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.
Suitable Medical Kits available to buy online
Related services available at Fleet Street Clinic
Bosnia is where East meets West.
It is a country on the Balkan Peninsula in southeastern Europe and has become somewhat a destination for adventurous travellers.
Beautiful Ottoman architecture, rugged mountains, captivating castles, raft-able rivers, and humble hiking trails are all reasons why travellers are choosing Bosnia as their next travel destination. The unveiling of the Via Dinarica mega hiking trail means the number of tourists to the Balkan country of Bosnia Hercegovina is expected to rise steeply. The 1930km trail provides a corridor linking traditional cultures between the former Yugoslavian nations. So whether you plan to mill about the city of Mostar, stroll the streets of Sarajevo, or take a hike in the hillside, ensure you follow our top travel tips to stay healthy.
All travellers are advised to be in date with their routine immunisations, including diphtheria, tetanus and polio (DTP) and measles, mumps and rubella (MMR). Europe has seen huge outbreaks of measles this year alone, so all travellers should make sure they have received at least two doses of the measles-containing vaccination. A simple blood test can be done for all those who are unsure about their immunity. Some travellers may wish to consider vaccinations for Hepatitis A and Hepatitis B, rabies and tick-borne encephalitis. The activities you plan to do whilst travelling will determine which vaccines would be required. If you have any doubts or concerns, we also suggest booking a pre-travel consultation with a specialist travel nurse to discuss your options.
Trekking and Ticks
Bosnia offers a wealth of outdoor activities. Those who plan to take advantage of the great outdoors should strongly consider vaccination against tick-borne encephalitis (TBE). TBE is a bacterial infection. Usually, it is spread through an infected tick bite. However, during Spring to Autumn, the consumption of unpasteurised dairy produce also carries a risk. Contracting the illness causes a fever with neurological complications. It is vaccine-preventable. Protection requires 2 doses of the vaccination, given at least 2-weeks apart. A third dose is given 5-12 months later to give longterm protection. You should also avoid ticks by wearing long trousers and socks. Using DEET insect repellant should also repel them.
If you spot a tick on you, it needs to be removed promptly. Use some flat tweezers or a tick remover and clean the bite with alcohol to reduce the risk of infection.
See our Ultimate Bug Kit.
Rabies is a fatal virus that can be found in the saliva of an infected mammal. Most commonly a wild dog. Exposure can happen through a bite, scratch or a lick to an open area of the skin. You cannot catch rabies from another person and it cannot spread through unbroken skin. You should, where possible avoid contact with animals when travelling, especially wild or stay animals.
Rabies is almost always fatal once symptoms appear, but treatment before this is very effective. Pre-travel rabies vaccination offers great protection. And means that in the unlikely event you come into contact with the rabies virus, fast and effective treatment can be given easily and in the country of the incident.
Pre-travel rabies protection requires a series of 3 vaccinations given as injections into your upper arm. Your vaccines will be given over a 3-week period, or over 1 week if an accelerated course is needed, prior to travel. Travellers at greater risk are those who plan to do outdoor activities such as hiking, trekking, cycling or caving. You should consider a rabies vaccine if you plan to do any of these activities whilst visiting Bosnia.
First Aid Kit
For those trekking in the hills, packing good basic first aid kit is essential. When travelling in rural areas, access to healthcare can be limited. Travelling with a medical kit will give you access to basic provisions needed to treat minor injuries and pains.
Basic provisions include pain relief, plasters and medication to treat an upset stomach, such as loperamide and oral rehydration salts. If access to safe water may be limited, consider packing chlorine dioxide tablets. Cuts, scapes blisters and even a twisted ankle can occur, so take blister pads, some waterproof dressings and a bandage to deal with any minor injuries whilst you are there. If you take regular prescription medication, ensure you pack enough for the duration of your trip and carry the prescription with you.
By Anna Chapman | Travel Nurse | August 2019
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!
By Laura Berry | Flu Project Coordinator | September 2018
I’ve just returned from Montenegro, which is a beautiful country and still relatively undiscovered in terms of European tourist destinations. The beautiful beaches, Venetian towns and stunning scenery make a trip really worthwhile.
One of the great pleasures of travelling is to be able to enjoy local cuisine and gastronomic specialities of the region. It can help you discover the culture of a place and connect with local people in an authentic way.
However, the last thing you want is for travellers diarrhoea to ruin a trip. The majority of tummy trouble abroad happens in the first week of travel and is caused by bacterial infections (such as salmonella) which can’t be prevented by vaccination. They are found in unclean water and ill-prepared food, and the only defence against them is to be careful with food and water whilst away.
How to help avoid dodgy tummies while away:
- Ensure food is cooked and served hot immediately.
- Don’t eat unwashed or unpeeled raw fruit and vegetables.
- Don’t drink tap water – bottled water is easily available and those hiking or camping in remote areas will need to be prepared to purify water themselves
- Wash hands before each meal and after going to the toilet. Alcohol hand gel can be used when hand washing facilities are not available
- Avoid easting unpasteurised dairy produce.
You can buy a Worldwide Gastro Kit online to
Other items for considering when in Montenegro:
- Tick-borne encephalitis can be an issue in Montenegro for those travellers heading off into the mountainous regions during the summer months. Although primarily spread via the infected bite of a tick, the illness can also be contracted via unpasteurised dairy products, so best to avoid the traditional Montenegrin cheese that is offered in these areas. There is a vaccination against the illness that is highly effective.
- Consider a vaccination against Hepatitis A which can occur in areas of Montenegro where travellers cannot guarantee they have safe access to water. Those who are camping or hiking in remote areas should ensure that they have a way to secure a safe water supply, either by boiling water, using a filter or chlorine dioxide tablets. Hepatitis A is a virus that affects the liver and is vaccine preventable.
The Fleet Street Clinic stocks medication for travellers diarrhoea, medical travel kits and our experienced travel clinic nurses can help advise. If you’ve been on holiday and suffering from a lingering tummy bug, you can get a same-day diagnosis and medication using our PCR machine, you can email or call us to find out more.
Tick-borne encephalitis in Sweden
The summer months are great for exploring Scandinavia. What many people don’t realise is that vaccinations against Tick-borne encephalitis should be considered if your travel plans take you out into the countryside. If you plan on spending time in forested areas, particularly around Gothenburg, Upland, Sodermanland and the Islands around Stockholm, you could be at risk of the disease.
What is Tick-borne Encephalitis (TBE) ?
TBE is a viral infection that affects the central nervous system. It is spread via the bite of a tick, or by ingesting unpasteurised milk and dairy precasts from animals that carry the diseases. Transmission season is usually in the summer months between April and October. There is an effective vaccination available against tick borne encephalitis to prevent the disease. It requires 2 vaccinations 14 days apart with a booster dose given 1 year later.
Other countries that have a risk of the disease include Eastern and Western Europe, Russia, Finland, China and Japan.
In addition to the vaccination, preventing tick bites is really important, especially if you plan to do outdoor activities such as camping, hiking in rural areas during transmission seasons.
You can prevent ticks by:
- Wearing DEET insect repellent with a minimum of 50% DEET concentration.
- Wearing long trousers and tucking them into your socks, and shirts with long sleeves.
- Treating clothes with permethrin.
- Inspecting your body for ticks and removing them promptly.
- You can purchase out Ultimate Bug Kit.
Although rabies is not present in terrestrial animals in Sweden, bats can still carry the virus. Those travellers who plan on exploring caves, such as in Abisko in Lapland may wish to consider being immunised against rabies prior to travel.