Yellow Fever Update:

Recent news reports have raised concerns about yellow fever vaccine safety. It is important to understand the risks and benefits.

For decades, the yellow fever vaccine was considered to be extremely safe. More recently, however, we have become aware of a low rate of serious adverse effects occurring when older travellers are vaccinated for the first time. The two main types of adverse effects are called YEL-AVD and YEL-AND – the first involves damage to organs such as the liver, and the second damages the nervous system. Yellow fever vaccines contain live viruses that do not harm people with a normally functioning immune system but do seem to cause harm in a tiny proportion of people with an ageing immune system, as well as those with reduced immunity from other causes.

In one of the largest medical studies of yellow fever vaccine safety, the rate of YEL-AND in people aged 60-69 was 2.5 per 100,000 people vaccinated, and in over 70s was 1.6 per 100,000. For YEL-AND, the rates were zero and 4.0 per 100,000 respectively.

According to the US Centers for Disease Control, in the absence of a yellow fever outbreak, the “background” risk of yellow fever occurring in unvaccinated travellers on a 2-week trip to a zone where yellow fever is present is calculated to be:

• West Africa: 50 cases per 100,000, with 10 deaths per 100,000
• South America: 5 cases per 100,000, with 1 death per 100,000

Yellow fever vaccinating centres normally explain these risks to everyone they vaccinate, and in particular to travellers aged over 60.  Vaccination for personal protection is recommended where benefit outweighs the risks, and a medical waiver is given when it is not safe for the vaccine to be used. Age alone is not a reason for issuing a waiver.

Other factors that complicate the picture include the following:

• There are active outbreaks of yellow fever in several parts of the world, notably at present in Brazil as well as in several African countries, so the risk to travellers is often much higher than that quoted above.
• Vaccination is the only way to prevent and control yellow fever and is often the only possible public health measure for entire populations.
• Many countries therefore rigorously enforce vaccine requirements as a condition of entry.
• Yellow fever vaccine shortages are common – there is currently a serious shortage in the USA, and the vaccine is not always available when needed.
• Awareness of vaccine risks has come with a stricter approach to recommending vaccine only when travellers are definitely going to be at risk; however, an unintended consequence of this has been to delay the opportunity to vaccinate travellers for the first time until they are older and at greater risk of adverse effects.

The World Health Organization now considers vaccine protection to be life-long, though border officials in several countries do not always recognise this. A small number of recent cases of yellow fever in Brazil among people who had been vaccinated previously has raised further doubt about this policy, and Brazil currently recommends revaccination every 10 years.  Revaccination has not been linked to adverse effects.

There is currently extensive UK press coverage (that has also been picked up in the US) of YF vaccine adverse effects – one death occurred shortly after vaccination in a distinguished cancer researcher, and a psychotic reaction in a former BBC journalist vaccinated in Greece. Both cases were attributed to the vaccine because of the timing. Further clinical details are not available, so we can’t yet be certain of a direct link, but this news will undoubtedly have a considerable impact on public perception of the vaccine.

Written by: Richard Dawood, Medical Director and specialist in travel medicine

Book your yellow fever vaccination today.

Links:

• Cancer pioneer Martin Gore’s sudden death from routine jab  –  Source: The Times
  
• I had a yellow fever jab, then the voices told me: ‘Kill! Kill! Kill!” – Source: The Times

The risk of rabies is still widely unknown to the general public.

If caught and symptoms develop, rabies is almost invariably fatal.

Rabies is spread through the saliva of an infected animal and is present in over 150 countries worldwide. Up to 100 children die each day from rabies, and more than 55,000 people a year are killed from the disease, mainly in Asia and Africa.

If bitten or scratched by an infected animal you need to act quickly. Even with pre-travel vaccinations, a course of post-exposure vaccinations are required to prevent disease. If you haven’t had pre-travel vaccinations, the treatment is much more intense. If treatment is given correctly and promptly after exposure, then rabies can be cured but once symptoms develop, it is too late.

Some countries are deemed high-risk of rabies.

Considering this, it’s alarming when we experience resistance from travellers who feel this vaccination isn’t necessary for travel, especially if they are visiting a high risk location.

We feel so passionately that if you are travelling somewhere with a known risks of rabies it only seems sensible to protect yourself against it. Rabies is a vaccine-preventable disease, so make sure you get vaccinated before you travel.

For more information on rabies and travel health, visit our rabies page here.

The Fleet Street Clinic is passionate about travel. We have provided rabies vaccinations for over 20 years. Our team of expert travel medical professionals provide advice and detailed consultations to ensure you have a healthy trip.

You can book a travel consultation or rabies vaccination appointment online.

Uzbekistan is home to spellbinding architecture and ancient cities. In terms of sights alone, Uzbekistan is Central Asia’s biggest draw and most impressive showstopper. Fabulous mosques, medressas and mausoleums are just some of the pulls for tourists when visiting Uzbekistan while more eccentric views can be seen at the fast disappearing Aral Sea and Nuratau Mountains.

