Travel health update

Travel advice for patients with lymphoedema; Using videos to educate travellers; Yellow fever vaccine shortages 

TRAVEL ADVICE FOR LYMPHOEDEMA PATIENTS

As a consequence of my breast cancer, a problem close to my heart is lymphoedema. Having recently been referred for this problem, I was given a leaflet about ‘Holidays and Travel’ from the Lymphoedema Support Network (LSN). Not available as a PDF unfortunately, the leaflet can be purchased for your patients from the LSN at http://www.lymphoedema.org/, for a small fee to cover printing and production costs. The publication provides excellent advice on many topics, including:

• Seeking advice well in advance of a departure date, partly due to the reduction in available limbs for vaccine administration
• Carrying standby antibiotics especially for those with previous experience of cellulitis;
• Using an insect repellent containing 50% DEET
• Always wearing a compression garment when on a flight and, for those with severe lymphoedema, wearing a second compression garment or bandage on top as an extra support on a long flight
• Avoiding sunburn and using a good quality sun block (at least SPF 25), reminding the reader that sunburn can occur through compression garments, particularly synthetic ones.

LSN also has some excellent information on their website for healthcare professionals, including a link to a BMJ Learning Module on chronic oedema and lymphoedema which the LSN supports.

VIDEOS TO EDUCATE TRAVELLERS

I’m increasingly thinking about the use of appropriate videos to help educate our patients. Not only do they save us time but they can convey the information in a more acceptable format, rather than didactic advice we’ve traditionally given. A new video entitled Travelling Well has been developed by Dr Deb Mills, an Australian doctor who specialises in travel medicine. The video enables the viewer to learn some tips about how to stay healthy when overseas and illustrates the consequences of poor preparation re travel. The film, which illustrates some important points but in a light hearted and very watchable fashion, lasts just over 15 minutes so perhaps this may be suitable to play in your waiting area. Other short educational videos I would consider using for my patient to watch in a consultation while I need time to focus on preparing the vaccines include topics on malaria, bite prevention, travellers’ diarrhoea and hepatitis B – links to these are all at http://www.janechiodini.co.uk/tools/videos/

YELLOW FEVER VACCINE SUPPLY

This year has been somewhat fraught with difficulty over vaccines supplies of one kind or another. Issues arise when there is also only one supplier in a country, as is the case in the UK with yellow fever vaccine. Sanofi Pasteur MSD has been working closely with NaTHNaC and TRAVAX plus the Medicines and Healthcare Regulatory Agency (MHRA) to help ease the situation. Multi-dose vials of Stamaril® will be available from the end of October 2013: each vial provides ten doses, and they are presented in a box containing 10 vials – meaning a total investment of 100 doses. This presentation is unlicensed in the UK. Once reconstituted, the vaccine must be used within a six-hour period. More information is available both on NaTHNaC and TRAVAX websites, and of course from the company. NaTHNaC has also collected data from yellow fever vaccination centres who responded to their request and has been able to publish a list of centres that (as of the end of September) still had vaccine available. This can be accessed on the NaTHNaC website in an excel spreadsheet, divided into the different regions of the country (excluding Scotland). NaTHNaC has also produced a series of FAQs to help travellers. For more information go to www.nathnac.org and www.travax.nhs.uk