The 12 days of Christmas: consultations of the travel nurse

On the first day of Christmas…

1 Returning traveller with gastroenteritis after consuming under-cooked partridge. It’s not a good idea to eat any undercooked meats from a travellers’ diarrhoea or from a parasitic infection point of view. Even in the UK we learn that the risk of campylobacter in poultry is very high and we are being advised not to wash the bird prior to cooking as this can risk spreading the bacteria to work surfaces where it may remain active for some time. More chickens are to be sold in a roasting bag to avoid direct contact. Are turkeys available like this?

On the second day of Christmas…

2 ‘Turtle doves’ setting off to their exotic honeymoon destination where prescription only malaria chemoprophylaxis is recommended. UK malaria guidelines advice is to avoid getting pregnant for the following times after completing the course of malaria tablets for 3 months for mefloquine, 1 week for doxycycline and 2 weeks for atovaquone plus proguanil.

On the third day of Christmas…

3 Healthcare professionals are travelling to work in Sierra Leone to work in the Ebola crisis and need their travel vaccines. They tell you they are receiving full training prior to departure including PPE training. To understand the great importance of correct technique see the video at https://www.youtube.com/watch?v=AxdlOqs2_ww

On the fourth day of Christmas…

4 Members of a family calling in for malaria prophylaxis for Goa, need to be informed that since the advice changed in the UK malaria guidelines in July 2014, risk in the area is not considered sufficiently significant for people who are in good health to need to take tablets but good bite prevention and awareness of symptoms and action for urgent diagnosis is essential.

On the fifth day of Christmas…

5-minute appointment given to you to see a last minute traveller requiring yellow fever vaccination. Such a request in this timescale is impossible! Remember the guidance regarding timing for travel consultations in the RCN competency document at http://www.rcn.org.uk/__data/assets/pdf_file/0006/78747/003146.pdf. If you can’t have longer it may be safer to redirect this traveller to a private travel clinic.

On the sixth day of Christmas…

6 Members of a family travelling to Pakistan to live for 9 months – none have had polio vaccination in the past ten years. Guidance recommends they all receive polio vaccine (Revaxis) prior to departure. This immunisation should be documented in an International Certificate of Vaccination or Prophylaxis (ICVP) and if yellow fever vaccination also needs recording, this should be documented on a separate ICVP. (See NaTHNaC FAQ).

On the seventh day of Christmas…

7 years since a traveller visiting Equador had their first dose of hepatitis A vaccine. The Green Book guidance states you just need to give this person a booster dose of hep A vaccine and not restart the course. This traveller would then have 25 years protection from this dose.

On the eighth day of Christmas…

8-month+ pregnant woman intending to travel to Israel just before Xmas. A certificate would be required by the airline and travel over 36 weeks gestation in an uncomplicated pregnancy (32 weeks in multiple pregnancy) would not be allowed! A new advice leaflet for malaria and pregnancy from the RCOG is available at https://www.rcog.org.uk/globalassets/documents/patients/patient-information-leaflets/pregnancy/pi-malaria-and-pregnancy.pdf

On the ninth day of Christmas…

9 ‘Ladettes’ dancing their way to a hen party in Ibiza. Personal safety and security would be part of the travel advice important for this group. Awareness of the dangers of excessive alcohol, which could result in unwanted behaviours such as condomless sex, sexual assault and rape, clearly a challenging topic to address but important to always be on guard.

On the tenth day of Christmas…

10 ‘Lords’ leaping off to the ski slopes in France. While no travel vaccines would be required other than being up to date on vaccines advised for life in the UK, all safety precautions including the wearing of good protective head protection is essential. The tragic accident of Michael Schumacher this year is a salutary warning of the dangers of the slopes.

On the eleventh day of Christmas…

11 Pipe band members heading off to a competition in Spain. Travel insurance is still recommended in addition to having a European Health Insurance Card (EHIC). A new app for this is available – see http://www.nhs.uk/NHSEngland/Healthcareabroad/EHIC/Pages/about-the-ehic.aspx

On the twelfth day of Christmas…

12 School children about to head off on a school ‘adventure’ trip. Don’t forget the guidance document from Health Protection Scotland. I recently spoke at the MASTA conference on this – see http://www.janechiodini.co.uk/education/conference/masta •]