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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.

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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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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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By Dr Jennifer Sisson*

Felt a chill in the autumn air? It’s a sign that the 2016 influenza season is approaching.
This year, two types of flu vaccine will be available from GPs, travel clinics and some pharmacies.
However, one of the two is the better choice for Australians heading overseas.
First, let me explain why there are two vaccines.
The first is the familiar 3-strain ‘trivalent’ influenza vaccine (TIV). It’s the cheaper of the two and is suitable for most healthy people. This year’s TIV formula will protect against the three principal flu strains predicted for 2016 – A(H1N1), A(H3N2), and B/ Brisbane.
The second option is a 4-strain or quadrivalent influenza vaccine (QIV), which became available in Australia for the first time last year. The additional fourth strain in this year’s QIV protects against the B/Phuket strain.
It’s this newer quadrivalent vaccine that’s the better option for travellers, according to one of Australia’s leading experts on flu, Dr Alan Hampson, the Chairman of Australia’s Influenza Specialist Group (ISG).
“Travellers are more likely to have greater exposure to A or B flu strains that are already circulating, as well as to new strains that could emerge outside Australia – especially in Asia,” said Dr Hampson.
“Plus, the B flu viruses occasionally predominate in parts of Asia. For anyone travelling overseas, having the quadrivalent vaccine makes good sense.”

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By Dr Jennifer Sisson*

Measles. It just won’t go away.
Despite having been effectively wiped out in Australia through our national immunisation program, cases doggedly persist here due to international travel.
In fact, cases are increasing each year. Australia has recorded 70 confirmed infections in the first three months of 2016, putting us well on track to pass last year’s total of 104.
Virtually all of these cases involve Australian travellers or foreign visitors infected overseas. Just last week, NSW Health issued a public warning after separate incidents in which foreign tourists – two young children from India and two backpackers from Europe – arrived in Australia infected with the highly contagious virus.
Those at risk of developing measles in coming days and weeks not only include other passengers who shared international and domestic flights with the four, but fellow hostel guests, and the staff and patients of hospital and medical facilities where they sought treatment.

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By Dr Eddy Bajrovic*

There are many reasons to wash your hands regularly and choose food and beverages with extra care when you travel overseas.
In developing countries, traveller’s diarrhoea, hepatitis A and E, cholera, and polio are among the many diseases linked to poor sanitation and hygiene, typically from eating, drinking (or just handling) something that’s been contaminated.
Another reason is paratyphoid fever, which has become recognised as a growing risk for international travellers – especially in parts of Asia.
Collectively known as enteric fever, paratyphoid and its better-known ‘cousin’, typhoid are caused by two distinct Salmonella bacterium – Salmonella paratyphi (strains A, B, or C), and Salmonella typhi respectively.
Potentially severe and occasionally life-threatening, they cause high fever and inflammation of the intestines when ingested in food or beverages contaminated by the faeces of an infected person.

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