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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)?

 

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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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The Australian government is advising pregnant women to consider postponing travel to Indonesia due to the potentially harmful impact of the Zika virus on their babies.
The Department of Foreign Affairs and Trade’s smartraveller website warns that Indonesia is experiencing sporadic transmission of the mosquito-borne virus.
It advises: “Given the possibility that Zika virus can cause severe malformations in unborn babies, and taking a very cautious approach, pregnant women should discuss any travel plans with their travel doctor and consider postponing travel to Indonesia."
Zika has been linked to a surge of microcephaly and other neurological conditions effecting thousands of babies. Most have occurred in Brazil but another 12 countries have now reported microcephaly in the infants of returned female travellers.
Taiwanese authorities quarantined a 22-year-old Indonesian sailor who displayed the typical Zika symptoms of fever and red eyes on arrival at Kaohsiung International Airport earlier in the month. It’s not known where the sailor was infected, however the Indonesian Ministry of Health sent a team to the man’s East Java village of Tangkil last week to determine if the virus was present in mosquitoes at or near his home.

‘Exercise high degree of caution’ - DFAT

Smartraveller’s overall travel advice for Indonesia otherwise remains unchanged: Australians are advised to protect themselves against mosquito bites and exercise ‘a high degree of caution’ in Indonesia, including Bali, due to the ongoing ‘high threat of terrorist attack’. Dengue fever and chikungunya fever are both circulating widely across Indonesia.
The new advice on Zika brings Australia into line with the World Health Organization and America’s Centers for Disease Control and Prevention (CDC) in advising pregnant women against travel to areas where the virus is circulating.
Indonesian authorities say they have taken steps to respond to a possible outbreak of Zika. Dengue patients have been secretly tested for Zika, the health ministry's director general for disease prevention and control, Mohammad Subah told the local media outlets.
Zika virus is not yet a notifiable disease in Australia, so cases among returned travellers are not being collated by the National Notifiable Diseases Surveillance System in the same way as dengue, chikungunya and other vector-borne diseases. 

No decline in Zika - WHO

According to its latest weekly Zika situation report, the WHO’s risk assessment remains unchanged: It sees no overall decline in the Zika epidemic in the Americas, though case rates have dropped in some countries or parts of countries. Zika is also circulating in regions of Asia and the Pacific. 
The CDC has advised that the USA has now recorded 3 infants with microcephaly on its Zika Pregnancy Register and 3 stillborn babies with birth defects. There have been 756 US travellers return home with Zika. 
El Salvador is the latest country in the Americas to report microcephaly in a child born to a Zika-infected mother, taking the number of countries with confirmed cases to 12.
Last week, Spanish doctors reported the details of a congenital Zika infection in the foetus of a woman infected with Zika in Venezuela. 
There is no vaccine available to prevent infection with Zika and travellers heading to risk areas are advised to use strict measures to avoid mosquito bites.

Read more on Zika from Travelvax Australia, the WHO and CDC. To discuss your travel plans, including the risk of insect-borne infections and any vaccinations recommended for your trip, call our free travel health advisory service on 1300 360 164.

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Take condoms with you, and use them. That’s the message to young Aussie backpackers following a study showing high rates of unsafe sex with new partners among young international travellers heading to full moon parties in Thailand.
British researchers say high-risk sex among young travellers attending the hugely popular all-night beach parties on Koh Tao and Koh Phangan is fuelling the global spread of sexually transmitted infections (STIs) such as chlamydia, HIV and gonorrhoea (including antibiotic-resistant strains like Neisseria gonorrhoea) along with unplanned pregnancies.

What the study found

In a survey of 1238 young single travellers - including 72 Australians – visiting Thailand, the researchers found that overall almost 40% had sex with a new partner. Of these, 37% had unprotected sex.
The survey also revealed:
- UK and Swedish backpackers were most likely to have unprotected sex, at rates of 49% and 46% respectively.
- Australians had a 30% rate of unprotected sex.
- Most likely to practice safe sex were Canadian and German backpackers, with up to 80% consistently using condoms.
- Backpackers were more likely to have sex with travellers from other countries, while males are also likely to use local sex workers.

STIs – who’s at highest risk?

In 2013, a 14-year study of STI patterns and rates among 112,180 international travellers found that the type of infections varied among different classes of travellers.
Those most likely to be diagnosed with an STI were:
- Male travellers
- Younger adults
- Businesspeople
- VFRs (Visiting Friends and Relatives abroad)
- Short-stay travellers (less than 30 days)
- Immigrants
- Travellers who had not sought pre-travel medical advice
The most common travel-related STIs where non-gonococcal or other unspecified urethritis, acute HIV infection, and syphilis. For men, urethritis and epididymitis were most common, while cervicitis topped the list of STIs for women. 

