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Cholera Countries

Monday, June 18th, 2012


Risk factors and disease burden
Cholera transmission is closely linked to inadequate environmental management. Typical at-risk areas include peri-urban slums, where basic infrastructure is not available, as well as camps for internally displaced people or refugees, where minimum requirements of clean water and sanitation are not met.

  • Cholera is an acute diarrhoeal disease that can kill within hours if left untreated.
  • There are an estimated 3–5 million cholera cases and 100 000–120 000 deaths due to cholera every year.
  • Up to 80% of cases can be successfully treated with oral rehydration salts.
  • Effective control measures rely on prevention, preparedness and response.
  • Provision of safe water and sanitation is critical in reducing the impact of cholera and other waterborne diseases.
  • Oral cholera vaccines are considered an additional means to control cholera, but should not replace conventional control measures.

Click here to see the WHO report on Cholera- worldwide-Outbreaks and cases

Important: The oral cholera vaccine can be given at the same time as other injected vaccines.

Primary immunisation:

  1. Adults and children over 6 years of age – 2 doses of oral vaccine -at 1-6-week interval.
  2. Children aged 2-6 years – 3 doses of vaccine are necessary but each dose is given with a similar 1-6-week interval.
  3. Should more than 6 weeks elapse between any doses, the primary immunisation course must be restarted. All individuals must complete the immunisation course at least 1 week prior to potential exposure.

Boosters – a single booster to augment immunity is recommended:

  1. Adults and children over 6 years of age. A booster can be given 2 years after the primary course. If more than 2 years have elapsed since cholera vaccination the primary course must be repeated.
  2. Children aged 2-6 years. A booster dose is given after 6 months.

Contra-indications

The oral cholera vaccine should not be administered to patients with:

  1. Confirmed anaphylactic reaction to oral cholera vaccine or any excipients
  2. Acute gastrointestinal illness or febrile illness at the time of vaccination

Read More on Patient UK Website

Facts about Yellow Fever

Monday, June 18th, 2012

According to WHO, 2005 figures, an estimated 200 000 people are infected, and 30 000 people die from yellow fever each year. The virus is endemic in tropical regions of Africa and the Americas. Check Maps Here.

The protective effect (immunity) occurs within one week in 95% of people vaccinated.

You should have a yellow fever vaccination at least 10 days before your travel.

Transmission

Yellow fever is a viral haemorrhagic fever – (Arbovirus of the flavivirus genus) transmitted to people by infected Aedes and Haemogogus mosquitoes.

Sylvatic (or jungle) yellow fever: In Tropical Rain Forests, Yellow Fever occurs in Monkeys that are infected by wild mosquitoes. These infected monkeys pass the virus to other mosquitoes that feed on them. The infected mosquitoes bite human beings and other living animals entering the forest, resulting in new cases of yellow fever.

Intermediate yellow fever: In humid or semi-humid parts of Africa, small-scale epidemics occur. Semi-domestic mosquitoes (that breed in the wild and around households) infect both monkeys and humans. Increased contact between people and infected mosquitoes leads to transmission. Many separate villages in an area can suffer cases simultaneously. This is the most common type of outbreak in Africa. An outbreak can become a more severe epidemic if the infection is carried into an area populated with both domestic mosquitoes and unvaccinated people.

Urban yellow fever: Large epidemics occur when infected people introduce the virus into densely populated areas with a high number of non-immune people and Aedes mosquitoes. Infected mosquitoes transmit the virus from person to person.

Image from Infection Landscapes

Symptoms of Yellow Fever:

Mild:

  • Hadache
  • High temperature
  • Nausea and vomiting
  • Jaundice – yellowing of the skin and whites of the eyes
  • Bleeding


Severe:

  • 20-50% of those with severe illness will die of the disease.
  • The “yellow” in the name is explained by the jaundice, it means yellow discoloration of eyes and skin.

For More Information please follow the links from WHO

Global Alert and Response (GAR)

All about Yellow fever

Malaria Tablets

Monday, June 18th, 2012

Doxycycline, 100mg (50 capsules = £ 80)Prophylaxis of malaria, started 1–2 days before entering endemic area and continued for 4 weeks after leaving (see notes above), adult and child over 12 years, 100 mg once daily.
Atovaquone/proguanil (12 tablets = £ 90)Prophylaxis of malaria, started 1–2 days before entering endemic area and continued for 1 week after leaving, adult and child over 40 kg, 1 tablet daily
Paediatric Malarone (12 tablets = £ 120)Prophylaxis of malaria, started 1–2 days before entering endemic area and continued for 1 week after leaving, child body-weight 11–21 kg, 1 tablet once daily; body-weight 21–31 kg, 2 tablets once daily; body-weight 31–40 kg, 3 tablets once daily; body-weight over 40 kg use Malarone® (‘standard’) tablets
Proguanil (100mg) (98-tab pack = £ 80)Prophylaxis of malaria, preferably started 1 week before entering endemic area and continued for 4 weeks after leaving (see notes above), 200 mg once daily; infant up to 12 weeks body-weight under 6 kg, 25 mg once daily; 12 weeks–1 year body-weight 6–10 kg, 50 mg once daily; child 1–4 years body-weight 10–16 kg, 75 mg once daily; 4–8 years body-weight 16–25 kg, 100 mg once daily; 8–13 years, body-weight 25–45 kg, 150 mg once daily; over 13 years body-weight over 45 kg, adult dose
Lariam/Mefloquine (8 tablets = £ 90)Prophylaxis of malaria, preferably started 2½ weeks before entering endemic area and continued for 4 weeks after leaving (see notes above), adult and child body-weight over 45 kg, 250 mg once weekly; body-weight 6–16 kg, 62.5 mg once weekly; body-weight 16–25 kg, 125 mg once weekly; body-weight 25–45 kg, 187.5 mg once weekly

Yellow Fever Risk Areas

Monday, June 18th, 2012

Following map shows the areas in Africa, where you need to have Yellow fever Vaccine, with Certificate, before you enter.

