If you think your travelmate is behaving (more) strangely than usual, there maybe a reason. A small percentage of travellers to high altitudes (ie in excess of 4000m) will develop the symptoms of acute mountain sickness. This may vary from mild headache, lassitude and altered sleep through to altered conscious state and severe illness requiring emergency treatment. The altered conscious state can occasionally make people stagger, say or do silly things and may be an early sign.

Prevention

• The key is gradual and slow ascent to allow the body to acclimatise.
• Spend a few days below 2400m before ascending higher.
• The altitude at which you sleep is more important than that which you spend the day.
• Limit ascent to 300m per day (try not to sleep at an altitude 300m higher than the previous day).
• “Climb high and sleep low”
• Have a rest day for each extra 1000m.
• Drink at least 4 litres of fluid daily
• Restrict alcohol and sedatives.
• If possible symptoms occur, tell someone, and rest at the same altitude for an extra day or descend if more severe symptoms.
• Use prophylactic medications with a past history of AMS, or is sudden ascent.
• Illness at altitude is considered to be AMS unless clearly otherwise
• Try to travel with an experienced mountain climber or guide.

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• While we eagerly await post covid19 travel remember there are many vaccine preventable diseases to consider before your next trip
• When a Covid 19 vaccine is available it may be required by some airlines before travelling
• Travellers overseas have up to a 50% chance of suffering travel-related illness.
• Reduce your risk of illness with a medical checkup and personalize advice to best protect your health overseas, TCA Drs have up to date details of what countries require vaccinations
• Vaccinations may be considered necessary for protection against diseases you may encounter, for routine health measures or as legal requirements for entry into some countries
• Some vaccinations require a course over weeks to months so contact your nearest Travel Clinic at least six to eight weeks before departure.
• TCA doctors will need to know the countries to be visited, length of stay in each country, time of the year in each country (season), type of accommodation (major hotel or tent) and type of travel (bus tour or backpack).
• TCA Drs will inform you of what vaccines you should have to travel and how long these vaccines last.

Check list prior to departure:

• Medical check up at least 6 weeks prior to travel
• Vaccinations and medications up to date
• Pack medical kit
• Dental check up
• Optometric check up
• Passport and visas up to date
• Pick up tickets
• Travel insurance (including emergency evacuation cover)
• Travellers cheques, credit cards
• Leave copy of itinerary with responsible person

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Planning ahead can make the difference between enjoying or spoiling your trip. Never leave children alone. Children generally adapt well to change, but will still need to have their specific needs met.

In general consider:

• Immunisation- make sure these are up to date inline with the NHMRC recommendation.
• Food and fluid replacement- always carry something with you, especially fluids in warm areas
• Clothing- changes appropriate to the climate
• Insect Protection- preparations of up to 30% DEET for skin, and permethrin impregnated external clothing and nets.
• Medical Kit- include paracetamol (eg Panadol, Panamax, Dymadon, Tylenol, Tempra) or ibuprofen (eg Nurofen) for dressings, sunscreen, Gastrolyte, antihistamines such as promethazine for allergy, travel sickness and sleep.
• Entertainment- books, games, toys appropriate to age

Children travelling overseas are more prone to common problems such as trauma, respiratory, gastrointestinal and skin infections, sunburn and insect bites. However, two conditions deserving special mention with your doctor are diarrhoea and malaria.

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Cholera is a bacterial infection of the gut spread by contaminated food or water related to poor hygiene.

• Results in severe diarrhoea and dehydration
• Tends to affect the malnourished rather than tourists
• 50% of severe cases result in death
• An oral cholera vaccine is available which can also give some protection against travellers diarrhoea

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We offer an extensive list of corporate health services including:

