Dengue Fever has been in the news following two cases linked to travel to the Spanish island of Ibiza. This has sparked concerns about the spread of mosquito-borne illnesses in Europe, which is especially unusual for this time of year.
Dengue fever is a viral infection transmitted by the Aedes mosquito, which is found in tropical and subtropical regions worldwide. With rising temperatures and changing climates, there is a risk of mosquitoes and other disease vectors spreading to new areas, potentially causing outbreaks of diseases such as dengue fever.
The two cases of dengue fever in Ibiza were reported by the Spanish Ministry of Health and were both in residents of Germany who had visited the island before becoming ill. Each case was accompanied by two family members who were also suspected to have had dengue fever.
The risk of dengue fever in Spain is highest between the months of May and November, when mosquitoes are most active so to have cases at this time of year is uncommon.
So, why are we seeing cases outside of the usual infection months?
The reason is multi-facetted.
Our medical director and travel health specialist, Dr Richard Dawood explains:
“Firstly, there is the introduction or spread of mosquitoes to “pastures new” – places that might have been previously inhospitable, perhaps through temperature; or alternatively, that offer an environment with plenty of suitable breeding sites that they are suddenly able to take advantage of. These mosquitoes can bring disease with them, or can spread it around if there is a reservoir in the local population.
Secondly, there is the possibility of introducing disease to a vector population that is already established, ready and waiting. This is exactly the (long-standing) concern with yellow fever. There are mosquito species in Asia, for example, that are easily capable of spreading yellow fever were it to be introduced by an infected traveller – which is why Asian countries are so careful to insist on proof of yellow fever vaccination from travellers arriving from the endemic zones of Africa and South America. Asia is yellow fever-free, and wants to remain so. However, this type of introduction has already recently happened in Australia, where Japanese encephalitis (a virus infection that can cause rare but serious complications in humans) has recently established a reservoir of infection in farm animals, that may be impossible to reverse. It is also happening with Lyme disease spreading gradually into parts of Europe (and the UK) with a susceptible tick population.
Similar concerns apply to Zika – there is very large potentially susceptible mosquito population that could spread the virus in many tropical countries, if introduced; dengue fever; and also potentially malaria, in parts of the world that have been the target of successful elimination campaigns, but where mosquito populations could still spread it, were it to be reintroduced, if control measures are neglected or ceased.
With changing climates, a valid concern about global warming is that it could create conditions in which populations of mosquitoes and other vectors thrive and spread – hence the crucial importance of vigilance, surveillance, and early action if needed.”
How can you protect yourself from Dengue Fever?
There is no vaccine against dengue licensed in the UK, though several candidate vaccines are in development.
The best way to protect yourself against dengue fever is to take measures to avoid mosquito bites. This includes wearing protective clothing, using mosquito repellent, and staying in places with air conditioning or screens on windows and doors.
If you develop a high fever during or after travelling to an affected area, seek medical advice as soon as possible and provide details of your recent travel history. Dengue is often also accompanied by a rash and joint or muscle pain.
In conclusion, rising temperatures and changing climates have the potential to create conditions in which populations of mosquitoes and other disease vectors thrive and spread. It is crucial for public health authorities to remain vigilant and take early action if needed to prevent the spread of diseases such as dengue fever. By taking appropriate measures to protect against mosquito bites, travellers can reduce their own individual risk of contracting dengue as well as other insect-borne infections.
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Measles Outbreak – What You Need to Know
The WHO has issued a warning about recent outbreaks of measles in Europe and the USA. Cases of measles have risen rapidly in recent months in Italy, Romania and most recently in US.
Measles is a highly contagious virus with potential for serious complications.
Initial symptoms can include:
- Runny nose
- High Temperature
- Spots in the mouth
- Aches and pains
- Sore eyes and swollen eyelids
A rash appears after 2-4 days which can present as blotchy spots, often starting at the head and progressing down.
Medical Advice for Measles
If you think you may be suffering from measles, or are concerned about risk of infection when travelling, please see your doctor straight away.
Travelling to areas with a risk of measles
Make sure you are up-to-date with your vaccinations before you travel, including the measles, mumps and rubella (MMR) vaccine. If your child will be travelling, the MMR can be given from 6 months of age. If you have not had measles or if you have not had two doses of MMR, you may be at risk. Measles is easily passed from person to person and can be a serious illness in adults as well as children. It is never too late to have the vaccine.
Call Fleet Street Clinic for medical assistance, advice on vaccinations and travel precautions on 0207 353 5678 email firstname.lastname@example.org
ADVICE ON TICK-BORNE DISEASE IN EUROPE
Tick-borne Encephalitis (TBE) is a viral disease that is spread by the bite of an infected Ixodes tick. It is estimated that the disease infects at least 13,000 people every year.
