Outbreak Information and News
Cambodia - Dengue
According to WHO, Cambodia's
Ministry of Health has reported more than 1,600 cases of
dengue fever, a significant increase over the average
incidence, throughout the country since January 2012.
Travelers are advised to practice daytime insect
precautions. Did you know Dengue mosquitoes like to bite
indoors?
Africa - Malaria Drug
Resistance
Researchers at the University of
London wrote in the Malaria Journal today that
Drug-resistant malaria may be emerging in Africa. A recent
study suggests the most powerful drugs against the disease
are losing potency on the continent most affected by it.
Genetic mutations in the parasite that causes malaria are
starting to make the parasite resistant to artemether, the
drug originally developed from a Chinese herbal remedy and
the key ingredient in the Australian drug, Riamet.
Studies in Cambodia and Thailand have shown that drugs based
on artemisinin, the class of remedies to which artemether
belongs, are becoming less effective there. The World Health
Organization has been leading efforts to contain the
resistant strain amid concerns it may spread to Africa,
rendering the best treatments useless and endangering
millions of people.
Peru - Leptospirosis
Flooding has caused an outbreak
of leptospirosis in Peru, especially in the Loreto region.
This is the worst flooding seen in this area for over 20
years. Peru has reported more than 300 cases and 3 deaths
associated with leptospirosis thus far in 2012. Health
authorities have alerted people to take precautions against
the infection. The disease is caught from animal urine
usually contaminating fresh water. Travellers need to
especially avoid contact with fresh water if they have open
wounds.
Rabies Death in US Soldier
Recently the media reported the
death of a young US soldier from Rabies. According to the
Centers for Disease Control and Prevention, he was the first
military member to die of the disease since 1974. Spc Kevin
Shumaker was bitten on the hand by a stray while breaking up
a dog fight at a remote Afghanistan base in January 2011. It
wasn’t until eight months later - and after his Afghan
deployment - that the 24-year-old began to display symptoms
of rabies at Fort Drum in New York. He died on August 31.
The man reported to family members and close friends that he
had been bitten by a feral dog and had sought medical
treatment, which he described as wound cleansing and
injections. However, an Army investigation revealed no
documentation of a reported bite wound or treatment.
This case highlights the importance of all travellers being
aware of rabies and seeking medical advice in the event of a
bite. Travellers also need to remember to look inside their
yellow vaccination book to ensure the precise World Health Organisation
recommendations are followed.
More info.
Cholera - Thailand
Alice Springs TMA have advised
that South Australia has had 2 cases of cholera in
travellers to Phuket (and in particular Phi Phi islands) in
recent weeks. Details of the clinical course of the illness
are not to hand, but it appears that the travellers had a
relatively mild illness. Their common exposures were
multiple, but included swimming in a lagoon and eating at
food markets on the way to the islands. There is an
oral
cholera vaccine which is given as two drinks a week apart,
starting 3 weeks before departure. It is available at all TMA clinics.
Diabetes in Travellers and
Shift Workers?
An interesting study has found
that disrupted sleep and circadian rhythms decreases the
ability of the pancreas to secrete insulin. (Lack of insulin
is what causes diabetes) An experiment by neuroscientists in
Boston USA had 21 participants spending nearly 6 weeks in
the lab. For the first 3 weeks they averaged 5.6 hours of
sleep per 24 hr period while simultaneously experiencing 28
hour days – which is similar to 4 hours of jet lag
accumulating each day. That combination of restricted sleep
and disrupted circadian rhythm caused a 32% drop in insulin
secretion after a meal. Garvan Institute endocrinologist
Professor Don Chisholm stated “If people are undertaking
work or travel where they have a fair amount of sleep or
circadian rhythm disruption it’d even more important that
they eat sensibly and exercise regularly.” Sci Trans Med
2012.
More info.
Gastro from a Swimming Pool
Did you know?
People who have diarrhoea within the previous 2 weeks should not swim in any
swimming pool or spa.
Federal Government figures show there have been 1400
crytosporidiosis cases across Australia so far this year,
compared with 1800 in 2011 and 1480 in 2010. The most recent
2 week reporting period saw 258 infections – almost double
the number seen over the same period last year. Professor
Una Ryan, a professor in biochemistry at Murdoch Uni in
Perth, said the cryptosporidium parasite could be passed
directly from human to human, but was also commonly
transmitted via contaminated water, especially swimming
pools.
