As a travel nurse based in London, I was concerned to hear the recent warning from health officials about the spread of tick-borne encephalitis (TBE) virus in several parts of the country. The UK Health Security Agency (UKHSA) has confirmed three cases of TBE virus in patients in Yorkshire, Norfolk, and on the border of Hampshire and Dorset. Further tests on ticks across the country have found that the disease, which was commonly found in parts of Europe and Asia until now, is now present in the UK. The experts have warned that it is unlikely that TBE virus will disappear, so it’s essential to establish a surveillance program. 

Public health officials say the risk is low, but it’s essential for walkers to take precautions and seek medical help if they fall ill after being bitten, especially if by a tick.  

As a clinic that specialises in travel, we are used to urging everyone to take precautions to protect themselves from tick bites anyway, but this news reinforces the importance of doing this at home as well as when travelling abroad. It is essential to cover your ankles and legs, apply insect repellent, and check clothes and your body for ticks, particularly when visiting areas with long grass such as woods, moorlands, and parks. 

In most cases the TBE virus typically causes mild flu-like symptoms, but it can also lead to severe infection in the central nervous system resulting in meningitis or encephalitis a high fever with headache, neck stiffness, confusion, or reduced consciousness, and long-term impairment.  

As a travel nurse, I think it is really important to educate people about the symptoms of TBE to encourage them to seek medical help immediately if they experience any of these symptoms, but also to emphasise the fact that infections are preventable. 

Ticks are becoming more common in parts of the UK, mainly due to increasing deer numbers. They live in undergrowth and latch on to humans when they walk through long grass. It is thought infected ticks may have arrived in the UK via migrating birds. Scientists had suspected the virus had arrived in the UK in 2019, following a couple of cases, but complexities involved in testing meant these could not be confirmed. 

It’s crucial to emphasise the significance of vaccination for individuals who are considered of a higher risk. You are much more likely to catch TBE if you work outdoors or if you enjoy outdoor activities such as camping, hiking, dog-walking, countryside rambling and even jogging. Children playing outside may be especially vulnerable. 

Vaccines can provide protection, and as there is currently no known cure for tick-borne encephalitis virus, those individuals who would be considered at higher risk are advised to be vaccinated as a precaution.  

It’s worth noting that a vaccine is used routinely in areas of high incidence in Europe, and its advisable to consider vaccination for individuals with outdoor occupations in regions where the virus is prevalent.  

For the general public the risk of contracting TBE is relatively low. Therefore, it’s essential to educate people about TBE and encourage them to take precautions to protect themselves from tick bites, particularly when travelling to areas where the virus is found. 

Related services available at Fleet Street Clinic 

Tick Borne Encephalitis Vaccination 

GP Services 

Travel Clinic 

For further reading, more news coverage can be found here: 

Gov.uk – Tick Borne Encephalitis detection in England 

The Times – Tick-borne encephalitis warning to walkers

The Telegraph – First cases of rare tick disease found in England 

Albania, located in Southeastern Europe, is a tourist haven this time of year.

Albania has much to offer, from stunning mountain scenes to crumbling castles to picture-perfect beaches all with easy-going charm and a friendly atmosphere. Right now the tales of its beauty haven’t quite reached the masses, but we have a feeling this is likely to change in the not too distant future.

If you plan on staying in Albania‘s capital, Tirana, be sure to see the rotating restaurant/ bars for spectacular city views.  Or take to the countryside and seashores to take in the ubiquitous sight of the abandoned concrete bunkers of Albania. Fearing invasion during the Cold War, Albania’s leader Enver Hoxha forced his country to build tens of thousands of bunkers throughout the country. These days you’ll see most in a state of slow decay but some have been given a new lease of life as a hotel, home or museum.

Visit Berat, to see the ‘town of a thousand windows’. This fascinating city dates back to the Ottoman Empire. The most striking feature of Ottoman architecture is the collection of whitewashed houses and towering minarets which adorn the hill to its castle. It is easily a highlight of visiting Albania. If, however, you prefer the great outdoors scale the peaks and troughs of the Accursed Mountains and take in the captivating castles of Gjirokastra.

Whatever your plan to do, be sure to follow our top travel tips to stay healthy in Albania.

Routine Vaccinations

All travellers to Albania are advised to be in-date with their routine immunisations. These include diphtheria-tetanus and polio and measles, mumps and rubella. Europe has seen huge outbreaks of measles in recent years. Therefore, all travellers should make sure they have received at least two doses of the vaccination, MMR.

