderate intensity of respiratory diseases activity. Several weeks of increases in ARI/ILI were reported in Slovakia and in the Russian Federation, but increased activity in these countries may be associated with other circulating respiratory viruses

The Americas
In both in the tropical and northern temperate zones, pandemic influenza virus continues to circulate at low levels but overall pandemic influenza activity continued to decline or remain low in most places.

Australia
As at 12 February 2010, there have been 37,713 confirmed cases of pandemic (H1N1) 2009 influenza and 191 deaths reported since May last year. The total figure includes 160 new reports so far this year, with no deaths. National influenza activity remains low.

Encouraging results from TB Vaccine trial

Wed, 17 Feb 2010 11:40:00 +1100

In Tanzania the trial of a new vaccine against tuberculosis provides great hope that we may soon have an effective weapon against this scourge which is of grave concern world-wide against a background of malnutrition and HIV/AIDS and the emergence and spread of drug-resistant strains. The century old BCG "vaccine" has provided some protection, particularly for babies, but has proved ineffective on a large scale. However, very encouraging results come from the "DarDar" trial conducted in Dar es Salaam, Tanzania by Dartmouth Medical School (USA), and Tanzania's Muhimbili University of Health and Allied Sciences, published in January. Two thousand and thirteen HIV-infected out-patients were involved in the trial whereby half (1006) were given the vaccine and half (1007) received placebo injection. After a median 3.3 years the trial was terminated when it appeared that significant protection was being provided to the vaccinated group. Investigators are now working with a pharmaceutical company to develop a form of the vaccine that could be mass produced. There are other experimental vaccines currently on trial so there is a distinct possibility that the TB "epidemic" in Africa will be controlled in the near future.

World Cup South Africa 2010

Wed, 17 Feb 2010 11:35:00 +1100

Excitement is growing as the time draws near for the Soccer World Cup in South Africa –kickoff date is 11th June with South Africa playing Mexico in Johannesburg while in Cape Town former world champions France face off against Uruguay, The Socceroos campaign starts on 14 June when they take on formidable Germany in the Moses Mabhida Stadium in Durban. There are 10 venues scattered throughout the country with the finals scheduled to take place in the magnificent Soccer City stadium in the south west of Johannesburg on 11th July.

Southern Africa boasts beautiful landscapes, is rich in culture and is home to some amazing animals. In most of the country winter months are comfortably dry except for the south-eastern Cape where there is winter rainfall (resulting in excellent grape growing conditions) Staying healthy while travelling will ensure that fans get the most out of their trip to see the World Cup. While similar to Australia in many respects there are significant differences from a health point of view. Risks from vaccine preventable diseases such as Hepatitis A, Hepatitis B and typhoid fever are much higher and not all areas of South Africa have access to safe drinking water. South Africa has the highest rate of HIV infection in the world so safe sex practice is essential. Road traffic accident rates are also amongst the highest in the world; driving on unfamiliar rural roads should be avoided, especially at night. There is a risk of schistosomiasis (bilharzia) in South Africa acquired from swimming or wading in freshwater rivers, streams or lakes; swimming in chlorinated pools or in salt water does not present a risk of schistosomiasis. Australia is free from rabies but South Africa definitely is not. There is no Reciprocal Health Care Agreement between South Africa and Australia. All travellers should obtain comprehensive medical insurance that includes cover for medical evacuation costs. Medical facilities in urban areas are generally of a high standard, but can be costly. Healthcare in remote regions may be basic.

If exploring other parts of South Africa, such as Kruger National Park, malaria should also be considered. There is no malaria risk in any of the cities where World Cup matches are scheduled.. Malaria is a risk factor all year in the low altitude areas of the Mpumalanga Province (including Kruger National Park), Northern Province, and north eastern KwaZulu-Natal as far south as the Tugela River. Risk is greatest September to May. Malaria prevention options should be discussed with a travel medicine specialist prior to departure.

A comprehensive summary of health precautions for South Africa can be found on our Destination Fact Sheets http://www.traveldoctor.com.au/Fact%20Sheet%20Sth%20Africa.pdf

Ensure that you stay healthy to enjoy the experience, enjoy the country, enjoy supporting the Socceroos by taking sensible precautions before travelling. Now is the time to consult a travel health professional at a Travel Doctor –TMVC clinic

Avian influenza situation - Indonesia

Wed, 17 Feb 2010 11:30:00 +1100

The Ministry of Health of Indonesia has announced a new case of human infection of H5N1 avian influenza. A 25-year-old female from South Jakarta District, DKI Jakarta Province died on 25 Jan 2010. Laboratory tests were positive for H5N1 virus infection. The patient was possibly infected from direct contact with poultry. Of the 163 cases confirmed to date in Indonesia, 135 have been fatal.

Airport Body Scanners – a medical perspective

Mon, 15 Feb 2010 14:30:00 +1100

Full-body (aka Whole body) scanners have been introduced in certain USA and European airports as an updated security device and are scheduled to be introduced at international airports in Australia. International travellers are therefore likely to be subjected to full-body scans at one time or another. Some health concerns have been raise d in the community about these scanners.

There are two types of scanner, both are used to penetrate through clothing and identify unusual objects. One type which is currently in use is " millimetre wavelength imaging" using high-frequency radio wave technology which does not emit ionizing radiation, and the second is the "back scatter" scanner which uses ionising radiation i.e. X-rays.

Millimetre wave scanners beam radio waves over the body's surface at high speed from two antennae simultaneously as they rotate around the body. The energy reflected back from the body or other objects on the body is used to construct a three-dimensional image. The energy projected by millimetre wave technology is 10,000 times less than a cell phone transmission. While not emitting radiation these scanners produce a fuzzier image than back scatter scanners.

Back Scatter scanners emit a low level of X-rays at the traveller and measure what bounces back to construct a two-dimensional image. The X-rays used in the backscatter machines in airports have such low energy that they literally bounce off the skin. For comparison when X-rays are used for medical imaging purposes, they have to be energetic enough to get through the human body. Expressed quantitatively, the average chest X-ray delivers 20 microsieverts of radiation, and a chest CT scan 7,000 microsieverts whereas the back scatter scanner delivers 0.1 microsievert of radiation, thus the dose received in one simple chest X-ray is equivalent to that received in 200 full-body scans.

No one can be sure of the absolute degree of risk at such trivial doses and obviously no exposure equals no risk. However, the additional risk above and beyond the normal background radiation we are all exposed to is minuscule. It would require 10,000 scans to reach the maximum level of safe radiation exposure recommended for the public in a year (1,000 microsievert). Flying itself increases exposure to ionising radiation through cosmic rays and the additional radiation received through a full-body scan is equivalent to an extra two minutes flying at cruising altitude.

The Australian Government's radiation protection philosophy is based upon the premise that no radiation exposure is justified unless it produces a positive net benefit and that the magnitude of dose received, the number of people exposed and the likelihood of unnecessary exposures are kept as low as reasonably achievable. At the present time, there are no technologies other than strip searching that can offer the same security benefits of backscatter x-ray security scans. The alternative of not scanning offers no benefit from a security perspective. Thus, the increase in security obtained by these scanners is currently judged to outweigh the slight risk from the small exposure to additional "elective" radiation.

First Human Bird Flu case in 2010

Fri, 15 Jan 2010 00:53:30 +1100

A laboratory-confirmed human case of avian influenza (H5N1) virus infection has been reported from Penkabaru in Sumatra, Indonesia. The patient, a 4-year-old child, has recovered but remains in hospital for observation. The child had been in contact with a dead backyard chicken.
This would be the 162nd case in Indonesia since 2005 and the 1st in 2010.

A suspected 2nd human case of avian influenza (H5N1) is being treated
in the same hospital. The patient is severely ill and the outcome of
laboratory tests is awaited.

Prescription Drugs "over the counter"

Wed, 13 Jan 2010 23:45:42 +1100

One of our senior doctors has recounted the tale of a traveller in India who purchased "antimalarial drugs" over the counter for use as a preventive medication. While the identity of the drug is not certain it probably was a drug now known to be ineffective because of a high degree of resistance. The dosage advised was inappropriately high and bizarre for any type of antimalarial medication.. This experience repeats a lesson that we have mentioned many times in the past. Take precautions before you leave for travel. You may not be able to rely on prescription medications purchased over the counter in other countries. However cheap, they might be the wrong drug, the wrong dosage or might even be bogus.

Access to sleeping sickness drugs

Mon, 12 Jan 2009 11:45:00 +1100

Sleeping sickness is a classical disease included in the risk basket of travellers in Africa. The risk is higher for those visiting National Parks or Game Reserves in particular in East and Southern Africa. The most common subspecies affecting travellers is T.b. rhodesiense, which causes the acute form of the disease. Urgent treatment targeting the parasite but also supporting treatment like platelets transfusion or dialysis is usually needed in these patients.

Drugs for sleeping sickness treatment are not in the market and can only be obtained via WHO. The drugs are provided free of charge thanks to the agreement signed with sanofi-aventis (eflornithine, melarsoprol and pentamidine) and Bayer Schering Pharma (suramin and nifurtimox).

Drugs have to be requested to WHO:
simarrop@who.int ++41. 794 682 726 or ++41. 227 911 345
francoj@who.int ++41. 796 198 535 or ++41. 227 913 313

Due to the acuteness of the disease and the urgent need of treatment, WHO has been supporting selected centres (table 1) that have requested to keep a stock of drugs to treat sleeping sickness. Therefore in case of urgent need, these centres could be contacted to receive a help out waiting for the full treatment from WHO. The drugs are scheduled to reach the requesting Institution between 24 or 48 hours depending on the distance between the Institution and Geneva.

WHO has set up a surveillance system to collect information on imported HAT cases diagnosed out of disease endemic countries. Consequently WHO is kindly requesting to receive information as regards any sleeping sickness cases diagnosed. Reports of cases diagnosed could be sent to:
simarrop@who.int ++41. 794 682 726 or ++41. 227 911 345
francoj@who.int ++41. 796 198 535 or ++41. 227 913 313

Prescription Drugs "over the counter"

Mon, 11 Jan 2010 10:40:00 +1100

One of our senior doctors has recounted the tale of a traveller in India who purchased "antimalarial drugs" over the counter for use as a preventive medication. While the identity of the drug is not certain it probably was a drug now known to be ineffective because of a high degree of resistance. The dosage advised was inappropriately high and bizarre for any type of antimalarial medication. This experience repeats a lesson that we have mentioned many times in the past. Take precautions before you leave for travel. You may not be able to rely on prescription medications purchased over the counter in other countries. However cheap, they might be the wrong drug, the wrong dosage or might even be bogus.

Pandemic Influenza end of year WHO update

Thu, 8 Jan 2009 17:00:00 +1100

As of 27 December 2009, worldwide more than 208 countries and overseas territories or communities have reported laboratory confirmed cases of pandemic influenza H1N1 2009, including at least 12220 deaths.

Situation update:

The most active areas of pandemic influenza transmission currently are in central and eastern Europe. Focal increases in rates of Influenza-Like Illness/Acute Respiratory Infection (ILI/ARI) during recent weeks were reported in at least three eastern European countries, Georgia, Montenegro, and Ukraine. A high intensity of respiratory diseases activity with concurrent circulation of pandemic influenza persists in parts of southern and eastern Europe, particularly in Greece, Poland, Bulgaria, Serbia, Ukraine, and the Urals Region of the Russian Federation.

In Western Europe, influenza transmission remains active and widespread, but overall disease activity has peaked. At least 13 of 21 countries (testing more than 20 sentinel samples) reported that 30% or more of sentinel specimens were positive for influenza, down from a peak of over 70%. All influenza viruses detected in Western Europe were pandemic H1N1 2009, however, very small numbers of seasonal influenza viruses, making up less than 1% of all influenza viruses detected, were reported in Russia.

Limited available data indicates that active, high intensity transmission is occurring in Northern African countries along the Mediterranean coast (Algeria, Tunisia, and Egypt).

In Central Asia, limited data suggest that influenza virus circulation remains active, but transmission may have recently peaked in some places. In West Asia, Israel, Iran, Iraq, Oman, and Afghanistan also appear to have passed their peak period of transmission within the past month, though both areas continue to have some active transmission and levels of respiratory disease activity have not yet returned to baseline levels.

In East Asia, influenza transmission remains active but appears to be declining overall. Influenza/ILI activity continued to decline in Japan, in northern and southern China, Chinese Taipei, and Hong Kong SAR (China). Slight increases in ILI were reported in Mongolia after weeks of declining activity following a large peak of activity over one month ago.

In southern Asia, influenza activity continues to be intense, particularly in northern India, Nepal, and, Sri Lanka. Seasonal influenza A (H3N2) viruses are still being detected in very small numbers in China making up about 2.5% of the influenza A viruses detected there.

In North America, influenza transmission remains widespread but has declined substantially in all countries. In the US, sentinel outpatient ILI activity has returned to the seasonal baseline, and indicators of severity, including hospitalizations, paediatric mortality, and P&I mortality have declined substantially since peaking during late October. Rates of hospitalization among cases aged 5-17 years and 18-49 year far exceeded rates observed during recent influenza seasons, while rates of hospitalizations among cases aged>65 years were far lower than those observed during recent influenza seasons.

In the tropical regions of Central and South America and the Caribbean, influenza transmission remains geographically widespread but overall disease activity has been declining or remains unchanged in most parts, except for focal increases in respiratory disease activity in a few countries.

In the temperate regions of the southern hemisphere, sporadic cases of pandemic influenza continued to be reported without evidence of sustained community transmission.

90th Human avian influenza case in Egypt

Wed, 23 Dec 2009 17:00:00 +1100

The Ministry of Health of Egypt has reported a new laboratory confirmed human case of avian influenza A(H5N1) on Sat 19 Dec 2009. The case is a 21-year-old female from the El Tanta District of Gharbia Governorate. She was admitted to Tanta Fever Hospital where she received oseltamivir treatment on the same day. She is in a stable condition. Investigation revealed that the case had close contact with dead poultry and was involved in slaughtering sick birds. Of the 90 laboratory confirmed cases of avian influenza reported in Egypt, 27 have been fatal, but of the 38 human cases confirmed so far in 2009, only 4 have been fatal, possibly as a result of immediate resort to oseltamivir treatment.

Pandemic vaccine is now approved for children

Thu, 3 Dec 2009 22:35:35 +1100

The current Pandemic H1N1 2009 vaccine, Panvax, for the latest pandemic influenza strain has been approved by our TGA for use in children, from 6 months of age. It has been shown to be safe and effective in all the age groups, but does require two doses, given 28 days apart.
The dose for children aged 6 mo - 3 years is half the full dose.

Initially the vaccine will be from the same vials as the current adult vaccine, but soon pre-filled syringes of the half-dose (for children below 3 years of age) will be available.

For those children who will be traveling overseas shortly, a single dose offers very good protection in the short term, but the second dose offers longer lasting protection.

The Commonwealth government health emergency web site has FAQs to assist:

http://www.healthemergency.gov.au/internet/healthemergency/publishing.nsf/Content/kids-vaccine-qna-toc

The vaccine is available now in all Travel Doctor-TMVC clinics.

Avian Influenza 2009 Update

Tue, 1 Dec 2009 18:07:02 +1100

Country-by-country detailed update is available in the Avian Flu Destination Risk Status section on the Fluthreat website: www.fluthreat.com.au

There have been only a few outbreaks during 2009 with the problem still being endemic in Egypt and Indonesia (although the latter has not reported outbreaks this year to international agencies.) Major outbreaks have not been reported elsewhere since early in the year. Extensive problems in Bangladesh and the neighbouring Indian states of West Bengal and Assam with spread to Sikkim and Nepal have been brought under control. From January 2009 to date human cases have been notified from China(7), Egypt (38) and Vietnam (4). In the latter half of the year Egypt is the only country still showing human infections. There have been a number of newspaper reports this year of human cases in Indonesia which have not been officially confirmed. The total number of human cases since the epidemic started in 2003 is recorded as 444. Of these 262 have died.

World Health Organisation Pandemic (H1N1) 2009 - update 76

Mon, 30 Nov 2009 14:27:01 +1100

Weekly update
27 November 2009 -- As of 22 November 2009, worldwide more than 207 countries and overseas territories or communities have reported laboratory confirmed cases of pandemic influenza H1N1 2009, including over 7820 deaths.

As many countries have stopped counting individual cases, particularly of milder illness, the case count is likely to be significantly lower than the actual number of cases that have occurred. WHO is actively monitoring the progress of the pandemic through frequent consultations with the WHO Regional Offices and member states and through monitoring of multiple sources of data.

Situation update:
In temperate regions* of the northern hemisphere, the early arriving winter influenza season continues to be intense across parts of North America and much of Europe. In North America, the Caribbean islands and a limited number of European countries there are signs that disease activity peaked.

In the United States and Canada, influenza transmission remains very active and geographically widespread. In the United States, disease activity appears to have peaked in all areas of the country. In Canada, influenza activity remains similar but number of hospitalisations and deaths is increasing. Most countries in the Caribbean have ILI and SARI** levels coming down.

In Europe, widespread and increasing transmission of pandemic influenza virus was observed across much of the continent and most countries that were not yet experiencing elevated ILI activity in the last few weeks, have seen a rapid increase in ILI. Very high activity is seen in Sweden, Norway, Moldova and Italy. Over 99% of subtyped influenza A viruses in Europe were pandemic H1N1 2009. Impact on health care services is severe in Albania and Moldova. Some countries seem to have peaked already: Belgium, Bulgaria, Belarus, Ireland, Luxemburg, Norway, Serbia, Ukraine and Iceland.

In East Asia, influenza transmission remains active. Intense influenza activity continues to be observed in Mongolia but has peaked already. In Japan, influenza activity remains stably elevated, but may be decreasing slightly in populated urban areas.

ILI activity in India and Nepal and Sri Lanka has increased.

In the tropical zone of the Americas and Asia, influenza transmission remains variable but low in many countries. In the tropical areas of Central and South America, most countries continue to report declining influenza activity, with the exception of Ecuador and Venezuela.

In the temperate region of the southern hemisphere, little pandemic influenza activity has been reported.

*Countries in temperate regions are defined as those north of the Tropic of Cancer or south of the Tropic of Capricorn, while countries in tropical regions are defined as those between these two latitudes.

**Abbreviations: influenza-like-illness (ILI), acute respiratory infection (ARI), and severe acute respiratory infection (SARI)

Cruise Ship Cleanliness

Wed, 25 Nov 2009 22:47:02 +1100

Researchers from the Carney Hospital in Boston, Massachusetts, the Cambridge Health Alliance and Tufts University School of Medicine in a study published in the Clinical Infectious Disease journal found that only 37 percent of 273 randomly selected public restrooms on cruise ships (that were checked on 1,546 occasions) were cleaned at least daily. Toilet seats were the best cleaned but less than half of toilet flush devices, toilet stall doors and stall handhold bars had been cleaned, and only 35 percent of interior bathroom door handles and 29 percent of baby changing tables had been cleaned. This was a random study of cleansing practices confined to public restrooms and specifically did not link the findings to any disease outbreak.

