BRITISH BROADCASTING CORPORATIONÌý
RADIO SCIENCE UNITÌý
CHECK UP 4. - Travel HealthÌý
RADIO 4Ìý
THURSDAY 26/08/04 1500-1530Ìý
PRESENTER:
BARBARA MYERSÌý
CONTRIBUTOR:
JANE ZUCKERMANÌý
PRODUCER:
ELISABETH TUOHYÌýÌýÌý
NOT CHECKED AS BROADCAST
MYERS
Hello. We make some 58 million trips abroad every year, so there are bound to be some accidents and incidents along the way - an upset stomach from contaminated food or water can certainly spoil a trip, though coming back with symptoms of malaria or evidence of parasitic worms is a souvenir that nobody wants. There are plenty of precautions though that you can take before you set off. Many infectious diseases can be vaccinated against and you can certainly carry insect repellent.Ìý
But there's packing and there's panicking. So if you're planning a trip and want sensible advice call now - the number 08700 100 444. Or maybe you're just back and wondering if perhaps you've picked up something on route - in which case e-mail checkup@bbc.co.uk.Ìý
And joining me in the studio today is Dr Jane Zuckerman, she's a consultant in travel medicine. I'm wondering Jane, if you've got room in your luggage for just one first aid item what do you take?Ìý
ZUCKERMAN
That's a challenging question. The one item I think I would probably take would be a first aid kit in which there would be a needle and syringe, if I'm allowed to push it for two small items within. Simply because you just never know when you might need either medical or dental intervention and to have access to your own clean needles to help prevent the transmission of blood borne viruses has got to be the number one consideration.Ìý
MYERS
And no one's going to take off you at the airport as a vicious weapon?Ìý
ZUCKERMAN
No they shouldn't do because most of these kits now come very complete, they have a customs clearance certificate in them and obviously I would urge travellers to make sure that they put it in their luggage that goes in the hold of the plane, that will ensure that it isn't taken away.Ìý
MYERS
Alright let's go to our first call. Penny Maynard is getting ready for a holiday to North India in October. Penny, have you got a particular question about that?Ìý
MAYNARD
Hello yes. I was just wondering, I heard your trailer, and I was quite interested because my travel company have told me to contact my GP, my GP has told me to contact - is it MASTA and I really can't find out very much about what we need for Bhutan. We're actually doing Bhutan, West Bengal and Rajasthan and I've got my 17-year-old son and my 73-year-old mother with me.Ìý
MYERS
Okay so you'd like some advice and at the moment no one's really helping you in particular with the ...Ìý
MAYNARD
Not very much with Bhutan no.Ìý
MYERS
Okay, so - well Jane.Ìý
ZUCKERMAN
Okay Penny let's see what I can do to help and I hope I can. The very first question and probably the most important - how long are you going for?Ìý
MAYNARD
Altogether 16 days - we're in Bhutan for six days and India for 10 days.Ìý
ZUCKERMAN
And what kind of a holiday is it - is it a tourist holiday - are you staying in a hotel?Ìý
MAYNARD
We're staying in hotel - well the Rajasthan one I've sorted out myself - that's all fairly nice hotels. The Bhutan one has been done through a company and I've been given a list of hotels and I've actually read them up in Lonely Planet and they all look fairly nice.Ìý
ZUCKERMAN
Right, so it's a hotel based holiday for just over two weeks, sounds rather lovely, so let me help you. The things that you need to be concerned about are food and water borne disease. So you need to consider things like hepatitis A, typhoid, causes of travellers' diarrhoea. Also important, because you're going to the Indian subcontinent, is malaria. There's a specific malaria prophylaxis for that neck of the woods, which includes chloroquine and proguanil as the drugs of choice. And those are really the main travel health needs that you will have for that holiday.Ìý
MYERS
It sounds as though Penny's trying to put a package of help together and not really getting it though, either from the GP or some other organisation. I'm just wondering really - I know Jane, obviously, you are involved in travel health clinics - is that really the way forward - do you have to pay and go and see a specialist on this matter?Ìý
ZUCKERMAN
Unfortunately that's the way the travel medicine is going. It's become a specialist discipline - it's grown and grown. And as a consequence there are specialist travel clinics that are available throughout the country who look after the travel health needs of people like Penny and travellers and it is the way that travel medicine is going to be practised.Ìý
MYERS
