The latest news in Travel Medicine - antibiotic-resistant diseases, biting insects and more!
In November 2019, Dr Michael Oehley from the Waikato Travel Clinic attended the New Zealand Society of Travel Medicine Conference, where he caught up with all the latest research and news in the field of travel medicine. The top ten new research papers in travel medicine were reviewed, and the International Society of Travel Medicine's recent conference in Washington D.C. was also summarised. Here Dr Oehley shares some key learnings which are relevant to travellers:
1. There is no evidence that personal precautions prevent traveller's diarrhoea.
If you're going to get it, you're going to get it, I'm afraid! Most cases are caught at restaurants, so travellers are advised to stock up on treatments so that you can manage your symptoms when the 'Delhi Belly' or 'Montezuma's Revenge' strikes.
2. Mosquitoes aren't the only insects that bite.
Travellers would be wise to wear insect repellent all day, every day; and sleep under treated mosquito nets at night while in the tropics. This is not only to reduce the risk of contracting dengue, zika, malaria or other mosquito-borne diseases - but also to prevent bites from sandflies, ticks and fleas which can transmit illnesses like leishmaniasis, scrub typhus and the plague.
3. Intra-dermal rabies pre-exposure prophylaxis is safe and effective.
Increasingly the research is showing that the cheaper, quicker methods of administering the rabies vaccine before travel (such as the 2 x 2 I.D. doses one week apart, or the 3 x 1 I.D. doses across three weeks) are safe and efficacious. One study showed an effectiveness of 99.99% (3 failures in 37,000 patients), and patients given the 2 x 2 I.D. doses followed by one booster 1-3 years later had very high titres of antibody in their blood (showing high levels of immunity).
4. Japanese encephalitis is more common that you think.
Travellers spending more than a few weeks in popular tourist destinations such as Bali or Phuket need to think about getting the Japanese encephalitis vaccine ($367 for 2 doses one week apart). This disease is carried by water-dwelling nocturnal mosquitoes - and a lot of tourist resorts are nearby vast fields of submerged rice paddies - the perfect breeding ground for the Culex mosquito.
5. Climate change is driving the spread of tropical diseases.
As the planet's temperature appears to increase, so does the range of mosquitoes, fleas, ticks, insects, bats and other vectors of disease. Also, as human activity encroaches further on natural environments, so too do vectors come into increasing contact with humans. Travellers need to be aware of this, and plan appropriately by making an appointment to see your friendly travel doctor before venturing overseas. This includes the Pacific Islands, where zika, dengue, chikungunya, typhoid and hepatitis A are significant risks.
6. Multi-drug resistant typhoid fever is a growing problem.
Travellers to Pakistan, India, Bangladesh, Nepal and other parts of Asia are strongly recommended to get the typhoid fever vaccine prior to travel. There are increasing rates of antibiotic resistance in this disease, particularly in Pakistan and parts of Nepal and India. In some cases, typhoid is now resistant to every antibiotic used to treat it. Vaccination is the best prevention.
7. Air pollution is an issue in Asia.
Countries like India and China are having significant problems with air pollution, such as the crisis in Delhi presently. For patients with asthma, COPD, heart failure and other cardiorespiratory conditions, it is essential that you reconsider travel to large Indian or Chinese cities, or ensure that you take high quality particulate masks (available from hardware stores) to improve your breathing.
8. Most cases of malaria brought to New Zealand are from India or Africa.
One group of travellers that often does not seek advice from a doctor prior to travel are ex-pats heading 'home' to visit friends and relatives. Unfortunately, these travellers are the most likely to contract illness (perhaps because they don't take the risk seriously). Indian nationals and African nationals returning home to New Zealand are the two groups most likely to contract malaria, a potentially fatal parasitic disease. Wear insect repellent and take malaria chemoprophylaxis (tablets)!
If you are travelling and want to know more about the above issues in travel medicine, book an appointment with Dr Michael Oehley to get the most up-to-date, evidence-based pre-travel medical care. We'll make sure that you Travel Well.