Nevertheless the findings reveal a potential for disease transmission given that disease carrying organisms such as flu viruses can survive for some time on surfaces such as door handles, and the study emphasise the recommendation regarding adequate and thorough handwashing both for personal protection and as a public health procedure.

Pandemic Flu Plus Dengue Dual Infections

Wed, 25 Nov 2009 22:46:31 +1100

To date the World Health Organization has reported several cases of patients afflicted with co-infections of H1N1 influenza and dengue fever.

Most reported cases were from Vietnam and the island of Barbados. There have been two deaths reported in Vietnam this week from the dual infections.

In Barbados, 8 cases were confirmed (confirmation by RT-PCR) and reported on the West Indies island this week.

The increased risk of dengue virus co-infection on the outcome of infection with the pandemic H1N1 2009 influenza virus cannot be quantified. However, in endemic areas, dengue virus co-infection is likely to increase the risk of a fatal outcome.

Only personal protective measures against mosquito bites is available as a prevention for dengue infection but the Pandemic Influenza Vaccine is available free to all in Australia and every traveller should be vaccinated before going abroad.

Travel Doctor-TMVC clinics chosen to do Japanese encephalitis vaccine research in children

Thu, 19 Nov 2009 11:28:07 +1100

Travel Doctor-TMVC clinics in Melbourne and Brisbane have been selected to participate in a world-wide trail of the new Japanese Encephalitis vaccine in children. The vaccine is already available in Australia for people 18 years old or above, and the manufacturers need to demonstrate the effectiveness and safety in children. While it is considered a very safe and effective vaccine, because it is new, the study must be performed, and we will be assisting in recruiting patients for this important study in both Melbourne and Brisbane.

If families are considering having their children vaccinated, and the children are between 6 months and 18 years of age, they may be suitable for enrolment in the study and vaccination for free.

Further details can be obtained by contacting the study co-ordinator, via: tony.gherardin@traveldoctor.com.au

Influenza vaccine for 2010

Sat, 14 Nov 2009 18:33:14 +1100

It has been agreed by Australia's regulatory bodies that the Southern Hemisphere influenza vaccine for 2010 will contain the following strains.

- an A/California/7/2009 (H1N1)-like virus;
- an A/Perth/16/2009 (H3N2)-like virus;
- a B/Brisbane/60/2008-like virus.

The A/California is the new pandemic swine flu virus, (same as in panvax), so this is part of next years seasonal vaccine, and those who have had panvax will be getting a booster. The A/Perth strain is not currently in any vaccine. The B/Brisbane is the same strain as in the 2009 Northern hemisphere vaccine (but new to the Southern hemisphere).

This means a single seasonal vaccination will be available, and those who have had the pandemic vaccine will get a welcome booster effect. Please note that it does not mean that those who have had pandemic vaccine cannot have next years vaccine, the opposite is true, it is important to get next seasons vaccine to boost immunity and be protected against the other strains.

It also does not mean that people should not get the pandemic vaccine now, rather it presents a great opportunity for better immunity to be achieved, and by using pandemic vaccine widely now, we can reduce any chance of transmission within our community, which improves the situation next year as well.

More information is available at:
http://www.who.int/csr/disease/influenza/recommendations2010south/en/index.html

Pandemic quarantine measures in Egypt

Fri, 6 Nov 2009 11:17:13 +1100

Travellers to Egypt need to be alert to the fact that thermal imaging equipment has been installed at Sharm el Sheikh International airport and that quarantine measures are being enforced. It is unclear at this time how long this screening procedure will be maintained. The Daily Mail (UK) carried a report on November 1st that 40 British children -- some as young as 4 -- were marched off by armed airport guards as they landed for half-term holidays in Egypt because they were thought to have swine flu. Some were quarantined in a makeshift hospital for as long as five days.

Airport security checks may include Swine Flu check

Sun, 18 Oct 2009 16:25:37 +1100

Airports in the USA are already posting signs warning passengers about the H1N1 flu, and asking them to stay home if they think they are sick. It appears that now that passengers, in addition to the standard security checks, may be asked to pass through a screening device and have their temperature taken. Such precautions have been in place in some Asian and Middle Eastern countries but if you are travelling through the USA you need to be prepared to undergo such a check and also be prepared to answer questions about your health. It is even possible that you may be quarantined if a passenger on you flight is suspected of having swine flu.

These measures are bound to cause some controversy but the safest precaution you can take now is to have the Australian swine flu vaccination available free of charge and to have the vaccinator issue you with evidence of this which can be shown at any health checkpoint you might meet in your travels.

Cholera and Climate Change

Tue, 13 Oct 2009 20:48:53 +1100

The periodic flow of warm sea water across the surface of the central and eastern Pacific Ocean, called El Niño, leads to higher atmospheric temperatures and heavy rains. A World Health Organization study found that during the 1997-98 El Niño a rise in sea surface temperature coupled with excessive flooding were significant factors in cholera epidemics in Bangladesh, Djibouti, Somalia, Kenya, Tanzania, and Mozambique. 2009 happens to be an El Niño year which may well account for the recent cholera outbreak in Papua New Guinea. But what is the association between the rise in surface sea temperature and cholera?

Cholera is a disease caused by a bacterium – Vibrio cholerae – resulting in diarrhoea, sometimes of massive proportions, frequently ending in death unless the victim is rapidly re-hydrated. The vibrio flourishes in water and therefore cholera is easily spread in situations where water supply and sanitation are poor. Thus epidemics of cholera are frequent in poor areas, but for long it was not understood how the infection spread from region to region and from continent to continent. In the last decades of the 20th Century research work carried out in Bangladesh and the USA revealed the secret of cholera's "dispersability". The bacterium turns out to be a normal inhabitant of brackish and estuarine environments and can attach to particular species of the microscopic creatures called plankton. They can remain so attached for up to 15 months at least, and it is probable that ship ballast by transporting plankton is responsible for the widespread occurrence of the cholera bacterium in coastal waters in many continents (including Australia – as long ago as 1977 a few sporadic cases were traced to drinking untreated river water.)

Plankton flourish in warm waters. The association with El Niño conditions is clear but more than that, when coastal seas warm up under the effects of climate change the proliferation of plankton will be associated with a higher level of cholera organisms. As evidence mounts for the effects of climate change on all aspects of our environment the accelerating spread of cholera is yet one more concern that needs to be added to the mix.

Hepatitis A in Australia

Tue, 13 Oct 2009 20:48:24 +1100

Victoria's chief health officer John Carnie issued a warning on Friday evening [9 Oct 2009] advising people to avoid eating semi-dried tomatoes unless they are thoroughly cooked. The Department of Health and Human Services has received 12 Hepatitis A notifications this week and several people infected have reported eating semi-dried tomatoes. The prevalence of Hepatitis A in Australia, despite this small outbreak, remains vey low and does not justify a program of vaccination for the population as a whole, but this report is a reminder that Australians are not exempt from potential exposure to the virus. Hepatitis A vaccination provides very efficient protection and is advised for all overseas travellers; this report shows that it can be useful under home conditions as well.

Pandemic Update

Mon, 5 Oct 2009 19:47:59 +1100

As of 20 September 2009, there have been more than 300,000 laboratory confirmed cases of pandemic influenza H1N1, 3917 deaths, in 191 countries and territories reported to WHO.
As more and more countries have stopped counting individual cases, particularly of milder illness, the case count is significantly lower than the actually number of cases that have occurred. While the case counts no longer reflect actual disease activity, WHO is actively monitoring the progress of the pandemic through frequent consultations with the WHO Regional Offices and member states and through monitoring of multiple sources of data.

In the temperate regions of the northern hemisphere, influenza-like-illness (ILI) activity continues to increase in many areas. In North America, the United States has reported continued increases in activity above the seasonal baseline for the last 2 to 3 weeks, primarily in the southeast but now also appearing in the upper midwest and the northeast. In Europe and Central and Western Asia, the United Kingdom is reporting regional increases in ILI activity in Northern Ireland and Scotland and the Netherlands, France, Ireland, and Israel are reporting rates above the seasonal baseline. In In Japan, influenza activity continues to be slightly above the seasonal epidemic threshold. The increases in ILI activity have been accompanied by increases in laboratory isolations of pandemic influenza H1N1 2009 in most of these areas.

In the tropical regions of the Americas and Asia, influenza activity remains variable. In parts of India, Bangladesh and Cambodia, influenza transmission continues to be active, while other countries in the Southeast Asia have been recently reporting declining transmission (Indonesia, Singapore and Thailand). Although most countries in the tropical regions of the Americas are still reporting regional to widespread geographic spread of influenza activity, there is no consistent pattern in the trend of respiratory diseases. Peru and Mexico have reported an increasing trend in some areas, while most others are reporting an unchanged or decreasing trend (most notably Bolivia, Venezuela and Brazil).

In the temperate regions of the southern hemisphere, influenza transmission has largely returned to baseline (Chile, Argentina, and New Zealand) or is continuing to decline (Australia and South Africa).

WHO Recommends composition for 2010 Southern Hemisphere Influenza Vaccine- includes pandemic strain

Wed, 30 Sep 2009 20:03:03 +1000

The WHO expert committee on influenza has made the recommendation to include the new pandemic influenza strain in next year's seasonal vaccine. The recommendation is that the 2010 southern hemisphere vaccine, due out in March, will contain:
• An A/California/7/2009 (H1N1)-like virus (Pandemic strain)
• An A/Perth/16/2009 (H3N2)-like virus
• A B/Brisbane/60/2008-lke strain

Because the pandemic strain has become the predominant strain circulating, it is viewed as the most likely to remain circulating next season.

It is not clear yet whether the new strain will be easily able to be incorporated into a single vaccine, or whether two injections (one with pandemic strain, and one with the other two seasonal strains) will be created. WHO will provide more advice on the detail of this aspect later in the year.

Rabies Awareness - World rabies Day

Sun, 27 Sep 2009 13:19:26 +1000

28th September has been designated World Rabies Day to draw attention to the facts that more than 50,000 people die from rabies every year, and that rabies is a vaccine preventable disease. We are fortunate in that rabies does not exist in Australia, New Zealand and the South Pacific islands (although the related lyssavirus infection has been transmitted by bats in Queensland.) Travellers elsewhere must discuss with a doctor the advisability of receiving a course of anti-rabies vaccination and/or other precautions. For further details on rabies please see the World Health Organisation fact sheet on http://www.who.int/mediacentre/factsheets/fs099/en/

Pandemic Influenza (H1N1 2009) vaccine to be available in Travel Doctor clinics from Wednesday 30th

Sun, 27 Sep 2009 13:06:57 +1000

The new vaccine being distributed by the Departments of Health is available from Wednesday 30th September. It has been shown to be safe and effective, and is being distributed and administered for free (for vaccine) and under medicare arrangements. It is a single injection and available for anybody over 9 years old. Arrangements for children under 9 years will be announced in the next few weeks.

It is sensible for Australian travellers to be vaccinated, and can be done with usual travel vaccines, at no extra cost.

It is available at Travel Doctor-TMVC clinics for anybody who wants to be vaccinated , not just travellers. It is particularly important for those in higher-risk groups to consider being vaccinated, this includes:
• Indigenous people
• Pregnant women
• People with chronic disease, as recommended for seasonal influenza
• Frontline health workers
• Parents and guardians of young infants

However anyone else, including healthy people who wish to be protected can be given the vaccine. It is anticipated that enough vaccine to vaccinate everyone in Australia will be made.

Hepatitis A immunisation for adoptee contacts

Mon, 21 Sep 2009 20:39:02 +1000

Data from a study conducted at three adoption clinics in the United States, each screening 100--200 incoming adoptees for hepatitis A each year, indicate that 1%--6% of newly arrived international adoptees are acutely infected with Hepatitis A virus. The study follows reports to the Centers for Disease Control of 34 cases of adoptee associated Hepatitis A infections since 2007 in whom there was no history of international travel or other risk factors for the infection. Following on these findings the Advisory Committee on Immunization Practices (ACIP) has recommended hepatitis A vaccination for all previously unvaccinated persons who anticipate close personal contact (e.g., household contact or regular babysitting) with an international adoptee from a country where there is a high or moderate rate of hepatitis A infection during the first 60 days following arrival of the adoptee in the United States. The first dose of the 2-dose hepatitis A vaccine series should be administered as soon as adoption is planned, ideally 2 or more weeks before the arrival of the adoptee.

Swine flu contagious longer than thought

Mon, 21 Sep 2009 20:38:38 +1000

When the coughing stops is probably a better sign of when a swine flu patient is no longer contagious, experts said after seeing new research that suggests the virus can still spread many days after a fever goes away. Experts have been telling people to stay home from work and school and avoid contact with others until a day after their fever breaks. The new research suggests they may need to be careful for longer -- especially at home where the risk of spreading the germ is highest. Swine flu also appears to be contagious longer than ordinary seasonal flu, suggested by three new reports, from Canada, Singapore and Mexico.

Swine flu symptoms can include fever, cough, sore throat, runny or stuffy nose, body aches, headache, chills and fatigue, and sometimes diarrhoea and vomiting. Young children may be cranky, less playful or not eat as much as normal, People who have had swine flu should cover their mouths when they cough or sneeze and wash their hands a lot once they do return to work and school.

Bolivian Banks Ban Face Masks

Mon, 21 Sep 2009 20:38:13 +1000

Sept 15, 2009 (AFP) - Bolivian banks have banned customers from wearing masks on their premises, in a bid to curb an epidemic of robberies by people taking advantage of swine flu fears to hide their faces. "We have decided that only staff can wear masks, while clients can no longer enter with masks," Hoggier Hurtado, president of the federation of savings banks in the central city of Santa Cruz, told El Dia newspaper. The decision came after a bank heist in broad daylight on Thursday at the Family Cooperative by five people wearing masks commonly used in Bolivia to protect against the A(H1N1) virus. Santa Cruz police have backed the decision and police chief Johnny Vargas said thieves are taking advantage of the precautionary measures advocated by health authorities against the pandemic to commit their crimes. "Unfortunately, there are many people who commit crimes by using masks, which prevents us from identifying their faces despite the security cameras," Vargas said. Santa Cruz, located in the wealthiest region of the South American country, is the epicenter of the A(H1N1) outbreak in Bolivia, accounting for 70 percent of the 1,500 confirmed cases of infection.

Pandemic flu current world situation

Mon, 14 Sep 2009 00:07:43 +1000

In the latest weekly update the World Health Organisation reports that in the temperate region of the southern hemisphere (represented by countries such as Chile, Argentina, Australia, New Zealand, and South Africa), influenza activity continues to decrease or return to baseline.

Active transmission persists in tropical regions of the Americas and Asia. Many countries in Central America and the Caribbean continue to report declining activity for the 2nd week in a row. However, countries in the tropical region of South America (represented by countries such as Bolivia, Ecuador, and Venezuela) are reporting increasing levels of respiratory disease.

In the tropical regions of Asia, respiratory disease activity remains geographically regional or widespread but the trend is generally increasing as noted in India, Bangladesh, and Cambodia.

In the temperate regions of the Northern Hemisphere activity is variable. In the United States, regional increases in influenza activity are being reported, most notably in the south-eastern states. Most of Europe is reporting low or moderate respiratory diseases activity, but parts of Eastern Europe are beginning to report increases in activity.

WHO Collaborating Centres and other laboratories continue to report sporadic isolates of oseltamivir-resistant influenza virus. 21 such virus isolates have now been described from around the world, all of which carry the same mutation that confers resistance to the antiviral oseltamivir but not to the antiviral zanamivir. Of these, 12 have been associated with post-exposure prophylaxis, 4 with long term oseltamivir treatment in patients with immunosuppression. Worldwide, more than 10 000 isolates of the pandemic (H1N1) 2009 virus have been tested and found to be sensitive to oseltamivir. WHO will continue to monitor the situation closely in collaboration with its partners, but is not changing its guidelines for use of antiviral drugs at this time.

Pandemic (H1N1) 2009 influenza virus continues to be the predominant circulating virus of influenza, both in the northern and southern hemisphere.

H1N1 Vaccine Update: One Dose May Be Sufficient for Most Groups

Mon, 14 Sep 2009 00:07:16 +1000

Preliminary studies of two vaccines against 2009 H1N1 virus have been published online this week in the prestigious New England Journal of Medicine .
Using a variety of dosages and schedules, the industry-supported studies, one in Australia and another in the U.K., comprised some 300 healthy adults and evaluated the immunogenicity of the vaccines 3 weeks after administration. The immune response to a single 15-μg dose of unadjuvanted vaccine was rated as "robust" by researchers. Both vaccines showed good immunogenicity. The journal's editorialist says the data suggest that the single 15-μg dose "should be immunogenic" in the groups prioritized for vaccination; however, younger children will probably still require two shots. Side effects included tenderness at the injection site and pain.
The editorialist observes: "It is reassuring that the manufacturing process for these vaccines is identical to that used for seasonal vaccines, which have a strong record of safety."

Business executive travel Survey

Mon, 14 Sep 2009 00:06:37 +1000

Tourism Tidbits provides a busy travel professional with a glimpse into how corporate travellers view travel security. Tourism Tidbits wishes to emphasize that readers should see these findings are merely preliminary and should be aware that additional research will need to be done.
Today's business traveller must deal with much more than merely lost luggage. In a world of terrorism and violence business travellers around the world must know how to protect themselves from such new issues as express kidnappings, room invasions, stolen goods, and acts of terrorism committed against international business hotels.
To gain a sense of how the business community is dealing with these new and ever-changing challenges The Association of Corporate Travel Executives (ACTE) requested in the Spring of 2009 that two Arizona State University professors Timothy J. Tyrrell, and Cassia Spohn along with Lori Pennington-Gray, of the University of Florida, and Dr. Peter Tarlow of Tourism & More conduct a preliminary survey of its members.