And so you'll get the advice and also perhaps the necessary immunisations - for example you mentioned there hepatitis and typhoid - would you expect to be vaccinated against those?Ìý
ZUCKERMAN
Yes, you should expect to be vaccinated against those. The specialist travel clinics do provide literally a one stop shop for all your travel health needs. There are travel clinics in primary care but not every general practice runs travel clinics. But certainly if you go to a specialist travel health centre they should be able to meet all your travel health needs and a little bit more to ensure that you have a safe and healthy travel and return well as well.Ìý
MYERS
Penny, I hope you have a great time. I'll move to another call now - James is on the line and I know Jane you mentioned there malaria prophylaxis, as you called it, that's the sort of technical term for prevention and James is concerned about malaria pills, so he's on route to Tanzania. What have you got in mind James, is this a country you've been to before and you know that you're going to need to take something, have you tried various malaria prevention?Ìý
JAMES
I have and I've been to Africa about every two years for the last 10 years or so. And on some occasions I have taken malaria pills, on others I've gone there having brought some with me and then old hands have said you're best not to take them. Their argument being that if you take a prophylaxis you could end up masking the symptoms and actually make things worse and that you're better off to recognise the symptoms and take precautions of covering up and using mosquito nets and so on.Ìý
ZUCKERMAN
I think I need to rectify this rather quickly James, if I may. Clearly you're an experienced and frequent traveller, it's not that the malaria tablets will hide the symptoms at all and it's a little cavalier for travellers not to take malaria tablets - it really is very important to take them together with bite avoidance measures. Malaria is a very serious disease, there are different strains, but we see about a couple of thousand people who return to the UK each year with malaria and rather worryingly around about 10 cases per year result in death. So I have to emphasise it really is important to take malaria prophylaxis and to take bite avoidance measures. Now tell me where are you going in Tanzania on this occasion and for how long?Ìý
JAMES
Well this time I'm going - I'm going to be there for four weeks and this time I'll be in Dar es Salaam for a couple of days and then out to the Selous.Ìý
ZUCKERMAN
Right okay. Well I'm sure you've taken malaria tablets before but there are other listeners who may not know that there are a choice of malaria tablets to take. There are a whole range of them and we'll start of with one that is fairly well known to the public, it's a drug called Mefloquine, that's been given a rather bad press but is actually a very effective drug and if prescribed carefully and appropriately can be very suitable for people. There are some contrary indications to be aware of in general terms - those are kind of psychiatric problems, neurological and cardiac problems. So there's one drug called Mefloquine, there's another drug called Doxycycline, which we have a lot of experience with as an antibiotic and that also does have lots of advantages, can be a disadvantage to women who are taking the pill, but Doxycycline is a very effective drug. And another drug to take for, particularly travel to Tanzania where there's chloroquine resistance malaria, is a drug called Malarone. So those are the top three. However, if those three are all not suitable for you for one reason or t'other, including the schedules of taking them, apart from the medical issues, then one can use chloroquine and paludrine but it's something that we'd really leave as a last resort. So I'd rather hope that one of the top three would be suitable for you and that you would taken them regularly and when you come back, because that's also most important - the malaria parasite can sit in the bloodstream and liver for a little while, even when you leave a malarious country, together with bite avoidance measures and then all will be well.Ìý
MYERS
James, you know what to do - do the right thing. Thank you very much for that call, enjoy your trip to Tanzania. And we'll move to Lorraine, if we may next. She is waiting to talk to us about insect bites, I guess that could be mosquito bites or other bites. What's your concern Lorraine?Ìý
LORRAINE
