You may get resistant bacteria in your bowel during travel and they can subsequently become a problem. If you develop an infection caused by these resistant bacteria it can be hard to treat because not many antibiotics will be effective against them. We have recently learnt that many people going to some destinations such as India and Egypt acquire resistant bacteria. If you get diarrhoea while away the rate of acquisition is higher and taking antibiotics to treat diarrhoea increases the risk further. We are thus discouraging people from taking antibiotics for diarrhoea unless the diarrhoea is severe. It is also worth telling your doctor you have recently travelled if you need to have surgery or get an infection as first line antibiotics may not work.
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When entering Tanzania proof of yellow fever vaccination may be required if some one is entering from a country with a risk of yellow fever such as Kenya. People arriving from areas with out yellow fever should not need proof of it. However, a study done last year showed unpredictable checks at borders and even people who were arriving from Europe or Dubai were sometimes checked. Checks were more likely at land borders than at airports and more likely at Arusha than Dar es Salaam and Zanzibar. Consequences of not having a valid certificate or exemption note included fines, clearance after a short discussion, inability to obtain a visa and even vaccination at the border. It seems everyone arriving in Tanzania should either be vaccinated or carry an exemption note. This should be unnecessary for those not entering from endemic countries however after reading the study it seems necessary.
Remember that Zika is a risk in Asia as well as Latin America. This year more than 100 cases have been diagnosed in Thailand and Singapore reported its first locally acquired case in August and now has over 300 cases. Cases have been reported in clusters in Geylang, Bedok, Bishan, Hougang, Sengkang, and Toa Payoh townships. No cases involve the Marina, Central, Orchard, or Tanglin areas. In the States 93 locally acquired cases have been reported from Florida including Miami Beach.
A recent report described transmission of zika virus from a male with no symptoms from the infection to his female sexual partner. Previously we had only seen it passed from men with symptoms from the infection. (So the information in my April blog has been proven to be wrong.) There has also now been a report of transmission from a female to her male partner. The guidelines now recommend abstinence or condom use and avoidance of pregnancy for 6 months for anyone after travel to risk areas for Zika. New Zealand recommendations are available : http://www.health.govt.nz/our-work/diseases-and-conditions/zika-virus#sexual With numerous illnesses transmitted by mosquitoes, sand flies, ticks and even tsetse flies the fewer bites you get the better. Different types of mosquitoes spread different things- those that feed in the evening and overnight spread malaria and Japanese encephalitis while day feeding ones spread dengue, Zika and Chickungunya.
Wearing long sleeves and long pants means you have less exposed skin. Garments with insect repelling properties can be purchased at outdoor stores or you can treat them with permethrin. Bed nets are really helpful if treated with insecticide. You can purchase treated nets or permethrin solution from http://www.skinshield.co.nz. Repellent on exposed skin should be reapplied regularly. Both DEET and picardin containing repellents work well. Strengths of DEET over 50% don’t repel any better but do last longer however they may be irritating on the skin. Apply repellents only to exposed skin and not over cuts or wounds. A big change is that from July 11 2016 when you have a yellow fever vaccination the certificate will now say that the vaccine is valid for the lifetime of the person vaccinated instead of 10 years as it was previously. This follows a decision from WHO because the protection from the vaccine is longer than 10 years for most people. The American CDC however warns that if someone is going to a high yellow fever risk region, were pregnant when they were first vaccinated or HIV positive a second dose may be indicated. It also remains to be seen if the border officials of all countries accept the new duration of protection. If travelling with an expired certificate is should not be altered in any way but should be considered adequate.
There has been a yellow fever outbreak in Angola since December 2015 with over 3,000 cases and over 300 deaths. Because of it nearly 11 million doses of yellow fever vaccine have been given there in emergency vaccine campaigns. The numbers of new cases have declined but it continues to spread. An outbreak is now occurring in neighbouring Democratic Republic of Congo and travellers with yellow fever have gone from Angola to Kenya and China as well. A different yellow fever outbreak is also occurring in Uganda . Because of this yellow fever certificates will probably be checked at borders more strictly than usual so be sure you have your certificate if travelling in such countries in the near future and certainly be vaccinated before you go.
A few women have been infected with Zika by their sexual partners. The men have all passed the infection on either just before having the illness or during it or shortly after it. No cases have been seen from men who didn't have symptoms. Because the virus can remain in semen longer than it is in the blood stream it is advised that men abstain or use condoms for at least 6 months after Zika infection. Those who travel to Zika areas but who don't get any symptoms of the infection should abstain or use condoms for 8 weeks.
Remember it isn't just Latin America that has Zika outbreaks at the moment. It is also closer to home. So far this year there have been 60 confirmed cases of Zika in New Zealand. Forty one of them had travelled to Tonga and 19 to Samoa or American Samoa.
There is concern that Zika infection during pregnancy is harming unborn babies. Because there is neither a vaccine nor prophylactic medications available to prevent Zika virus infection, the CDC in America recommends that all pregnant women consider postponing travel to areas where Zika virus transmission is ongoing. If a pregnant woman travels to an area with Zika virus transmission, she should strictly avoid mosquito bites.
Updates on areas with ongoing Zika virus transmission are available online (http://wwwnc.cdc.gov/travel/notices/). Two new viral illnesses are spreading rapidly in Central and South America. Chickungunya virus travelled with an infected person to the Caribbean in late 2013. Since then it has spread to 45 countries in the Caribbean and Latin America with 1.7 million suspected cases. It causes fever and joint aches and pains. The other, Zika, probably travelled to Brazil in 2014 and is spreading north wards. It causes a similar illness to dengue but is milder however there is concern that it is the cause of an unexpected increase in babies being born with small heads in Brazil. Both infections are spread by day time feeding Aedes mosquitoes which are widespread and breed in urban areas well. It is important to use repellent to try and minimise mosquito bites.
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