Corporate travel executives do travel
With an average stay of under 3 days it may be inferred that business executives do their work and then return home without spending a great deal of time mixing business with leisure. This finding contradicts what many travel professionals believe. However, this survey reflects executive travel while other business travellers may wish to combine business with holiday travel.
Middle and Midrange luxury hotels seem to be the hotels of preference
The respondents were asked to indicate the type of hotel that they used while on travel (hotel tier). The largest percentage (37.5%) indicated "Mid-priced hotels with breakfasts provided. The second largest percentage indicated that they use an "upscale" (35.0%) hotel. The third largest percentage indicated that they use an "upper scaled hotel" (17.5%). No one indicated that he or she used an economy or "luxury" hotel. The importance of this finding is that communities seeking additional business travellers may desire to match hotel tiers with their business marketing campaigns.
Travel safety and security are now on the corporate travel radar screen
A major part of the survey dealt with the issue of corporate travel safety and security. Of those who chose to respond to questions concerning risk and safety, twenty respondents reported a risk incident. It should be noted, however, that the companies with the largest number of trips chose not to respond to this question. The average number of trips per firm for the firms responding to this question was 9,043 trips compared to the overall survey average of 25,639. The greatest number of incidents has to do with weather related problems (2184) followed by cultural barriers (495) health emergencies (441) and property crimes (160). There were 15 incidents of terrorism incidents reported and 2 incidents of violent crime reported.
Travel safety precautions are implanted irregularly
There appears to be a difference between what a company has considered doing to protect its traveling executives, what policies it actually has adopted and if this adopted policy is practiced. Thus, Some 35% of the companies surveyed indicated that they had considered some form of travel security policy and procedures, but only 11% of these companies had adopted such a plan into their policy, but 52% claim to practice travel security.It should be noted that this survey touched on travel to a myriad of developed and developing world locations and that the amount of security may be connected to perceived security threats.
It may be of note that one of the least expensive items, a medical supply kit, was considered by 42.9% of the companies, but only 35.7% of these same companies report actually supplying them.
The implications of this study for tourism and travel professionals yield important data
The data seem to indicate that safety concerns such as risks to health, potential pandemics, and weather problems are the greatest threat to business travelers. Currently business travelers may be protecting themselves sufficiently to escape major crimes and/or may be staying in places that provide good tourism security.
The business market is one that will constitute an ever-increasing percentage of the travel market, especially when leisure travel may be curtailed or reduced due to economic considerations. As such, travel and tourism professionals who want to gain a greater share of the business travel market need to find new and innovative ways to assure both the business-person"s safety and security and reduce many of the hassles of travel. Those communities with creative business travel policies, customer-friendly security and schedules, and viable alternatives during poor weather conditions increase their chances for greater market share and profits.

WHO Pandemic (H1N1) 2009 briefing note 8- Recommended use of antivirals

Thu, 27 Aug 2009 19:09:32 +1000

On 21 AUGUST 2009 WHO issuied guidelines for the use of antivirals in the management of patients infected with the H1N1 pandemic virus.

The guidelines represent the consensus reached by an international panel of experts who reviewed all available studies on the safety and effectiveness of these drugs. Emphasis was placed on the use of oseltamivir and zanamivir to prevent severe illness and deaths, reduce the need for hospitalization, and reduce the duration of hospital stays. The pandemic virus is currently susceptible to both of these drugs (known as neuraminidase inhibitors), but resistant to a second class of antivirals (the M2 inhibitors). Worldwide, most patients infected with the pandemic virus continue to experience typical influenza symptoms and fully recover within a week, even without any form of medical treatment. Healthy patients with uncomplicated illness need not be treated with antivirals. On an individual patient basis, initial treatment decisions should be based on clinical assessment and knowledge about the presence of the virus in the community. In areas where the virus is circulating widely in the community, clinicians seeing patients with influenza-like illness should assume that the pandemic virus is the cause. Treatment decisions should not wait for laboratory confirmation of H1N1 infection. This recommendation is supported by reports, from all outbreak sites, that the H1N1 virus rapidly becomes the dominant strain.

Treat serious cases immediately

Evidence reviewed by the panel indicates that oseltamivir, when properly prescribed, can significantly reduce the risk of pneumonia (a leading cause of death for both pandemic and seasonal influenza) and the need for hospitalization. For patients who initially present with severe illness or whose condition begins to deteriorate, WHO recommends treatment with oseltamivir as soon as possible. Studies show that early treatment, preferably within 48 hours after symptom onset, is strongly associated with better clinical outcome. For patients with severe or deteriorating illness, treatment should be provided even if started later. Where oseltamivir is unavailable or cannot be used for any reason, zanamivir may be given. This recommendation applies to all patient groups, including pregnant women, and all age groups, including young children and infants.

For patients with underlying medical conditions that increase the risk of more severe disease, WHO recommends treatment with either oseltamivir or zanamivir. These patients should also receive treatment as soon as possible after symptom onset, without waiting for the results of laboratory tests. As pregnant women are included among groups at increased risk, WHO recommends that pregnant women receive antiviral treatment as soon as possible after symptom onset. At the same time, the presence of underlying medical conditions will not reliably predict all or even most cases of severe illness. Worldwide, around 40% of severe cases are now occurring in previously healthy children and adults, usually under the age of 50 years. Some of these patients experience a sudden and very rapid deterioration in their clinical condition, usually on day 5 or 6 following the onset of symptoms. Clinical deterioration is characterized by primary viral pneumonia, which destroys the lung tissue and does not respond to antibiotics, and the failure of multiple organs, including the heart, kidneys, and liver. These patients require management in intensive care units using therapies in addition to antivirals. Clinicians, patients, and those providing home-based care need to be alert to warning signals that indicate progression to a more severe form of illness, and take urgent action, which should include treatment with oseltamivir. In cases of severe or deteriorating illness, clinicians may consider using higher doses of oseltamivir, and for a longer duration, than is normally prescribed.

Antiviral use in children

Following the recent publication of two clinical reviews, [1,2] some questions have been raised about the advisability of administering antivirals to children. The two clinical reviews used data that were considered by WHO and its expert panel when developing the current guidelines and are fully reflected in the recommendations. WHO recommends prompt antiviral treatment for children with severe or deteriorating illness, and those at risk of more severe or complicated illness. This recommendation includes all children under the age of five years, as this age group is at increased risk of more severe illness. Otherwise healthy children, older than 5 years, need not be given antiviral treatment unless their illness persists or worsens.

Danger signs in all patients

Clinicians, patients, and those providing home-based care need to be alert to danger signs that can signal progression to more severe disease. As progression can be very rapid, medical attention should be sought when any of the following danger signs appear in a person with confirmed or suspected H1N1 infection:
• shortness of breath, either during physical activity or while resting
• difficulty in breathing
• turning blue
• bloody or coloured sputum
• chest pain
• altered mental status
• high fever that persists beyond 3 days
• low blood pressure.

In children, danger signs include fast or difficult breathing, lack of alertness, difficulty in waking up, and little or no desire to play.

French Polynesia has high swine flu rate

Mon, 24 Aug 2009 21:03:02 +1000

With a total population of some 260,000 the islands of French Polynesia which includes Tahiti have reported 10,000 people affected by swine flu and so far there have been 3 deaths according to a rport by Agence France Presse.. Most of the islands have reported cases, the worst hit being Rapa, with a population of 600, the most southerly island in the French overseas territory at 1,300 kilometres (800 miles) from Tahiti. Paris has sent medical reinforcements to the territory to help fight the pandemic.

Egypt enforces ban on Hajj pilgrims

Wed, 19 Aug 2009 22:29:47 +1000

On Monday 17th August Egypt prevented dozens of pilgrims over the age of 65 or under 25 from travelling to Mecca as part of measures to prevent the spread of swine flu. Arab health ministers agreed in July to restrict the number of people allowed to go on hajj and umrah after an Egyptian woman back from Saudi Arabia became the first swine fly death in the Middle East and Africa. An airline official said that fifteen percent of passengers who arrived on Monday at Cairo airport to travel to Saudi Arabia on pilgrimage were prevented from leaving. The travel ban affected those over 65 and those under 25 because they are the most at risk of being contaminated by swine flu. Pilgrims wanting to go on umrah or hajj must also show airport officials in Cairo medical certificates to prove they do not suffer from any chronic diseases, including diabetes.
Source: Agence France Presse

Counterfeit Tamiflu purchased over the internet

Wed, 19 Aug 2009 22:29:09 +1000

Department of Health and Ageing - 12 August 2009

There are media reports of concerns about the purchase of fake Tamiflu over the internet.

Australia's medicines regulator, the TGA, does not believe there is a big market for counterfeit Tamiflu coming into Australia over the internet but warns consumers that medicines purchased online could be unsafe.

The TGA is a member of the Permanent Forum on International Pharmaceutical Crime (PFIPC) and receives regular updates on medicine and medical device problem reports, including incidents of counterfeit goods.

The TGA works closely with border control agencies and with therapeutic product manufacturers to check for counterfeit medicines entering Australia.

While there is not a big market for counterfeit drugs in Australia because of our affordable medicines, people still do purchase drugs over the internet and risk them being counterfeit.

Most medicines purchased over the internet have not been evaluated for safety or effectiveness by the TGA and the TGA warns the Australian public of the dangers of purchasing medicines by the Internet, particularly in relation to the dangers involving counterfeit therapeutic goods.

Pandemic influenza WHO update

Wed, 19 Aug 2009 22:28:50 +1000

In a statement published on August 11th the World Health Organisation said that the Pandemic Influenza A H1N1 virus has caused a total of 1,462 deaths worldwide since it was first detected in April.

A total of 177,457 confirmed infections have been officially reported from over 170 countries and regions, but those figures are obviously lower than the real number of A/H1N1 cases as many countries with sustainable community-level transmissions were no longer required to test and report new cases. The pandemic appears to have peaked and is now in decline in some countries in the southern hemisphere, including Argentina, Chile, Australia and New Zealand. However, the spread of the virus is still being seen in many tropical countries and in Asia, particularly in India, Thailand and Vietnam.

Tamiflu resistance - Pandemic H1 N1 influenza Global update

Fri, 7 Aug 2009 23:41:03 +1000

Tamiflu resistance - Pandemic H1 N1 influenza Global update

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Health officials raised the alarm about a strain of swine flu that is resistant to the Tamiflu treatment. A Tamiflu-resistant mutation of A(H1N1) had been found around the US-Mexico border in El Paso and close to McAllen, Texas. Experts had gathered in La Jolla, California, on Monday 3rd August to discuss responses to the outbreak, and warned that resistant strains were likely emerging because of overuse of antivirals like Tamiflu. "In the United States Tamiflu is sold with a prescription, but in Mexico and Canada it is sold freely and taken at the 1st sneeze. Then, when it is really needed, it doesn't work," said Cerqueira late Monday. Cases of A(H1N1) that were resistant to the anti-viral medicine have now been found in the United States, Canada, Denmark, Hong Kong and Japan.

Vaccines:

WHO spokeswoman Fadela Chaib said the agency hoped to give an update on its vaccine plans later this week. Novartis has started human testing of H1N1 swine flu vaccine candidates while Sanofi-Aventis, the world leader in flu shots, will commence within days, company officials said on Tuesday [4 Aug 2009]. GlaxoSmithKline, the other "big 3" flu vaccine supplier, said it would initiate clinical studies later this month. Healthcare officials are relying on a vaccine to contain the spread of disease, providing a potential sales windfall for those companies that are able to deliver quickly and in large volume.

Australia's CSL has so far been the fastest commercial operator, after starting its 1st clinical trials in Australia 2 weeks ago.

Meanwhile, a Taiwanese biotech company on Tuesday [4 Aug 2009] started mass production of a swine flu vaccine before even completing clinical trials, in a bid to get a jump before the start of the winter flu season. Adimmune Corp, the island's only human vaccine manufacturer, said it was starting production at its plant in central Taichung.

Source: ProMED newswire

Pandemic influenza in pregnant women

Mon, 3 Aug 2009 22:31:42 +1000

WHO Pandemic (H1N1) 2009 briefing note 5

31 JULY 2009 | GENEVA -- Research conducted in the USA has drawn attention to an increased risk of severe or fatal illness in pregnant women when infected with the H1N1 pandemic virus. Several other countries experiencing widespread transmission of the pandemic virus have similarly reported an increased risk in pregnant women, particularly during the second and third trimesters of pregnancy. An increased risk of fetal death or spontaneous abortions in infected women has also been reported.

Increased risk for pregnant women

Evidence from previous pandemics further supports the conclusion that pregnant women are at heightened risk. While pregnant women are also at increased risk during epidemics of seasonal influenza, the risk takes on added importance in the current pandemic, which continues to affect a younger age group than that seen during seasonal epidemics. WHO strongly recommends that, in areas where infection with the H1N1 virus is widespread, pregnant women, and the clinicians treating them, be alert to symptoms of influenza-like illness.

WHO recommendations for treatment

Treatment with the antiviral drug oseltamivir should be administered as soon as possible after symptom onset. As the benefits of oseltamivir are greatest when administered within 48 hours after symptom onset, clinicians should initiate treatment immediately and not wait for the results of laboratory tests. While treatment within 48 hours of symptom onset brings the greatest benefits, later initiation of treatment may also be beneficial. Clinical benefits associated with oseltamivir treatment include a reduced risk of pneumonia (one of the most frequently reported causes of death in infected people) and a reduced need for hospitalization. WHO has further recommended that, when pandemic vaccines become available, health authorities should consider making pregnant women a priority group for immunization.

Danger signs in all patients

Worldwide, the majority of patients infected with the pandemic virus continue to experience mild symptoms and recover fully within a week, even in the absence of any medical treatment. Monitoring of viruses from multiple outbreaks has detected no evidence of change in the ability of the virus to spread or to cause severe illness. In addition to the enhanced risk documented in pregnant women, groups at increased risk of severe or fatal illness include people with underlying medical conditions, most notably chronic lung disease (including asthma), cardiovascular disease, diabetes, and immunosuppression. Some preliminary studies suggest that obesity, and especially extreme obesity, may be a risk factor for more severe disease.

Within this largely reassuring picture, a small number of otherwise healthy people, usually under the age of 50 years, experience very rapid progression to severe and often fatal illness, characterized by severe pneumonia that destroys the lung tissue, and the failure of multiple organs. No factors that can predict this pattern of severe disease have yet been identified, though studies are under way. Clinicians, patients, and those providing home-based care need to be alert to danger signs that can signal progression to more severe disease. As progression can be very rapid, medical attention should be sought when any of the following danger signs appear in a person with confirmed or suspected H1N1 infection:

· shortness of breath, either during physical activity or while resting

· difficulty in breathing

· turning blue

· bloody or coloured sputum

· chest pain

· altered mental status

· high fever that persists beyond 3 days

· low blood pressure.

In children, danger signs include fast or difficult breathing, lack of alertness, difficulty in waking up, and little or no desire to play.

Preliminary information important for understanding evolving situation - Pandemic (H1N1)

Fri, 31 Jul 2009 18:40:36 +1000

WHO Pandemic (H1N1) 2009 briefing note 4 - Preliminary information important for understanding the evolving situation

24 JULY 2009 | GENEVA -- The number of human cases of pandemic (H1N1) 2009 is still increasing substantially in many countries, even in countries that have already been affected for some time.

Our understanding of the disease continues to evolve as new countries become affected, as community-level spread extends in already affected countries, and as information is shared globally. Many countries with widespread community transmission have moved to testing only samples of ill persons and have shifted surveillance efforts to monitoring and reporting of trends. This shift has been recommended by WHO, because as the pandemic progresses, monitoring trends in disease activity can be done better by following trends in illness cases rather than trying to test all ill persons, which can severely stress national resources. It remains a top priority to determine which groups of people are at highest risk of serious disease so steps to best to protect them can be taken.

In addition to surveillance information, WHO is relying on the results of special research and clinical studies and other data provided by countries directly through frequent expert teleconferences on clinical, virological and epidemiological aspects of the pandemic, to gain a global overview of the evolving situation.

Average age of cases increasing

In most countries the majority of pandemic (H1N1) 2009 cases are still occurring in younger people, with the median age reported to be 12 to 17 years (based on data from Canada, Chile, Japan, UK and the United States of America). Some reports suggest that persons requiring hospitalization and patients with fatal illness may be slightly older.

As the disease expands broadly into communities, the average age of the cases is appearing to increase slightly. This may reflect the situation in many countries where the earliest cases often occurred as school outbreaks but later cases were occurring in the community. Some of the pandemic disease patterns differ from seasonal influenza, where fatal disease occurs most often in the elderly (>65 years old). However, the full picture of the pandemic's epidemiology is not yet fully clear because in many countries, seasonal influenza viruses and pandemic (H1N1) 2009 viruses are both circulating and the pandemic remains relatively early in its development.

Although the risk factors for serious pandemic disease are not know definitively, risk factors such as existing cardiovascular disease, respiratory disease, diabetes and cancer currently are considered risk factors for serious pandemic (H1N1) 2009 disease. Asthma and other forms of respiratory disease have been consistently reported as underlying conditions associated with an augmented risk of severe pandemic disease in several countries.

A recent report suggests obesity may be another risk factor for severe disease. Similarly, there is accumulating evidence suggesting pregnant women are at higher risk for more severe disease. A few preliminary reports also suggest increased risk of severe disease may be elevated in some minority populations, but the potential contributions of cultural, economic and social risk factors are not clear.

Vaccine situation:

The development of new candidate vaccine viruses by the WHO network is continuing to improve yields (currently 25% to 50 % of the normal yields for seasonal influenza for some manufacturers). WHO will be able to revise its estimate of pandemic vaccine supply once it has the new yield information. Other important information will also be provided by results of ongoing and soon-to be-initiated vaccine clinical trials. These trials will give a better idea of the number of doses required for a person to be immunized, as well as of the quantity on active principle (antigen) needed in each vaccine dose.

Manufacturers are expected to have vaccines for use around September. A number of companies are working on the pandemic vaccine production and have different timelines.

Northern hemisphere Seasonal Influenza Virus Vaccine for 2009-2010 available

Tue, 28 Jul 2009 21:14:43 +1000

Sanofi Pasteur, the vaccines division of sanofi-aventis Group, announced today that it has shipped the first doses of the 2009-2010 formulation of Fluzone((R)), Influenza Virus Vaccine. Fluzone vaccine is indicated for active immunization in people 6 months of age and older against influenza disease caused by influenza virus subtypes A and type B contained in the seasonal influenza vaccine. Fluzone vaccine is the only vaccine licensed in the United States for children as young as 6 months of age through adults.

Sanofi Pasteur, the only U.S. manufacturer of inactivated influenza vaccine, is committed to supporting the U.S. Centers for Disease Control and Prevention's (CDC) recommendation for annual immunization against seasonal influenza. The company has begun shipment of its Fluzone vaccine to health-care providers to assist them in their early seasonal influenza immunization efforts. In total, Sanofi Pasteur expects to supply over 50 million doses of Fluzone vaccine to the U.S. for the 2009-2010 season.

The CDC recommends that health-care providers begin their immunization efforts for seasonal influenza as soon as vaccine is available and continue their immunization efforts throughout the entire influenza season. Immunization for seasonal influenza remains a public health priority. On average each year, one out of five Americans suffers from seasonal influenza, approximately 226,000 are hospitalized and 36,000 die from influenza-related complications.

Although seasonal influenza cases typically peak in February, seasonal influenza can occur at any time from early fall to late spring. The influenza vaccine offers protection for the full season, so there is no need to delay immunization once vaccine is available. However, those who missed an immunization opportunity early in the season are urged to seek immunization throughout the influenza season because immunization is beneficial in disease prevention as long as influenza is circulating in the community.

The vaccine formulation for the 2009-2010 season contains three strains of the influenza virus: the A/Brisbane/59/2007 (H1N1)-like virus; the A/Brisbane/10/2007 (H3N2)-like virus; and the B/Brisbane/60/2008-like virus. The three strains for the new influenza vaccine formulation were confirmed by the Food and Drug Administration's (FDA) Vaccines and Related Biological Products Advisory Committee in February 2009 and correspond with recommendations made by the World Health Organization (WHO) also in February. Influenza vaccine is formulated each year to match the strains predicted to circulate during the upcoming season. This formulation for the 2009-2010 influenza season introduces a new B strain. The two A strains are unchanged from the 2008-2009 season formulation.

