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By Dr Eddy Bajrovic, Medical Director, Travelvax Australia.

There’s no substitute for travel vaccinations.
You can be fastidious about what you choose to eat and drink.
You can diligently apply insect repellent to ward off disease-carrying insects.
You can stay well clear of cute puppies or monkeys that might be carrying rabies.
But, as I tell patients during pre-travel medical consultations, those are measures you should take AS WELL AS having the travel immunisations recommended for you and your specific journey.
Why do travellers need a two-tiered approach – immunisation + prevention measures – to travel health?
Modern vaccines are undoubtedly more effective and last longer than ever. They are a cost-effective investment towards many years of healthy travel.
However, what a Hepatitis A injection, for instance, can’t guarantee is that you still won’t encounter it (or another food and water-borne disease-causing organism) during your travels, as careful as you might be about food and beverages choices, and personal hygiene. (Hep A is spread by the faecal-oral route and is very common in all developing countries.)
Any traveller who’s been vaccinated AND follows the safe food and water guidelines can be reasonably confident of avoiding infections – even in high-risk regions like Asia and Africa. 

 

Aussies love ‘riskier’ destinations

Taking steps to avoid the risk of illness while travelling is also important because not all travel diseases can be prevented through vaccination. For instance, there’s no vaccine for the mozzie diseases, malaria, dengue fever and Chikungunya fever (although there are vaccines being developed for all three) among others.
I make these points because I recently read the results of a survey of 1042 Australian travellers, which confirmed Asia – including Indonesia and India – as the most popular travel destination for Aussies. Two in every 3 of those surveyed had travelled to Asia in the past 5 years.
The fact is that Aussies visiting Asia, Africa and other developing regions of the world have a higher risk of contracting a food-, water- or insect-borne disease, according to health agencies like the World Health Organization and America’s Centers for Disease Control and Prevention.
Indeed, most of the average 600,000 malaria deaths each year occur in Africa, while the majority of cases of Hepatitis A, typhoid and measles that doctors see among Australian travellers were picked up in Asia.
It’s also a fact that as more Australians are travelling each year, more of them are returning home with diseases which could have been avoided through immunisation or by taking effective prevention measures – or both.

 

More travellers fly out, more diseases fly in

This week, I looked up the latest national statistics from the Australian government-run National Notifiable Diseases Surveillance System. Almost all of the diseases listed below were diagnosed in a returned traveller, or someone in contact with one: 

HEPATITIS A: There’ve been 161 cases to date this year – 4 less than last year’s 12-month total. In the previous 5 years (2007-2012) Australia averaged 283 cases – almost all ‘imported’ by or linked to travel. (It’s worth noting that in the decade from 1991-2000 we averaged a staggering 1975 Hep A cases a year. Many of those notifications occurred among Indigenous Australians, before a more inclusive national vaccination program in 2005 cut the number of local cases dramatically.)

MEASLES: Measles has been virtually eliminated in Australia and the 129 cases reported to date this year were either contracted during travel (the majority of recent ones in Bali) or resulted from contact with a traveller – often a family member or friend.

TYPHOID: To date this year 123 cases have been recorded – 1 less than the total for all of 2012. The average for the past 5 complete years is 115, whereas 10 years ago (1997-2002) the average was half that number (64 cases). The increase is due to the rising number of travellers visiting typhoid hotspots, such as India.

JAPANESE ENCEPHALITIS: There have been 4 cases this year, compared to 1 last year.

MALARIA: The 354 infections this year are all ‘imported’ cases – up on the 346 total for last year. (The figure is actually down on recent years: The 5-year average is 441 cases.)

DENGUE FEVER: A whopping 1653 cases already this year compared with 1541 in all of 2012. The 5-year average is 1098, reflecting an upsurge involving massive epidemics across virtually every tropical and many-subtropical region of the world.

CHIKUNGUNYA: This year, 120 travellers have returned to Australia with the infection compared to just 19 last year, highlighting the rising incidence of the disease in Asia and the Pacific.

RABIES: Between 2007 and 2011, an average 13 people a month returned home to face a period of worrying uncertainty and a long series of injections as part of post-exposure treatment for rabies. Of the 780 possible exposures in that time, 78.3% occurred in Southeast Asia, mainly Indonesia (47.6%). Of these, 95.2% occurred in Bali and mainly involved monkeys (49.4%) or dogs (35.8%). Only 4.0% of these unlucky Aussies were vaccinated against rabies prior to their exposure. 

 

Travellers lacking basic knowledge

The traveller survey, commissioned by pharmaceutical company Sanofi Pasteur, also revealed other disturbing findings and, frankly, some bizarre notions about travel health. For instance:
- Two thirds of the parents interviewed reportedly thought that simply being aware of what was safe and what wasn’t was enough to protect them and their family from getting sick overseas. Yet, 1-in-5 drank water straight from the tap, while around 50% said they brushed their teeth using tap water or ate food from street stalls.
- More than half (56%) of those aged 18-34 thought vaccinations were not required for Asia, while 47% believed there was no risk of illness.
- One third of these young travellers got their pre-travel health advice from travel companions or friends.
– 95% of those surveyed had no idea that the recommended time for a pre-travel medical is 4-6 weeks before departure. (Ideally, individuals and families should ideally see their GP or a travel medicine clinic at least 2 months before travelling to give vaccines sufficient time to offer full protection.)
I have to say that relying on a friend to learn what you might need to safeguard your health abroad is risky at best.
Unless they tell you to see a doctor – ideally one experienced in travel medicine – in plenty of time to receive the right immunisations and lots of tailored information on preventing illness and staying healthy overseas.
Now, THAT would be good advice.

Call Travelvax Australia’s travel health advisory service on 1300 360 164 (toll-free from landlines) for obligation-free, country-specific information on recommended immunisations, plus advice on avoiding food-, water- and insect-borne diseases. You can also book a one-stop, pre-travel medical appointment at your nearest Travelvax Australia clinic.

 

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