Latest News
© Pavla | Dreamstime.com

In tropical regions, chickenpox (or varicella) is a disease affecting older children or adults that’s more likely to strike during the ‘tourist’ season when it’s dry and the temperatures are cooler. For temperate climates, which most Australians live in, spikes of infection occur mostly in winter or spring1.

Proof indeed!
Before the chickenpox (varicella) vaccine was introduced into our national immunisation program in 2005 (a single dose was given to children under 14 years of age), each year over 200,000 cases of chickenpox were reported and around 1,500 of those needed hospitalisation. Even worse, an average of 7 deaths annually resulted2. Now, some 11 years later, that annual number of cases is now around 2,4003, and the greatest benefit has been seen in children aged 1-4 years and indigenous Australians4.

The USA added the vaccine to its routine vaccination program in 1996 in response to an estimated 4 million chickenpox cases each year, including 11,000 to 13,500 hospitalisations and 100 to 150 chickenpox-related deaths. The result was an astounding 85% reduction in the incidence of chickenpox. However because of continued outbreaks in schools and high rates of ‘breakthrough’ infections among immunised children3, a second dose was included in the routine childhood immunisation schedule in 2006. The National Notifiable Diseases Surveillance System has since documented an overall 97% reduction in the incidence of chickenpox since the varicella vaccination program was implemented5.

What do we do next?
Leading Australian immunisation resources, the Australian Technical Advisory Group on Immunisation (ATAGI) and the National Health and Medical Research Council (NHMRC), through the Australian Immunisation Handbook, have recommended a second vaccine dose as it provides protection similar to that of natural infection, adds to herd immunity and minimises the chance of breakthrough infection in children under 14 years of age, but acknowledge that the lack of funding means that it must be paid for by parents and carers privately.

The disease
Varicella-Zoster Virus (VZV), better known as chickenpox, is one of eight herpes viruses that can cause infection in humans and it’s highly contagious - up to 90% of household contacts will develop the disease. The virus is transmitted via the upper respiratory tract by aerosol spread of infected respiratory secretions or contact with the vesicular fluid from those infected. There is a 10 to 21 day incubation period and infected individuals are contagious from 2 days before the onset of the typical vesicular rash until all the rash vesicles are crusted. Typically the illness commences with a prodromal phase with symptoms such as fever, malaise. 1-2 days later the typical itchy, blister-like rash begins to appear. Initially the blisters (vesicles) affect the trunk and face and then spread to the rest of the body. Each vesicle has a red base which develops into a pustule that eventually forms a crust. New vesicles continue to appear for 3 to 7 days, with an average of 300 lesions (but can number from 10 up to 1,500).

Some 5% of children exposed actually get subclinical infections with subsequent immunity without knowing that they had contracted the infection.

Serious complications of acute varicella infection are rare, occurring in approximately 1% of cases. These may present as secondary bacterial infections of the skin lesions, pneumonia, encephalitis and hepatitis. Infection is usually more severe in adolescents and adults2. Following infection, antibodies are produced which will keep the virus at bay; however as we age, we become more susceptible and the virus can emerge and cause the painful herpes zoster infection, also known as shingles.

Vaccines: What we have and who do we give it to?
In Australia there are 2 vaccines containing live, attenuated varicella zoster virus, plus 2 others used only in children that are in combination with measles, mumps and rubella.
While not publicly funded, varicella vaccination is also recommended for non-immune adults at high risk of developing the disease: healthcare professionals, child-care workers, non-immune women prior to falling pregnant and parents. Also, household contacts with no immunity should be vaccinated to prevent the virus’ spread to immunosuppressed individuals. The vaccine schedule for the 14 years and older age group is 2 doses administered at least 4 weeks apart. An important note is that varicella-containing vaccines are contraindicated for pregnant women and pregnancy should be avoided for at least 28 days after vaccination.

If you’re travelling overseas
The risk of chickenpox is as high in developed countries as in developing ones. Very few countries include the vaccine in their routine childhood schedules - Canada, Costa Rica, Germany, Greece, Korea, Latvia, Luxembourg, Qatar, Saudi Arabia, UAE, Uruguay, USA and some parts of Spain & Italy1 - but coverage is increasing. Non-immune adults and children should consider vaccination, especially if planning longer stays or extensive travel.