My partner actually lives in Spain, he comes back to England about three times a year but when in Spain normally round about once every six to eight weeks he gets bit by mosquitoes. Now he uses Nepthon [phon.] at night - the little tablets that you put in the room in the light. He's tried everything. Not only does he just get bitten but they turn into almost things the size of boils and he can get several all over his body. And I just wondered if there were any tablets that he could take - I mean if I get bitten I get a little scratch and I knock the head off and it's finished, these things turn into monsters on him.Ìý
ZUCKERMAN
Okay Lorraine, let's see whether I can help with this as well. There are all kinds of things in the night that bite, there are also things in the day that bite and it's not an uncommon story. Human beings react to insect bites in a different way and some people are fortunate like yourself that they hardly swell up and unfortunately for people like your partner and even myself they swell up and can be very unpleasant. It's part of the allergic reaction to the contents of the bite from the insect and so really what I would suggest that your partner should consider is taking some antihistamines because they work in order to dampen down the allergic reaction. So antihistamines together with a drug like aspirin or paracetamol, whichever is most suitable for him and using cold compresses, should help alleviate the problem. But he is unfortunately susceptible to getting nasty bites. I should just mention as well that if they do look like they're coming to a head - you described them coming to look like a boil - then that can sometimes indicate that there's an infection and at that point it might be sensible to see a doctor in case he needs a course of antibiotics, if the bite has become infected. I hope that helps.Ìý
MYERS
Okay?Ìý
LORRAINE
Thank you.Ìý
MYERS
Thank you very much Lorraine. Somewhat following that theme I've had an e-mail and this is from Margaret who says that she's had a mastectomy - removal of a breast - and she's been left with lymphadaema in the arm and she would like to go to Zambia but she's worried about insect bites and indeed what sort of drug treatments she should be using against malaria. It sounds as though it's a nice thing to want to do but would you advise going where you would need to have anti-malarials if you've had this problem?Ìý
ZUCKERMAN
There are plenty of people like Margaret who either have lymphadaema, which is a swelling of the arm that happens rather unfortunately, commonly, when you have a breast operation and there are also a lot of people who travel with underlying medical problems. And I think the main message I'd like to give is one of reassurance and that is that for these people as long as you seek travel health advice there's really no reason why you shouldn't be able to travel and travel healthily and come back safely and have an enjoyable trip. But yes there are concerns that we need to consider and particularly with a swelling of the arm. It just would mean that if Margaret was unfortunate enough to have a bite then it - the swelling in the arm could exacerbate the effects and so the effects of the bite could last a little bit longer. And rather like the last caller, Lorraine and her partner, particularly, the bites just get a little bit more swollen, they take a little bit longer to heal. But in terms of malaria tablets and making sure not to get any diseases - as long as this is done in consultation with an experienced travel health practitioner there are drugs that can be prescribed appropriately to make sure that she stays well when she travels and it shouldn't restrict her in any way.Ìý
MYERS
We've had questions about appropriate insect repellents, because of course you can avoid bites in the first place or can you - do any of these repellents really work?Ìý
ZUCKERMAN
Bite avoidance measures are a very necessary component to avoiding contracting malaria and bite avoidance measures include wearing loose long sleeved clothing, particularly in the evening. The mosquito that transmits malaria bites from dusk to dawn. So loose long sleeved clothing - that includes socks over the ends of your trousers, long sleeves for your arms - are the best form of prevention. Followed by using insect repellent and most of us recommend two types of insect repellent - one that contains varying percentages of deete, which is an insecticide which is safe and comes in different proportions for children and adults. There are also natural products which have been found to be just as efficacious. Other methods of avoiding bites are to use mosquito nets, particularly ones that don't have holes in them, because if you have a hole and you sleep next to the hole then you're likely to attract a friendly mosquito bite. And of course there are other methods of ensuring that you don't get bitten by using insect repellents that are through electric appliances. And of course the failsafe method is to stay in an air conditioned environment - that the windows don't open then it can't get in in the first place. But that is not necessarily available for everybody.Ìý
