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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.

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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.

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By Dr Eddy Bajrovic*

These days, finding uncrowded breaks in overseas destinations like Indonesia, the Maldives, Mexico or the Pacific islands means exploring ever more remote locations.
Unless you can afford a five-star option, that often means living like the locals with very basic sanitation and dodging disease-carrying insects far from reliable medical help.
Illness or injury can not only put an end to your surfing odyssey, but may mean not-always-safe local medical treatment, or very costly evacuation and repatriation, followed by weeks – or months – out of the water.
Keeping the dream afloat means getting yourself and your kit prepared well before departure. 

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While more than half of Australians in the travel-loving 65-plus age bracket are at risk of pneumococcal pneumonia, only 1-in-5 is vaccinated against the potentially fatal disease, a national survey has found.

Conducted by Lung Foundation Australia as part of Pneumonia Awareness Week (May 9–15), the survey found 52% of people aged over 65 are at increased risk of contracting the bacterial infection through an existing medical condition or lifestyle factors – particularly current or past smoking.
Despite this higher risk, 40% of over 65s surveyed weren’t aware that a pneumococcal vaccine exists.
Often fatal, pneumonia affects the small sacs in the lungs which, in a healthy person, fill with air with each breath. Pneumonia infections (bacterial, viral or fungal) cause the lungs to fill with pus and fluid, which makes breathing painful, causing coughing and limiting oxygen intake.
Pneumococcal pneumonia, caused by the bacterium Streptococcus pneumoniae, is the only bacterial pneumonia for which vaccine protection is available.
A single dose of pneumococcal vaccine is recommended for adults when they reach 65 and is free for them under the Federal Government’s National Immunisation Program. Those who have a medical condition, such as cardiac, liver and congenital diseases, are at risk of infection and may require additional doses to ensure that they are adequately protected.

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By Dr Eddy Bajrovic*

As the mercury dips each autumn, winter viruses loom large on the horizon.
Not just the more familiar seasonal influenza and colds (rhinoviruses): Winter is also the peak season for norovirus, the most common cause of gastroenteritis worldwide.
Noroviruses thrive in nursing homes, hospitals, large offices, universities, schools… in fact, in any confined, crowded space. Which is why norovirus outbreaks are not uncommon on cruise ships and at holiday resorts.
What make norovirus so contagious that it causes more than 90% of the world’s non-bacterial outbreaks of gastroenteritis? There are a couple of reasons.
Firstly, a single infected person can shed literally billions of norovirus particles. It takes as few as 18 particles to infect another person and they can be infected in a number of ways.
Secondly, just like influenza, noroviruses are constantly mutating. And, like flu, past infection offers no immunity to the new strains that emerge every couple of years.
The global economic burden of norovirus is a staggering $60 billion per year, with an annual estimated death toll of 200,000, according to new estimates drawn from studies of the disease and its impact. 

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