Condoms have some limitations

Condoms are as important as sunscreen, personal insect repellent, and sanitising hand gel.
While condoms are widely available overseas, their quality can vary. Our advice is:
- Take your own from Australia: You can be sure of their quality.
- If you purchase them overseas, first check the expiry date and make sure the pack carries a recognised quality assurance mark.
- Use only water-based lubricants with latex condoms.
It’s important to remember that condoms have limitations.
Condoms WILL protect against: HIV, Hepatitis B and C, gonorrhoea, chlamydia, and syphilis.
Condoms WILL NOT prevent: Genital herpes, genital warts, pubic lice, or scabies.
Read more about male and female condoms and how to use them correctly. 

Safe sex is smart – at any age

Enjoying sun, sea and sex on holiday is not just for 20-somethings: a separate British study published in the journal, Sexually Transmitted Infections found that older holiday-makers – one-in-20 men and one-in-40 women aged 35 to 74 – had a sexual relationship with a new partner while travelling abroad.
Researchers found that those travellers who found a new sexual partners abroad were also more likely to engage in risky behaviour, such as unprotected sex. They concluded: “These proportions are likely to increase as older people maintain good health, have the financial means to travel, and are now more likely to experience partnership breakdown.”
Regardless of age, if you’ve had unprotected sex while abroad, have a sexual health check-up – including a screening for STIs – through your GP, a sexual health clinic, or a Travelvax Australia clinic as soon as possible after you return.
A thorough check-up provides reassurance and ensures there is no delay in treatment if you returned home with an STI. Just as importantly, by getting diagnosed and treated early you could help prevent the spread of antibiotic resistant infections in your community.

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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.

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An insect-borne disease that can cause permanent scarring is nearing epidemic levels in parts of the Middle East and East Africa, posing a risk to Australian travellers visiting the regions.
Until recent years cutaneous leishmaniasis was largely contained to areas around Aleppo and Damascus in Syria. However, Syria’s war has done three things: Created ideal conditions for the insects to breed, prevented infected people from being treated, and caused the mass migration of millions of refugees into previously non-infected neighbouring countries, especially Turkey, Lebanon, and Jordan.
Described by doctors as ‘catastrophic’, the outbreak of the ‘Old World’ disease is now affecting hundreds of thousands of people living in refugee camps or trapped in conflict zones.
An epidemic is also occurring in Eastern Libya and Yemen, scientists say in a new report. Yemen reports around 10,000 new cases each year and with Yeminis migrating to Saudi Arabia, it’s highly likely leishmaniasis will also surface there.
The conflict and mass displacement in Syria has also created the risk of tuberculosis, measles and polio, along with cholera and brucellosis, highlighting the importance of travellers to the Middle East receiving routine ‘childhood’ immunisations, if required, along with other vaccines that may be recommended for their individual itinerary.

More about leishmaniasis… Leishmaniasis is a parasitic disease found in parts of the tropics, subtropics, and southern Europe. There are two main forms – cutaneous and visceral – both transmitted by bites from infected sand flies. The former causes disfiguring skin ulcers, while the latter results in severe systemic disease that is usually fatal without treatment. India, Bangladesh, Nepal, Sudan, South Sudan, Ethiopia and Brazil account for 90% of visceral leishmaniasis, while 90% of cutaneous leishmaniasis cases occur in Afghanistan, Algeria, Iran, Saudi Arabia, and Syria, as well as the South American countries of Brazil, Colombia, Peru, Bolivia and Argentina. Read more on the disease and prevention

How leishmaniasis is treated… Therapy varies, depending on the clinical form of leishmaniasis, the infecting species and the region where infection is acquired. It usually consists of oral or parenteral medication, or a topical medication used on the effected area. Travellers concerned that they may have been infected through sand fly bites should call Travelvax on 1300 360 164, or see an infectious disease specialist or their GP.

How to prevent it… There are no vaccines or drugs to prevent leishmaniasis. Prevention relies on avoiding sand fly bites by:
- Where possible, staying indoors between dusk to dawn, when sand flies are most active.
- Wearing long sleeves and pants, shoes and socks when outdoors – especially after dark.
- Apply insect repellent containing DEET, Citriodiol or Picaridin to exposed areas, including under the edges of sleeves and pant legs.
- Sleeping in any air-conditioned or well-screened room, or...
- Sleeping under a bed net.
- Spraying with a knock-down insecticide may provide some protection. Fans inhibit the movement of sand flies, which are weak fliers.
Sand flies are so small (approximately 2–3 mm) that they can pass through the holes in ordinary bed nets. Although closely woven nets are available, they may be uncomfortable in hot climates. Buying a net treated with permethrin or another contact insecticide will enhance the effectiveness of your bed net.
DIY kits are available to treat bed nets and clothing.
Read more about leishmaniasis and how to prevent infection.

Like to know more?
If you have questions regarding upcoming travel to the Middle East, including routine, recommended or required vaccinations, please contact Travelvax Australia on 1300 360 164. We can provide no-cost, no-obligation country-specific advice and arrange for a pre-travel medical consultation at a Travelvax Clinic.