• Corporate health screening – A comprehensive appraisal of past, current and potential health issues along with recommendations for dealing with any identified problems through a comprehensive health evaluation report, blood analysis and medical assessment. Follow-up management and regular reappraisals are encouraged to ensure goals are met.
• Pre and post deployment medicals for long or short term consignments – We access the most accurate and up to date advice on vaccination requirements, malaria prophylaxis and other global health issues. Pre-assignment medical assessments focus on both the employee’s physical competency to perform the job as well as their ability to manage ongoing health issues that could place them and their company at risk whilst deployed.
• Post-assignment assessments, specific screening programs for children and annual medicals are advisable.
  Aim to identify prospective employees at an increased risk of injuring themselves, injuring others or exacerbating pre-existing conditions.
• Injury Management–Travel Clinics Australia injury management begins at a preventative level- doctors work with employers to develop safety procedures aimed at preventing accidents. Injured workers are given priority treatment at clinics and most TCA clinics are affiliated and situated within a short distance of both private and public hospitals ensuring the highest level of service under our management. Some clinics are able to offer onsite rehabilitation and physiotherapy.
• Return to work– We aim to reduce the impact of workplace injury on both the employee and the employer. We identify and document any work capacity and negotiate an early return to work, which may include identifying restricted or alternative duties, resulting in managing injuries while the injured worker is maintained at their place of employment.

We can help protect the health of your staff by:

• Offering a ‘one-stop shop’ service to supply most traveller’s health needs during a consultation
• Providing onsite staff training, education sessions and vaccinations if necessary
• Issuing vaccine reminders and a staff vaccination report
• On-site laboratory- full blood pathology, ECG, audiometry (hearing testing), spirometry (lung function testing) and urine analyses

Call us to discuss your requirements and we will tailor a plan and quote to suit your exact needs and discounts may apply for large groups. For more information on corporate health please contact our head office or call (03) 9528 1222.

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A DVT is a blood clot that may form in the deep leg veins. It may travel around the body (ie embolise) and cause damage to vital organs, such as a the lungs. The jury is still out on absolute proof of air travel per se being a cause of thromboembolism. However, some people with recurrent clots or where there is a history of other family members with clots may need to be screened for the Factor V Leiden gene which predisposes to DVTs.

Cabin-related risk factors include

• immobilisation, cramped position,
• insufficient fluid intake,
• low humidity
• hypoxia

Most of these can be prevented with:

• regular calf exercises
• moving around the cabin every 2 hours
• adequate fluid intake
• avoidance of diuretics including the effects of too much alcohol or caffeine

Higher risk travellers such as those with a past history of thrombosis may be also be advised to wear supportive stockings and use self-injectable anti-thrombotic agents. Aspirin is an antiplatelet agent and is most effective on the arterial side rather than on the venous circulation but there is some evidence that it is mildly effective and may be preferred by travellers to injecting themselves.

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Dengue fever is a mosquito-borne infection which presents with sudden onset of a high fever, generalized muscle and/or joint pains and headache. Nausea, vomiting and a rash may also be present.

Transmission occurs during the day (unlike malaria) and many countries around the world have the Dengue viruses. Areas where the disease is endemic include Asia, the South Pacific, the Caribbean Basin, Africa, and Central and South America. Most common areas affected are South-East Asia and tropical South America. There have been five epidemics in north Queensland in the last decade however, because virtually all the cases have been imported, north Queensland is not considered to be an endemic area per se.

There is no vaccine, but the disease is usually self-limiting.

Dengue fever exists in four serotypes or different forms. If a person has been infected by one of the serotypes, they gain immunity to that particular serotype. The immune response to one form of the virus does not protect against the three other forms of the virus. Thus, an immune response to one of the serotypes of Dengue is not protective against being infected by a different serotype.

Secondary dengue infections occur when an individual has developed an immune response to one of the dengue serotypes (by a previous infection) and then he or she contracts another infection by one of the other serotypes.

A complication, secondary infections can, in relatively rare cases, cause a more serious disease called dengue haemorrhagic fever. DHF is found predominantly amongst children and adolescents. While DHF in adults is a serious disease it is more serious for children.

Dengue should be considered in any traveller who has fever and symptoms occurring within three weeks of travel to a tropical area, especially an epidemic area. Because there is no vaccine, travellers must take measures to avoid mosquito bites.

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Diphtheria is a bacterial infection spread by nasal droplets such as occurs with coughing or sneezing.