If you’re unsure of your immunity, you can have a simple blood test to find out. Some travellers may wish to consider vaccinations for Hepatitis A and Hepatitis B, Rabies, and Tick-Borne Encephalitis. It is best to book a pre-travel consultation with a travel nurse to discuss your holiday plans. Together you can discuss what vaccines you’ll need.

Trekking and Ticks

The dramatic peaks of the Accursed Mountains spread their spoil between Kosovo, Albania and Montenegro. Those who plan to take advantage of the great outdoors should strongly consider vaccination against tick-borne encephalitis (TBE). TBE is a bacterial infection spread via tick bites or the consumption of unpasteurised dairy produce (between spring to autumn). Contracting the illness causes a fever with neurological complications.  

TBE is vaccine-preventable and consists of 2 doses of the vaccination being given at least 2 weeks apart.  A third dose is given 5-12 months later to give longer-term protection. Travellers should also avoid ticks by wearing long trousers and socks, and using DEET insect repellant. If you spot a tick on you, it needs to be removed promptly with some flat tweezers or a tick remover and cleaned with alcohol to reduce the risk of infection.

Rabies

Rabies is a fatal virus found in the saliva of infected mammals. Travellers can be exposed to it through a bite, scratch or a lick to an open area of skin.  Therefore, you should avoid contact with animals, especially wild and stray animals. The vaccination against rabies means that treatment can be given easily and in the country should a risk of rabies occur.

You will require a series of 3 vaccinations to be given over a 3 week period. Or over 1 week if a rapid course is needed. Travellers at greater risk are those who plan to do outdoor activities such as hiking, trekking, cycling or caving.

For more information on our vaccines, please visit our, travel and wellness vaccination pages.

First Aid Kit

For those trekking in the hills, packing good basic first aid kit is essential. The availability of health care and first aid supplies are very limited in rural areas, particularly outside Tirana. Therefore, you should make sure you bring your own adequate basic provisions. These include pain relief, plasters and medication to treat an upset stomach, such as loperamide and oral rehydration salts. 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.

Access to safe water may be limited. You should consider packing chlorine dioxide tablets to purify your own water. Alternatively, you can purchase a water-to-go bottle which has a built-in filter. If you take regular prescription medication, be sure you pack enough to last your entire journey. And, remember to carry the prescription with you just in case.

Book your travel appointment today

By Anna Chapman |  Travel Nurse | September 2019

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.

Vaccinations

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.

Find out more about our travel and wellness vaccinations.

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

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.

Book your travel appointment today

By Anna Chapman |  Travel Nurse | August 2019

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.

Fast Facts

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.

Autumn in Japan

Japan’s Autumn runs from September – November and attracts many visitors each year to view the beautiful changing of the Autumn foliage, known as koyo.

Taking outings to appreciate the beauty of autumn has been a custom in Japan for centuries. For many years now, this has become a popular activity for tourists too. Visitors explore the whole country to find the best ‘Autumn’ spots to view the natural beauty of landscapes bursting with yellow, orange and red leaves.

This activity tends to divert travellers away from the urban cities and into rural environments. Unfortunately, this increases exposure to some harmful diseases.
If you’re planning a trip to Japan this autumn….check out our travel vaccination advice.

Tetanus

Whether you are visiting the ultra-modern counterpart of Tokyo or taking a trip to Japan’s must-see landmark of Mount Fiji, traveller’s should ensure they are up-to-date with their tetanus vaccine. The vaccination is a combination vaccine with diphtheria and polio (DTP), which is routinely given to all children in the UK. However, you should ensure you and your children are up-to-date with your routine vaccinations before travelling. The vaccine can be given once every 10 years to those at risk.

Arm yourself with Insect Repellent

You can catch a number of diseases from mosquito and tick bites. You can minimise your risk by wearing long loose clothing and wearing plenty of insect repellant with a minimum of 50% DEET. Our Ultimate Bug Kit is available to purchase online. 

Japanese Encephalitis (JE) is transferred by mosquito bites. There is an increased risk for those travelling in rural areas with rice fields, marshlands, or pig farming areas. It is advised to avoid these areas, particularly during mosquito feeding times, dawn and dusk.
Those travelling to the Ryukyu Islands (Okinawa) should consider the Japanese Encephalitis vaccination as the highest risk season is typically April to December. Travellers with long-stays planned in rural area’s should also strongly consider the Japanese Encephalitis vaccine.

