Will you be traveling to Rio de Janeiro to attend or work on the Rio 2016 Olympics and Paralympics games?  It is a common phenomenon for people to focus heavily on attending or working at the Olympics – then having to spend much of their time seeking medical care, having to leave early, or even be hospitalised, for a problem that should have been resolved prior to travel.

Take a moment to review our travel health checklist for Rio 2016 to help keep you enjoying your time at the games!

Before you go:

>>Come and see us four weeks before you depart – don’t forget to bring along a record of any past vaccines you have received.

1.    Vaccinations

Routine vaccines should be up to date.

• Diphtheria/Tetanus/Polio (within past 10 years)
• MMR
• Possibly pneumococcal vaccine for adults aged over 65
• Chickenpox (varicella) – CDC recommended as these are routine immunisations is USA
• Whooping Cough (Pertussis) – CDC recommended as these are routine immunisations is USA

Travel vaccines: The following travel vaccines may also be recommended for your trip:

• Hepatitis A
• Typhoid
• Hepatitis B –
• Yellow fever (certificate NOT required for entry – may be required by other countries for onward travel)
• Rabies
• Flu (Southern hemisphere strains – ask us for details)

While you are there:

2.    Insect-borne diseases

Dengue, chikungunya and Zika are mosquito-borne virus infections that cause rash, fever, joint and muscle aches, and eye pain or conjunctivitis.

Malaria

Rio de Janeiro is malaria-free, with no risk of yellow fever at present.

If you will be travelling to the Amazon basin or other places in South America that have a risk of malaria, you may need to take preventive medication.

Preventing insect-borne diseases

Vaccination gives long term protection against yellow fever and malaria medication is an important precaution if you are at risk.

Bite avoidance is the best available approach.

Preventing bites

Reduce your risk of dengue, chikungunya, Zika, yellow fever and malaria by doing all you can to reduce the numbers of bites. Disease-carrying mosquitoes bite during the day as well as in the evening and at night:

• Cover up
• Using plenty of DEET-containing insect repellent
• Wear clothing impregnated with permethrin when working in the open
• Using mosquito nets or plug-in killers in your room at night
• Using our Ultimate Bug Kit.

3.    Food and water safety

Gastro-intestinal illness is by far the most likely problem that visitors to the Olympics will encounter. On a recent 8-week stadium tour of South America, up to 40% of tour members experienced travellers’ diarrhoea. Hot, crowded conditions and a “mass gathering” environment add to the risk: it is very important to take extra care with food hygiene.

It is worth investing in a gastro medical kit which contains all the necessary medicines should you get sick at any point during your travels.

4.    Sun and heat exposure

• Cover up & wear a hat
• Good quality sunglasses
• Stay well hydrated – even more important should you become ill with travellers’ diarrhoea.
• Use plenty of high SPF sunscreen (Apply insect repellent after sunscreen; reapply both regularly).

5.    Sexually transmitted infection

There are very high rates of sexually transmitted infections, blood-borne infections, and HIV. Avoid putting yourself at risk, or travel with appropriate barrier contraception.

6.    Personal security and safety

This has been a real problem in Rio in the past, and in other parts of Brazil: be alert to the risks. According to the FCO, “Crime levels are high. Violence and crime can occur anywhere and often involve firearms or other weapons. You should be vigilant, particularly before and during the festive and carnival periods.” Visiting favelas is not advisable.

Rape and other sexual offences against tourists are rare, but there have been attacks against both men and women. Some have involved ‘date rape’ drugs. Buy your own drinks and keep them within sight at all times.

Brazil has a high road traffic accident rate and a zero tolerance policy on drink driving. Always wear seatbelts.

7.    Medical kit

Pack a travel medical kit. Include all prescription and over-the-counter medicines you rely on using at home – medicines you take only occasionally as well as regularly (most medicines are easily available in Brazil but are packaged in Portuguese with much scope for confusion). Take first aid items. Include medicines for travellers’ diarrhoea (oral rehydration solution,nausea medication, loperamide, antibiotics). Take insect repellent, plug-in mosquito killers, and permethrin. Consult us for further advice, or to provide bespoke supplies. See more about our kits here.

8.    Local medical care

Public hospitals provide free emergency care but are not recommended. English is not widely spoken, you may need an interpreter. Many private hospitals offer a very high standard of care.

Recommended hospitals:

• Hospital Samaritano
• Hospital Pro Cardiaco
• Americas Medical City

The emergency ambulance number is 192.

There are no reciprocal health agreements in place so comprehensive travel insurance is essential. We recommend membership of the Blood Care Foundation, available at very low cost, to guarantee access to safe blood for transfusion.

9.    Getting there (and back): Flying and DVT

The direct flight time from London to Rio is approximately 12 hours: consider the risk of DVT, wear comfortable non-restricting clothing for the journey, keep well hydrated, stretch and move frequently, and don’t take sleeping pills or excessive alcohol if the journey will be spent in an upright, seated position. Consider wearing compression stockings. If you have any increased risk factors for DVT, talk to us about further steps that may be advisable.

Use our free calculator to see your DVT level of risk by clicking here.

