Transcript It`s not all about the `Jabs`

Student Travel Health Advice –
It’s not all about the ‘Jabs’
Samantha Gaudion
Benefits of a Pre Travel Consultation:
Provide up to date verbal and written advice on a range of travel
health issues
Information about recent disease outbreaks
Administer/issue travel health vaccinations, malaria tablets and
other medications
- NaTHNac
Other Travel Health Risks
Environmental Risks
Exposure to Blood and other Body Fluids
Infectious Disease and Potential Risks
Injury and Violence
Psychological Health
-WHO
Objectives
To highlight student travellers as a ‘Special Risk Group’
Discuss some common travel clinic scenarios and look at the ‘Non
Vaccine’ preventable infections and risks related to each scenario
Highlight 3 key areas related to student travellers
Discuss useful Tools to aid a travel consultation when time is tight!
Special Groups of Travellers
Pregnant Women
Humanitarian Aid Workers
Children
Long-term travellers/Expatriates
The Elderly
Military Deployment
Travellers with Chronic Illnesses Study Abroad
Those with Disabilities
Mass Gatherings
Immunocompromised Travellers Expedition Travel
Visiting Friends and Relatives
(VFRs)
OH risk- Medical Electives
- Dawood; CDC
Students as a Special Group – Why?
Most have never travelled outside of Europe or the UK
Age and Maturity
Visiting High Risk Destinations
Last Minute Presentations
Lack of Funds
High Risk Activities
Backpacking
Charity work
VFRs
Group Work
Think about all the ‘Non Vaccine’
Preventable Infections and Risks for
your Student Traveller
Traveller 1 - Polly
Polly, aged 18 yrs. plans to volunteer in a remote Nepalese village
undertaking construction work- building a school and teaching
children. She will be away for 3 months, 2 months volunteering and 1
month travelling around North India with a girlfriend using local
transport. She will be staying with a host family then backpacking.
The village uses tap water from a stream and has some electricity.
She leaves in 4 weeks. She has a history of depression and is
currently taking Citalopram.
She has never travelled outside of Europe before.
Traveller 2 - Ben
Ben, aged 19 yrs. is planning on backpacking around Thailand with 3
mates for 1 month. He has presented last minute and leaves in 6
days. They have no specific itinerary, but fly into Bangkok and will be
spending the majority of their time on the South Islands. They will be
staying in backpacker accommodation, travelling by bus and boat.
He has no PMH and is taking no regular medications.
He has travelled to South Africa with his family for a holiday as a
child.
Traveller 3 - Susie
Susie, aged 20 yrs. is planning on a University organised charity
climb of Mount Kilimanjaro for 1 week, she will then extend her trip to
go diving in Zanzibar. She will be away for 3 weeks in total. Her
boyfriend will be joining her for the trip.
She will be staying in huts for the climb and will be backpacking
thereafter, staying in hostels/budget accommodation and using local
buses and boats. She leaves in 6 weeks, has no PMH of note and is
taking the COCP.
She has travelled around Peru and Bolivia in the past.
Non Vaccine Preventable Risks
• Food and
• Dengue Fever
Water
Contamination • Travel
Insurance
• Personal
• Outbreaks
Hygiene
• Travellers
Diarrhoea
• Personal
Safety
• Personal
Protection
Measures
• Rabies
Prevention
• Motion
• Sun and Heat Sickness
• Accidents
• VTE Risks
• Counterfeit
Medications
• Female
Travellers
• OH Risks
• Altitude
Sickness
• Lone
Travellers
• Transporting
• Culture Shock Medications
• Sexual Health • Avian Flu
• Bilharzia
• Hajj
• Contraception • Tick Bites
• Diving
• Sporting
Events/
• Humanitarian
Dangerous
Aid
• Wildlife
• Legionnaires
Accidents
Sexual Health
Culture Shock
Accidents
RTAs kill more people around the world than malaria
Leading cause of death age 5-29 yrs esp. in developing countries
1.3 million people are killed on roads and up to 50 million people
are injured in RTAs each year
Drowning 2nd leading cause of unintentional injury with
approximately 359 000 deaths worldwide
- WHO
British Behaviour Abroad Report 2013
Hospitalisations
2011/12
3,739
2012/13
3,599
Deaths
Rapes
Sexual Assaults
Drug Arrests
6,237
127
154
816
6,193
138
172
669
Brits hospitalised in Thailand has increased by a third
RTAs linked to these 285 cases
-FCO
Thailand
70% of all road deaths
12,000 deaths a year vs. 3,000 in UK
38 people die each day in motorcycle accidents
Why?
