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Don Daeng & Mekong River

High on the list of up-and-coming tourist destinations for Australian travellers is the Lao People's Democratic Republic, or Laos. Now, it’s the varied and spectacular landscape and historic architecture that draw the tourists - the region is very popular with Europeans who tend to visit during their peak summer months. But not that long ago, Vang Vieng in the country’s north was popular with backpackers in search of a party. The picturesque town became (in)famous for the tragic deaths of young men and women who had taken to ‘zip-lining’ and ‘tubing’ down the Nam Song river while extremely inebriated. 

Laos is land-locked, sandwiched between Myanmar to the west, Thailand to the south-west, Cambodia to the south, China to the north and Vietnam to the west. Over two-thirds of the terrain is mountainous, crossed by the mighty Mekong River which produces spectacular waterfalls and rapids, especially during the May to October tropical monsoon season (annual rainfall ranges from 1,360mm in Luang Prabang to 3,700mm in the Bolaven Plateau). The chief arable regions, with rice as the main crop, are in the south-central plains of Savannakhét and Champasak provinces. Adjacent to the Cambodian border is Si Phan Don, an archipelago of 4,000 islands that sits in a 10km-wide stretch of the Mekong River – 3 of the islands are popular with tourists: Don Khet, Don Khon and Don Khong.

In an early kingdom established in what is now the province of Champasak, a temple complex was constructed which formed part of the ancient Khmer cultural landscape. This is Wat Phu and, like the structures near Siem Reap in Cambodia, it is made of sandstone that has been ornately carved to honour the deities and the rulers of the time. Both Hinduism and Buddhism have been followed at different times over the centuries. Now, around half of the Laotian population are Theravada Buddhists and the overwhelming majority of the remainder adhere to various Lao folk religions.

You can still find influences from the time when Laos formed part of the French Colonial Empire from the late 1800s until it gained self-rule in 1953. Baguettes and French restaurants are common in the capital Vientiane, but it’s the famous Laotian cuisine that is a big drawcard, featuring such delicacies as Khao Niaw (sticky rice), Sai Oua (Lao sausage) and Larb.

General health concerns are similar to those in other developing countries in the region.

Vaccinations for Laos

There are no REQUIRED (mandatory) vaccinations: Yellow fever is NOT a requirement, unless you arrive from an endemic country of Africa or South America.  
Updating your childhood vaccinations is considered ROUTINE before any overseas trip. Check with your GP and, if necessary update measles-mumps-rubella (MMR) , diphtheria-tetanus-pertussis, chickenpox, and polio. Also ensure you are protected against seasonal influenza, the most common vaccine-preventable illness among international travellers.
Heading the list of RECOMMENDED vaccinations is Hepatitis A, considered a moderate risk for all travellers, regardless of the length of stay or type of accommodation. Hepatitis B is especially relevant for young singles, frequent flyers, and those heading ‘off the beaten track’ where medical facilities are scant. There’s a moderate risk of typhoid in Laos and vaccination is recommended for even short stays, especially if planning to visit towns or villages. Cholera is not generally a risk in Laos. (Read about Rabies and Japanese encephalitis below).

