Sussex Travel Clinic

Hove Clinic

01273 749100

Worthing Clinic

01903 254774

Chikungunya – no it’s not an exotic meal or a piece of clothing!

HiRes

What is it?
Chikungunya is a virus spread to humans by the bite an infected Aedes aegypti mosquito.

Mosquito biting

They bite during daylight hours, breed in stagnant water and find us tasty.

These mosquitoes can be recognised by the white stripes around their legs, you’d have to catch one though to check!

They can also spread dengue and west Nile fever.

Interesting Fact:

The name chikungunya comes from a word in the Makonde language (one of the native languages in Tanzania) that means ‘that which bends up’. This is due to the crippling joint pain caused by the virus (Public Health England – April 2014)

Where in the world can it be found?

CHIKWorldMap-022415

Map from CDC website

How does Chikungunya make me feel?

The incubation period can be 2-12 days, but is normally 3-7 days.

It normally starts with a sudden onset of fever and pain in the joints.

The joint pain is often very unbearable, but usually lasts for a few days or may persist for weeks.
Other common symptoms can include:

  • Muscle pain
  • Fatigue
  • Nausea
  • Headache
  • Rash

Often diagnosis can be confused with other viral illnesses such as dengue fever in areas where these infections also occur. Symptoms can vary in each individual from mild or non-existent to severe.

Most people make a full recovery, but in some cases, joint pain and arthritis may continue for several months or even years.

Occasionally eye, neurological and heart complications can occur, and gastrointestinal complaints.

Serious complications are uncommon, but in older people the disease can contribute to the cause of death.

Children may develop neurological symptoms such as seizures as a complication of the disease.

Interesting Fact:

Chikungunya cannot be directly spread from person to person. When the mosquito feeds on the blood of a person infected with chikungunya, the virus enters and multiplies within the mosquito. After about 8 to 10 days, the mosquito can transmit the virus to another human by biting them, and can do this for the rest of its life.

If a person gets chikungunya abroad and becomes ill on their return to the UK, they can’t pass the infection onto anyone else. This is because the Aedes mosquito is not present in the UK, as the temperature is not consistently high enough for it to breed.

(Public Health England – April 2014)

What treatment is there?

There is no particular anti-viral treatment for chikungunya. Headache and fever symptoms can be treated symptomatically. Some people need to be admitted to hospital if their illness is severe or if complications arise.

Chikungunya can be diagnosed with a blood test.

 

How do I stop myself getting Chikungunya?

There is no vaccine or drug to prevent chikungunya.

The only way to prevent chikungunya is to avoid mosquito bites by using insect repellents and wearing appropriate clothing.  Aedes mosquitoes bite during the day particularly around dawn and dusk.

 

How can I stop mosquitos biting me?

Clothes are your best protection – normally only use repellents on remaining exposed areas of skin.

Wear loose fitting, light coloured clothing. Mosquitos can bite through tight clothing.

You can also treat clothes with permethrin spray (an insecticide that kills insects on contact) this should only be used on clothing NOT skin.

ex4-anit-mosquito          33406-2-Mosquito-Net-Compact-Bell                  small_635107058451943669

 


Insect repellent
– DEET has been proven to be the most effective preparation in preventing mosquito bites, it is the repellent of choice in areas with diseases such chikungunya and dengue.

DEET has been used as an insect repellent for around 50 years and it is available in different concentrations.

50% concentration is recommended.

DEET can be used for children over the age of 2 months. For children, use clothing as the main barrier and repellent only where necessary.

It can be used in pregnancy and breast feeding women.

If you are using sunscreen, it is advised that repellent must be applied after sunscreen.

Remember to remove repellent with soap and water when it is no longer needed.

Do not spray directly onto faces, spray on hands first and then apply to face. Wash hands after applying to prevent contact with lips and eyes.

Never use on cuts, abrasions or irritated skin.

Always follow manufacturer’s instructions.

Alternative recommended insect repellents are those containing Picaridin 20% and these can be used for children aged two years and older (NATHNAC)

Oil of lemon eucalyptus-based repellent is also available however this repellent only lasts as long as 15% DEET and so needs applying more frequently. Lemon eucalyptus essential oil is a different product and is not recommended as an insect repellent. (NATHNAC)

It is best to avoid sunscreen that is combined with repellent.

If you think that you or your children are reacting to an insect repellent, stop using it, wash treated skin and then seek advice from a doctor.

In your room – Consider using plug in vaporisers that release an insecticide mist in your room

Try to stay in accommodation that is air-conditioned, this usually reduces the number of insects in your room.
Those that sleep during the day, particularly young children, or sick or older people, should sleep under a mosquito net that has been treated with insecticide. The World Health Organisation (WHO) recommends this type of net. The insecticide used in these nets mean that a mosquito will be killed on contact if it lands on the net. Cot nets are available.

Carry a sewing kit and tape to repair any holes or tears.

 

So what doesn’t work as an insect repellent?    

There is no proof (scientific or otherwise) that bath oils, electronic “buzzers”, essential oils, garlic, homeopathic remedies, odour baited mosquito traps, tea tree oil, skin moisturisers, smoking, vitamin B tablets or yeast extract (Marmite®), prevent insect bites.

Citronella based repellents are not recommended, as they do not protect you for very long. (NATHNAC)

 

Further advice about insect bite prevention can be found on the following websites:

Fit For Travel

NathNac

 

We sell a wide range of repellents, nets and insect bite avoidance devices in our clinics and on our online shop.

 

Come down and speak to one of our lovely team for advice.