The seasonal influenza vaccine does not incorporate the A/California/7/2009(H1N1) virus strain of the novel A(H1N1) influenza and is not expected to offer protection against this new type of influenza. Sanofi Pasteur is working with the WHO and the CDC on the development of a separate vaccine for the novel A(H1N1) influenza, commonly referred to as the new "swine" influenza.

Arab countries to exclude elderly and children from pilgrimage

Fri, 24 Jul 2009 17:44:20 +1000

Arab health ministers, in a special session of the Regional Committee for World Health Organization (WHO) Eastern Mediterranean Regional Office on pandemic H1N1 held in Cairo on Wednesday 22 July, agreed to exclude certain groups from Muslim pilgrimage in a bid to curb the spread of A/H1N1 flu.

At a press conference Hussein Gezairy, WHO Regional director for Eastern Mediterranean, said that people who are under the age of 12 or over 65, and those who suffer from chronic diseases like blood pressure, kidney and liver disease would not be permitted to go for Hajj and Umrah (pilgrimage to Mecca at any time of the year)

Gezairy said the current evidence from the global experience shows that cancellation of mass gatherings does not necessarily lead to containment of transmission of the virus. However, mitigation of the spread of the flu in mass gatherings can be aimed at by the proper application of non-pharmaceutical measures such as community level social distancing, good personal hygiene and use of personal protective equipment. In a draft resolution the Health Ministers of Yemen, Saudi Arabia, Jordan and Egypt decided to take more measures for Hajj and Umrah and the draft resolution also said Saudi Arabia would turn the health precautionary measures recommended by the international consultative workshop held in Jeddah on June 27-30 into preconditions for Hajj and Umrah this year.

Meanwhile, Saudi Health Minister Abdullah Bin Abdul Aziz said the ministry has initiated all measures necessary to detect the disease and to protect both its citizens and expatriates. Egypt's Health Minister Hatem el-Gabli said there would be some accredited medical centers in Egypt and Saudi Arabia to check the health condition of people going to Hajj and Umrah.

The number of flu cases in the Arab countries has been growing, with Saudi Arabia recording the highest number, and Egypt's Ministry of Health confirmed on Sunday July 19 the first influenza A/H1N1 death in the country and the Middle East region.

Egyptian Mufti Sheikh Ali Gomaa said on Tuesday that the elderly and sick people are allowed to postpone Umrah and to cancel Hajj this year.

Notification of updating Australia's official Yellow Fever vaccination requirements

Fri, 17 Jul 2009 11:56:07 +1000

On 1 August 2009 Australia's yellow fever Vaccination requirements will change. Australia's list of yellow fever declared regions will be updated to include 24 new countries and the Misiones Province of Argentina. The update brings Australia's formal advice from in line with the World Health Organization's recommendations.

Yellow fever is a quarantinable disease under the Quarantine Act 1908. Australia requires any person over one year of age to hold an individual international yellow fever vaccination certificate if they have, within six days prior to their arrival in Australia, stayed overnight or longer in a declared yellow fever infected country.

The Department of Health and Ageing (DoHA) recognises that this amendment will have a minimal impact on travel medicine providers, as they are already providing advice to travellers on the risks of yellow fever for the newly included countries.

Australia's formal new list of declared countries is now:

Africa (32): Angola, Benin, Burkino Faso, Burundi, Cameroon, CAR, Chad, DR Congo, Rep Congo, Cote d'Ivoire, Equatorial Guinea, Ethiopia, Gabon, Gambia, Ghana, Guinea, Kenya, Liberia, Mali, Mauritania, Niger, Nigeria, Rwanda, Sao Tome & Principe, Senegal, Somalia, Sudan, Tanzania, Togo, Uganda

South America (13):

Argentina Misiones Province, Bolivia, Brazil, Colombia, Ecuador – mainland, French Guiana, Guyana, Panama, Paraguay, Peru, Suriname, Trinidad and Tobago, Venezuela

For further information regarding Australia's yellow fever vaccination requirements refer to the DoHA yellow fever fact sheet at the following link:www.health.gov.au/internet/main/publishing.nsf/Content/health-pubhlth-strateg-communic-factsheets-yellow.htm

WHO recommendations on pandemic (H1N1) 2009 vaccines

Wed, 15 Jul 2009 14:35:54 +1000

On Tue 7 Jul 2009, the Strategic Advisory Group of Experts (SAGE) on Immunization held an extraordinary meeting in Geneva to discuss issues and make recommendations related to vaccine for the pandemic (H1N1) 2009. SAGE reviewed the current pandemic situation, the current status of seasonal vaccine production and potential A(H1N1) vaccine production capacity, and considered potential options for vaccine use.

The experts identified 3 different objectives that countries could adopt as part of their pandemic vaccination strategy:
- protect the integrity of the health-care system and the country's critical infrastructure;
- reduce morbidity and mortality; and
- reduce transmission of the pandemic virus within communities.

Countries could use a variety of vaccine deployment strategies to reach these objectives, but any strategy should reflect the country's epidemiological situation, resources and ability to access vaccine, to implement vaccination campaigns in the targeted groups, and to use other non-vaccine mitigation measures.

Although the severity of the pandemic is currently considered to be moderate, with most patients experiencing uncomplicated, self-limited illness, some groups such as pregnant women and persons with asthma and other chronic conditions such as morbid obesity appear to be at increased risk for severe disease and death from infection.

Since the spread of the pandemic virus is considered unstoppable, vaccine will be needed in all countries. SAGE emphasized the importance of striving to achieve equity among countries to access vaccines developed in response to the pandemic (H1N1) 2009.

The following recommendations were provided to the WHO Director-General:

All countries should immunize their health-care workers as a 1st priority to protect the essential health infrastructure. As vaccines available initially will not be sufficient, a step-wise approach to vaccinate particular groups may be considered. SAGE suggested the following groups for consideration, noting that countries need to determine their order of priority based on country-specific conditions: pregnant women; those aged above 6 months with one of several chronic medical conditions; healthy young adults of 15 to 49 years of age; healthy children; healthy adults of 50 to 64 years of age; and healthy adults of 65 years of age and above.

Since new technologies are involved in the production of some pandemic vaccines, which have not yet been extensively evaluated for their safety in certain population groups, it is very important to implement post-marketing surveillance of the highest possible quality. In addition, rapid sharing of the results of immunogenicity and post-marketing safety and effectiveness studies among the international community will be essential for allowing countries to make necessary adjustments to their vaccination policies.

In view of the anticipated limited vaccine availability at global level and the potential need to protect against "drifted" strains of virus, SAGE recommended that promoting production and use of vaccines such as those that are formulated with oil-in-water adjuvants and live attenuated influenza vaccines is important.

As most of the production of the seasonal vaccine for the 2009-2010 influenza season in the northern hemisphere is almost complete and is therefore unlikely to affect production of pandemic vaccine, SAGE did not consider that there was a need to recommend a "switch" from seasonal to pandemic vaccine production.

WHO Director-General Dr Margaret Chan endorsed the above recommendations on 11 Jul 2009, recognizing that they were well adapted to the current pandemic situation. She also noted that the recommendations will need to be changed if and when new evidence becomes available.

Travel Doctor-TMVC clinics now part of the global GeoSentinel project

Mon, 13 Jul 2009 14:34:01 +1000

Travel Doctor clinics have joined Australia's only GeoSentinel project in Melbourne as "satellite locations". The GeoSentinel is a combined initiative of the International Society of Travel Medicine (ISTM), and the US Centres for Disease Control (CDC) to monitor illnesses amongst returning travellers in different parts of the world, and act as a global surveillance and early-warning system for emerging travellers diseases.

GeoSentinel programs have been quite successful in identifying previous disease outbreaks, and trends of travellers illnesses, and now Travel Doctor is able to add considerable experience of returned travellers to enhance this important project, which ultimately is about improving and protecting the health for all travellers. More information about the GeoSentinel program can be found at www.istm.org

Possibility of a new rabies vaccine

Thu, 9 Jul 2009 15:37:40 +1000

A rabies vaccine that reverses the disease in mice after just one injection may pave the way to cheap, effective prevention of the fatal illness. As reported in Nature a team of virologists and immunologists at Thomas Jefferson University, Philadelphia in the United States have engineered a new strain of the rabies virus that induces a far more potent immune response than current vaccines. In mice already infected with a virulent rabies strain, a single administration of the new vaccine was enough to clear the virus from the body, even after early symptoms had appeared.

Further testing may reveal the vaccine's potential for eradicating the disease in dogs and provide a cheaper and easier alternative to current vaccination for humans which is expensive and involves three vaccinations over the period of a month.

Tamiflu resistance emerges

Thu, 9 Jul 2009 15:36:14 +1000

The first report of pandemic H1N1 2009 virus resistance to oseltamivir (Tamiflu) came from Denmark last week followed by another report from Japan. There is now a third report from Hong Kong where the resistant virus was isolated from a patient who had not been treated with the drug. Resistance to Tamiflu has been well documented with seasonal flu and indeed in the last flu season in the USA more than 90% of cases showed resistance. As with all antibiotics and antivirals extensive use of an agent will inevitably result in the emergence of resistant strains of the micro-organism. Given the widespread use of Tamiflu this development is not unexpected and it is also not unexpected that there should now be calls to restrict the use of the drug. It is reasonable to think that Tamiflu should be used only in vulnerable groups (pregnant women, those with underlying diseases, etc) especially as it appears that the pandemic virus disease is at least no more severe than seasonal flu. The alternative drug zanamivir (Relenza) is administered as an inhaled powder and therefore has not been as widely used as Tamiflu and resistance has not so far been reported.

New drug being tested in Africa for river blindness

Mon, 6 Jul 2009 22:11:09 +1000

From WHO -- A clinical trial is being launched in three African countries of a drug that could eliminate onchocerciasis, or river blindness, one of the leading infectious causes of blindness across Africa. The drug, moxidectin, is being investigated for its potential to kill or sterilize the adult worms of Onchocerca volvulus, which cause onchocerciasis.

"This is a devastating illness that has plagued 30 African countries for centuries, in particular the populations in the most remote areas 'beyond the end of the road'," says Dr Uche Amazigo, Director of the African Programme for Onchocerciasis Control (APOC). "Over 100 million people are at risk of infection with onchocerciasis in Africa and a few small areas in the Americas and Yemen."

Onchocerciasis is also called river blindness because the black fly which transmits the disease breeds in fast flowing rivers, and blindness is the most incapacitating symptom of the disease which also causes debilitating skin disease.

The development of moxidectin for onchocerciasis is being conducted through a collaboration of the WHO, with Wyeth Pharmaceuticals. The work ranges from the development of a formulation for human use and initial studies in healthy volunteers, to clinical studies and community studies in Africa.

The trial will take place over the next two and a half years. Currently, the disease is controlled by ivermectin, which has been donated for more than 20 years by the pharmaceutical company Merck & Co. for use in onchocerciasis endemic countries. Treatment with ivermectin has enabled significant progress in the control of onchocerciasis, and currently reaches more than 60 million people in Africa annually.

However, ivermectin kills the O. volvulus larvae but not the adult worms, so annual treatments for an extended period of time (at least 11-14 years) are required to ensure disease control. Since moxidectin kills not only the larvae but also sterilizes or kills the adult worms, it has the potential to interrupt the disease transmission cycle within around six annual rounds of treatment. The drug could be distributed through the community-directed mechanisms set up in collaboration among APOC, African control programmes, and NGOs for the distribution of ivermectin.

US changes its recommendations for vaccines after a possible rabies exposure in the US

Wed, 1 Jul 2009 23:56:57 +1000

The US Advisory Committee on Immunisation Practice (ACIP) has announced a change to the recommended treatment for a person who has had a possible exposure to rabies virus, usually by dog or bat bite or scratch, in the US. They have recommended that the 5th dose of rabies vaccine , due at day 28 after starting treatment can be omitted. This will effectively change the recommendations for human rabies prevention in the US as follows: the PEP series will consist of the administration of human rabies immune globulin (20IU/kg body weight) on day 0 and 4 doses of vaccine (1ml administered intramuscularly) on days 0, 3, 7, and 14.

They have made this recommendation in response to a shortage of vaccine in the US, not because there is evidence that the 5th dose is unnecessary.

For travellers and others outside the US, there is no change to current standard 5-dose prevention regimes, and WHO have not changed their recommendations for managing patients who have had a possible rabies exposure.

Australia moving to new "Protect" phase of pandemic alert

Sun, 21 Jun 2009 22:53:00 +1000

On 17 June 2009, the Federal Minister for Health and Ageing, Nicola Roxon, after consultation with State and Territory governments, announced that Australia has developed a new response phase to manage the outbreak of H1N1 Influenza 09 (Human Swine Influenza) called PROTECT.
On the advice of the Chief Medical Officer, Professor Jim Bishop, and the Australian Health Protection Committee, a new pandemic phase has been created to guide the ongoing Australian response to the disease.

The new phase recognises that the infection with H1N1 Influenza 09 is not as severe as originally envisaged when the Australian Health Management Plan for Pandemic Influenza (AHMPPI) was written in 2008 and that this new disease is mild in most cases, severe in some and moderate overall.

PROTECT sits alongside CONTAIN and SUSTAIN phases with a greater focus on treating and caring for people in whom the disease may be severe.

PROTECT is a measured, reasonable and proportionate health response to the risk that the infection poses to the Australian community. It is consistent with the message from the WHO when it lifted its Pandemic Alert to 6, that countries will need to adjust their responses to accommodate the knowledge we now have that this disease is moderate in most cases.

Jurisdictions will be making arrangements progressively over the next few days to move to this new level and we anticipate that all states will be at this level by next Friday 26 June.

Safety of Anti-flu drugs in pregnancy

Sun, 21 Jun 2009 22:52:46 +1000

We know from past experience that seasonal influenza ("ordinary flu") can be worse in pregnant women. Experience so far has shown this to be true for "swine flu" as well. Doctors will therefore be advising pregnant women to take one of the antiviral drugs early if flu develops. There is now good evidence that there is no need for concern about this.

A report published by scientists from Japan and Canada, and published electronically in the Canadian Medical Association Journal on June 15, indicates both from experimental modelling and from close review of patients who have taken the drugs that there is no evidence of harm. Oseltamivir (Tamiflu) appears to be the drug of choice because there are more data on its safety in pregnancy. Zanamivir (Relenza)may also be used, but there are less data available. Both oseltamivir and zanamivir are considered to be safe with breastfeeding.

World Health Organisation - Influenza Alert Raised

Sun, 14 Jun 2009 21:54:52 +1000

The Director General of the World Health Organisation on 11 June raised the level of influenza alert from Phase 5 to Phase 6. This announcement has been expected given the large number of countries involved and the clear evidence of local transmission of the virus within countries.

The precautions advised by the WHO for Phase 6 are already in place in the various Australian States and Territories'

Although some countries may apply individual quarantining regulation WHO continues to recommend no restrictions on travel and no border closures.

The Direcetor General's announcement can be read on http://www.who.int/mediacentre/news/statements/2009/h1n1_pandemic_phase6_20090611/en/index.html

The WHO recommends that all countries now place greater emphasis on providing care with a decreased emphasis on stopping the spread of the virus.

Influenza A (H1N1) - update

Wed, 10 Jun 2009 22:37:06 +1000

As of 06:00 GMT, 8 June 2009, 73 countries have officially reported 25,288 cases of influenza A(H1N1) infection, including 139 deaths.

9 June 2009: The total of confirmed H1N1 Influenza 09 cases in Australia as at 1500 AEST has risen to 1,211.

The national breakdown is: WA 20, NT 6, Tas 9, ACT 10, SA 13, Qld 53, NSW 89, Vic 1,011.

Influenza A (H1N1) - Upgraded Response in Victoria

Fri, 5 Jun 2009 09:57:14 +1000

The Australian Health Protection Committee (AHPC) and the Chief Medical Officer, Professor Jim Bishop, have advised that it is appropriate to raise the pandemic response to a modified SUSTAIN response for Victoria while keeping the national level at CONTAIN for the other states and territories.

The measures to be put in place in Victoria as part of a modified SUSTAIN approach will enable Victoria to more appropriately respond to the relatively higher number of cases and the sustained community transmission of the infection in Victoria. About three quarters of confirmed cases recorded so far have been in Victoria.

Measures taken by governments have so far helped to delay and reduce the spread of the virus H1N1 Influenza 09 (Human Swine Influenza). While Australia has recently experienced an increase in cases as was always likely to be the case, this has occurred up to a month later than in other countries such as the UK, Canada and Japan. All delay and contain efforts have provided more time for doctors and scientists to better understand the disease so that Australia can better target its response.

Moving to Modified SUSTAIN will enable Victoria to:

more intensively target those people who are at highest risk. For example, undertake testing in high risk settings like aged care facilities, hospitals and special schools to help identify cases;

implement extensive contact tracing where there are people at risk of severe complications, such as those in nursing homes and special schools;

target antivirals to people exhibiting the clinical case definition of Human Swine Flu, along with their immediate household contacts; and

require people who are confirmed to have Human Swine Flu to isolate themselves for three days following the commencement of antiviral treatment.

Given the high level of socialisation and contact in school settings, the AHPC has agreed that health authorities throughout Australia should continue to focus on actions in schools as they are a key vehicle for spread of the virus.

Health officials continue to request that any school aged children at potential risk from Human Swine Influenza stay at home for seven days.

States and Territories will apply a policy of voluntary exclusion from school for a period of seven days for all children returning from areas where there is a high prevalence of the virus circulating in the community.

All States and Territories will be asked to undertake random sampling testing (known as sentinel testing) of influenza-like illness and increased sampling of cases to monitor the rate of increase of spread in the community and any changes in the dominant circulating influenza strain.

Influenza A (H1N1) update

Fri, 5 Jun 2009 09:56:33 +1000

As of 06:00 GMT, 1 June 2009, 63 countries have officially reported 17 410 cases of influenza A(H1N1) infection, including 115 deaths.

The total of confirmed Human Swine influenza cases in Australia as at 0500 AEST 3 rd June has risen to 502. This includes a second case for Tasmania.
All Australian states and territories now have at least one confirmed case. The breakdown is: ACT 4, NSW 69, SA 7, Qld 23, Tas 2, Vic 395, WA 1, NT 1

Influenza A(H1N1) Update

Mon, 1 Jun 2009 23:13:35 +1000

1 June 2009: There were five (5) new confirmed cases of Human Swine Flu reported overnight, all in Queensland. The new cases include two people in Cairns including the mother of the 13 year old girl who was confirmed as having H1N1 Influenza on Saturday and a year eight student from St Maryâ€™s Catholic College, Woree. There are three from the Gold Coast. One of these was a passenger on the Pacific Dawn that berthed in Sydney on Monday 25 May 2009. The other two people were identified contacts of this case. This brings the number of confirmed Swine Flu cases in Queensland to 20.