Malaria and mozzies

Laos’ annual malaria data for 2014 showed that there had been 38,131 cases with 28 deaths. The capital Vientiane is the only area considered to be malaria-free and the mosquito-borne disease remains a SIGNIFICANT RISK in other areas of the country. America’s CDC ranks the overall malaria risk as ‘very low’ for travellers but warns that 65% of cases are the potentially fatal P. falciparum strain. (Adding a more dangerous dimension to the malaria risk is the multi-drug resistance that is now widespread along parts of the north-east and south-east borders.) 
Malaria medication: For Australians, the most commonly prescribed and effective anti-malaria chemoprophylaxis (started before potential exposure to prevent malaria and continued during your stay in the malarial area and for a period of time after leaving it) includes Doxycycline or Malarone. Ask your doctor which of these is most appropriate for you.
Whether or not you take medication to prevent malaria or treat it is a decision you should make after discussing your travel itinerary with a doctor, ideally one experienced in travel medicine. Your doctor will determine whether taking prevention medication or carrying a drug to treat malaria at the first sign of infection would be best for you, based on your itinerary, length of stay, and level of exposure.
Other reasons to pack repellent
Dengue fever infection is even more common than malaria in Laos, while its ‘cousins’, chikungunya and the Zika virus can occur there, too. All are spread by two species of day-time feeding mosquitoes, Aedes aegypti and Aedes albopictus. Unlike the mainly rural-dwelling mosquitoes that spread malaria, the Aedes mozzies are equally at home in the biggest cities or the smallest villages – anywhere, in fact, people live.
Two other mosquito-borne diseases that are present but much less common among travellers are lymphatic filariasis, a parasitic disease caused by thread-like worms, and Japanese encephalitis (JE). JE is thought to occur countrywide in Laos, with most human cases reported from June to September. However, JE is rare among travellers and vaccination is usually reserved for those spending an extended period in rural farming areas, those living in endemic areas, or those staying in locations where outbreaks are occurring.
BYO repellent and bed net
Effective insect repellents can be hard to obtain in Laos, so bring enough from home to last the duration of your stay. Some guesthouses and hotels don’t have mosquito nets either so, once again, if you plan to stay in budget accommodation, pack your own permethrin-impregnated net.
Beware other ‘bities’, too
Mozzie bites aren’t the only ones to be wary of. The rabies risk in Laos is rated ‘high’ although, as with Japanese encephalitis, vaccination is usually recommended for long-stay expats or those travelling in rural areas, especially if on bicycle tours, camping, or hiking etc. However we advise that you discuss rabies vaccination with your doctor, as at-risk bites are also reported in the first couple of weeks of travel.
Be prepared for traveller’s diarrhoea
The risk of traveller’s diarrhoea (TD) in Laos is rated ‘moderate’, which makes it important to follow the rules of personal hygiene – especially regular hand washing – and selecting the safer food and beverage options. TD often clears up without specific treatment, but it’s wise to keep oral rehydration fluids on hand to replace lost fluids and electrolytes. Travellers who pass three or more loose bowel motions in an eight-hour period accompanied by other symptoms of dysentery like fever, nausea, vomiting, abdominal cramps and blood in stools should consider taking a course of antibiotics. Ask about the appropriate medication and dosages during your pre-travel medical consultation. If diarrhoea persists despite therapy, see a doctor – the cause may be a parasitic infection. Learn more about traveller’s diarrhoea and how to avoid it

WHAT TO PACK

Insect repellent – Apply repellent containing an active ingredient, such as DEET (30-50% formulations for adults, or up to 30% for young children aged from 6 months), Picaridin, or oil of lemon eucalyptus when outdoors. Read more on avoiding biting insects
A treated bed net – Permethrin is an insecticide that is safe for humans, but kills insects that come into contact with material treated with it. You can buy a net that’s already treated or make up the solution and treat your net, clothing, hats etc.  
Sunscreen – To ward off the tropical sun’s UV rays, take a 50+ sunscreen and apply it to all exposed skin as directed when outdoors.
First-aid kit – In case of an accident, it’s reassuring to know you have a travel first-aid kit containing syringes, needles, sutures etc. that local medical personnel can use, along with basic first-aid items you might need from day to day. The standard of medical facilities in Laos is extremely limited, particularly outside Vientiane (Australia’s embassy has a medical clinic for nationals). Travellers are advised to avoid surgical procedures, (including dental work) due to the danger of hepatitis, HIV/AIDS and other infections from unsterile dental and medical instruments.
Finally, read more on the importance of comprehensive travel insurance, areas to avoid, and local conditions on Smartraveller, the Australian Department of Foreign Affairs’ website for Australian travellers. Warnings are in place for travellers to Xaisomboun province due to attacks in recent years and the department also advises against travelling by road between Vang Vieng and Luang Prabang, and from Kasi to Phou Khoun and Muang Nan.
Australia’s embassy in Laos is located at KM4, Thadeua Road, Watnak Village, Sissatanek District, Vientiane. Telephone: +856-353800 Facsimile: +856 – 353801 E-mail: This email address is being protected from spambots. You need JavaScript enabled to view it. Website: laos.embassy.gov.au
(In a consular emergency if you are unable to contact the Embassy you can contact the 24-hour Consular Emergency Centre on +61 2 6261 3305 or 1300 555 135 within Australia or +61 421 269 080 for SMS.)
For more expert, no-obligation advice on staying healthy on your next overseas trip, or to book your pre-travel medical consultation at a Travelvax Australia clinic, please call 1300 360 164 (toll-free for landlines).

 

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Australia has seen an increasing number of dengue notifications in recent years – the more-than-2,000 confirmed cases reported last year were the highest in 20 years. Of the 2129 notifications, around 1 in 4 were in adults aged between 25 and 34 years. So we are asking - Are Australian travellers putting themselves at risk because of the Aussie ‘you’ll be right, mate’ mind-set, or is it due to the YOLO (you only live once) attitudes of younger travellers? Or could it be a lack of awareness which is fuelling this increase in infection rates?