1. http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseases-related-to-travel/varicella-chickenpox
2. http://www.ncirs.edu.au/assets/provider_resources/fact-sheets/varicella-fact-sheet.pdf
3. http://www9.health.gov.au/cda/source/rpt_3.cfm
4. http://www.who.int/bulletin/volumes/92/8/13-132142.pdf?ua=1%20A
5. http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5604a1.htm

 Talk to anyone born prior to the 1960s and they will tell you about how polio used to be a terrifying reality. Hundreds of thousands of children across the globe were left paralysed in its wake and confronting images of wards full of iron lung machines circulated. With the introduction of the Salk vaccine in the mid-1950s, polio outbreaks became less frequent – the last epidemic to hit Australia was in the early 1960s. By 1966, the oral Sabin vaccine came into use and this was replaced with a more effective inactivated vaccine in 2005.  

About polio

Polio is a potentially serious viral illness spread through contact with infected faeces or saliva. It is made up of 3 types of wild polio virus WPV 1, 2 & 3 – all of which can cause disease. Polio has a variable incubation period of 3-21 days. Infected individuals are most infectious from 10 days before to 10 days after the onset of symptoms. In 90% of cases, polio infection passes without symptoms but, if they are present, they include headache, fever, vomiting, tiredness, neck and back stiffness, limb pain with or without paralysis. Severe paralytic polio occurs as a complication of WPV in 1 in 200 cases. It affects the spinal cord in 79% of cases, which leads to acute flaccid paralysis (AFP) affecting the limbs (mainly the legs and is asymmetrical). Paralytic polio can lead to death in 2 - 5% of children and 15 – 30% of adults. There is no cure and treatment is supportive; immunisation is the only way to prevent infection.

The largely asymptomatic nature of polio is a major hurdle in the eradication efforts as authorities try to identify cases in often remote regions of the world.

 

Figure from Global Polio eradication initiative 2011 report  http://www.polioeradication.org/Portals/0/Document/Data&Monitoring/IMB_Reports/IMB_Report_April2011.pdf

 Eradication efforts

In 1988, the World Health Assembly (WHA) resolved to target polio with a view to achieving eradication by the year 2000 and formally founded the Global Polio Eradication Initiative (GPEI). At the time the GPEI was established, more than 1000 children a day worldwide were diagnosed with polio. Since then, in excess of 2.5 billion children have been immunised against polio and there has been some success in eradicating certain strains of WPV: the last case of WPV type 2 was reported in 1999 and the last WPV type 3 in 2012.

By 2006 the number of WPV cases had reduced by more than 99% and only four countries showed no interruption in WPV transmission, namely Afghanistan, India, Nigeria and Pakistan. India was removed from the list of endemic countries in March 2014 and in October 2015 Nigeria was also taken off the list.

In 2016 year-to-date, there have been 22 cases of polio reported across the globe compared to 350, 000 in 1988 and until last week (11th of August) the only 2 countries reporting wild polio were in fact Afghanistan and Pakistan. But in a major setback to the global eradication campaign, Nigeria has notified the WHO that after more than 2 years without wild polio 2 children have been diagnosed with paralytic polio in the northern state of Borno.

Polio Global Eradication Initiative – Data and monitoring http://www.polioeradication.org/Dataandmonitoring/Poliothisweek/Poliocasesworldwide.aspx

It was in 2012 that the World Health Organisation (WHO) instigated the Polio Eradication and Endgame Strategic Plan 2013 -2018 which outlined an all-inclusive strategy addressing how to deliver a polio-free world by 2018.

Successes

The Regional Commission for the Certification of Polio Eradication declared the WHO’s 11 country South-East Asia Region free of circulating wild poliovirus in March 2014 when India’s polio status changed. The region was the 4th of the 6 WHO regions to be certified as having interrupted all indigenous WPV circulation (the Americas in 1994, the Western Pacific in 2000 & the European Region in 2002).