The total of confirmed Human Swine Influenza cases in Australia as at 0500 AEST today was 302. Every Australian States and Territory now has at least one confirmed case. The breakdown is: ACT 4, NSW 57, SA 6, Qld 20, Tas 1, Vic 212, WA 1, NT 1.

Influenza H1N1 -update

Mon, 1 Jun 2009 23:13:18 +1000

The total of confirmed human swine influenza cases in Australia as at 1800 AEST 29 May is 168.

The breakdown is: ACT 3, NSW 48, NT 0, Qld 11, SA 6, Tas 0, Victoria 99, WA 1.

There is a concomitant rise in the number of H3 (seasonal) influenza cases being noted. Standard flu vaccination is effective in reducing the chances of picking up flu during the coming winter. The fewer cases there of seasonal flu in the community the lesser is the chance of the swine flu virus being modified to become more virulent so although the current flu vaccine does not appear to protect against swine flu, vaccination is strongly recommended to all, whether travelling overseas or not.

Influenza H1N1 update

Fri, 29 May 2009 13:30:35 +1000

29 May 2009: There has been one (1) new confirmed cases of H1N1 Influenza 09 (Human Swine Influenza) in Australia since last night.

South Australia recorded one more positive result from a person who was on the cruise ship that recently arrived in Sydney.

This brings the total of confirmed human swine influenza cases in Australia as at 0600 AEST today to 148.

The breakdown is: ACT 3, NSW 33, NT 0, Qld 9, SA 6, Tas 0, Victoria 96, WA 1.

Influenza H1N1 - update

Fri, 29 May 2009 13:30:01 +1000

As of 06:00 GMT, 27 May 2009, 48 countries have officially reported 13,398 cases of influenza A(H1N1) infection, including 95 deaths. Singapore and Romania have been added to the list of countries reporting confirmed cases.

For Australia as at 5 am AEST today 28th May .

The breakdown is:

ACT 3

NSW 19

QLD 7

SA 3

VIC 34

WA 1

Total 67

Update Influenza H1N1

Tue, 26 May 2009 23:12:17 +1000

As of 06:00 GMT, 24 May 2009, 46 countries have officially reported 12,515 cases of influenza A (H1N1) infection, including 91deaths. Since the last WHO update the following additional countries have reported cases: Honduras (1), Iceland (1), Kuwait(18), and the United Arab Emirates (1).

There have now been 23 confirmed cases in Australia, with Western Australia reporting its first confirmed case, while additional cases have been confirmed in Queensland, Victoria and NSW.

The spot emergence of cases through communities is to be expected. The rapid, and at present efficient, public health responses about containment - that is isolation, contact tracing and prophylaxis from Government stockpile, and some social quarantine measures like temporary school closures appear to be currently effective in limiting the spread of the virus.

This means that the overall threat is modest, and combined with the fairly mild nature of the clinical illness, means that people should not panic, but be sensible about seeking medical opinion if influenza symptoms are present.

For the workplace, it is appropriate to go to a higher state of alert, have ILI protocols activated, such as some level of screening at entry to workplaces, a focus on workplace hygiene, and consideration of having the seasonal influenza vaccine.

H1N1 update

Mon, 25 May 2009 22:08:19 +1000

As of 06:00 GMT, 23 May 2009, 43 countries have officially reported 12,022 cases of influenza A(H1N1) infection, including 86 deaths.

Mexico has reported 3892 laboratory confirmed human cases of infection, including 75 deaths.

The United States has reported 6552 laboratory confirmed human cases, including 9 deaths.

Canada has reported 719 laboratory confirmed human cases, including one death.

Costa Rica has reported 20 laboratory confirmed cases, including one death.

The following countries have reported laboratory confirmed cases with no deaths -

Argentina (1), Australia (12), Austria (1), Belgium (7), Brazil (8), Chile (24), China(11), Colombia (12), Cuba (4), Denmark (1),Ecuador (8), El Salvador (6), Finland (2),France (16), Germany (17), Greece (1), Guatemala (4), India (1), Ireland (1), Israel (7), Italy (14), Japan (321), Korea, Republic of (3), Malaysia (2) Netherlands (3), New Zealand (9), Norway (4), Panama (76), Peru (5), Philippines (1), Poland (2), Portugal (1), Russia (1), Spain (126), Sweden (3), Switzerland (2) Thailand (2), Turkey (2), United Kingdom (117).

Clinical Picture of "Swine Flu"

Mon, 25 May 2009 22:07:49 +1000

From reports from countries which so far have had the greatest number of cases of Influenza A(H1N1) infections the World Health Organisation has published a summary of the findings which are here summarised

Most cases appear to have an uncomplicated, typical influenza-like illness and recover spontaneously. The most commonly reported symptoms include cough, fever, sore throat, malaise and headache. Fever has been absent in up to 1 in 6 surviving hospitalized patients. Nausea, vomiting and/or diarrhoea) have occurred in up to 38% of outpatients in the United States.
Approximately 2–5% of confirmed cases in the United States and Canada, as well as 6% in Mexico, have been admitted to
hospital. [The reason for hospitalisation is not specified but would be acute shortness of breath associated with, or following, the above symptoms.]

Almost one-half of the patients hospitalized in the United States
and 21 of 45 (46%) fatal cases in Mexico for whom data are available
have had underlying conditions, including pregnancy, asthma, other lung diseases, diabetes, morbid obesity, autoimmune disorders and associated immunosuppressive therapies, neurological disorders and cardiovascular disease. [These underlying conditions are similar to those that may lead to fatal complications associated with seasonal flu.]

In mild cases supportive treatment (e.g. paracetamol, fluids) based
on symptoms should be provided as needed. Salicylates (such as
aspirin and aspirin-containing products) should not be used in
children and young adults. Where antiviral medication is available, early administration in at-risk patients (those with underlying conditions or who are pregnant) with oral oseltamivir or inhaled zanamivir is advised.

The full report can be found on
http://www.who.int/wer/2009/wer8421.pdf

Swine Flu Count in Victoria reaches 6 while South Australia reports first case

Fri, 22 May 2009 18:05:57 +1000

Victorian health authorities have announced that two more cases of human swine flu in Victoria have been detected. One is a classmate of the 10-year-old boy from the Clifton Hill school who was confirmed as a H1N1 case yesterday. This girl, also 10, had already begun a course of anti-virals and is in home quarantine. The other case is a 25-year-old Melbourne man who flew in to Melbourne from Los Angeles on Tuesday. The man has been placed in home quarantine. The Victorian government has announced that the Clifton Hill Primary School in Melbourne will be closed for the rest of the week as a precautionary measure to minimise the chance of spread of human swine flu.

SA Health has also announced the first confirmed case of Human Swine Influenza in South Australia. The South Australian case is a 15 year old girl has the virus. She & other family members have been treated with anti-virals and are in home quarantine. SA Health also reported that the girl attended school this week and classroom contacts are being followed up. In addition, the school will be closed for seven days as a precaution and will reopen next Friday, 29 May 2009. Health officials have also asked all students from the school to remain in home isolation during the next seven days in order to limit the possibility of Human Swine Flu in the community.

In the meantime the World Health Organisation has reported that as of 21 May 2009 at 06:00 GMT, 21 May 2009, 41 countries have officially reported 11 034 cases of influenza A(H1N1) infection, including 85 deaths. Of these deaths 75 have occurred in Mexico, 8 in the USA and one each in Canada and Costa Rica.

Surveillance of Human Swine Flu Cases in California

Fri, 22 May 2009 18:05:27 +1000

nitial surveillance for hospitalized cases of novel influenza A (H1N1) infection in California indicates that the majority of patients were discharged after short hospital stays. Previously healthy patients without underlying chronic medical conditions recovered with an uncomplicated hospital course and a median length of stay of 2.5 days (range: 1-7 days). Although one 3rd of hospitalized patients had abnormal chest radiographs with multilobar infiltrates, only 9 percent were treated with oseltamivir; nonetheless, most had favourable outcomes. Of 5 pregnant women, 2 developed serious subsequent problems - however, the role that preceding infection with novel influenza A (H1N1) played in these outcomes is unclear.

Four new cases of Swine Flu have been confirmed in Australia

Fri, 22 May 2009 18:04:58 +1000

The Victorian Department of Human Services reports that 2 siblings (aged 10 & 12) of the 9 year old Melbourne boy who was yesterday reported as having returned a positive test, have also been confirmed as having Human Swine Influenza. The family had all returned to Australia from Los Angeles on May 12th. All are reportedly exhibiting mild symptoms and have not required hospitalisation.

As noted in yesterday's Travel Doctor-TMVC News Alert, based upon what is known about this form of influenza, authorities believe that the boys were non-infectious when they travelled back to Australia. As a precaution, however, other passengers on their flight are being contacted. As a further precaution, Victorian Public Health officials have also visited the primary school attended by 2 of the boys, providing ant-viral medication to classmates & contacts as well as information about symptoms of Influenza Like Illness (ILI) to parents at the school.

The NSW Department of Health also confirmed a new case of swine influenza on yesterday. A NSW woman apparently caught the virus while travelling in the United States earlier this month and was prescribed Tamiflu while still overseas. She had recovered from the illness and was no longer considered infectious when she returned to Australia last week.

It is important to remember that all these cases are in returning travellers and that at this point in time transmission in the general community has not been reported in Australia.

Internationally now, over 10,000 people in 41 countries have been confirmed as having swine flu, so it is not unexpected that additional cases have been confirmed in Australia. Further cases in travellers returning to Australia can be expected.

WHO is not recommending travel restrictions related to the outbreak of the influenza A (H1N1) virus. The Department of Foreign Affairs & Trade travel advisory for Mexico recommends that Australians reconsider their need to travel to Mexico due the outbreak of influenza A (H1N1).

Travellers to countries where Swine Flu has been confirmed should consider appropriate preparation prior to departure, including being vaccinated with the current seasonal influenza vaccine (although the degree of protection afforded against Swine Flu is unclear at present). Travellers should also consider taking a Travel Doctor-TMVC Flu Kit with them.

Travellers in countries where Swine Flu has been confirmed should note that they could experience some disruption to day-to-day activities. For example, Japan, which has now reported 178 Swine Flu cases (159 confirmed by WHO), closed more than 4,400 schools, colleges & kindergartens for the rest of the week to slow the spread of the virus. Visitors to many public places - from the parliamentary visitors' gallery to the national sumo tournament in Tokyo - have been asked to disinfect their hands on entry, wear surgical face masks, or both.

The above measures simply reflect good hand & respiratory hygiene practices, which are designed to limit the spread of viruses. Travellers in affected regions should contact a health professional if feeling unwell, and especially if developing symptoms of an Influenza Like Illness.

Influenza A(H1N1) cases in Australia

Wed, 20 May 2009 23:03:50 +1000

Media reports state that Australia now has three confirmed cases of swine flu, after new cases were reported in Victoria and New South Wales.

In Melbourne, a nine-year old boy, returning from Los Angeles on May 12th has reportedly been confirmed as having a mild case of swine influenza. While Authorities believe that he was non-infectious when he travelled, other passengers on his flight are being contacted. As a further precaution, 24 of the boy's classmates from an inner Melbourne school have been quarantined. According to reports, the boy's parents and siblings had all been tested and treated with Tamiflu and were in isolation in their home.

Media reports also note that NSW also confirmed a new case of swine influenza on Wednesday. A NSW woman apparently caught the virus while travelling in the United States earlier this month and was prescribed Tamiflu while still overseas. She had recovered from the illness and was no longer considered infectious when she returned to Australia last week.

If these cases are confirmed by the relevant State Health Department, the emergence of new cases of Swine Flu were in Australia were to be expected, and should not come as a surprise. It is clear that H1N1 is continuing to spread to different countries and that (as reported in a previous Travel Doctor-TMVC alert regarding confirmation of cases in Japan), human-to-human transmission has occurred outside Mexico and the USA

It is important to remember that all these cases are in returning travellers and that at this point in time community transmission has not been reported in Australia.

Influenza A(H1N1) cases in Japan

Wed, 20 May 2009 23:03:29 +1000

KOBE, Japan, May 19, 2009 (AFP) - Japan reported 178 swine flu infections Tuesday [ official WHO figure 159] and closed more than 4,400 schools, colleges and kindergartens for the rest of the week to slow the spread of the virus, officials said. Visitors to many public places -- from the parliamentary visitors' gallery to the national sumo tournament in Tokyo -- have been asked to disinfect their hands on entry, wear surgical face masks, or both.Japan's first domestic cases of the (A)H1N1 virus were confirmed Saturday in the western cities of Kobe and Osaka, where they spread quickly in and between two high schools that had met for a volleyball tournament. Hundreds have since been tested for the virus, and face masks have become ubiquitous on subways and in shopping centres of the affected prefectures of Osaka and Hyogo in the central region of the main island of Honshu. Japan's first confirmed cases of swine flu were four people who tested positive after they flew in from North America earlier this month. They were immediately quarantined along with about 50 fellow passengers.

Influenza A (H1N1)

Wed, 20 May 2009 23:03:11 +1000

As of 06:00 GMT, 18 May 2009, 40 countries have officially reported 8829 cases of influenza A(H1N1) infection, including 74 deaths. The pattern emerging now around the world is that this virus is probably less serious than first suspected, and although capable of causing severe , or fatal, disease in people who are chronically ill already, is most likely a relatively mild disease in most healthy individuals.

A new summary papare published today in MMWR from CDC in the US states:

In the United States, early reports of illnesses associated with novel influenza A (H1N1) infection have indicated the disease might be similar in severity to seasonal influenza, with the majority
of patients not requiring hospitalization and only rare deaths reported, generally in persons
with underlying medical conditions. As of May 17, 2009, 553 cases had been reported in California.
Of the 553 patients, 30 have been hospitalized. This report summarizes the 30 hospitalized cases, including a detailed description of four cases that illustrate the spectrum of illness severity and underlying risk factors.

While this perhaps can be interpreted as good news, all Governments should remains cautious, and continue to monitor and respond to this evolving threat. Australians should seek immunisation with seasonal influenza vaccine, and should seek Travel-Doctor TMVC consultations before travelling overseas.

Influenza A(H1N1) - WHO update 31

Mon, 18 May 2009 23:02:48 +1000

As of 06:00 GMT, 17 May 2009, 39 countries have officially reported 8480 cases of influenza A(H1N1) infection.

Mexico has reported 2895 laboratory confirmed human cases of infection, including 66 deaths. The United States has reported 4714 laboratory confirmed human cases, including four deaths. Canada has reported 496 laboratory confirmed human cases, including one death. Costa Rica has reported nine laboratory confirmed human cases, including one death.

The following countries have reported laboratory confirmed cases with no deaths - Argentina (1), Australia (1), Austria (1), Belgium (4), Brazil (8), China (5), Colombia (11), Cuba (3), Denmark (1), Ecuador (1), El Salvador (4), Finland (2), France (14), Germany (14), Guatemala (3), India (1), Ireland (1), Israel (7), Italy (9), Japan (7), Malaysia (2), Netherlands (3), New Zealand (9), Norway (2), Panama (54), Peru (1), Poland (1), Portugal (1), Republic of Korea (3), Spain (103), Sweden (3), Switzerland (1), Thailand (2), Turkey (1), and the United Kingdom (82).

WHO is not recommending travel restrictions related to the outbreak of the influenza A(H1N1) virus.

Individuals who are ill should delay travel plans and returning travelers who fall ill should seek appropriate medical care. These recommendations are prudent measures which can limit the spread of many communicable diseases, including influenza.

Influenza A(H1N1) WHO update 28

Mon, 18 May 2009 23:00:52 +1000

Mexico has reported 2446 laboratory confirmed human cases of infection, including 60 deaths. The United States has reported 3352 laboratory confirmed human cases, including three deaths. Canada has reported 389 laboratory confirmed human cases, including one death. Costa Rica has reported eight laboratory confirmed human cases, including one death.

The following countries have reported laboratory confirmed cases with no deaths - Argentina (1), Australia (1), Austria (1), Brazil (8), China (4), Colombia (7), Cuba (1), Denmark (1), El Salvador (4), Finland (2), France (14), Germany (12), Guatemala (3), Ireland (1), Israel (7), Italy (9), Japan (4), Netherlands (3), New Zealand (7), Norway (2), Panama (29), Poland (1), Portugal (1), Republic of Korea (3), Spain (100), Sweden (2), Switzerland (1), Thailand (2), and the United Kingdom (71).

WHO is not recommending travel restrictions related to the outbreak of the influenza A(H1N1) virus.

Individuals who are ill should delay travel plans and returning travelers who fall ill should seek appropriate medical care. These recommendations are prudent measures which can limit the spread of many communicable diseases, including influenza.

Dengue Fever Worldwide update and reminder

Thu, 14 May 2009 23:00:21 +1000

While attention in the country turns to the dangers of swine flu an old and known disease continues to claim victims in many tropical and sub-tropical countries, namely dengue.

Official figures obtained in counties where the disease is most prevalent are usually under-estimates but in Brazil there have been more than 160,000 cases in the first quarter of the year and more than 13,000 people have contracted the disease this year in southern Vietnam. Sri Lanka has reported nearly 4000 cases and Cambodia just under 1000. There are continual reports of outbreaks in so many countries that the disease must be regarded as an ever-present danger in the tropics (including north Queensland)..

Spread by the daytime biting mosquito, there is no vaccine to prevent the disease. Travellers should use repellents containing DEET on exposed skin and Permethrin on clothing, bedding and mosquito netting and wear light-weight long sleeve shirts and pants when outdoors.

New Influenza outbreak - picture becoming clearer

Tue, 12 May 2009 10:13:44 +1000

The recent emergence of a new influenza A (H1N1) virus has caused great concern for public health authorities and in many communities around the globe. Initial reports appeared to be of a severe infection with a high death rate, and the global health responses triggered by WHO and others reflected a real concern tempered by the lack of quality information about the virus and the disease. This week, early reports are published by different scientific groups who have been able to commence the complex analysis of the characteristics of this new virus. The virus does appear to be much more transmissible than the usual seasonal influenza A strains, and so the potential for a global epidemic is quite real, and WHO are correct in their advice to Governments about planning for a pandemic situation. In a normal season, about 1 person in 10 who contacts a seasonal virus will develop the disease, but this new strain appears to be infecting about 1 person in 3. The severity of the illness, while not as bad as the 1918 pandemic (A H1N1), appears to be about the level of the 1957 pandemic A (H2N2) which is thought to have claimed many million lives worldwide. Currently, the virus seems to produce relatively mild symptoms, and several of the recorded deaths to date have been in persons with other chronic medical problems. While it appears from the genetic make-up of the virus the genes have derived from pig strains of influenza A, there is no clear evidence that the virus has caused disease in pigs, and it remains likely that this is simply a new genetic combination that has established a transmission opportunity directly into the human population. It is quite possible that future seasonal vaccine will also contain the antigens for this new strain.