MYERS
Okay, let's move to another caller. Peter is on the line and is planning a trip to Kenya, which sounds fun Peter, with a baby though - that sounds more challenging.Ìý
PETER
Yes, hello.Ìý
MYERS
Hello.Ìý
PETER
Hi, I'd like to ask if it's safe to take a baby to Kenya at five months old and if we do take her what precautions such as inoculations and malaria prevention medication should we give her?Ìý
ZUCKERMAN
Okay Peter, rather like the other callers I need to ask you for how long you're going?Ìý
PETER
Approximately six weeks.Ìý
ZUCKERMAN
Six weeks. And are you going to be staying in a hotel, just a quick itinerary, if I may ask?Ìý
PETER
We'll be staying in an apartment in the centre of - or somewhere close to the centre of Nairobi but also spending a fair amount of time in a small town - an hour or so out of Nairobi.Ìý
ZUCKERMAN
Okay, there are some concerns which you do need to be aware of. Certainly your baby is too young to receive some immunisations against food and water borne diseases. So, for example, the age limit for typhoid is 18 months, for hepatitis A it's either one or two years, depending which brand of vaccine is administered. Yellow fever, which is very evident in Kenya, is a vaccine preventable disease but the vaccine also has an age limitation of nine months. So there are some issues there which, again, I would suggest need to be discussed with an experienced travel health practitioner to weigh up risks and benefits, to see what to do. In terms of malaria prophylaxis or malaria tablets, because again Kenya being in Africa and similar to James going to Tanzania and Penny going to the Indian subcontinent, clearly there is malaria to understand here. And your baby can be protected against malaria, again all the choice of malaria tablets exists for your five month old baby, bar the fact that Doxycycline would not be appropriate. So again there are tablets which she should be able to take to protect her against malaria but it does require a face-to-face consultation with a travel health practitioner just to dot the Is and cross the Ts.Ìý
MYERS
So from what you've said Jane it would be somewhat easier if Peter had left this trip perhaps another 18 months, until his daughter was well two and able to have the necessary vaccines, in which case you know then she's going to be safe...Ìý
ZUCKERMAN
Yes.Ìý
MYERS
I mean are you prepared to take the risk here Peter, I don't know how it works with a little one like that?Ìý
PETER
Well I suppose typhoid and Yellow Fever could kill a child without ...?Ìý
ZUCKERMAN
They could, I mean I think it's the period of your travel that concerns me more because clearly the risk increases the longer that you're going to be there. So yes there are some things that you need to think about there. Typhoid can be a very serious disease, as can Yellow Fever. It really does depend on really understanding exactly what you're going to be doing in Nairobi and when you're in the more rural circumstance what you're going to be. It's risks and benefits, looking at the length of time that you're going to be there. If this is a leisure trip then I might very gently suggest that you might think about doing it a little bit later on.Ìý
MYERS
Turning that round a little bit Jane and imaging that either the baby was perhaps even younger or being breast fed - I'm not sure whether your daughter is or not - wouldn't you get any benefit when the baby is in the very early days and maybe being breast fed, any immunity sort of carried by the breast milk?Ìý
ZUCKERMAN
There are - there are some antibodies that are carried in breast milk but they're not necessarily going to be very specific to the infectious diseases that you find in an African country like Kenya. So not necessarily. And again it's much better to wait for the baby to be a little bit older and to have the immunisations. Of course if the mother has been vaccinated there may be the expression of the antibodies as a result of the vaccination coming through the breast milk. But again the quantity may not necessarily confer high levels of protection for the baby. So I wouldn't use it as a failsafe mechanism, it's much better to think about vaccines when the baby's a bit older.Ìý
MYERS
Quite a lot to think about there Peter. Thank you very much though for the call and thank you for those words of advice.Ìý
Let's go to Rosie with what may be a more straightforward question about deep vein thrombosis, Rosie what exactly is your worry?Ìý
ROSIE