• Features include a severe sore throat, swollen glands, and swallowing and breathing may become difficult.
• The diphtheria vaccine, which is combined with tetanus and pertussis vaccines, is a routine NHMRC vaccination in Australia that may need to be boosted before any trip.

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Disability is no longer a contraindication for travel and those with chronic illness or physical disabilities are finding it increasingly easy to move to most places on the globe.

• Wheelchairs and aircraft seating need to be arranged well before travel
• For those with low vision, special arrangements need to be made for guide dogs
• If your hearing is reduced, use visual cues in order to avoid accidents from quiet vehicles such as electric luggage trolleys at airports and bus stations
• Travellers with chronic illness or immunodeficiency (such as with diabetes or on medication for organ transplants) need to carry a letter from their doctor detailing their medical conditions and medications
• People with intellectual disability need to be self-sufficient or accompanied by someone familiar with their needs
• Continuous oxygen can be arranged for the appropriate medical indications such as chronic airways disease
• Carry a Medic-alert tag
• Obtain information on medical facilities in the area you will visit.

There are many resources now available both in print and on the web to help organise a trouble free trip.

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Gastroenteritis / Gastrointestinal diseases (stomach upsets) are more common in travellers to developing countries (up to 50%) and are caused by bacteria, viruses, worms or other parasites. They are usually associated with improperly prepared foods, untreated water or poor personal hygiene.

There is little risk of getting these diseases in countries such as the United States, Canada, Japan, the United Kingdom and Europe. Risk is less if staying in major city hotels and increases as accommodation becomes more backpacking in style.

Health requirements overseas are often not as stringent as in Australia and these diseases can be quite dangerous, so travellers are urged to carefully consider the following advice.

Symptoms commonly include diarrhoea and crampy stomach pains and there may be nausea or vomiting. Generally, stomach upsets are mild and last about 2 days. Traveller’s diarrhoea is defined as 3 or more loose bowel motions per 24 hours.

There are a number of preventive and treatment strategies that are extremely effective and which need to be discussed with your doctor.

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Hepatitis A is the most frequently occurring vaccine-preventable infection in travellers.

• It is a viral infection of the liver spread by person to person (faeco-oral route) or by contaminated food and water
• Resort level of accommodation does not exclude the risk
• Death rate up to 3%
• Up to one in 50 travellers are affected with jaundice, abdominal pain, fever and malaise for up to 3 months, severity greater with age
• Preventable with vaccination and careful attention to personal hygiene and diet

Hepatitis B is a vaccine preventable viral infection of the liver spread by infected body fluids –blood, semen, mucus, and saliva.

• At least 150,000 people are chronic carriers of the disease and 1200 deaths are reported annually in Australia. A significant percentage of travellers develop the disease overseas
• Up to 50% infected with hepatitis B will die from cancer of the liver later in life or liver failure
• Acute infection features jaundice, abdominal pain, fever and malaise for up to 6 months
• Hepatitis B vaccine is now routinely given to neonates and adolescents

Other forms of hepatitis include C, D & E and are transmitted in similar ways to hepatitis A and B, however no vaccines are available for these yet.

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Although preventive strategies do reduce the risk of illness, sometimes things just happen and you need to find a doctor. Everyone has a tale to tell, but the reality is that good quality medical help is readily available for most travellers.

• If you are staying with family or friends, they can take you to their own local practitioner. Most public and major city hospitals maintain a high quality 24 hour medical service for travellers and are therefore quite experienced at meeting all medical needs.
• Your hotel or hostel can usually put you in touch with a competent medical practitioner.
• Dedicated travel clinics in general supply excellent post-travel health care and consulates or embassies are also a good initial contact, especially for more serious problems.
• An increasing number of travel health insurance companies are now supplying an international 24 hour emergency telephone number as a first point of contact. The traveller calls this number and depending on the nature of the problem, are either referred to the nearest medical service or arrangements made to transport them home.

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According to the World Health Organisation, influenza is thought to cause serious illness to 3-5 million people and death to up to ½ million people worldwide.

