Travel health update

All has been quiet in travel health for a while and then suddenly we get a bumper bundle of information! Two chapters of the Green Book have had updates with a third to come – read on!

JAPANESE ENCEPHALITIS

While we know Japanese encephalitis (JE) is endemic in rural areas of Asia, especially where rice is grown and pigs coexist, it’s also found occasionally in urban areas. The highest risk times occur during and just after wet seasons, when mosquitoes are most active. The transmission does vary from country to country but chapter 20 of the Green Book has been updated to inform us that cases of JE are also reported outside of the normal seasonal period of high transmission. For those at risk, completion of a course of vaccine is advised prior to departure and although the vaccine licence only allows a new 0 and 7 day schedule for those 18- 64 years, the Green Book recommends that this rapid schedule can also be used off license in children from 2 months and adults over 65 years of age when there is genuinely insufficient time to complete the standard schedule of 0 and 28 days. Full immunity takes one week to develop after the second dose. Details about the 2nd booster doses are now clearly laid out (see page 4) https://www.gov.uk/ government/publications/japanese-encephalitis-the-green-book-chapter-20 and I’ve updated my vaccine chart accordingly – item 3 at https://www.janechiodini.co.uk/tools/

YELLOW FEVER

A new section has been added to chapter 35 of the Green Book (page 7) on yellow fever for those who may have immunosuppression or HIV infection. Vaccine may be given safely to asymptomatic HIV-infected persons with a CD4 count greater than 200 and a viral load that is suppressed, if yellow fever risk is unavoidable. Specialist advice should be sought in these cases. Further useful resources are also provided for specialist guidance including the British HIV Association guidelines for immunisation of HIV-infected adults (BHIVA 2015). For those with chronic inflammatory disease on long term corticosteroids, alone or in combination with drugs such as methotrexate, the Green Book defines the dosage and duration of administration of such drugs in order to determine whether a traveller is likely to be immunosuppressed or not, and able to receive live vaccine. Again, specialist advice – and caution – is advised in these circumstances. https://www.gov.uk/"‹"‹"‹"‹"‹"‹"‹government/publications/yellow-fever-the-green-book-chapter-35

RABIES

Next month I hope to report on the anticipated changes to rabies vaccine schedules. Rabipur has already had a licence change to a new schedule of days 0, 3 and 7 for use pre-exposure under some circumstances, but more news when the Green Book chapter is published.

TICK NEWS

NICE has published guidelines about awareness of Lyme disease, diagnosis, management and information for people with Lyme disease at https://www.nice.org.uk/guidance/ng95/chapter/recommendations. Lyme disease, or Lyme borreliosis, is a bacterial infection spread to humans when they are bitten by an infected tick. Public Health England has also produced a good information leaflet at https://www.gov.uk/government/publications/lyme-disease-signs-and-symptoms. Although Lyme disease is a problem in the UK, we also associate the tick with tick borne encephalitis in travellers so the prevention/removal principles still apply. Ticked Off! is a campaign that has been devised by ARCTEC and the London School of Hygiene & Tropical Medicine. They have teamed up with UK charity Lyme Disease Action with the ultimate goal of achieving more research and more attention on this disease. They’re currently seeking crowdfunding for the project – more details at: https://www.crowdfunder.co.uk/ticked-off

MY ‘HARRY POTTER’ PAGE!

I appreciate it’s so hard to provide all the traveller advice within the restricted time given for your consultation. At times we can only give an overview of the information and then allow the traveller to undertake some ‘self-directed learning’! I use a page on my website during the appointment to show them where to go to learn more and I’ve recently added quite a few more simple buttons to help direct them. These include general advice but also specific information e.g. yellow fever leaflet, travel insurance for those with medical conditions, bite prevention advice.

See https://www.janechiodini.co.uk/help/tar/