Poor roads
Bad driving
Speeding
No seatbelts
Poorly maintained vehicles
Under influence of alcohol/drugs
Failure to follow local road rules
Lack of emergency services
Road Safety Top Tips
Avoid hiring
motorcycles/mopeds
Always wear a helmet
Remember which side of the
road to drive on
Know the emergency number
Avoid alcohol and drugs
Avoid driving at night
Do not exceed speed limits
Check tyres, brakes, lights and Adequate travel insurance
seatbelts
Recommended taxis
Avoid poorly maintained,
Avoid hitchhiking
overcrowded buses, trains
Pedestrians and cyclists
Water Safety Top Tips
Never swim after drinking alcohol or taking drugs
Do not swim alone
Check water depth before diving
Never dive from a balcony into a swimming pool
Check tides, currents, safe places to swim
Avoid a heavy meal before swimming
Low temperature = hypothermia
Sexual Health
Sexually Transmitted Infections (STIs)
Chlamydia
Genital Warts
Gonorrhoea
HIV
Trichomoniasis
Hepatitis A
Chancroid
Hepatitis B
Syphilis
Hepatitis C
Donovanosis
Scabies
Genital Herpes
Lymphogranuloma venereum
Stats:
More than 1 million people acquire a STI every day
Highest rate of new cases in sub-Saharan Africa
499 million new cases of curable STIs (gonorrhea, chlamydia,
syphilis, trichomoniasis) occur every year in adults aged 15-49 yrs
536 million people living with incurable HSV type 2
291 million women have HPV infection
33.2 million people living with HIV/AIDs
Transmission
Unprotected intercourse (vaginal, anal, oral)
Intimate skin on skin contact
Contaminated blood and blood products
Contaminated syringes and needles
Dental procedures
Tattoos, piercing, acupuncture
Mother to child
Travellers Risk
1 in 10 of British travellers have casual sex with a new partner
whilst abroad
Highest incidence in 15-30 yr. old age group
Only 75% used condoms on all occasions
Influenced by alcohol or drug use = loss of inhibitions
Increased number of partners
Sex tourism – commercial sex workers
Unscreened blood products and used needles and syringes
Tattoos, piercing, acupuncture, drug use
Sexual Health Advice
Condoms with the ‘British Kite’ or ‘CE’ mark
Check Expiry
Check undamaged and intact
Screening on return if UPSI or risks - even if asymptomatic
Also:
Avoid sharing needles, open blades
Avoid tattoos, acupuncture, piercings
Avoid blood transfusions/blood products
Take a sterile needle pack
A term first created by Oberg (1960) as ‘shock of the new’
Anxiety and confusion when entering a new culture can affect
people
• Intellectually
• Emotionally
• Behaviourally
• Physically
Aspects associated with
Work Related Problems
Language and Cultural Differences
Facilities and Adaptation to Unfamiliar
Environment
Sense of Loss about Friends and Family.
Loneliness and Isolation
Personal Violence and Health Risks
Deccan
ChronicleMarch 2014
18 People
Feared Dead
in Nepal
Plane Crash
Management Strategies
Careful planning and support to facilitate safe travel
Consider daily activities
Realistic expectations
Research culture, laws and customs
Adequate rest
Regular contact with family and friends
Key Considerations:
Do they understand the risks of the environment they will be
staying in?
How close to healthcare will they be in the event of an accident or
being unwell?
How capable are they at being able to look after themselves? How
will they cope with any minor illness/injury i.e. Travellers Diarrhoea
In Polly’s Case:
What are her coping strategies? Are they transferable?
What are her fall back measures?
Tools
Websites:
http://www.fitfortravel.nhs.uk/home.aspx
http://www.nathnac.org/travel - YF, Dengue Fever, JE
http://www.nhs.uk/Conditions/vaccinations/Pages/vaccination-scheduleage-checklist.aspx
https://www.malariahotspots.co.uk
http://www.who.int/topics/malaria/en
Patient Information Leaflets
Any
Questions?