Current situation

While the eradication programme has had successes, many factors stand in the way of reaching the eradication goal:

- The growing conflict and insecurity in the Horn of Africa and Middle East has played a major role in precipitating outbreaks in this area
- Increased instability in Pakistan, allowing continued transmission
- Disruption to immunisation activities in these areas has led to low population immunity and ongoing insecurity hampers the efforts to respond to outbreak reports
- Rapid detection of cases can be hindered in some areas by suboptimal surveillance
- Supplementary immunisation activities have had insufficient impact on stopping transmission in Pakistan and Afghanistan – this is mainly due to poor planning which results in the same groups of children missing vaccine doses.

Recommendations for travellers

In May 2014, the WHO declared the international spread of wild poliovirus from endemic areas into polio-free areas a ‘public health emergency of international concern’ and instituted some temporary recommendations: currently these only apply to Afghanistan & Pakistan and require that residents are to be vaccinated against polio and supplied with an International Certificate of Vaccination or Prophylaxis.

According to the US Centers for Disease Control and Prevention (CDC): Long-term travelers (staying >4 weeks) to the polio-infected countries may be required to show proof of polio vaccination when departing the polio-infected country. To meet these WHO requirements, long-term travelers should receive polio vaccine between 4 weeks and 12 months before the date of departure from the polio-infected country.

Australian children receive a primary course of polio vaccinations as part of the National Immunisation Program. For those adults who have completed a primary course and will be travelling to countries where wild poliovirus transmission still occurs, a single booster dose is recommended. However travel requirements do occasionally change in response to outbreaks, so up to date advice should be sought from your travel health provider or through the Australian Government Department of Health website.

© Artofphoto | Dreamstime.com

Both food poisoning and stomach flu can give rise to nausea, vomiting, cramps and diarrhoea - but the two conditions are in fact of different aetiology. Consuming food that has been contaminated with viruses, bacteria or parasites at some point during production causes food poisoning, whereas stomach flu is a viral infection of the digestive system. Stomach flu is most commonly brought on by norovirus or rotavirus, and is different from the conventional flu, which attacks the respiratory system. Both food poisoning and stomach flu cause a condition known as gastroenteritis –inflammation of the gut, which may involve the stomach, the small and/or large intestine.

According to the World Health Organization (WHO) report on the estimates of the global burden of foodborne diseases in 2010, there were approximately 600 million foodborne illnesses causing 420,000 deaths. 

Read more ...

© Paulus Rusyanto | Dreamstime.com

With final packing and preparations well underway for those lucky travellers heading to the Olympic Games, there are just 16 days until the official opening ceremony. Travelvax has compiled a medical checklist outlining a few specific concerns for travel to Brazil, as well as the predictable stomach upsets, sunburn and security.

Events of the 2016 Olympic and Paralympic Games, while primarily set in Rio de Janeiro during August and September, will also take place in Belo Horizonte, Brasilia, Manaus, Salvador and São Paulo. To these areas, more than 200 member nations will arrive bringing over 10,000 athletes; in excess of 1 million visitors are expected to view the spectacle. As could be expected, the risk of spreading communicable diseases is increased with such large numbers - crowding, shared accommodation, travellers from all continents, as well as the diverse and varying ecology of Brazil, will put travellers and host-country residents at risk.

Read more ...

© Zurijeta | Dreamstime.com

Each year the Hajj pilgrimage takes place in Saudi Arabia when more than 3 million Muslims from over 183 countries converge on the city of Mecca. From a public health point of view, any gathering of this size presents its own problems as the risks of infectious diseases being spread across the globe when the pilgrims return home are amplified.

Every able-bodied Muslim who has the means to do so must attend the Hajj at least once in his or her lifetime. The annual gathering, which takes place from the 8th to the 12th day of Dhu al-Hjja (the last month of the Islamic year), will take place this year between the 9th and 13th of September. Another pilgrimage, Umrah, can be carried out at any time of the year.

Due to the sheer numbers attending the Hajj, the risk of spreading communicable diseases is increased - severe crowding, shared accommodation, difficulty in attending to personal hygiene and environmental pollution all play a part. To minimise the likelihood of this, each year the Saudi Ministry of Health (MOH) publishes health recommendations, with particular emphasis on those who are likely to suffer from complications from any illness.