Influenza A(H1N1) - WHO Update 25

Tue, 12 May 2009 10:12:44 +1000

As of 06:00 GMT, 11 May 2009, 30 countries have officially reported 4694 cases of influenza A(H1N1) infection.

Mexico has reported 1626 laboratory confirmed human cases of infection, including 48 deaths. The United States has reported 2532 laboratory confirmed human cases, including three deaths. Canada has reported 284 laboratory confirmed human cases, including one death. Costa Rica has reported eight laboratory confirmed human cases, including one death.

The following countries have reported laboratory confirmed cases with no deaths - Argentina (1), Australia (1), Austria (1), Brazil (8), China (2, comprising 1 in China, Hong Kong Special Administrative Region, and 1 in mainland China), Colombia (3), Denmark (1), El Salvador (4), France (13), Germany (11), Guatemala (1), Ireland (1), Israel (7), Italy (9), Japan (4), Netherlands (3), New Zealand (7), Norway (2), Panama (15), Poland (1), Portugal (1), Republic of Korea (3), Spain (95), Sweden (2), Switzerland (1) and the United Kingdom (47).

WHO is not recommending travel restrictions related to the outbreak of the influenza A(H1N1) virus.

Influenza A(H1N1) - WHO update 24

Mon, 11 May 2009 12:49:54 +1000

As of 07:30 GMT, 10 May 2009, 29 countries have officially reported 4379 cases of influenza A(H1N1) infection.

Mexico has reported 1626 laboratory confirmed human cases of infection, including 45 deaths. The United States has reported 2254 laboratory confirmed human cases, including two deaths. Canada has reported 280 laboratory confirmed human cases, including one death. Costa Rica has reported eight laboratory confirmed human cases, including one death. The following countries have reported laboratory confirmed cases with no deaths - Argentina (1), Australia (1), Austria (1), Brazil (6), China, Hong Kong Special Administrative Region (1), Colombia (1), Denmark (1), El Salvador (2), France (12), Germany (11), Guatemala (1), Ireland (1), Israel (7), Italy (9), Japan (4), Netherlands (3), New Zealand (7), Panama (3), Poland (1), Portugal (1), Republic of Korea (3), Spain (93), Sweden (1), Switzerland (1) and the United Kingdom (39).

WHO is not recommending travel restrictions related to the outbreak of the influenza A(H1N1) virus.

Individuals who are ill should delay travel plans and returning travelers who fall ill should seek appropriate medical care. These recommendations are prudent measures which can limit the spread of many communicable diseases, including influenza.

First Australian swine flu tested positive

Mon, 11 May 2009 12:48:10 +1000

The first Australian to test positive for swine flu has been identified in Queensland, but she is no longer infectious.Four other persons being tested for the virus have returned negative results, health authorities say. Officials say there have been no more cases of swine flu in Queensland after Australia's first case was confirmed in Brisbane this morning.

A New South Wales woman, aged in her 20s tested positive after she flew into Brisbane on a flight from Los Angeles on Thursday.Queensland Health says it is unlikely she was infectious when she boarded the flight in the US because she returned a "weak positive" test for the disease.

The woman had had a mild infection while overseas, and essentially is non-infectious and already in the normal recivery stage of her illness. This means that she is not a risk to other persons, and unable to infect other people.

Federal Health Minister Nicola Roxon says the woman had fully recovered by the time she returned to Australia. As a precaution Ms Roxon said authorities were contacting other passengers who were on the woman's flight from Los Angeles.

Influenza A(H1N1) - WHO update 23

Sun, 10 May 2009 13:34:49 +1000

As of 06:00 GMT, 9 May 2009, 29 countries have officially reported 3440 cases of influenza A(H1N1) infection.

Mexico has reported 1364 laboratory confirmed human cases of infection, including 45 deaths. The United States has reported 1639 laboratory confirmed human cases, including two deaths. Canada has reported 242 laboratory confirmed human cases, including one death.

The following countries have reported laboratory confirmed cases with no deaths - Argentina (1), Australia (1), Austria (1), Brazil (6), China, Hong Kong Special Administrative Region (1), Colombia (1), Costa Rica (1), Denmark (1), El Salvador (2), France (12), Germany (11), Guatemala (1), Ireland (1), Israel (7), Italy (6), Japan (3), Netherlands (3), New Zealand (5), Panama (2), Poland (1), Portugal (1), Republic of Korea (3), Spain (88), Sweden (1), Switzerland (1) and the United Kingdom (34).

WHO is not recommending travel restrictions related to the outbreak of the influenza A(H1N1) virus.

Individuals who are ill should delay travel plans and returning travelers who fall ill should seek appropriate medical care. These recommendations are prudent measures which can limit the spread of many communicable diseases, including influenza.

Influenza A(H1N1) - WHO update 22

Sat, 9 May 2009 21:53:16 +1000

As of 16:00 GMT, 8 May 2009, 25 countries have officially reported 2500 cases of influenza A (H1N1) infection. Mexico has reported 1204 laboratory confirmed human cases of infection, including 44 deaths. The United States has reported 896 laboratory confirmed human cases, including two deaths. The following countries have reported laboratory confirmed cases with no deaths - Austria (1), Brazil (4), Canada (214), China, Hong Kong Special Administrative Region (1), Colombia (1), Costa Rica (1), Denmark (1), El Salvador (2), France (12), Germany (11), Guatemala (1), Ireland (1), Israel (7), Italy (6), Netherlands (3), New Zealand (5), Poland (1), Portugal (1), Republic of Korea (3), Spain (88), Sweden (1), Switzerland (1) and the United Kingdom (34). WHO is not recommending travel restrictions related to the outbreak of the influenza A(H1N1) virus. Individuals who are ill should delay travel plans and returning travelers who fall ill should seek appropriate medical care. These recommendations are prudent measures which can limit the spread of many communicable diseases, including influenza.

Influenza A(H1N1) - WHO update 20

Fri, 8 May 2009 10:54:53 +1000

As of 18:00 GMT, 7 May 2009, 24 countries have officially reported 2371 cases of influenza A (H1N1) infection. Mexico has reported 1112 laboratory confirmed human cases of infection, including 42 deaths. The United States has reported 896 laboratory confirmed human cases, including two deaths. The following countries have reported laboratory confirmed cases with no deaths - Austria (1), Canada (201), China, Hong Kong Special Administrative Region (1), Colombia (1), Costa Rica (1), Denmark (1), El Salvador (2), France (5), Germany (10), Guatemala (1), Ireland (1), Israel (6), Italy (5), Netherlands (2), New Zealand (5), Poland (1), Portugal (1), Republic of Korea (3), Spain (81), Sweden (1), Switzerland (1) and the United Kingdom (32).

Influenza A(H1N1) - WHO update 18

Thu, 7 May 2009 09:18:15 +1000

As of 16:00 GMT, 6 May 2009, 23 countries have officially reported 1893 cases of influenza A (H1N1) infection. Mexico has reported 942 laboratory confirmed human cases of infection, including 29 deaths. The United States has reported 642 laboratory confirmed human cases, including two deaths. The following countries have reported laboratory confirmed cases with no deaths - Austria (1), Canada (165), China, Hong Kong Special Administrative Region (1), Colombia (1), Costa Rica (1), Denmark (1), El Salvador (2), France (5), Germany (9), Guatemala (1), Ireland (1), Israel (4), Italy (5), Netherlands (1), New Zealand (5), Portugal (1), Republic of Korea (2), Spain (73), Sweden (1), Switzerland (1) and the United Kingdom (28). WHO is not recommending travel restrictions related to the outbreak of the influenza A(H1N1) virus. Individuals who are ill should delay travel plans and returning travellers who fall ill should seek appropriate medical care. These recommendations are prudent measures which can limit the spread of many communicable diseases, including influenza.

Another measles alert in WA

Tue, 5 May 2009 20:45:04 +1000

Two passengers on board an Emirates flight from Dubai to Perth last week have been found to be suffering from measles. The health department is actively tracing possible contacts. Measles is highly contagious and the disease can be communicated to others in the early stages before the development of a rash. Previously widely regarded as a relatively harmless "childhood illness" it is in fact a potentially very serious disease and anyone who does not have antibodies, either because of a previous infection or from immunisation is vulnerable. A previous alert in Perth resulted from measles acquired in Thailand by a returning Australian who had refused immunisation prior to travel, and another small outbreak arose from various contacts in a crowd attending meetings conducted by a visiting "guru." Measles immunisation is offered to all infants at age 12 months with a booster dose in adolescence. If there is doubt whether either of these two doses has been received then vaccination is strongly recommended. This applies particularly to anyone travelling to countries where the immunisation coverage is likely to be low, but these recent experiences in WA show that measles is easily imported and we need a high degree of immunity in the general population to prevent outbreaks.

Influenza A(H1N1) - WHO update 14

Tue, 5 May 2009 09:56:51 +1000

As of 18:00 GMT, 4 May 2009, 21 countries have officially reported 1085 cases of influenza A (H1N1) infection. Mexico has reported 590 laboratory confirmed human cases of infection, including 25 deaths. The United States has reported 286 laboratory confirmed human cases, including one death. The following countries have reported laboratory confirmed cases with no deaths - Austria (1), Canada (101), China, Hong Kong Special Administrative Region (1), Costa Rica (1), Colombia (1), Denmark (1), El Salvador (2), France (4), Germany (8), Ireland (1), Israel (4), Italy (2), Netherlands (1), New Zealand (6), Portugal (1), Republic of Korea (1), Spain (54), Switzerland (1) and the United Kingdom (18). It is considered prudent for people who are ill to delay international travel and for people developing symptoms following international travel to seek medical attention, in line with guidance from national authorities. Individuals are advised to wash hands thoroughly with soap and water on a regular basis and should seek medical attention if they develop any symptoms of influenza-like illness.

Influenza A(H1N1) - WHO update 10: Sat May 2nd

Sun, 3 May 2009 19:47:16 +1000

The situation continues to evolve. As of 18:00 GMT+1, 2 May 2009, 16 countries have officially reported 658 cases of influenza A(H1N1) infection. Mexico has reported 397 confirmed human cases of infection, including 16 deaths. The higher number of cases from Mexico in the past 48 hours reflects ongoing testing of previously collected specimens. The United States Government has reported 160 laboratory confirmed human cases, including one death. The following countries have reported laboratory confirmed cases with no deaths - Austria (1), Canada (51), China, Hong Kong Special Administrative Region (1), Costa Rica (1), Denmark (1), France (2), Germany (6), Israel (3), Netherlands (1), New Zealand (4), Republic of Korea (1), Spain (13), Switzerland (1) and the United Kingdom (15). Further information on the situation will be available on the WHO website on a regular basis. WHO advises no restriction of regular travel or closure of borders. It is considered prudent for people who are ill to delay international travel and for people developing symptoms following international travel to seek medical attention, in line with guidance from national authorities. There is also no risk of infection from this virus from consumption of well-cooked pork and pork products. Individuals are advised to wash hands thoroughly with soap and water on a regular basis and should seek medical attention if they develop any symptoms of influenza-like illness.

The origin of the recent swine influenza A(H1N1) virus infecting humans

Sun, 3 May 2009 19:46:06 +1000

Preliminary analysis of the genome of the new H1N1 influenza A virus responsible for the current pandemic indicates that all genetic segments are related closest to those of common swine influenza viruses. Preliminary analysis suggests at least 2 swine ancestors to the current H1N1, one of them related to the triple reassortant viruses isolated in North America in 1998. So far, the new strain has not been reported in pigs. It is not clear whether this is due to insufficient surveillance of the swine population or whether this virus has been generated in a very recent reassortment event.

7 Countries Have Confirmed Cases of Swine Flu

Thu, 30 Apr 2009 23:18:31 +1000

A total of 2 new swine flu cases were confirmed in Israel and as many as 11 in New Zealand, bringing the number of countries with confirmed cases to at least 7 on Tuesday [29 Apr 2009]. But all, with the exception of Mexico, said the patients were recovering or had been hospitalized with only mild symptoms, leaving health officials struggling to determine why the disease has killed only in Mexico. In Mexico, 20 fatalities have been confirmed, and the number of deaths considered likely to have been caused by the flu rose to 152, up from 149 on Monday [28 Apr 2009], according to Mexico's health minister. The number of people believed to be infected surpassed 1600. In the United States, the number of infections stood at 91 with 1 death ( a Mexican child) on 29th April. Given extensive human-to-human transmission, the World Health Organization (WHO) raised its global pandemic flu alert level on Monday [27 Apr 2009], but it recommended that borders not be closed nor travel bans imposed, noting that that the virus had already spread and that infected travelers might not show any symptoms. However, many countries are tightening border and immigration controls, and on Tuesday Britain advised against any nonessential travel to Mexico. Japan announced that it would no longer allow Mexican travelers to obtain visas upon arrival. The United States, France and Germany have also warned against nonessential travel to Mexico. Canada had done the same. Another 10 countries are investigating possible cases, including China and Russia, which were set to quarantine passengers suspected of having the flu. At least 9 countries in Asia were checking air passengers arriving from North America, and China was tightening land border checks as well. Hong Kong, Taiwan and Russia were set to quarantine passengers suspected of having the flu. Travel Doctor continues to advise that elective travel to Mexico be deferred, and that travel to other countries where infections have been observed be cautious by regular checking of situation updates. This is still an emerging issue, and frequent status changes may occur.

WHO raises Pandemic alert Level from 4 to 5

Thu, 30 Apr 2009 23:17:55 +1000

Based on assessment of all available information and following several expert consultations, Dr Margaret Chan, WHO's Director-General raised the current level of influenza pandemic alert from phase 4 to 5. She stated that all countries should immediately activate their pandemic preparedness plans. At this stage, effective and essential measures include heightened surveillance, early detection and treatment of cases, and infection control in all health facilities. Dr Chan said that this change to a higher phase of alert is a signal to governments, to ministries of health and other ministries, to the pharmaceutical industry and the business community that certain actions should now be undertaken with increased urgency, and at an accelerated pace. "I have reached out to donor countries, to UNITAID, to the GAVI Alliance, the World Bank and others to mobilize resources.I have reached out to companies manufacturing antiviral drugs to assess capacity and all options for ramping up production. I have also reached out to influenza vaccine manufacturers that can contribute to the production of a pandemic vaccine."

Swine Flu Update

Tue, 28 Apr 2009 21:31:19 +1000

As the threat from Swine flu evolves, WHO has increased the level of concern by declaring the current phase of preparedness at stage 4. This means the virus has the ability to cause infections in whole communities, and has the potential therefore to cause a pandemic. WHO do not recommend travel restrictions. Public health authorities around the world are implementing their pandemic plans and responding to the higher threat level. More than 140 deaths have been reported in Mexico amongst more than 1500 cases, and reports of confirmed milder disease have appeared from a number of countries around the world. Most of these are travellers who have been in Mexico, but almost none have had contact with pigs, indicating the person to person spread of the virus. Suspect cases are under surveillance in Australia, but no proven cases have occurred. While no formal travel restrictions are in place, it is generally considered sensible that travel to Mexico be deferred if possible at this time. WHO has recommended the development of a specific vaccine, but production would take several months to implement. The virus appears to be sensitive to the anti-viral agents oseltamivir and zanamivir, and these used early in the illness, or preventively for contacts of proven cases is recommended as current practice.

Influenza-like illness in the United States and Mexico

Mon, 27 Apr 2009 16:37:51 +1000

WHO- 24 April 2009 -- The United States Government has reported seven confirmed human cases of Swine Influenza A/H1N1 in the USA (five in California and two in Texas) and nine suspect cases. All seven confirmed cases had mild Influenza-Like Illness (ILI), with only one requiring brief hospitalization. No deaths have been reported. The Government of Mexico has reported three separate events. In the Federal District of Mexico, surveillance began picking up cases of ILI starting 18 March. The number of cases has risen steadily through April and as of 23 April there are now more than 854 cases of pneumonia from the capital. Of those, 59 have died. In San Luis Potosi, in central Mexico, 24 cases of ILI, with three deaths, have been reported. And from Mexicali, near the border with the United States, four cases of ILI, with no deaths, have been reported. Of the Mexican cases, 18 have been laboratory confirmed in Canada as Swine Influenza A/H1N1, while 12 of those are genetically identical to the Swine Influenza A/H1N1 viruses from California. The majority of these cases have occurred in otherwise healthy young adults. Influenza normally affects the very young and the very old, but these age groups have not been heavily affected in Mexico. Because there are human cases associated with an animal influenza virus, and because of the geographical spread of multiple community outbreaks, plus the somewhat unusual age groups affected, these events are of high concern. The Swine Influenza A/H1N1 viruses characterized in this outbreak have not been previously detected in pigs or humans. The viruses so far characterized have been sensitive to oseltamivir, but resistant to both amantadine and rimantadine. It is not protected against by the current seasonal influenza vaccine. The implication for travellers at this stage is that travellers should be alert to this emerging threat, and report any influenza-like illness following travel in the area. Tamiflu is an appropriate prevention for those with contact with proven cases, or where an influenza-like illness occurs and no immediate medical assessment is available.

New Japanese Encephalitis Vaccine available - April 2009

Mon, 27 Apr 2009 16:37:17 +1000

The new vaccine is now available in Travel Doctor-TMVC clinics around Australia. It involves two vaccinations of JESPECT vaccine , one month apart, and is licenced in Australia for people at risk of the disease and who are 18 years and older. Australia is the first country to get this new technology vaccine, and Travel Doctor-TMVC is the national provider of the vaccine in our state-of-the-art travel medicine clinics.