 

Written by Nicki Harrison – Lead Nurse Sussex Travel Clinic

January 2015

 

 

Reference/bibliography list:

Fit for Travel – http://www.fitfortravel.nhs.uk/advice/disease-prevention-advice/chikungunya-fever.aspx

TRAVAX – http://www.travax.nhs.uk/diseases/non-vaccine-preventable/chikungunya.aspx

Gov.UK – Public Health England – https://www.gov.uk/chikungunya

WHO – http://www.who.int/mediacentre/factsheets/fs327/en/

 

What  is Tuberculosis ?

Tuberculosis (TB)  is a bacteria that can invade any part of the body but most commonly the lungs are affected.

There are 2 types of TB infection

1- Active TB – this can take months or years to develop.

2- Latent TB-  has no symptoms and is not infectious to others .

However  10- 15 % of people with latent TB can go on to  develop active TB in their lifetime.

Incidence of TB

Africa has the highest TB infection rate with more than 300 people per 100:000. The UK has a very low number of TB cases 13:100:000 (1)

How is TB spread?

TB is  caught by inhaling the droplets that are spread by coughing sneezing and spitting. The risk of infection is highest in situations of close prolonged contact with infected persons.

Symptoms of TB

The symptoms of TB include any of the following :

  • Productive cough
  • Weight loss
  • Night sweats
  • Loss of appetite
  • High temperature

Treatment of TB

Although TB is a very serious condition it can be treated successfully with antibiotics.

Prevention of TB

There is a vaccine available to prevent TB called BCG but it is only effective in the under 16 – 35 year age group.There are no studies that prove effectiveness beyond age 35 years of age.

The UK BCG vaccination programme was discontinued in 2005 as a result of the continuing decline of TB infection in the UK indigenous  population. The UK programme is now focused on  targeting those babies and children most at risk of exposure to Tb( 4 )

Travellers- Do I need a BCG vaccine for travel?

Most travellers are considered to be at low risk of catching TB.

Risk of exposure increases in those travellers living  and working in close contact with the local populations in high risk TB countries for prolonged periods of time ( > 3 months) and those working with TB  infected persons. Travellers that have other health conditions that affect their immune system they could be more at risk of catching TB.

 Which travellers should have the BCG vaccine?

  • Travellers age 16 years or under who are going to living in countries with a high incidence of TB ( 40 per 100.000 cases) for 3 months or more.
  • Healthcare  workers aged up to 35 years of age who are likely to come into contact with infected cases in high incidence countries (5)

TB Frequently Asked Questions

1. My child missed their BCG vaccination at school,  why has it been stopped?

Rates of TB in the UK population have fallen to very low levels over the past 15 years. The BCG vaccination programme was changed to reflect this and is now only given to people in at-risk groups.

(http://www.nhs.uk/Conditions/vaccinations/Pages/bcg-tb-vaccine-questions-answers.aspx#teenagers)

2. I am travelling abroad and want the bcg vaccine but have been told I don’t meet the criteria?

The vaccine is recommended for those under 16 years who are going to live or work with local people for more than three months in a country where the annual incidence of TB is 40/100,000 or greater.

(https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/148511/Green-Book-Chapter-32-dh_128356.pdf)

3Can you catch TB on an aeroplane?

TB is a difficult disease to catch because it requires prolonged exposure to an infected person. For example, you are very unlikely to catch it by sitting or standing next to someone who is infected. The CDC and WHO have concluded that the risk of TB transmission on an aircraft does not appear to be greater than in other confined spaces.

(https://www.nathnac.org/pro/factsheets/TB.htm)

 4I had BCG vaccine as a child how long does it last? Do I need a booster?

 Protection has been shown to last for 10 to 15 years (WHO, 1999). Although the protection afforded by BCG vaccine may wane with time, there is no evidence that repeat vaccination offers significant additional protection and repeat BCG vaccination is not recommended.

(https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/148511/Green-Book-Chapter-32-dh_128356.pdf)

5. I am under age 35 and planning to work on an orphanage in Kenya for 3 months and am worried I may catch tb but have been told I can’t have the vaccine- Why?

BCG is not usually recommended for people aged over 16 years, unless the risk of exposure is great e.g. healthcare or laboratory workers at occupational risk. There is insufficient data on the protection afforded by BCG vaccine when it is given to adults – aged 16 years or over and virtually no data for persons aged 35 years or over.

 http://www.nhs.uk/Conditions/Tuberculosis/Pages/Symptoms.aspx

 6. I had BCG vaccine ages ago can I have a test to prove I am still immune?

There is no test to demonstrate immunity to Tuberculosis . Evidence of a previous BCG vaccination includes: documentary evidence; a clear, reliable history of vaccination; or evidence of a characteristic scar.

7. What happens if I do catch TB after travelling to a risk country?

You would be referred to a specialist for treatment. Treatment for tuberculosis (TB) depends on which type you have, although a long course of antibiotics is most often used.

8. How will I know if I have caught TB ? What are the symptoms ?

The symptoms of tuberculosis (TB) depend on where the infection occurs. TB usually develops slowly. Symptoms may include: persistent cough /breathlessness/lack of appetite and weight loss/ a high temperature / night sweats/extreme tiredness or fatigue. If you experience symptoms you should see your GP as soon as possible.

To book an appointment for a BCG vaccine please call 01273 749100 or 01903 254774 or book online

References

  1. Travax – http://www.travax.nhs.uk/diseases/vaccine-preventable/tuberculosis.aspx
  2. NHS Choices- http://www.nhs.uk/conditions/Tuberculosis/Pages/Introduction.aspx
  3. NathNac- http://www.nathnac.org/travel/factsheets/tuberculosis.htm
  4. Department of Health Green Book – tuberculosis chapter page 393 – https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/148511/Green-Book-Chapter-32-dh_128356.pdf
  5. Department of Health Green Book – tuberculosis chapter page  398 – https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/148511/Green-Book-Chapter-32-dh_128356.pdf

Written by Helen Thorpe RGN