In a survey carried out on over 1,000 Australian travellers by the pharmaceutical company Sanofi, 40% of them admitted to a YOLO attitude when travelling. The survey also exposed a lack of homework before eating food from street vendors and security lapses through falling asleep outdoors. What’s more, over 40 % of travellers said they did get sick, 50% didn’t have the recommended vaccinations and more than 60% didn’t consult their GP or a travel medicine specialist clinic prior to travel!

But back to dengue fever…

Dr Cameron Webb, University of Sydney-based medical entomologist and clinical lecturer, said recently that ‘dengue fever cases were increasing globally and travellers are bringing the disease back to Australia’ as a result. Unfortunately, many popular holiday destinations are also prone to outbreaks of dengue. The opportunities to be infected are most certainly there: In June last year, there were 824,300 short-term resident departures from Australia and many of the top 10 tourist destinations (Indonesia, Thailand, Singapore, Fiji and India) are dengue endemic countries. Western Australia was in number one spot across the country last year with 533 dengue notifications - maybe that’s because cheap air fares to (dengue-affected) Bali make it a popular travel destination.

Dengue, like other mosquito-borne diseases caused by Zika and chikungunya viruses, is transmitted by Aedes aegypti and Aedes albopictus mosquitoes. The mosquito vectors are both aggressive day-time feeders that breed and bite in urban locations and prefer cool, shaded places. They are found in areas close to people, their favourite source of the blood meal the females need to lay eggs. 

While only about 25% of people infected with dengue viruses actually get symptoms, those that do fall ill can experience fever, headache, pain behind the eyes, rash, and severe aching of muscles, joints, and bones (and this is the reason why dengue also has another more evocative name, ‘breakbone fever’).

Dengue isn’t just a problem for travellers, it’s one of the most significant mosquito-borne viral diseases globally with a worldwide public health burden estimated at around 50 to 390 million infections, including dengue fever and the potentially fatal dengue haemorrhagic fever (DHF) and dengue shock syndrome (DSS). The mounting disease presence across the globe is believed to be due to climate change, the expansion of dengue vectors to new geographic regions, increasing human movement across borders, global trade and urban migration.

Our advice to avoid dengue?

Before you ask, there isn’t a dengue vaccine ... or at least not yet for tourists. A vaccine has been developed and is currently registered in 11 countries – but they are all countries with a significant dengue burden, and this is where the vaccine will be most useful. It is expected to reduce the levels of severe dengue illness and the resulting hospitalisations through its actions in the 9 to 45 years age group. 

For many travellers staying at major resorts, there will be mosquito control programs in place that substantially reduce the risks of dengue. Perhaps this is why fewer older Australian travellers are returning infected with dengue. However, even if staying in a resort with minimal risk, be aware that day trips to local villages or towns may bring with them a risk of exposure to mosquitoes, so take steps to avoid these bites.

Minimise mosquito bites and you reduce the risk of infection

Dr Webb says Australian travellers can reduce their risk of being bitten by following these measures:
– The mosquitoes that spread dengue viruses bite during the day. This means travellers must be actively avoiding mosquito bites during the day, not just in the afternoon and evening. Wearing loose, long-sleeved shirts and long pants outdoors together with topical insect repellents will provide the best protection.
–The most effective insect repellents are those containing DEET, Picaridin or extract of lemon eucalyptus oil. It is always best to take insect repellent with you from Australia as it may be difficult to find suitable formulations at your holiday destination. See here for the range of repellents that Travelvax stocks. 
– Where possible, ensure where you’re staying is air conditioned and has screened windows and doors.
– Get rid of any standing water around your accommodation, including pot plant bases and other containers that collect water.
– If you are using sunscreen, apply it first BEFORE your insect repellent.
– If you’re likely to be consistently exposed to insect bites, soak your clothing and bed net (if your room is not screened) with permethrin. This contact insecticide repels mosquitoes and other insects, and also kills them when they come in contact with the treated material. (Permethrin shouldn’t be applied directly to your skin.) Read more about permethrin and how to protect yourself against insect bites
– Mosquito coils and “plug-in” devices can also assist in reducing mosquito bites around your accommodation
The fewer times you get bitten, the lower the risk of infection. Don’t get bitten and there’s absolutely no chance at all.
No excuse for the lack of awareness now.

Did you know you can get no-obligation, country-specific advice on insect-borne diseases and other potential health risks of your next overseas destination by calling Travelvax Australia’s travel health advisory service on 1300 360 164 (free to landlines)?