One child’s loose bowel movement in a typical town pool
could result in an average concentration of 20,000
cryptosporidium oocysts per litre – a level easily capable
of causing disease, she said. “A swimmer swallowing just
10ml of pool water could ingest an average 200 oocysts,
which is well above a dose capable of causing infection”.
“Studies worldwide have shown that there is at least one
accidental faecal release every week in most swimming
pools”. Qld has so far reported the highest number of
infections this year, with 838 in the sunshine state, 183 in
NSW and 133 in the NT. Crytosporidiosis is a protozoal
gastroenteritis. It is usually self-limiting, but can cause
chronic severe illness in those with weakened immune
systems.
RUM
Project ... Spot Quiz
What you are supposed to do
with old or expired drugs that may be laying around your
house?
A) flush them down the
toilet
B) put them in the household rubbish
C) thrown them in a fire
D) give them to the RUM Project
E) use them anyway - waste is bad
Scroll down for the answer
...
Travelling with Cancer
Special issues regarding flying
-
Cerebral oedema (swelling on the brain) may develop at
altitude in people with brain tumours and within 6 weeks of
craniotomy. Although there is no specific data to support
the practice, anecdotally those patients with a brain tumour
who are stable on a steroids, are usually advised to double
the dose the day before air travel, and then to drop the
dose back once they arrive at their destination.
-
Confusion and psychosis can occur during flights due to
hypoxia and many other causes even without brain
disease.
-
Intra-abdominal gas expansion can occur during flights
within 10 days of bowel surgery or colonoscopy causing
pain and threatening wounds. I have experience first
hand after laparoscopic surgery... the experience was 8
days post-operatively, and the sensation was that I
honestly thought I might explode! It was truly very
unpleasant and I had wished at the time that we could
have driven home instead of flying.
-
Exacerbation of lymphoedema (swelling of limbs) can
occur during and after long air flights. Prophylactic
use of compression garments can be useful at times.
-
Expansion of pleural effusion and ascites (fluid in the
chest or abdomen) can occur during a flight but rarely
develop quickly enough to cause acute symptoms.
-
Low cabin humidity may disturb or distress patients with
dry mouths after radiotherapy or from narcotic
medication. Hamilton’s Aqua spray may be helpful, FESS
saline spray may assist with nasal passages and sucking
on something acidic like pineapple juice can assist with
dry mouths.
Other issues
-
Insurance: some health insurance providers may
not cover people with cancer who travel outside
Australia. Discussion regarding travel insurance should
occur well before any trips are planned and booked.
-
Extra costs: The patient may need an escort and
travel with their own oxygen or other medical equipment.
-
Medications: All prescription medications should
be in carry-on luggage and ensure you have an
appropriate letter for customs officials. Extra supplies
of medications should be carried in case the return trip
is delayed.
-
Medical documentation: Patients should carry a
detailed letter from their treating doctor (oncologist,
GP or other) covering the medical diagnosis, the
treatment plan, any allergies, current medications and
potential plans for the future in case of a change in
condition. What has been discussed about specific
interventions and resuscitation orders need to be clear
. The timing of prescribed medication may need to
account for time zone changes, eg pain medication still
needs to be taken regularly.
...Written by Dr D Mitchell Alice Springs TMA
The Alice Springs TMA Clinic
RUM Project ... Spot Quiz
What you are supposed to do
with old or expired drugs that may be laying around your
house?
A) flush them down the
toilet
B) put them in the household rubbish
C) thrown them in a fire
D) give them to the RUM Project
E) use them anyway - waste is bad
The correct answer is D
It is not safe or environmentally friendly to put expired
medication in the household rubbish, and especially
do not
flush them down the toilet. Medicines can contaminate the
environment when discarded via landfill sites and sewerage
facilities. Many medications are supplied packaged in
blister plastic made of PVC, which, when incinerated,
produce dioxin (usually found in Agent Orange). RUM in this
circumstance is not what we mix with coca cola, RUM stands
for Return Unused Medicines. It is a free service, funded by
our taxes. Your local Pharmacy has special yellow bins to
receive the medicines, which are then sent for high tech
disposal in Victoria.
RUM guidelines advise it is best to
remove cardboard outer packaging (and place in the household
recycling paper bin). Then, take the meds to shops next time
you go, and deliver the used tablets, bottles and blister
packs… to your local pharmacy. Many
TMA member clinics will
collect expired drugs when restocking kits, and drop them at
the pharmacy for you.
More
info.
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