Symptoms can occur from 4-28 days post-bite and include fever, fatigue and muscle aches.
The virus can also go on to affect the brain and spinal cord, causing meningitis, with up to 20% of cases resulting in death. Unfortunately, there is no specific treatment for TBE.
TBE occurs in 3 main geographical locations:
European TBE – Western Europe
Siberian TBE – Urals, Siberia, Far-Eastern Russia and Finland
Far Eastern TBE – far Eastern Russia, China and Japan
Transmission of TBE occurs mainly during the summer months, mainly via wild vertebrate animals such as rodents. It can be transmitted either by ingestion of unpasteurised milk, or milk products from infected animals or by the bite of an infected tick.
If you’re travelling to affected countries during the transmission period, you are most at risk if you are doing outdoor activities such as hiking, camping and walking in forested areas where ticks are abundant.
Take the following precautions to avoid infection:
Wear long trousers and sleeves. Impregnating clothing with permethrin and using insect repellents such as DEET are also good ways of preventing tick bites.
Get vaccinated. Ticovac (and Ticovac Junior for children) is advised for travellers who may be at risk. It requires two vaccinations prior to travel, and the third dose after a year can provide up to 5 years protection.
Check your body for ticks -especially in the armpits, groin and behind the knees.
Remove ticks promptly and correctly and clean the bite site with antiseptic.
|Where||Eastern Europe, Scandinavia, Siberia|
|How||Infected bite of a tick|
|Can it be prevented?||Yes – Vaccination and tick-prevention|
Tick Removal Tips
If you find a tick embedded on your skin you need to remove it, asap:
To remove a tick follow these steps :
- Use a pair of fine tweezers or a tick-remover
- Grasp the tick head as close the skin as possible
- Pull upwards at right-angles to the skin
Top tip: Avoid putting pressure on the body to avoid incomplete removal which may cause infection.
TICK-BORNE ENCEPHALITIS VACCINATION
There is a vaccination against tick-borne encephalitis (Ticovac and Ticovac Junior) which is highly effective against TBE. The primary schedule requires two vaccinations to be given 14 days apart, and a third dose to be given one year later. A booster vaccination is recommended after 3 years. The vaccination is suitable for adults and children over the age of one-year-old.
You can book a travel consultation appointment online to find out if you beed a tick-borne encephalitis vaccine for your next trip.
Christmas is coming and who doesn’t enjoy a Christmas market (or two!) A popular Christmas city break destination is Germany and visiting the fantastic Christmas markets is top of most travellers to-do list.
Read our advice on how to stay healthy during a winter city break in Germany:
Coughs, sneezes and Christmas wheezes
Christmas markets can be crowded places. A combination of cold damp weather and crowded areas means that it is easy to pick up a viral infection. Preventing the common cold can be helped by observing good hand hygiene to avoid that transfer on infection. If you do start with the sniffles, ensure you use a tissue to ‘catch it, kill it, bin it’ to stop the spread to others.
Don’t let the flu spoil your festive fun. In the Northern Hemisphere, seasonal influenza occurs during the winter months, with peak season around Christmas. Flu is spread from one person to another via coughing and sneezing and it very contagious in populated areas. It can, however, be easily prevented with a single flu vaccine, which ideally should be given several weeks before the ‘flu season’ begins to provide optimal protection.
Have a Merry measle-free Market
In recent years, many countries in Europe have seen dramatic surges in the cases of measles. Measles is an acute viral infection that has the potential for severe complications. Merry market goers should ensure that they have received 2 doses of the measles-containing vaccination, commonly known as the MMR, to ensure they have adequate protection against the disease.
If you would like more travel advice we’d recommend an appointment with one of our travel nurses.
Book your travel appointment today
By Anna Chapman | Travel Nurse | November 2018
A weekend in Dublin
The unique mixture of hedonism and heritage makes Dublin the perfect city break.
Be ready to eat and drink your way around the city, indulge and celebrate, both these things are encouraged wherever you go. The Irish definitely know how to live life to the full.
Here is our flu coordinator Laura’s guide to ensure you have a memorable weekend in Dublin.
Dublin requires a certain amount of pre-planning especially if you’re wanting a budget city break. Prices tend to steadily increase the closer you book to the date of travel. So, expect to pay more if you’re more of the spontaneous adventurer.
Depending on if you’re taking the whole family or travelling alone, we’d always book flights in advance. Especially expect to pay more on St Patrick’s weekend!
Book your accommodation early! There is a big rental shortage in Dublin and popular times throughout the year can result in overpriced accommodation at hostels, hotels and even Airbnb’s.