Tick-Borne Encephalitis (TBE) is transmitted by ticks and rarely by unpasteurised milk and dairy products. Travellers are at increased risk of exposure during outdoor activities in areas of vegetation (gardens, parks, meadows, forest fringes and glades). Ticks are usually most active between early spring and late autumn. We’d advise those travelling during that time to consider the TBE vaccination.

The main affected area is Hokkaido although there is a possible risk in Shimane Prefecture, Honshu.
Those travellers who aren’t planning on getting vaccinated should avoid eating and drinking unpasteurised milk products. We’d advise all adventurous eaters to consider the TBE vaccination prior to travelling.

Measles Outbreak

Earlier this year we saw outbreaks of measles across the globe, including a large outbreak in Okinawa in Japan. Most countries routinely immunise children against measles, in combination with mumps and rubella (the MMR). However, if for some reason you or your child have missed this then receiving two doses of the MMR vaccination before travelling will give effective protection. A simple blood test can determine immunity. Those found non-immune should book in for the vaccinations prior to travel.

The Flu

Seasonally Japan suffers from regular outbreaks of flu. Tokyo and other major metropolitan centres in Japan are very dense, which increases the spread of the flu. The flu vaccination available in the UK will dramatically reduce the chance of travellers catching the flu while abroad. 

Flight Times

 A flight from the UK to Japan are over 11 hours direct.  Prolonged periods of immobility on long-haul flights pose a risk of developing a blood clot or, deep vein thrombosis (DVT). Travellers can minimise the risk of this by ensuring they keep mobile and hydrated on the flight, avoid wearing restrictive clothing, and wearing flight stockings to aid circulation.

Altitude illness in Japan

Rapid exposure to low amounts of oxygen at high elevation can cause altitude sickness. There are a number of places in Japan which are higher than 2,500 metres, such as Mt Fuji, 3,776m.
Travellers should avoid travelling from altitudes less than 1,200m to altitudes greater than 3,500m in a single day. An ascent above 3,000m should be gradual. Travellers should avoid increasing sleeping elevation by more than 500m per day. Also, ensure a rest day (at the same altitude) every three or four days.

Book your travel appointment today

By Anna Chapman |  Travel Nurse | October 2018

Around 8 in 10 people don’t know what encephalitis is and so World Encephalitis Day aims to raise awareness of this illness, which causes brain inflammation and affects 6,000 people a year in the UK and has a high mortality rate.

Symptoms of Encephalitis

Infectious encephalitis usually begins with a ‘flu-like illness’ or a headache. Typically more serious symptoms follow hours to days, or sometimes weeks later. The most serious finding is an alteration in the level of consciousness. This can range from mild confusion or drowsiness to loss of consciousness and coma. Other symptoms include a high temperature, seizures (fits), aversion to bright lights, inability to speak or control movement, sensory changes, neck stiffness or uncharacteristic behaviour.

Autoimmune encephalitis often has a longer onset. Symptoms will vary depending on the type of encephalitis related antibody but may include: confusion, altered personality or behaviour, psychosis, movement disorders, seizures, hallucinations, memory loss, or sleep disturbances.

WHAT IS ENCEPHALITIS?

Encephalitis is an inflammation of the brain. It is caused either by an infection invading the brain (infectious encephalitis) or through the immune system attacking the brain in error (post-infectious or autoimmune encephalitis).

Anyone at any age can get encephalitis. There are up to 6,000 cases in the UK each year and potentially hundreds of thousands worldwide. In the USA there were approximately 250,000 patients admitted to hospital with a diagnosis of encephalitis in the last decade.

CAUSES OF ENCEPHALITIS?

The inflammation is caused either by an infection invading the brain (infectious encephalitis) or through the immune system attacking the brain in error (post-infectious or autoimmune encephalitis). Viruses are the most frequently identified cause of infectious encephalitis (e.g. herpes viruses, enteroviruses, West Nile, Japanese encephalitis, La Crosse, St. Louis, Western equine, Eastern equine viruses and tick-borne viruses). Any virus has the potential to produce encephalitis, but not everybody who is infected with these viruses will develop encephalitis. Very rarely, bacteria, fungus or parasites can also cause encephalitis.

SYMPTOMS OF ENCEPHALITIS

Infectious encephalitis usually begins with a ‘flu-like illness’ or a headache. Typically more serious symptoms follow hours to days, or sometimes weeks later. The most serious finding is an alteration in the level of consciousness. This can range from mild confusion or drowsiness to loss of consciousness and coma. Other symptoms include a high temperature, seizures (fits), aversion to bright lights, inability to speak or control movement, sensory changes, neck stiffness or uncharacteristic behaviour.