Angola, Benin, Burkina Faso, Burundi, Cameroon, Central African Republic, Chad, Congo, Cote d’Ivoire, Democratic Republic of the Congo, Ethiopia, Equatorial Guinea, Gabon, Gambia, Ghana, Guinea, Guinea Bissau, Kenya, Liberia, Mali, Mauritania, Niger, Nigeria, Rwanda, Sao Tome and Principe, Sierra Leone, Senegal, Somalia, Sudan, Tanzania, Togo, Uganda

Following map shows Yellow fever risk in South America.

Argentina, Bolivia, Brazil, Colombia, Ecuador, French Guiana, Guyana, Panama, Paraguay, Peru, Surinam, Trinidad & Tobago, Venezuela

Typhoid Countries

Monday, June 18th, 2012

Risk factors and disease burden

Cholera transmission is closely linked to inadequate environmental management. Typical at-risk areas include peri-urban slums, where basic infrastructure is not available, as well as camps for internally displaced people or refugees, where minimum requirements of clean water and sanitation are not met.

  • Cholera is an acute diarrhoeal disease that can kill within hours if left untreated.
  • There are an estimated 3–5 million cholera cases and 100 000–120 000 deaths due to cholera every year.
  • Up to 80% of cases can be successfully treated with oral rehydration salts.
  • Effective control measures rely on prevention, preparedness and response.
  • Provision of safe water and sanitation is critical in reducing the impact of cholera and other waterborne diseases.
  • Oral cholera vaccines are considered an additional means to control cholera, but should not replace conventional control measures.

Click here to see the WHO report on Cholera- worldwide-Outbreaks and cases

Important: The oral cholera vaccine can be given at the same time as other injected vaccines.

Primary immunisation:

  1. Adults and children over 6 years of age – 2 doses of oral vaccine -at 1-6-week interval.
  2. Children aged 2-6 years – 3 doses of vaccine are necessary but each dose is given with a similar 1-6-week interval.
  3. Should more than 6 weeks elapse between any doses, the primary immunisation course must be restarted. All individuals must complete the immunisation course at least 1 week prior to potential exposure.

Boosters – a single booster to augment immunity is recommended:

  1. Adults and children over 6 years of age. A booster can be given 2 years after the primary course. If more than 2 years have elapsed since cholera vaccination the primary course must be repeated.
  2. Children aged 2-6 years. A booster dose is given after 6 months.

Contra-indications

The oral cholera vaccine should not be administered to patients with:

  1. Confirmed anaphylactic reaction to oral cholera vaccine or any excipients
  2. Acute gastrointestinal illness or febrile illness at the time of vaccination

Read More on Patient UK Website

Fit for travel certificate

Monday, June 18th, 2012

Yellow fever Certificate is FREE

When you have vaccines from us, we can provide you free certificates.

Do you need a certificate for fitness to travel?

There are three kinds of certificates for travel:

1) Certificates you require for some vaccines to enter in to particular country/area. Such as Yellow Fever and Meningitis ACWY. In this case its free of charge in our Travel clinic.

2) Sometime your employer ask you to get a certificate, if you are fit for travel. Normally they pay for it.
Either your employer want to know that you are covered for your vaccines for your business trip or to make sure that you are fit for travel. In other sense they want to know if doctor can certify that nothing will happen to you, while you are on business trip abroad.

Please read below from BMA..

55. Are doctors required to complete fitness certificates e.g. fitness to travel or for sporting activities?

GPs are increasingly being approached to complete an array of certificates for medico-legal reasons. The completion of fitness certificates raises concern because even if a thorough history, examination and any necessary investigations are carried out, doctors are still not in a position to guarantee that a patient is fit for a particular activity. The BMA discourages doctors from signing certificates which indicate that the patient will, for example, be fit for the duration of the holiday, as current fitness is not a guide to future fitness. Doctors can only report on what is written in the patient notes, and reporting on future fitness could have medico-legal consequences for the doctor. The Association would therefore advise that if certificates are provided they should include words to the effect that ’based on information available in the medical notes, the patient appears to be fit to travel’. Fitness certificates fall outside a GPs NHS Terms and Conditions and doctors can charge at their own rate for undertaking the work.

If this is the case, then you need a proper consultation with doctor, which involves history taking, examination and advice. This will cost you £200, it also involves providing certificate saying, “based on information available and medical examination, the patient appears to be fit to travel’

If you need any investigations, it costs you more.

3) If you want a certificate as an evidence regarding your vaccines. eg what vaccines you had, or how many courses and when. It will cost you nothing. Its free. We can only mention about vaccines you have from us.