 

Image: Dreamstime

 

Snow is falling along with the mercury as winter bites in the southern states of eastern Australia.
If you are heading for the snowfields, we’ve got some advice to keep you healthy and safe on the slopes.

1 - Invest in quality eyewear

Snow can reflect as much as 80% of the sun’s rays – much higher than the reflection off sand, water, or cement – and it comes into your eyes from all angles. The higher the elevation, the less atmosphere there is to filter out harmful UV rays.
Your snow eyewear should:
– Provide 100% protection against both UV-A and UV-B radiation.
– Fit your face snugly from above your eyebrows to the middle of your cheeks
– Wrap around your face so UV rays and wind can’t reach your eyes from the side.
Eyewear that meets Australian Standard AS1067 is a guarantee that it will block at least 95% of UV radiation. Glacier goggles (or glacier sunglasses) are the best option: They fit like sunglasses but screen out light from the sides. Your optometrist can also fit prescription lenses.

2 – Be aware of snow blindness

Goggles also protect you from a very painful corneal injury (UV solar keratopathy or ‘snow blindness’). Essentially it is sunburn of the eye’s surface.
Snow blindness feels like sand or grit in your eyes. Its symptoms include watering of the eyes, bloodshot eyes, and uncontrollable twitching of the eyelid. If you experience the symptoms you should:
– Remove contact lenses if you’re wearing them.
– Lie down in a darkened room.
– Cover your eyes with a cool compress or dark cloth.
– Refrain from rubbing your eyes.
Happily, almost all cases of snow blindness heal spontaneously over a few days.

3 - Don’t forget the sunscreen

Vacations that involve snow skiing (or mountain climbing or high-altitude trekking) have the potential for sunburn because of increased levels of UV. UV radiation exposure increases by 4% for every 300m of elevation above sea level.
Even on a cloudy day, sunscreen should be applied at a rate of 2mg per square centimetre of exposed skin. Properly applied, a sunscreen with an SPF of +15 will protect you from 93% of UVB radiation; while SPF +30 protects against 97% of UVB; and SPF +50 offers protection against 98% of UVB.
SPF 30+ is the recommended sunscreen for fair-skinned people who burn frequently and rarely (or never) tan. For those with light-intermediate, olive, brown, or black skin who tan easily and rarely (if ever) get sunburned, SPF 15+ offers sufficient protection.
It’s worth remembering that all UV damage lasts a lifetime and potentially fatal melanomas can occur anywhere on the human body – even in the eye. If you damage your eyes or skin, the long-term effects may only become apparent years – even decades – later.

4 – Respond to hypothermia

Even experienced skiers, snowboarders and alpine hikers can get caught out by a sudden change of weather that sends the mercury plummeting. So, it pays to be aware of two other potential risks on the snowfields, hypothermia and frostbite.
Hypothermia can occur if your body temperature falls just a couple of degrees to less than 35°C. The initial signs include feeling cold and shivering with pale skin, which can progress to feelings of fatigue or exhaustion, drowsiness, confusion, slurred speech, and memory loss.
There are steps you can take to help someone with hypothermia until medical help arrives:
- Get them to a warm space out of the wind and remove any wet clothing.
- Raise their core temperature by wrapping their head, neck, chest, and groin in a blanket (electric, if you have one) or warm them with skin-to-skin contact under blankets or sheets.
- If conscious, encourage them to sit up to drink warm, non-alcoholic beverages, such as tea or coffee.
- After raising their core temperature, keep them wrapped in a warm blanket – including their head and neck.

5 – Know some frosty first-aid

Frostbite is any injury caused by freezing; usually the nose, ears, cheeks, chin, fingers, or toes. Severe frostbite can lead to permanent tissue damage – even amputation – especially in people with poor blood circulation.
Tell-tale signs of frostbite include reddened skin progressing to a white or greyish-yellow colour that may also feel unusually firm or ‘waxy’, along with numbness and blistering. With more advanced frostbite, the skin may darken and turn black.
Victims of frostbite also need urgent medical treatment from a trained professional, but there are simple steps you can take to provide initial first-aid:
- Get them into a warm space.
- Immerse the affected areas of skin in warm water (not hot) or warm the affected area using body heat.
- Don’t massage the affected areas – it could cause more damage.
- Arrange transportation to medical help. Walking on frostbitten feet or toes may increase the damage, particularly as the thawing and re-freezing of feet after they’ve been warmed will increase the tissue damage.

6 – Take care out there!