The Irish weather has a reputation for having four seasons in one day and for that reason pack clothes for all types of weathers. Layering is key, that way you can add and remove layers depending on the weather. An absolute essential is a lightweight raincoat for those unexpected downpours.
If you are an adventurous traveller, you will find your normal running trainers might not be enough for the unexpected weather and puddles! We’d recommend investing in some hiking boots, these will come in handy for those out of city days and will make sure your feet stay nice and dry.
No trip to Dublin is complete without a trip to the Guinness Brewery. This is a must do!
Believe it when people say the Guinness tastes different in Ireland, it definitely does. Just a tip – Save yourself from the huge queues and book your ticket online. Be ready to drink – your tour comes with a free taster at the end!
The city can be all-encompassing but make time to visit the landscapes and explore the natural beauty of the beautiful Irish cliffs. One of the natural wonders to visit would be the Giant’s Causeway. Breathtaking scenery!
You might find it easier to do this by renting a car, remember to bring a credit card and your passport. It can be very cheap, and lets you see all the best stops in your own time.
Locals know best
It is always handy if you know a local, they have all the insider knowledge and are able to steer you away from all the overpriced tourist traps and find something truly authentic. If like me, you don’t know a local, my advice is to ask around, you’re sure to find a friendly local who’ll share the history of Ireland with you in exchange for a pint of Guinness (or two!)
A bit of history
There are no shortages of bars and pubs in Dublin. A couple to definitely make sure you visit would be The Brazen Head and The Temple Bar.
The Brazen Head is Ireland’s oldest pub, the present building was built in 1754 as a coaching inn. However, it appears in documents as far back as 1653.
The temple bar is very loud and very busy, so not to everyone’s liking but if that is your scene then you won’t be disappointed. Many famous Irish legends have taken to their stage and entertain large crowds with their iconic songs and ballads throughout the years. Definitely sink an Irish whisky here!
Book your travel appointment today
By Laura Berry | Flu Project Coordinator | September 2018
Measles on the rise:
The World Health Organisation (WHO), has reported that measles cases are on the rise worldwide and in Europe alone, outbreaks have surged to a 20-year high.
The WHO states that reported measles cases (provided by each country) currently show that about 229,000 cases have already been reported, compared with 170,000 for 2017. Worryingly the 2018 number is likely to rise as the reporting deadline ends April ’19.
With a 50% increase in measles cases last year, it is important to understand the benefits of vaccinating against measles:
Dr Richard Dawood, our Medical Director explains;
“I recently heard about a patient suffering a bad attack of shingles. She didn’t believe in doctors, medicines or vaccines, I was told, and was languishing at home, with a dreadful, crusted rash across her body, and burning with pain. She had stuck to her beliefs and refused to take antiviral medication that could have aborted the attack or reduced the probability of ending up with long term nerve damage and lingering pain. Shingles can strike more than once, but since she doesn’t believe in vaccines (there is a good one that is 95% effective) she will have to take her chances of a recurrence in future. I disagree with her opinions, but her latest actions will harm nobody but herself.
But measles is different: when it comes to vaccination, personal choices and opinions have a direct impact on the health and wellbeing of others – individually as well as for entire communities. Measles vaccination is a major public health issue. Memories of the past outbreaks, epidemics, tragic disability and loss of life that drove research and ground-breaking vaccine development now belong to a previous generation. In these days of “fake news”, “influencers” and social networks, it has become too easy to undermine confidence in matters of public health. In the case of measles, concerns about vaccine safety are down to the “fake research” of Andrew Wakefield, who was struck off the medical register for concocting a spurious link with autism in the 1990s. But the damage was long-lasting.
The complications of measles are most severe in babies who are not yet old enough to be vaccinated, and children with reduced immunity. When the rate of vaccination in the general population falls below 95%, outbreaks occur and can easily spread, with the highest impact on those most vulnerable populations, undermining years of hard work around the world to bring measles under control.
That is what is happening now”.
VACCINATION AGAINST MEASLES
‘The highly contagious disease can cause severe diarrhoea, pneumonia and vision loss. It can be fatal in some cases and remains an important cause of death among young children”, according to the WHO.
The disease can be easily prevented with two doses of a safe and efficient vaccine that has been in use since the 1960s’.
Make sure you are up-to-date with your vaccinations including the measles, mumps and rubella (MMR) vaccine. Although the NHS immunisation schedule offers the vaccine to children from 12 months of age, the MMR can be given from 6 months. If you have not had measles or if you have not had two doses of MMR, you may be at risk. Measles is easily passed from person to person and can be a serious illness in adults as well as children. It is never too late to have the vaccine.