Latest from HSA's Pulse magazine

Mon, 20 Apr 2009 21:46:36 +1000

Implementing successful drug & alcohol plans. Travel News: The Scouts got it right - be prepared. HSA expands network Read these and more stories from the Autumn 2009 edition here: http://www.hsagroup.com.au/about_us/pulse-09-autumn/pulse-landing-page.htm

HSA merger to transform Medibank Private

Wed, 1 Apr 2009 00:00:00 +1000

Medibank Private and Health Services Australia (HSA) formally merged on 1 April 2009 The integration of the two organisations marks the next step in Medibank Private's transformation from a single product insurer to a broader health company. Through HSA, Medibank Private will offer occupational and travel health services to government and corporate Australia , including health assessments, workplace health and injury prevention, rehabilitation case management and return to work programs. HSA will also enable Medibank Private to accelerate the development of its own preventative and health management programs, building on the expertise acquired through the purchase of Wollongong based health fund, ahm, in late 2008. Medibank Private Managing Director, George Savvides, said the HSA integration represents a major milestone in Medibank Private's move to transform the company into an integrated health services and insurance group. "Our vision is for Medibank to become Australia 's leading provider of private health insurance and health solutions, and HSA is a major component of this plan. We are moving from the traditional health insurance role of passive payer , to be an active participant in our member's health and wellbeing. "Through the expansion of HSA's Health for Industry and Work Solutions businesses lines we can enhance our delivery of workplace health services to corporate Australia , while our Travel Doctor business will provide direct consumer access to quality healthcare. "With the merger of HSA, are now in a position to work toward our objective of improving the health of our 3.5 million members," Mr Savvides said. HSA Chief Executive Officer, Stan Macionis, said the merger would enhance both companies ability to meet customers needs. "HSA and Medibank Private have a long-shared interest in health services for industry. The synergies created in this merger will allow the strengths of both to come together to create Australia 's leading corporate health service company. "It will allow HSA to develop a greater range of services for our corporate clients, and to bring our capabilities to the broader community. "We are also excited to play a role in enhancing Medibank's preventative and health management capability for its private health insurance business," Mr Macionis said. Apart from growing its health services business, Medibank Private is also determined to take pressure off premiums and better meet the needs of its members in its core private health insurance business. "Healthcare is always going to be an expensive business, but Medibank must help keep private health insurance premiums affordable by making sure we operate as efficiently as possible. That is why we are investing in our iMed automated claims system, and in achieving integration with Medicare's eClipse claiming system," Mr Savvides continued. "Importantly, we are also working to improve our customer service to guarantee it meets member expectations. This includes the introduction of a new, flexible retail centre staffing system, ensuring our retail staff are available when members want them," he said. Specific initiatives include moving store openings from 9am to 10am when traffic is minimal, and changing staff hours to make more customer service officers available at peak times. Retail centres will become cashless, and functions will also be streamlined to allow retail staff to deal with complex member needs by simplifying processes and removing non essential activities. ENDS For further information please contact: James Connors Tel: 03 8622 5163 | Mob: 0433 992 677 | email: james_connors@medibank.com.au

Australian authorities approve flu pandemic vaccine

Fri, 27 Mar 2009 00:00:00 +1100

Australian health authorities have approved Sanofi Pasteur's influenza vaccine for use in the event of a pandemic. Emerflu has been authorised for marketing by the Australian Therapeutic Goods Administration based on a review of clinical trials evaluating the safety and efficacy of the treatment. Wayne Pisanco, president and chief executive of Sanofi Pasteur, the vaccines division of Sanofi-Aventis, says the approval is a "new milestone" in the preparation for a flu epidemic. "Sanofi Pasteur aims at contributing to the efforts of World Health Organization, Australia and other countries around the world to safeguard human health in the event of an influenza pandemic," he adds. http://www.hayspharma.com/news/regulatory-affairs/australian-authorities-approve-flu-pandemic-

Indian officials act on contaminated equipment

Tue, 17 Mar 2009 00:00:00 +1100

After an outbreak of hepatitis B in Gujarat state that reportedly killed at least 70 people and left about 240 others infected with the virus officials have seized hundreds of tons of recycled medical equipment and arrested more than 100 medical scrap dealers and 22 doctors over the past week. Two of the arrested doctors in the town of Modasa in Sabarkantha district, the centre of the epidemic, were charged with culpable homicide after it was learnt that some victims had been treated in their clinic. The doctors -- father and son -- had used the same syringes and needles on multiple patients, police said. Investigators found that medical waste pickers collected used needles and other equipment from hundreds of private hospitals, thousands of doctors and some government hospitals and then sold them to underground recycling gangs who traded in them. Hepatitis B is preventable with immunisation but two injections 4 weeks apart are needed so travellers should not leave medical consultation too late. It is also worth considering taking one of our Travel Doctor syringe packs which could be used should the need for an injection occur while travelling.

Swiss authorities contemplate compulsory measles vaccination

Mon, 23 Feb 2009 00:00:00 +1100

A conference of Cantonal Health Directors (cantons are responsible for outbreak control measures) recommended health authorities study and "seriously consider" mandatory vaccination against measles if current methods did not stop the disease spreading. The group says the spread of measles in the country has reached worrying levels and runs counter to World Health Organization (WHO) targets. Last year Switzerland experienced its worst measles epidemic since mandatory reporting of the disease in 1999. A similar problem has been reported from France. Since the beginning of 2008 the country has been experiencing a resurgence of measles. It started in a religious traditionalist group with low coverage and secondarily spread to the general population. The spread is a consequence of insufficient vaccine coverage (less than 90 % at 24 months of age) which had led to the accumulation of susceptibles over the last years. More than 550 cases have been notified in 2008, the vast majority being unvaccinated. One measles-related death has already occurred this year.

Peanut butter recalls USA

Thu, 12 Feb 2009 00:00:00 +1100

The Food and Drug Administration in the USA has issued a list of peanut butter products that might be affected by Salmonella contamination. This list can be accessed on http://www.accessdata.fda.gov/scripts/peanutbutterrecall/index.cfm Many hundreds of Americans across most States have been affected by this food-realetd infection, which appears to have arisen from poor manufacturing technique. It is not currently thought to be arising in other countries.

Japanese Encephalitis risks in Nepal

Wed, 4 Feb 2009 00:00:00 +1100

In the light of extensive surveillance throughout the country since 2004 the World Health Organisation's office in Kathmandu has issued an updated recommendation concerning immunisation against Japanese Encephalitis (JE). JE, which is transmitted by mosquitoes and can cause a severe illness with a high death rate, is known to occur in jungle areas including the Terai in the rainy season but cases have also been identified in peri-urban and urban areas in the Kathmandu valley. Travelers to any part of Nepal who will be in the country during the rainy season from June to September should consider vaccination against JE. Travel Doctor-TMVC clinics will have the appropriate vaccination available and will continue to monitor and advise on the situation.

New Japanese Encephalitis Vaccine Available

Mon, 2 Feb 2009 00:00:00 +1100

JESPECT, a vaccine prepared from inactivated Japanese Encephalitis (JE) virus, has been approved by the Australian Therapeutics Goods Administration (TGA) and is marketed here by Commonwealth Serum Laboratories. For the past couple of years, since the previously approved vaccine became unavailable, there has been an unmet need for travellers at risk. Clinics have been able to acquire very limited supplies of unregistered vaccine by application to the TGA on an individual "as- needs" basis. This cumbersome and unsatisfactory state of affairs has now been resolved by the introduction of the new vaccine. JE is a virus disease transmitted by mosquitoes mostly prevalent in rural areas of Asia (although small outbreaks of the disease have occurred in the Torres Straits islands and northern Queensland). Infection usually produces few symptoms but sometimes the virus can affect the brain resulting in a high possibility of death or brain damage. The risk to short-term tourists is very small indeed and vaccination is usually only needed for long-term travellers to, or resident in, areas of high prevalence in Asia. Immunisation with JESPECT involves two injections at four weeks' interval, is 99% effective, and produces only minor side-effects. Travel Doctor-TMVC clinics expect to have stocks available during March 2009. For further information please contact a Travel Health professional at a Travel Doctor-TMVC clinic.

Australia Helps Fund Bali Rabies Battle

Thu, 29 Jan 2009 00:00:00 +1100

Since the confirmation in December that four people had died in the previous month from rabies on Bali public health authorities have carried out mass vaccinations of dogs. Press reports indicate that Canberra has provided funds to support the campaign which so far has vaccinated more than 24,000 dogs. Some 1000 strays have also been put down. As advised in our Health Alert of 15th December any animal bite or possible rabies exposure should be managed appropriately with post-exposure prophylaxis (PEP), which consists of the administration of rabies vaccines on days 0,3,7,14,28 and the use of rabies immunoglobulin in those people who are not previously immunized; only 2 booster doses of vaccine are needed in those who are already vaccinated. Vaccinations against rabies are available at Travel Doctor-TMVC clinics, although are not generally recommended for short-term holiday stays.

Poliomyelitis Global Situation January 2009

Wed, 21 Jan 2009 15:54:36 +1030

The first new case of poliomyelitis in 2009 has been reported from Pakistan in the Sahiwal district of Punjab province, with six other cases under investigation. The Global Polio Eradication Initiative (GPEI) has confirmed 118 cases during 2008 in all four provinces of the country compared with 32 cases in 2007, 40 in 2006 and 28 in 2005. This upward tend is disappointing and there are many reasons for this including the importation of carriers from Afghanistan, insecurity in areas where there are clashes with Taleban forces, diarrhoea causing failure in absorption of the oral vaccine and some loopholes in adequate immunisation coverage. Regional Director for the WHO Regional Office for the Eastern Mediterranean Dr Hussein A Gezairy this week travelled to Afghanistan and Pakistan, on a high-level visit for polio eradication. Dr Gezairy met with senior political leadership in both countries In Afghanistan the most recent case of poliomyelitis had onset of paralysis on 27 November. The total number of case for 2008 was 31 compared 17 in 2007. The latest National Immunization Days were officially launched on 11 January by HE President Hamid Karzai Pakistan and Afghanistan are among the four countries where poliomyelitis is still endemic the others being India and Nigeria. In India the total number of cases for 2008 was 551 whereas the total for 2007 was 874.The two most recent cases (from Uttar Pradesh and Punjab) had onset of paralysis on 18 December. Western Uttar Pradesh had been free of indigenous poliovirus infection for nearly 18 months, before being re-infected in mid-2008 from Bihar. The case in Punjab state is from a migrant labour group underscoring the importance of fully implementing the targeted strategy of reaching these populations in states with a large number of migrant labourers (ie Punjab, Gujarat, Maharashtra, Delhi). The next immunisation round will be launched on 1 February. Monovalent oral polio vaccine type 1 (mOPV1) will again be used in Bihar, Uttar Pradesh and key re-infected areas, and trivalent OPV in the rest of the country. In Nigeria the total number of cases for 2008 was 788. The most recent case, from Lagos, had onset of paralysis on 13 December.The next nationwide Immunization Plus Days originally scheduled for 24-27 January have been postponed by one week. The activities will now be launched on 31 January, using monovalent OPV type 3 (mOPV3). Reports for 2008 in countries where poliomyelitis has re-emerged are listed below: Angola 27 An SIA schedule for the first half of 2009 is currently being discussed, including the possibility of conducting four NIDs in February, March, May and June. Benin 5 Burkina Faso 5 Chad 34 Ghana 8 Mali 1 Niger 15 Togo 3 Outbreak response activities throughout these countries is ongoing from January to March, including planned seven-country synchronized cross-border campaigns in February and March (in the six re-infected countries and Côte d'Ivoire). The risk of further circulation or additional importations into these western African countries depends fully on the quality of supplementary immunization activities in Nigeria and of the outbreak response activities in the re-infected countries themselves. Central Africa Republic 2 .Immunization campaigns planned for 26 January (measles campaign to which trivalent OPV will be added) has been postponed by one week. The activity was originally supposed to have taken place in December. Democratic Republic of Congo 5 The most recent case had onset of paralysis on 18 October .A second-round mop-up with mOPV3 in the south (Kasai Occidental) will be conducted on 20 January, following an initial mop-up in December, in response to the recently-confirmed case in the province. In the east of the country, outbreak response with mOPV1 is continuing, with the next campaigns planned for early February. Ethiopia 2. OPV was added to a staggered measles campaign throughout December. The campaign continues to the end of January. Nepal 6. Nepal remains at risk of importations from neighbouring India. Nationwide campaigns are planned for February and March. Sudan 26 from two countries (one WPV3 from West Darfur, Sudan; and 25 WPV1 from the southern Sudan/western Ethiopia cross-border area) Further activities are tentatively scheduled nationwide in both northern and southern Sudan in February and March. Immunization campaigns are currently underway in southern Sudan, using mOPV1. Increasing access to all populations (living in remote areas or areas of insecurity) remains the overriding challenge. Myanmar and Somalia,infected in 2007, reported no cases in 2008

Dangerous Jellyfish not confined to Queensland.

Thu, 15 Jan 2009 15:48:37 +1030

Australians will be familiar with the warning signs on North Queensland beaches about box jellyfish, together with the swimming nets and the bottles of vinegar tied to strategically placed poles for emergency treatment of jellyfish stings. A December report over ABC radio is a reminder that the jellyfish which has become so well known to Queenslanders in the summer months is not confined to Australian waters. Following intense efforts by the father of an Australian child who had a near fatal sting from a box jellyfish when swimming in the ocean off Koh Mak , Thai officials have issued warnings about the threat to bathers in the Gulf of Thailand. The Australian Government Smartraveller websitehttp://www.smartraveller.gov.au/ has a warning in its section on Thailand but not for any other country. In fact box jellyfish stings have occurred in the Philippines, Malaysia, Sarawak, Brunei, Sabah, the Solomon Islands, Papua New Guinea and in the US. In Thailand cases have been reported from Koh Samui, Koh Pha Ngan, Koh Phi Phi, Koh Lanta and Koh Mak. These occurrences are rare but they are potentially fatal. When jellyfish have been spotted it would be foolish to enter the water but they are not always easily seen. There is some evidence that when conditions are overcast and the sea is relatively still that is the time when the jellyfish are likely to be present, and although this may not be reliable it might be wiser not to risk sea-bathing under such conditions.

Urgent - New requirements for Australian visitors to the USA

Wed, 7 Jan 2009 15:47:33 +1030

Applicable from January 12, the Visa Waiver requirements for Australian passport-holders entering the United States will be changed. Currently the Visa Waiver Program allows eligible visitors from Australia and other participating countries to travel to the United States for business or pleasure for 90 days or less without first obtaining a visa. This Program is still in operation but under the new regulations such travellers must first obtain approval through the US' Electronic System for Travel Authorisation (ESTA). The ESTA website is at: https://esta.cbp.dhs.gov/. Prospective travellers will be required to provide basic biographic, travel and eligibility information online in order to receive authorisation prior to their departure. There is no charge to complete the application. You should expect to receive authorisation within a few minutes. However, you are advised to complete an ESTA as soon as you begin to plan your travel, and at least three days in advance, to avoid any last-minute delays. Travellers who do not have a valid ESTA on or after 12 January 2009 may be denied boarding, experience delayed processing or be denied admission at a United States port of entry. Once granted, electronic pre-clearance will be valid for up to two years and for multiple-entry visits to the United States. If you already hold a visa for the United States you do not need ESTA authorisation as this applies only to the Visa Waiver Program. The Australian Department of Foreign Affairs and Trade has details of the new entry requirements on its website at www.smartraveller.gov.au

Travelling with medications

Fri, 2 Jan 2009 15:46:52 +1030

The Minister for Human services has issued a press release reminding travelers overseas that drugs subsidised by the Pharmaceutical Benefits Scheme (PBS) can only be aen out of the country if they are strictly for personal use. Customs officers are authorized to inspect outgoing baggage for this purpose. Taking out PBS drugs not for personal use is regarded as exporting such drugs illegally and is subject to a fine of up to $5000 or up to two years imprisonment. It is wise for anyone taking out medications to have them in the original pharmacist's container properly labelled with the user's name. This should be backed by a letter from the prescribing doctor. Travel Doctor clinics will supply such a letter for our clients, included in the Health Guide booklet. This reminder applies of course only to Australian regulations and refers only to taking medications out of the country. Most prescribed medications for personal use will present no problems for tourists to most destinations. Restrictions usually will apply to drugs with potentially addictive components such as codeine, and some countries restrict the importation of psychoactive drugs; possession of anti-HIV drugs can result in refusal of entry into some countries. Experienced health professionals at TravelDoctor clinics can give some guidance on this issue but when in doubt information must be obtained from the consulate of the country you intend to visit.

Possible Rabies on Bali - Update

Tue, 16 Dec 2008 15:24:01 +1030

The reports of rabies cases on Bali, have been accepted by the public health authorities as being correct, it appears that laboratory confirmation has been done in Indonesia. We now consider that rabies exists on Bali, and any animal bite or possible rabies exposure should be managed appropriately with post-exposure prophylaxis (PEP), which consists of the administration of rabies vaccines on days 0,3,7,14,28 and the use of rabies immunoglobulin in those people who are not previously immunised, and only 2 booster does of vaccine in those who are already vaccinated. Vaccinations against rabies are available at Travel Doctor-TMVC clinics, although are not generally recommended for short-term holiday stays. Historically Bali has been considered rabies-free, but rabies is an extremely serious disease, and control efforts (vaccination of dogs) will need to be introduced. Travellers who experience an animal bite on the island of Bali, should wash the wound immediately and report the bite to medical services. In Australia, those bitten travellers should attend their closest Travel Doctor-TMVC clinic.

Malaria increase in tourists to Gambia

Wed, 10 Dec 2008 16:28:55 +1030

An increase in the number of cases of malaria among returning travellers from the West African state of Gambia has been noted by the surveillance groups TropNetEurop and GeoSentinel over the past month with a total of 39 cases including 2 fatalities and several patients in intensive care and on ventilators. It is surprising that so many travellers have been visiting a highly endemic area without chemoprophylaxis, which indicates that pre-travel advice has been insufficient. Gambia is a popular holiday destination for Europeans because of its good resorts and easy access. Despite the fact that it is a known malaria risk country many travelers think that a quick holiday e.g a "long week-end" does not carry much risk. Unfortunately it does. Travellers from areas further away such as Australasia are more likely to seek medical advice before going to countries in West Africa but those working in the UK and Europe may be tempted to take a break to a resort in Gambia. Medical advice before travel is essential. Some travellers had been advised to use chloroquine as a single drug prophylaxis, which has been obsolete in the Gambia for at least 15 years indicating that advice should be sought from specialised travel health professionals.

Safe Himalayan Trekking a Reminder

Mon, 10 Nov 2008 11:13:29 +1030

With an improvement in the political situation Nepal is beginning to see a welcome increase in the number of tourists. October and November offer the best weather conditions for trekking and climbing in the Himalayas but the French Embassy in Kathmandu has expressed concern at the fact that six fatalities have been reported since the end of September, five French citizens and one Iranian. Three of these deaths resulted from accidents but three were attributed to altitude sickness. Most Australasian tourists who undertake trekking in the Himalayas do so under the auspices of reliable tourist companies who impose strict standards of safety but there remain a number of more adventurous climbers who prefer to "do their own thing" hiring guides, who may or may not be reliable, on the spot. Both types of tourist would be well-advised to discuss their plans with experienced health professionals at a Travel Doctor-TMVC clinic before embarking on what is a highly exciting but potentially hazardous adventure

An unlikely but possible blessing from bedbugs

Mon, 10 Nov 2008 11:13:10 +1030

Researchers at the University of Sheffield in the UK have reported to a conference of the Royal Entomological Society on a unique "immune" organ in female bedbugs which may yield some answers in the understanding of biological defense reponses. Speculatively and hopefully this might ultimately lead to techniques for preventing infections such as sexually transmitted disease or even mosquito-borne disease like dengue or malaria. The organ has been known to entomologists for a couple of centuries but its function has been unknown until current research showed it to be a sort of reservoir of white blood cells acting as a first line of defense against micro-organisms Such an organ has not been found elsewhere and has apparently evolved to protect female bedbugs from being infected by a mating male. The violent method of fertilisation used by the male bedbug whereby the penis acts like a dagger and stabs the female randomly is not unique to bedbugs - it also occurs in some arachnids where the male has to act quickly to avoid being attacked and consumed by the female, but the unsanitary conditions in which bedbugs flourish means that this somewhat strange reproductive act would be just as likely to convey potentially fatal infection to the female as it would to fertilise her eggs. The "immune organ" reduces mortality. Futuristically knowledge about bedbug defenses may one day lead to reduced human mortality.