With dozens of people of wildly varying skill levels likely to be on the slopes at any one time, safety is everyone’s responsibility.
Off-piste collisions with trees, rocks and covered obstacles can result in serious injuries that may require urgent evacuation. It’s one domestic travel situation when it is important to have travel health insurance that suits the type of activity you’re undertaking.
Finally, it’s always a good idea to take a pre-travel course in first-aid and emergency resuscitation (CPR). The knowledge will give you the confidence to provide what help you can.
Before you travel, call Travelvax Australia’s telephone advisory service on 1300 360 164 (toll-free from landlines) for country-specific advice and information. You can also make an appointment at your nearest Travelvax clinic to obtain vaccinations, medication to prevent or treat illness, and accessories for your journey.

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Whether you’re heading to Brazil for the Games in August or just taking a short winter break in Fiji, the last thing you’ll want to bring home is dengue, chikungunya or Zika.
With no vaccines available to travellers for these nasty viruses, avoiding infection means dodging mosquito bites.
But, what really prevents bites from the aggressive, day-time biting Aedes species that transmit all three diseases, or other biting insects?

A new US study published in Consumer Reports compared the effectiveness of insect repellents. It confirmed what we knew: Products containing any of 3 active ingredients — DEET, Picaridin, or oil of lemon eucalyptus — work well against Aedes and Culex mosquitoes and Lyme disease-carrying deer ticks, while those marketed as ‘natural’ offered little protection, especially against Aedes mozzies.
But, the active ingredient’s concentration is just as critical. Repellents containing 15% - 30% DEET provide long-lasting protection against mosquitoes and ticks, while others with 7% DEET didn't work well against Aedes mozzies. (DEET is safe for children, and pregnant and lactating women, too.) 
A product containing 20% Picaridin was the study's top overall repellent, but one containing a 5% concentration of Picaridin scored far lower. Oil of lemon eucalyptus was the only naturally occurring compound to do well in the tests: Other plant oil-based products containing cedar, citronella, lemongrass, or rosemary provided little protection and often failed within 30 minutes. Once again, they were particularly ineffective against Aedes mosquitoes.

What works, what doesn't

A recent article by Beth Skwarecki neatly sums up the state of play as to what works and what doesn’t when it comes to products that claim to repel insects:
Wristbands and pricey gadgets don’t prevent mosquito bites. A wristband protects only your wrist, while ultrasonic devices don’t work at all.
Clip-on devices. They protect you from bites, but only if you sit still.
Some plants are natural repellents. But, planting them nearby isn’t enough.
Insect traps can be problematic. They may attract more mosquitoes than they kill.
Candles provide partial protection. There is some benefit – depending on which way the wind is blowing. Citronella candles don’t seem to work any better than plain candles.
Insecticide-treated clothing is worth the trouble. But, treated clothing works best with long sleeves and pants, and used in conjunction with an effective topical repellent applied to all exposed skin.

So, for now at least, the proven options are still the best – regardless of the maker’s claims, or how convenient or appealing the flashier gimmicks might appear.
But, select the repellent right for you (including kids) and read the label closely.

Image: Dreamstime

By Dr Eddy Bajrovic*

If you develop diarrhoea, nausea, vomiting, painful stomach cramps, with or without fever, it is a safe bet you’ve got acute infectious gastroenteritis or ‘gastro’.
Gastro comes under the term ‘traveller’s diarrhoea’ or, more colourfully, Pharaoh’s Curse, Bali Belly, or Montezuma’s Revenge (depending on where you encounter it).
Traveller’s diarrhoea (TD) is a very common travel complaint: half of all travellers visiting a developing country for a 2-week stay will experience it to some degree, according to the experts at the US Centres for Disease Control and Prevention (CDC).
Whether your symptoms are mild or severe, how effectively you treat them will usually determine how quickly you recover. More on how to treat TD and when to use ‘stopper’ drugs and antibiotics later in this article.
As your appetite returns, it’s just as important that you eat and drink the right things to help your recovery.

Read more ...

By Laurie Sullivan

Everyone’s heard a horror story of someone who has come a cropper over travel insurance.
They either don’t have insurance only to get sick/injured/ripped off overseas and their parents/family/friends had to sell a kidney to get them treated and brought home.
Okay, not a kidney, but you get the idea. It can turn into a very expensive nightmare.
Then there are those who are insured and make a claim only to get knocked back because of some obscure clause buried in the policy’s ‘fine print’.
These often-tragic tales become the stuff of travel urban legends, swapped in hushed tones by travellers who fervently hope that they’ll never add their own unhappy chapter.
The Australian government’s smartraveller website has many such stories. The altered names barely disguise the physical and financial pain visited on each luckless traveller and their families when holidays go wrong. 

Read more ...