Hi, yes I know there's been a lot of publicity about this but I'm very anxious about a trip I'm about to take in October to Australia and Japan and it's all kind of rather rushed and hurried in that I'm going to Australia for a week and then on to Japan for a week. I'm in my late 40s and I've already had some veins removed, because I had some varicose veins in my leg, and also my father was 45 when he died of a coronary thrombosis. And so I don't know whether the two could be linked genetically. I've already bought like support - these support flight stockings and got some aspirin but I wondered whether there was anything else I should consider.Ìý
ZUCKERMAN
Okay Rosie. I think the first thing to say is that although your father did pass away from a heart attack, which is also coronary thrombosis, there may be a predisposition to deep vein thrombosis but not necessarily. So I think the first thing I'd like to help you with is what to do on the long haul flights and certainly I would congratulate you on taking the initiative to get the stockings - that's exactly what I would recommend to do. Aspirin - as long as there are no contrary indications to you taking them - in other words you don't have any tummy ulcers or anything like that - there's no harm in taking a dose of aspirin as you board the plane but it's actually been proven scientifically now not to necessarily help to stop DVTs developing. So when you're on the flights you need to make sure that you keep hydrated, that doesn't mean that you shouldn't drink any alcohol, because alcohol is a quite powerful diuretic - in other words it makes you pass urine quite frequently - but if you have one small glass of alcohol balanced with two big glasses of water then that would ensure that you keep hydrated. And where possible to try and move on the plane, if you can get around the trolleys, it's often very difficult, what I usually do myself when I travel is just flex my ankles up and down every 15, 20 minutes or as much as I can possibly remember. And those are the sensible things and the practical things to do on the flight itself. But if I may just touch on what you've rather wisely spoke about is the genetic aspect of this. There is a possibility that there is a genetic, what we call, predisposition to deep vein thrombosis and I would actually suggest to you that it would be worthwhile seeing a haematologist and somebody who specialises in blood clots and blood clotting systems just to make sure that there isn't anything there that they can identify and if there is something there then they may well be able to provide some kind of drug treatment to help. It's worth excluding that.Ìý
MYERS
Thank you very much. Have a good trip - it sounds as though it's going to be perfectly safe with all those precautions. Let's move to, I think, our final caller - Keith is on the line waiting to talk to us and also planning his trip to the Himalayas, sounds fun. Hello are you there Keith?Ìý
KEITH
I am yes.Ìý
MYERS
Yes and what's your question?Ìý
KEITH
Well I'm planning a trip to Nepal and the Himalayas in February and was wondering is there any drug that you'd advise taking to help with altitude sickness?Ìý
ZUCKERMAN
Briefly Keith, if I may ask you - it's alright to ask a gentleman's age - so can I ask you how old you are?Ìý
KEITH
You may yes, I'll be 52 in August, at the end of this month.Ìý
ZUCKERMAN
Are you relatively fit and well?Ìý
KEITH
I am yes.Ìý
ZUCKERMAN
Excellent. You pose an interesting question, many, many people are travelling and climbing the Himalayas and other altitude destinations. There is a drug that can be prescribed with care and that's a drug called acetazolamide, it's a long complicated name but if you said it to a doctor he'd know exactly what you're talking about. And that can be prescribed for just a few days, two or three days, before you take the ascent and while you're ascending but it needs to be prescribed by a doctor. And certainly when I see people in our clinic for advice about altitude sickness I do a medical examination to make sure that the heart and lungs and everything is working just as it should do and then give the prescription with advice.Ìý
MYERS
Keith I hope that helps and I hope you have a great trip. I hope all our callers have great trips. Thanks very much to Jane Zuckerman, who's director of the Royal Free Travel Health Centre, our guest today. Thanks to you who have e-mailed and phoned us today. More information, as ever, you can phone our free and confidential help line 0800 044 044. You can also check our website, you log on to bbc.co.uk and follow the trail to Check Up. And join me again at the same time next Thursday afternoon, if you will, when our topic will be Celiac Disease.ÌýÌýÌý
ENDS
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