The World Health Organization (WHO) has published this year’s recommendations in the July 1 edition of its Weekly Epidemiological Record:

Required vaccinations:
- Proof of yellow fever vaccination is required from all travellers arriving from countries or areas at risk of yellow fever at least 10 days before arrival at the border (the MOH provides a list of affected countries in Africa and South/Central America). 
- Meningococcal meningitis (4-in-1) vaccination for ACW135Y strains is required from all pilgrims and workers at Hajj sites. Two vaccine options are available now, one a polysaccharide and the other a conjugate (longer-lasting and with additional benefits). Travellers arriving from the African meningococcal meningitis belt countries will receive preventative antibiotics on entry into Saudi Arabia. 
- Poliomyelitis vaccination for all pilgrims travelling from countries specified by the MOH. The certificate must show that the vaccine was given within a year, and not less than one month prior to departure, for Saudi Arabia. Additionally, regardless of age or vaccination history, one dose of the oral polio vaccine must be recorded. 

Recommended vaccinations:
- Seasonal influenza vaccination is recommended for all pilgrims and Hajj workers, particularly those with underlying medical conditions.

Other precautions recommended by the ministry are aimed at preventing Middle East Respiratory Syndrome-Coronavirus (MERS-CoV) infection and include the advice to postpone travel to the Hajj for the elderly, pregnant women and children, as well as those suffering from chronic diseases, immune deficiency disorders and malignancies.

Comprehensive information with full details is now available on this WHO webpage

Final health recommendations for each traveller will be decided in consultation with a medical practitioner. For more general travel health information, contact the Travelvax information phone line during business hours on 1300 360 164.

© Viewapart | Dreamstime.com

 

Booming low-cost air travel is helping to fuel outbreaks of dengue fever across Southeast Asian countries, according to an expert in the mosquito-borne disease.
The combination of no-frills Asian carriers and low oil prices have made cheap flights the norm between the 10 Association of Southeast Asian Nations (ASEAN) countries – Indonesia, Malaysia, the Philippines, Singapore, Thailand, Brunei, Cambodia, Laos, Myanmar (Burma), and Vietnam.
In addition, ASEAN’s Open Sky Policy – which allows unrestricted air travel by local airlines within the region – has made travel even more accessible for both Asian and international travellers.
“The increase in the number of budget airlines in the region has been dramatic in the last 10 to 15 years,” said Professor Tikki Pang, of the National University of Singapore.
“This is obviously helping dengue to move around the region: There is more movement of infected people. Flight distances in this part of the world are fairly short, so people can get on a plane for an hour or two even if they have dengue fever.”

Aussie travellers need to be on guard

Australian travellers visiting South-East Asia and other tropical regions can’t afford to be complacent about the risk from disease-carrying mosquitoes, said Dr Eddy Bajrovic, Medical Director of Travelvax Australia. Besides the dengue virus, chikungunya, malaria, Japanese encephalitis, and now Zika, may also be circulating.
But, dengue is by far the most common insect-borne disease in the tropics. Dengue rates have increased dramatically in recent decades – particularly in tropical Asia, Latin America, Africa, and the Pacific – with an estimated 390 million cases occurring annually and around 40% of the world's population at risk.
Dr Bajrovic warned that Australia may well be on track for another big year of imported dengue cases.
“Already this year there’s been 1235 cases compared with 1157 in the first 6 months of 2015,” he said.
“The majority of local travellers who bring home dengue were infected in Indonesia, Thailand and other popular Asian destinations.”

Dodging dengue means dodging bites

The dengue, Zika and chikungunya viruses are all transmitted by two species of Aedes mosquitoes, Aedes aegypti and Aedes albopictus. Both are aggressive day-time feeders that breed and bite in urban areas to be close to people, their favourite source of the blood meal the females need to lay eggs.
Minimise mosquito bites and you reduce the risk of infection. So…
– When outdoors, apply an insect repellent containing an effective ingredient such as DEET (30-50% formulations for adults, or 10-20% formulations for young children and infants as young as 2 months of age), Picaridin, IR3535, or preparations containing extract of lemon eucalyptus oil. Around dawn and dusk, when Aedes mosquitoes are most active, is the critical time to apply repellent.
– At these peak feeding times, move inside behind screened windows and doors. If that’s not possible, wear loose, long-sleeved shirts and long pants outdoors.
– 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.)
The fewer times you get bitten, the lower the risk of infection.
Don’t get bitten and there’s absolutely no chance at all.
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)?