After your return home

10. Post Travel Health

Report symptoms (e.g. fever, flu-like illness, rash, continuing diarrhoea) promptly, seek medical advice.

Don’t forget to mention your time in Brazil to anyone looking after you, if you need medical attention for any reason up to one year following return home.

If you need a pre-travel consultation, or have a health concern following a trip abroad, you can book an appointment online.

Further advice:

Centers for Disease Control & Prevention (US advice): http://wwwnc.cdc.gov/travel/notices/alert/2016-summer-olympics-rio

National Travel Health Network & Centre (NATHNAC) UK: http://travelhealthpro.org.uk/olympic-and-paralympic-games-2016-brazil/

Health Protection Scotland: http://www.fitfortravel.scot.nhs.uk/advice/general-travel-health-advice/rio-2016-olympicparalympic-games-brazil.aspx

European Centre for Disease Prevention and Control: http://ecdc.europa.eu/en/publications/Publications/Risk-assessment-mass%20gathering-Rio-2016-10May2016.pdf

Lancet Infectious Diseases: http://www.thelancet.com/journals/laninf/article/PIIS1473-3099(16)30069-X/fulltext

Blood Care Foundation: http://www.bloodcare.org.uk

Foreign & Commonwealth Office: https://www.gov.uk/foreign-travel-advice/brazil/safety-and-security

A new medical paper in Lancet Infectious Diseases has highlighted some of the countries at the highest risk for a major Zika virus outbreak. The study looked at air traffic between countries in the Americas, where Zika is already established, and places in Africa and Asia where the Aedes mosquitoes, the mosquitoes that can spread Zika, are most prevalent. The study also took other factors into account such as seasonality of transmission, population density, and economics to come up with a “hit list” of countries where Zika could potentially have the biggest impact.

Countries with larger volumes of travellers arriving from Zika virus-affected areas of the Americas and large populations at risk include:

• India (67,422 travellers arriving per year; 1.2 billion residents in potential Zika transmission areas)
• China (23,8415 travellers arriving per year; 242 million residents in potential Zika transmission areas)
• Indonesia (13,865 travellers arriving per year; 197 million residents in potential Zika transmission areas)
• The Philippines (35,635 travellers arriving per year; 70 million residents in potential Zika transmission areas)
• Thailand (29,241 travellers arriving per year; 59 million residents in potential Zika transmission areas).

Of the countries with the largest at risk populations, the authors suggested that India, the Philippines, Indonesia, Nigeria, Vietnam, Pakistan, and Bangladesh might be most vulnerable to impact because of their limited per capita health resources.

Dr Richard Dawood, Medical Director and co-founder of the Fleet Street Clinic, discussed the paper with one of its authors, as well as the current situation faced by travellers, on the Victoria Derbyshire programme on BBC2 on 2nd September.

“We have always known Zika could spread everywhere Aedes mosquitoes abound,” Dr Dawood told the programme. “This study tells us about the seasonality of risk of spread, and when/where it might take root, but does not model travel/risk of spread within Africa or Asia – so more studies are still needed.”

The study’s publication coincided with the arrival of Zika in Singapore – a major hub for Asian travel and Malaysia, with clear implications for further spread. With this news came the new evidence that Aedes aegypti mosquitoes are capable of passing the infection on to their offspring.

There is currently no vaccination available for the Zika Virus. If you have any questions and would like some more information and advice, please contact the Fleet Street Clinic on 020 7353 5678 or you can book a travel consultation appointment.

What is Coeliac disease anyway?

Coeliac disease is an auto-immune condition, defined as

a disease in which the small intestine is hypersensitive to gluten, leading to difficulty in digesting food.

We’ve all heard the term “gluten free” of late, something that has become synonymous with the fad diet of the moment, but for suffers of this fairly common disease, what does being a coeliac actually mean?

Gluten is a type of protein found in many types of food. Let’s be clear, being a coeliac does not mean that you have a gluten intolerance. When you are a coeliac, your immune system responds to the gluten in your food like it is a threat and attacks it. This in-turn damages the lining of the small intestine and hinders your body’s ability to digest nutrients from food properly.

What food can gluten be found in?

Any food containing:

• Wheat
• Barley
• Rye

The most common food with gluten in:

• Pasta
• Cake
• Breakfast cereal/bars
• Bread
• Bottled sauces
• Beer

What are the symptoms of coeliac disease?

There are many varied symptoms of being a coeliac but some of the most common symptoms are:

• Diarrhoea
• Bloating and passing wind more regularly
• Pains in your abdomen
• Feeling tired all the time

How do you treat coeliac disease?

Although there is no cure for being a coeliac, you will need to follow a gluten free diet to appease the symptoms. With a little time and effort, most sufferers can follow the diet and carry on about their regular life with no further complications from the illness.

This can be tricky at first as there are so many products you would pick up from your local supermarket that contain gluten. It’s best to speak with an expert for advice on how to manage your diet. At Fleet Street Clinic we can screen for many food intolerances as well as assisting you in every step of the way should your tests coming back positive for an allergy.

If you have any concerns regarding coeliac disease or any other type of food intolerance, please book an appointment online. Or you can contact on 020 7353 5678 for more information.