• Influenza is a virus that spreads easily between people through sneezing and coughing – especially in crowded areas. People can be contagious before they show symptoms of fever, malaise, aches and pains and a dry cough
• The best preventative measure is to be vaccinated, ideally before winter sets in because the influenza virus tends to survive outside the body longer when the weather is cold and dry. In temperate regions world wide, the peak incidence of the ‘flu’, is winter. Tropical regions tend to have influenza outbreaks year round
• Travel Clinics Australia readily vaccinates patients and travellers against this disease, with up to 90% protection in young adults
• Sometimes travellers tend to focus on vaccination against exotic diseases, yet influenza, which can debilitate and lead to serious complications, even death, needs to be considered and discussed with your Travel Clinics Australia doctor

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Japanese encephalitis (JE) is a viral infection spread by the Culex mosquito throughout greater Asia.

• Symptoms are usually absent although there may be reduced consciousness or fitting.
• 25% of people who contract the disease will die and up to 30% retain some neurological or psychiatric change.
• The risk of Japanese encephalitis differs seasonally.
• Prevention is through vaccination and avoiding mosquito bites.

Detailed vaccination advice suited to your risk factors for JE is available during a travel consult with any TCA doctor.

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Jet Lag

• Is how we feel when our normal body rhythms (circadian rhythms) are out of synchrony with the environment
• Worse when travelling long distances rapidly and travelling east
• Symptoms commonly include: fatigue, impaired vision, headache, sleep disturbance, hunger at inappropriate times, gastrointestinal upsets, urinary disturbance and poor mental or physical performance
• Re-adaption to normal function generally takes 1-2 hours per day and may hence take several weeks

To minimise jet-lag

• Break flight into sections not exceeding 4 hours time zone change, ie stop over en route
• Travel west, during the day and aim to arrive late afternoon/early evening
• Pre-adapt by adjusting the retiring and rising time by 1 hour each day until the destination time is reached. Retire later for the westward travel and earlier for the eastward
• Stay on home time for the whole journey. On arrival, immediately adopt local time for eating and sleeping
• Arrive 7 days ahead of the day on which you need to be reasonably competent
• Exercise, exposure to bright light, and a high protein diet may help minimise symptoms
• Melatonin tablets are a popular but unproven therapy
• Short term use of sleeping tablets can assist during flight or on arrival

On the plane

• Wear loose clothing
• Avoid dehydration – drink plenty of water, avoid alcohol and caffeine
• Eat small regular meals low in fat and carbohydrates
• Avoid smoking
• Walk every 1-2 hours if possible

Face-moisturising towels, brushing teeth and changing clothes can help ‘freshen up’.

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Malaria is caused by a parasite (protozoa of the genus Plasmodium), which is transmitted through the bite of an infected female of the Anopheline mosquito.

• The mosquito feeds on human blood and transmits the parasite, which invades the liver and then the red blood cells
• Symptoms typically include fever, rigors (uncontrollable shaking) headache, backache, nausea, vomiting, stomach, muscle and joint pains and hallucinations. There may also be jaundice, respiratory and gastrointestinal symptoms. Symptoms may disappear only to recur days later
• Malaria, which is on the rise worldwide, can cause serious illness and possibly death if not treated quickly
• There is no vaccine for malaria. It is still possible to contract malaria, even with preventative care. Protection includes avoiding being bitten by mosquitoes and by taking anti-malaria medications
• Malaria can be effectively treated early in the course of disease

Post travel

Malaria can occur for up to a year after leaving a malarious area, even if a traveller took antimalarial medications. Therefore see you doctor if you fall ill during that year with unexplained fever.

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Measles is a viral infection spread by droplets and can result in quite serious disease in both children and adults.

• Symptoms include fever, cough, rash
• 1 in 25 will develop pneumonia, and less commonly, encephalitis (brain inflammation) with the risk of brain damage or death
• Measles is a routine vaccination that may need to be updated prior to travel
• It is now given combined with mumps and rubella vaccination
• The vaccine is especially recommended for those who have only one documented dose given born eg those born between 1970 and 1984

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