Autoimmune encephalitis often has a longer onset. Symptoms will vary depending on the type of encephalitis related antibody but may include: confusion, altered personality or behaviour, psychosis, movement disorders, seizures, hallucinations, memory loss, or sleep disturbances.

DIAGNOSIS OF ENCEPHALITIS

Symptoms alone often do not allow sufficient ability to distinguish between the many diseases that can mimic encephalitis. Therefore, doctors perform a variety of hospital tests –  it is important that investigations are carried out as soon as possible as prompt diagnosis reduces mortality and improves the outcomes.

With increasing numbers of people travelling worldwide, it is important to highlight the risk of infectious encephalitis which can be spread by mosquitoes (Japanese encephalitis ), ticks (Tick-borne encephalitis,) or other animals (Rabies).

If you are concerned about travelling to an area with the possibility of encephalitis infection, please visit our country vaccination guide for specific advice on your destination.

Information from The Encephalitis Society 

You can protect yourself from Japanese Encephalitis and Tick-borne Encephalitis with vaccinations. Book your travel vaccination appointment today.

Health Risks of European Travel

How many of us know that European travel can pose a threat to our health?  Health risks aren’t normally associated with European travel – we think of quick flights and familiar cultures so assume we’ll be relatively safe on short-haul holidays. However, there are actually several diseases to watch out for, especially if you are not vaccinated.

Stay aware of these key diseases so that you can prepare properly to have a safe and happy holiday.

Four illnesses to be aware of when holidaying in Europe:

1. Measles

• Measles continues to spread within and throughout Europe this year. Large outbreaks of the disease have occurred, and it is thought that the drop in vaccination coverage within populations is responsible. Countries that are currently reporting outbreaks of measles include: AUSTRIA, BELGIUM, BULGARIA, CZECH REPUBLIC, FRANCE, GERMANY, HUNGARY, ICELAND, ITALY, PORTUGAL, ROMANIA SPAIN, SWEDEN.
• Measles is a highly contagious virus which can have life-threatening complications.
• International travel has played a large factor in the international spread of measles.

2. Tick-Borne Encephalitis (TBE)

• TBE season has begun in Europe this summer. TBE is a viral infection spread through the infected bite of a tick.
• TBE effects areas of northern and Eastern Europe, Russia and even China.
• Those at highest risk of the diseases are those that intend to spend time in rural forested areas during spring summer and autumn where ticks are present. Activities such as camping and hiking and cycling increase the risk.
• Those who are travelling to areas of transmission can minimise the risk of the disease by taking strict precautions against tick bites.

3. Hepatitis A

• Europe has seen an increase in Hepatitis A cases this year. The virus is spread through contaminated food and water.
• The highest risk countries are those in Eastern Europe, the Baltics, the Balkans and Turkey, but in recent months Germany and Portugal have seen an increase in cases.

4. Rabies

• Rabies is virus-spread through the bite of an infected mammal. The virus is almost always fatal if left untreated. Animals that can spread this disease include dogs, cats, bats, foxes and wolves.
• Eastern Europe poses the highest risk of rabies in Europe.
• Travellers at highest risk include those who plan on travelling to remote areas.

Vaccines can prevent travel-related illnesses

The good news is that all these diseases are vaccine preventable and can be avoided by organising vaccines before you travel.

Measles – All travellers should ensure that they have had at least 2 doses of vaccinations against measles. This is usually given as a routine vaccination in childhood (MMR vaccine) at 1 year of age, and then again as a pre-school booster

Tick-Borne Encephalitis – vaccination against the disease is available for individuals aged 1 year and above. It requires 2 vaccination 2 weeks apart.

Hepatitis A – A highly effective vaccination is available against Hepatitis A and can be given to children from 1 year of age. Once the schedule of 2 Hepatitis A vaccinations has been given, immunity lasts for 25 years.

Rabies – a vaccine-preventable disease which requires three doses of vaccination to be given prior to departure. Those who have not received the vaccination with potential exposure to rabies require more extensive treatment which is not always accessible.

Travel Vaccinations at Fleet Street Clinic

Fleet Street Clinic is a leading vaccination centre and offers all travel vaccinations at our clinic in the heart of London.

Book your appointment online today.

By Anna Chapman, Travel Nurse at Fleet Street Clinic