Sussex Travel Clinic

Hove Clinic

01273 749100

Worthing Clinic

01903 254774

A 50 year old woman has died of rabies following a dog bite whilst on holiday in Goa, India. The lady, of Indian origin, did not have pre- exposure rabies vaccinations before travel and did not seek any medical advice for 2 months after the dog bite. Unfortunately, the woman who did not present to the medical profession until symptoms of rabies had appeared was at first turned away from A & E at a Kent hospital. A spokesman for the hospital  said that as the UK is rabies-free, if a patient went to a hospital with vague symptoms, a doctor was unlikely to consider rabies as a diagnosis unless the patient highlighted wild animal contact in an at-risk country. “The hospital responded to the information supplied by the patient at the time,” he said.

The UK is rabies free; however, travelling to an area of high risk can pose a risk. In the last 10 years there have been four cases of imported rabies:

  1. 2001 – Nigeria – a visitor from Nigeria died after a dog bite overseas five months previously.
  2. 2001- Philippines- a traveller died who had contracted rabies whilst on holiday in the Philippines.
  3. 2005- India – a traveller died after being bitten by a puppy on a 2 week holiday in Goa.
  4. 2008- South Africa – a UK traveller died after being bitten whilst working in an animal sanctuary.

What is Rabies?

Rabies is a virus found in the salvia of an infected animal and is transmitted from the bite or scratch of an infected domestic or wild animal. Dog bites account for 99% of human rabies deaths. Initial symptoms of rabies include fever, pain and tingling at the wound site. As the virus spread through the nervous system inflammation of the brain and spinal cord occurs. Rabies is always fatal. The incubation period is usually 1-3 months, but can be from as little as 1 week up to 1 year.

Rabies is present in 150 countries worldwide and it is estimated that 55,000 people die from rabies every year.

Advice for Travellers

There is a very effective vaccine that can protect you against rabies. The vaccine should be given before you travel. Three doses of vaccine are required on days 0, 7 and 21 or 28. In the event of a bite or scratch you will need to seek medical advice and get two more top up vaccines.

If you have not had any rabies vaccine before you travel and you get bitten by an animal you will need to seek immediate medical treatment. In this instance you will need to receive a full course of rabies vaccine and a treatment called rabies immune globulin (RIG). RIG is a blood product and is not readily available in many countries, so if you are at risk it is recommended that you receive pre -exposure rabies vaccines before travel.

Am I at risk?

Your nurse will do an assessment to see if you need for pre-exposure rabies vaccine.

Assessment includes:

  • The incidence of rabies in the countries you are travelling to.
  • The availability and quality of rabies vaccine and rabies immune globulin (RIG).
  • The planned activities you may be doing on your trip..
  • The length of stay in a risk country.
  • The possibility of unrecognised or unreported exposure (e.g. young children).

Rabies pre-exposure vaccine should generally be given to adults and children who are at risk of rabies. These include:

  • If you are  travelling to remote areas where medical care is not readily available
  • If you are undertaking higher risk activities (e.g. cycling, running)
  • If you are travelling for long periods through rabies risk countries
  • If you are at occupational risk e.g. vets, animal handlers, and laboratory workers who handle the virus.

 

To book an appointment for a rabies vaccine please call 01273 749100 or book online

 

References

  1. http://www.who.int/mediacentre/factsheets/fs099/en/
  2. http://www.promedmail.org/
  3. http://www.nathnac.org/pro/factsheets/rabies.htm#indications

 

 

 

 

 

 

 

 

If you have ever had chicken pox you are at risk of getting shingles. The chicken pox virus stays in your system and can resurface as shingles later in life. The main symptoms are a painful rash that blisters and then scabs. Postherpetic neuralgia can occur after you have had shingles. This is nerve pain that can last for three months or more after the rash has gone.

In the UK it is estimated that about 3 people in every 1,000 have shingles in  every year. Although shingles can occur at any age it is more common over the age of 50 years. In those aged 80 years and over the incidence of getting shingles increases to about 11 people in 1,000 per year.

Vaccination

Zostavax is a vaccination that can reduce your risk of getting shingles. It is licensed for use in those aged 50 years and over. You can have the vaccine even if you have not had chicken pox.

You should not have the vaccine if:

  • you are allergic to any of its ingredients, including gelatin or neomycin.
  • you have a weakened immune system or take high doses of steroids.
  • if are pregnant or plan to become pregnant.
  • you should not get ZOSTAVAX to prevent chickenpox.
  • Tell your nurse if you have had a vaccine against pneumonia in the last 4 weeks. It is best to have these 4 weeks apart.

Further Information

http://www.nhs.uk/Conditions/Shingles/Pages/Introduction.aspx

http://www.zostavax.com/

 

 

Blood borne infections such as HIV and Hepatitis B and C are found worldwide, however, some countries have higher levels of infection. Blood borne infections are spread through  any activity causing contact with blood or body fluids. These include:

  • Unprotected sexual intercourse
  • Medical treatment with contaminated equipment
  • Activities that pierce the skin such as tattoos, acupuncture or  body piercings.
  • Contact sports such as rugby or boxing. This increase risk of contact with bodily fluids from an infected person.
  • Occupational exposure- health care workers are particularly at risk.

Hepatitis B

Hepatitis B(HBV) is a virus that can damage your liver and cause serious health problems.  This potentially fatal virus is spread the same way as HIV but it is 100 times more infectious. 350 million people are believed to be infected worldwide. .[1].   Thankfully, hepatitis b can be prevented through vaccination. If you are travelling to a high risk country you should consider a course of hepatitis b vaccine.

Hepatitis C

Hepatitis C (HCV) is similar to HBV in that it can be fatal and cause liver damage or serious health problems. HVC is found worldwide but is more common in Africa, Asia and South America. 3% of the world population are believed to be infected. .[2].   There is no vaccine to protect against HCV.

HIV

HIV infection occurs anywhere in the world. At the end of 2007 it was estimated that 33.2   million  persons were living with HIV infection  worldwide.[3].   Prevalence is highest in  Africa, South and South East Asia, and   Latin America and the Caribbean. Between 2001 and 2005,  41% of new diagnosis in UK citizens were aquired abroad. Highest risk countries were in Africa and Thailand.

Advice for Travellers

  • Practice safe sex – always use a condom and buy an adequate supply for your trip. Make sure condoms carry the
  • Avoid tattoos or body piercings in foreign countries
  • Carry a sterile medical kit with needles and syringes in if you are travelling to high risk areas
  • Have a course of hepatitis b vaccine before your trip
  • Consider joining the Blood Care Foundation – they can arrange screened blood worldwide for use in an emergency
  • Find out your blood group before travel

To book a hepatitis b vaccine or purchase a sterile medical kit call 01273 749100 or book online