Travel Nurse, Anna, shares her top tips on how to stay healthy during your trip to Uzbekistan.

Vaccinations

Ensure you are up-to-date with your travel vaccinations. The minimum advised for a trip to Uzbekistan is diphtheria tetanus and polio, and Hepatitis A. Typhoid, Hepatitis B and Rabies can be considered by some travellers. It is advisable to attend for a pre-travel assessment with a travel nurse 6-weeks before your trip as some vaccinations requires several injections to complete the course.

Food and water

Precautions against the dreaded traveller’s diarrhoea should be taken to prevent an upset stomach ruining your trip. Do not drink tap water in Uzbekistan, stick to bottled water or water that has been boiled. If you are trekking or visiting remote areas it’s a good idea to take either a water bottle with a filter or some chlorine dioxide tablets to make water safe to drink, should you not be able to find a shop with bottled water.

Sour milk dishes dominate the Uzbek cuisine. Cue caution if you want to try ‘kurt’, the famous fermented cheese balls. There is a risk of a bacterial disease called brucellosis that can be spread through unpasteurised dairy products such as cheese and milk.

Travelling further afield

Uzbekistan forms one of the countries on the old silk route. If you plan on a tour of the ‘Stans’ or attempting the whole Beijing to Istanbul route, you may need to consider other travel health precautions. Depending on your route, and also the time of year you intend to travel, you may wish to consider vaccinations against Tick-Borne Encephalitis and Japanese Encephalitis.

Altitude

Khazret Sultan, Uzbekistan’s highest peak stands at 4643m. Many popular walking and hiking routes such as Big Chimgan exceed over 3000m, making altitude related illnesses a hazard. Tips for reducing altitude sickness include a slow ascent route, keeping hydrated, ensuring that your sleeping altitude doesn’t exceed 500m per day. Diamox (acetazolamide) is a prescription medication that can reduce the symptoms of altitude related illness.

Book your travel appointment today

By Anna Chapman |  Travel Nurse | April 2019

Public Health England has issued a health warning aimed at travellers highlighting the risk of rabies.
Following the recent news whereby a UK resident sadly died after becoming infected with rabies following a cat bite during a visit to Morocco, there is need to remind travellers of the dangers of viral infections when outside of the UK.

Rabies is a virus infection of the brain which is usually transmitted from contact with an infected animal, through injuries such as bites and scratches.
Dogs are the main source of infection in most parts of the world, although almost any mammal can become infected.
Although not a concern in the UK, PHE highlights the dangers of animals whilst travelling:

‘Rabies is common in other parts of the world, especially in Asia and Africa. All travellers to rabies-affected countries should avoid contact with dogs, cats and other animals wherever possible, and seek advice about the need for rabies vaccine prior to travel.’

When visiting countries with rabies endemic it is best to avoid contact with animals especially stray or wild animals.

About Rabies

People are usually infected following a deep bite or scratch from an animal with rabies, and transmission to humans by rabid dogs accounts for 99% of cases.

The virus cannot infiltrate intact skin.

Initial symptoms of rabies include a fever with pain and unusual or unexplained tingling, pricking, or burning sensation (paraesthesia) at the wound site. As the virus spreads to the central nervous system, progressive and fatal inflammation of the brain and spinal cord develops.
What to do if bitten?

If a traveller has been bitten or licked, they should immediately wash the wound with soap and water as soon as they can. That will inactivate and wash out a lot of the virus (if there is virus present), and urgently seek medical care.

Once symptoms have developed, left untreated rabies is almost always fatal. Rabies is a 100% vaccine-preventable disease.

Rabies Vaccination

You should consider getting vaccinated against rabies if you are travelling to a country which is considered high-risk especially if you’re planning on travelling to more remote locations.

Pre-Exposure Vaccine

Rabies vaccination requires a course of 3 vaccinations for complete protection. Depending on how much time you have prior to travelling would determine which course of treatment is suitable for you.

Alternatively, those with time constraints can opt for the accelerated rabies vaccination course.
The accelerated option can be provided over 7 days; giving full protection within a week.

This option is suitable for spontaneous travellers and last-minute business trips to countries affected by rabies.

Post-Exposure Vaccine

All travellers who think they have been exposed to the rabies virus should urgently seek medical care and post-exposure vaccinations.

• If you’ve had your immunisations, you will require two doses of rabies vaccination, 3 days apart.
• If you are exposed to rabies and have not been vaccinated, a more intensive treatment of 5 vaccinations over a 30-day period, plus an injection of immunoglobulin is required.

Overall travellers should take precautions when travelling to countries where rabies is present.

Book Your Rabies Vaccine Online

Rabies: The Facts by The World Health Organisation
For more information on the risk of rabies in different countries, see the country information pages on the National Travel Health Network and Centre’s (NaTHNaC’s) website, TravelHealthPro.