Let the buyer beware A warning from Hong

Tue, 19 Aug 2008 08:47:42 +0930

Standard medications and even prescription drugs are widely available, and often cheaper, from unlicensed (and even from some licensed) purveyors in many overseas destinations, and also via the Internet. However, time and again we have reports of sub-standard drugs being purchased by travellers and the World Health Organisation has repeatedly warned about the trade in counterfeit drugs. (See for instance the posting on this site of 13th May). Of equal importance as a potential danger is the inclusion of unusual or dangerous ingredients in a preparation, unbeknownst to the customer. An example of this is a herbal preparation for treatment of arthritis which contains cortisone. A further example has recently come to light in an alert from the Hong Kong Department of Health about a preparation - Nangen Zengzhangsu - sold for erectile dysfunction which contains an ingredient used for the treatment of diabetes. This could lead to a life-threatening situation of low blood sugar. Travellers must not rely on obtaining safe and reliable medication overseas so it is best to take sufficient supply of prescribed drugs for the duration of travel. To cater for the treatment of common ailments associated with travel the Traveldoctor-TMVC clinics have a range of prepared kits designed to suit the type and duration of your itinerary as discussed with the clinic doctor who can also provide a prescription for any necessary preparation not included in a kit.

Is First World Food Hygiene always First Class?

Mon, 18 Aug 2008 08:46:19 +0930

When visiting "Western" countries like in Europe and Nth America, can we just assume that all food is safe to eat? Quite simply the answer is ‘No, not always.' The developed nations rely on a sophisticated public health service together with widespread public knowledge of the principles of food hygiene to protect consumers. But consider the number of outbreaks of Salmonella food poisoning reported in the press in the USA and Europe. Often this occurs inadvertently somewhere along the chain of food production, preparation and presentation or when problems with storage and preparation occur at the point of consumption. More concerning , however, is a report from France earlier this month where the Ministry of Agriculture and Fisheries stated that one in four cafes, snack bars and seafront restaurants in tourist hotspots across France are breaking hygiene rules or serving food unfit for consumption, thirty-seven establishments were shut down altogether, for failing to meet basic hygiene and food conservation rules, and allowing staff to work in dirty clothes. Such reports emphasise the fact that travel to Europe or other "developed" countries is not necessarily hazard free. This is consistent with our travellers' reports of the rate of diarrhoeal illness while visiting Europe, and the reason we have developed our special "Tour" medical kit. It reminds travellers that a pre-travel consultation at a Traveldoctor-TMVC clinic is a wise precaution for any destination overseas.

Kokoda trail is not a walk in the park

Thu, 14 Aug 2008 08:45:32 +0930

Following the track of the World War II Australian armed forces across the Owen Stanley ranges in Papua New Guinea has become a popular adventure. There are a variety of tours organized by a variety of agents and most – but not all - of the organisers arrange for some form of preparatory instruction on risks and precautions. A recent news item describing the rescue by US Navy helicopter of an Australian hiker, reportedly unconscious from a low blood sodium level, from a remote village on the track does illustrate the fact that are definite health risks in undertaking the tour. The journey is a strenuous one and apart from muscle and joint problems dehydration is a major challenge, but replacement of lost fluids with plain water only is not good enough without replacement of salt lost as well. At Traveldoctor-TMVC clinics our experienced health professionals can discuss this and all other related issues and problems posed by walking the Kokoda trail as well as providing the necessary immunizations and antimalarials. Traveldoctor-TMVC also has a Fact Sheet on the Kokoda Trail available on this website under Frequently Asked Questions in the Personal Traveller section Walking the Kokoda trail is a great adventure. It provides an understanding of an important part of Australian history. Let us help you prevent it becoming a part of your personal medical history.

AIDS infection linked to parasites

Sat, 2 Aug 2008 08:44:44 +0930

In an article published by the Public Library Of Science journal researchers have shown that experimental animals infected with the schistosomiasis parasite have a very much greater chance – 17 times greater than animals without the parasite - of being infected if subsequently exposed to the HIV/AIDS virus. These results go some way to explaining the ease and rapidity with which AIDS has spread in African countries where a high percentage of the population carry the schistosoma parasite. Schistosomiasis is disease caused by a parasite in water which can penetrate the unbroken skin or mucous linings of humans. Water becomes infected by contamination with urine or faeces and the parasite is conveyed through an intermittent stage carried by snails. Most of the waterways and streams in Africa are infected and although there is a treatment for individuals infected re-infection by re-exposure is more common than not in the local population. Most travelers who have acquired schistosomiasis have done so by swimming in Lake Malawi or similar waterways. Infection only occasionally produces early symptoms and diagnosis can be made by examination of urine or faeces, or by demonstrating antibodies in the blood. Although treatment is simple it is not always 100% effective and it is much better not to risk being exposed to the infection while travelling. Prevention against HIV/AIDS involves not participating in unprotected sexual encounters and it would be a foolhardy traveler indeed who runs the risk of being exposed to both the schistosoma parasite and the AIDS virus, but this study suggests the possibility that parasite infections may have indirect and unpredictable effects on the defense mechanisms of the human body. If nothing else ts study reinforces the advice not to swim in freshwater streams, rivers or lakes in Africa (or southeast Asia were schistosomiasis also occurs).

Australians travelling to the Olympics- Health Preparation

Fri, 22 Aug 2008 08:43:57 +0930

There will be many Australians lucky enough to attend this year's Olympic Games in Beijing, and many of them will also travel to other parts of China. Getting prepared properly means thinking about your health, and a visit to your nearest Travel Doctor-TMVC clinic will be more than worthwhile. Accessing healthcare in China is both difficult and expensive, so good pre-travel preparation helps ensure Olympic visitors will enjoy their trip. Travellers with pre-existing medical issues can discuss the safe management of those conditions with our professional staff. Our clinics have the necessary medical information, vaccinations and travellers medical kits to ensure your trip is as safe and healthy as possible. Effects of air pollution, unsafe local water supply, bird-flu risk and certain food hazards can all be minimised by getting up-to-date advice and preparation at Travel Doctor-TMVC clinics. We recommend vaccination against hepatitis A and typhoid, as well as influenza. Travellers who will be staying for longer periods may need to consider vaccines for rabies, Japanese encephalitis and hepatitis-B. All these are safe and available through Travel Doctor-TMVC. We also strongly recommend travellers carry one of our custom medical kits that contain prescription medications and instructions for the management of common traveller's ailments such as traveller's diarrhoea. Malaria is not a major problem for China, so travellers Beijing and other Chinese cities will not need anti-malaria medications. Travellers doing extra travel to isolated parts of China should discuss that risk with our experts. All travellers to China should have good travel insurance, and copies of their travel documents. Go Aussies!

Olympics visitors must "Beware of the Dog"

Fri, 4 Jul 2008 16:34:38 +0930

Exotic diseases are unlikely for visitors to China for the Olympic Games. A report by the Centers for Disease Control and Prevention (CDC) in the USA and the GeoSentinel Surveillance Network finds that during the past 10 years dog bites were one of the more common health problems travellers face when visiting China. (The Geosentinel Surveillance Network is a rapid communication network set up by the International Society of Travel Medicine in which TravelDoctor-TMVC participates). Other common ailments were respiratory infections, skin problems, injuries and diarrhea, the report says. With an estimated 600,000 foreign visitors and athletes, and as many as 2 million Chinese attendees, expected at the 2008 Olympic Games in August, the report says respiratory illnesses, such as asthma and bronchitis, may be the most common ailment encountered. The most frequent ailments for travellers receiving post-travel medical care have been acute diarrhea and dog bites as well as injuries, like sprains and strains. There were no reported cases of malaria or dengue fever among travellers in this study. In an accompanying statement Dr. Nina Marano, chief of the CDC's Travelers' Health and Animal Importation Branch said: "Travelers need to be cautious about dog bites, as China has the second highest rate [second to India] of human rabies cases in the world." Rabies is entirely preventable by vaccination but the perceived constraints are the high cost of the vaccination course and the low risk to travellers. Nevertheless this report needs to be considered by potential visitors in discussion with a travel health professional together with the individual needs for other vaccinations.

Airline Air is Clean , Australian study

Fri, 4 Jul 2008 16:34:09 +0930

Direct and indirect studies over the years in Europe and America have shown that spread of infection through recirculated air in commercial airliners does not occur, provided filtration systems are working properly. A recent study by the Australian Transport Safety Bureau comes to a similar conclusion i.e the risk of catching an infection when travelling by plane is no greater than it is in any other crowded and confined space where so-called "droplet" infection occurs. Airports provide more opportunity for the spread of infection than airplanes. With the increase in international travel there is an increased risk of infection simply because of increased close contact in planes and other vehicles, in waiting areas, on conducted tours, in restaurants and so forth. This aspect of infection has been posted earlier on this website – see "Flu vaccine as Travel Vaccine" - but it is also wise to be sure that you are immune to such vaccine preventable illnesses as measles, mumps, rubella, whooping cough and chicken pox

Barrier Reef creatures may yield malaria drug

Fri, 4 Jul 2008 16:33:38 +0930

The Geneva-based Medicines for Malaria Venture (MMV) has named an Australian drug discovery project using marine invertebrates from the Barrier Reef as its 2007 Project of the Year. The MMV was established in 1999 as a non-profitmaking foundation dedicated to reducing the burden of malaria by discovering, developing and delivering new affordable antimalarials through effective public-private partnership. The Australian project is one being carried out by the Eskitis Institute at Griffith University and involves screening and testing thousands of molecules obtained from marine invertebrates such as sponges, sea slugs and sea anemones. Similar projects have been underway for many years by research institutes in Australia, Japan, the USA and many other countries not only for antimalarial properties but also for compounds that may have anti HIV or anticancer actions. Eskitis Institute researchers have identified a unique chemical structure that specifically targets and kills the malaria parasite but these encouraging results do not mean that a new drug has been found in sponges or sea slugs as implied in some recent newspaper items. A great deal of work has still to be done to meet the goal of the MMV which is to register a new antimalarial drug every five years with the first one before 2010.

Counterfeit or ineffective anti malarial drugs

Tue, 13 May 2008 14:47:36 +0930

This site has previously reported on the prevalence of counterfeit or sub-standard antimalarial drugs on the world market. The problem continues despite the well-intentioned attempts of various governmental regulatory bodies. A study in six sub-Saharan countries in the most malarious parts of Africa which has just (May 7)been published in the Public Library of Science Journal illustrates the seriousness the problem. A range of antimalarial drugs was procured from private pharmacies in urban and peri-urban areas in the major cities of these countries and tested to measure active pharmaceutical ingredient content against internationally acceptable standards. Overall 35% of drugs tested failed the tests. Interestingly although the main manufacturers of the tested drugs were African or Indian companies 24% of those that failed the tests originated from Europe. It is well known that antimalarial drugs can be obtained over-the-counter in many countries in Africa and Asia and many travellers make the decision to wait until they reach the country of destination before buying antimalarials without bothering to consult a doctor. Based on this study (which reinforces results from other previous studies)such travellers will stand a one in three chance of having no protection from malaria. This is too high a risk. It is much better to have reliable professional advice, and to obtain reliable antimalarial drugs if so advised, before departing for a country where malaria is prevalent.

Influenza Mythbusters

Wed, 7 May 2008 16:41:54 +0930

The Influenza Specialist Group (ISG) consists of medical and scientific specialists as well as professional and patient groups from around the country. It cooperates with state and federal governments in educational activities about influenza and in conjunction with other organisations runs the annual Influenza Awareness Program. The Program, launched in 1992, informs key audiences about the consequences of influenza and the importance of preventing and treating infection. In March 2008, the ISG commissioned Galaxy Research, an Australian market research company, to conduct an online survey of 18-64 year old Australians at-risk of complications arising from influenza infection. Regular assessment of this population's attitudes to influenza vaccination is important in order to measure attitude shift and the impact of educational activities on vaccination rates. In addition, by identifying their reasons for or against vaccination, barriers and enablers to vaccination can be identified and appropriately addressed. The full and detailed results of the survey have been released by the ISG and information on this can be obtained at www.influenzaspecialistgroup.org.au Here we reproduce the "Mythbusters" appendix to the report. Myth: Influenza is not a serious disease Fact: Influenza (commonly known as flu) is a highly contagious and potentially life-threatening disease. Influenza is not the same as the common cold and even young and healthy people may take two weeks or more to fully recover from the illness. Influenza causes an estimated 2,500 deaths, 18,000 hospitalisations and 300,000 GP consultations annually in Australia. Perhaps surprisingly, the number of deaths from influenza each year is similar to the number of Australian road traffic fatalities. Myth: Influenza vaccination can cause influenza Fact: The influenza vaccine does not contain any live viruses and therefore cannot cause the illness. Myth: The influenza vaccine is not effective Fact: In healthy persons under 65 years of age the vaccine is 70% - 90% effective. Furthermore, studies in older adults have convincingly shown that vaccination greatly reduces the number of cases of pneumonia, hospitalisation due to respiratory illness as well as total deaths occurring during an influenza season. Myth: The influenza vaccine causes serious adverse events Fact: Serious adverse reactions to the influenza vaccine are rare, with most common reactions being local redness and swelling at the injection site. Other mild symptoms including headache, mild fever and sore muscles may occur in a very small percentage of people vaccinated but are limited to 24-48 hours duration.4 Allergic reactions may occur in people with a severe egg allergy and such people should not receive the influenza vaccine. Myth: People do not need to get vaccinated if they are healthy Fact: Anyone can contract influenza and being fit and healthy does not protect against infection. For some people the result of an influenza infection will be lost income through days off work, but for those at high risk of developing complications from influenza, the results can be much more serious, including hospitalisation or even death. Myth: It is not necessary to get vaccinated against influenza every year Fact: Influenza viruses have a great capacity to mutate and change. In light of this, a new vaccine is made each year to protect against the current strains. In addition, immunity provided by the current influenza vaccines begins to fade after a year, so it is important to get vaccinated against influenza every year, regardless of vaccine strain changes. Myth: Vaccination against influenza is a waste of time and money Fact: Even healthy young people may take two weeks or more to fully recover from influenza and people falling ill commonly need to take time off work, which may result in financial hardship. Furthermore, falling ill with influenza might mean missing out on important life events, as people often cannot get out of bed for several days. Influenza vaccination is the best way to help protect against influenza infection and the vaccine can be easily and quickly administered by a GP or other vaccination provider.

Hazards of swimming or wading ; a reminder.

Thu, 17 Apr 2008 15:16:48 +0930

Lurking in fresh water streams and lakes, and in floodplains, there are health hazards from microscopic organisms. Many people are now aware of the possibilities of acquiring bilharzia (schistosomiasis) in Africa or SE Asia but there is another problem occurring in many countries (including Australia) the condition known as Weil's disease (and by many other local names such as canefield fever, 7 day fever, canicola fever etc.) - the medical term for the condition is LEPTOSPIROSIS.

Tuberculosis exposure and travel

Fri, 14 Mar 2008 15:31:46 +1030

Tuberculosis, the world-wide scourge of the Victorian age and early 20th century, has been reduced to a very low prevalence in many countries including Australia and New Zealand and in recent years it has come to be regarded as posing a negligible risk for tourists elsewhere

Measles and Soccer

Fri, 14 Mar 2008 15:31:21 +1030

This year's UEFA European Soccer Championship will be held in Switzerland. Health authorities there have issued a warning of increased risk of measles among the huge number of foreign visitors expected. From November 2006 to February 13, 2008, a total of 1,405 cases of measles were registered in Switzerland, including 1,106 cases in 2007 alone

Chikungunya fever and potential for Australian outbreak.

Fri, 14 Mar 2008 15:30:52 +1030

Chikungunya fever, first described in East Africa, is caused by a virus transmitted by Aedes mosquitoes. It is characterised by symptoms very similar to those of dengue fever and laboratory testing may be necessary to distinguish between the two.

Novel way to vaccinate

Fri, 14 Mar 2008 15:30:26 +1030

Drops under the tongue may be the way that vaccines are administered in the future according to research done at the University of Seoul in South Korea. We have known for many years that some drugs can be administered as drops or a spray under the tongue

Measles Vaccination Not Associated with Autism confirmed

Fri, 14 Mar 2008 15:26:29 +1030

A study, published in Archives of Disease in Childhood online this month , examined children aged 10 to 12 years who had previously received the Mumps/Measles/Rubella vaccine.

Spandex tights make long haul flying easier and safer

Fri, 14 Mar 2008 15:25:53 +1030

A study published in the Medical Journal of Australia on 21 January suggests that wearing graduated-compression tights significantly reduces ankle swelling on long-haul flights.

Meningits Epidemic Warning

Fri, 14 Mar 2008 15:25:29 +1030

Expert health forecasters have warned that an epidemic of meningococcal meningitis in the so-called "meningitis belt" in sub-Saharan Africa could be the worst in a decade.

Troublesome temporary tattoos

Fri, 14 Mar 2008 15:24:58 +1030

Holidays are times for relaxation – relaxation from work stresses, relaxation from social stresses, relaxation from conventional norms. Holidays are times when everyday behaviour frequently is left behind, when (for example) someone who would not think of being tattooed when at home decides decorate him/herself this way. - and being concerned about the possibility of acquiring Hepatitis B or even HIV infection from contaminated needles compromises with temporary tattoos

Study on DVT

Fri, 14 Mar 2008 15:24:33 +1030

Although the link between air travel and venous thrombosis was first noticed in the 1950s exactly how many people will develop this (and therefore the risk of potential life-threatening pulmonary embolism) after a long flight remains unknown. This information is needed so that travellers can make informed decisions about trying to reduce that risk by, for example, taking small doses of anticoagulant medicine before a flight.

Fake anti-malarials are everywhere

Fri, 14 Mar 2008 15:23:52 +1030

The East African newspaper has reported on the discovery of a counterfeit ring in Kenya dealing with artemisinin-based anti-malarials which has raised fears of the emergence of resistance by the malaria parasite against the only category of drugs that is fully effective against the killer fever.

Flu vaccine as travel vaccine?

Fri, 14 Mar 2008 15:23:17 +1030

The flu is always with us. For many years now the flu vaccine has been with us; so influenza is a vaccine-preventable disease. Admittedly the vaccine will not protect against the myriad other viruses that can be associated with coughs and sneezes, having to have annual vaccinations is a hassle and about one in ten people will have a feverish reaction to the vaccine.

Make Rabies histrory project

Fri, 14 Mar 2008 15:22:34 +1030

The Alliance for Rabies Control which was formed last year and is registered as a charity in the United Kingdom is promoting a world-wide rabies awareness day on September 8 this year. Human rabies is virtually 100% fatal and yet is entirely preventable by vaccination.

WHO releases study on travel and blood clots

Fri, 14 Mar 2008 15:19:23 +1030

The World Health Organisation on 29th June released results from Phase I of the WHO Research Into Global Hazards of Travel (WRIGHT) project The study showed that plane, train, bus or automobile passengers are at higher risk of VTE when they remain seated and immobile on journeys of more than four hours.