Brazil carnival vaccines : heading to Rio for the carnival this year? Make sure you have your yellow fever vaccine!  Since December 2016 Brazil has been experiencing an outbreak of yellow fever that has now spread to Rio and the São... The post BRAZIL CARNIVAL VACCINES appeared first on London Vaccination...

Brazil carnival vaccines : heading to Rio for the carnival this year? Make sure you have your yellow fever vaccine! 

Since December 2016 Brazil has been experiencing an outbreak of yellow fever that has now spread to Rio and the São Paulo State.  Initially covering 21 Brazilian states by July 2017  777 confirmed cases were reported with 261 deaths (case fatality rate of 34%).  Since July 2017 a further 35 cases of yellow fever had been confirmed, of which 20 cases were fatal (case fatality rate 57%). Sao Paulo has been the worst-affected state, with 20 confirmed cases.

Recent spread of yellow fever into the municipality of Sao Paulo and the municipalities of Greater São Paulo suggest high risk for people who haven’t been immunised.  Recent news, 9 January 2018, reports 4 deaths in Sao Paulo State.

There has been one case of yellow fever infection in a traveller. December 2017 a traveller from the Netherlands staying in  in Mairipora, a municipality in the São Paulo metropolitan region became sick. He recovered fully after being hospitalised in the Netherlands on his return from Brazil. He has not had the yellow fever vaccine for Brazil 

Yellow fever spreads to humans via the bite of the Aedes mosquito. These are day time biters.  It is a viral infection, therefore can be difficult to diagnose and treat and is often misdiagnosed for other tropical infections or fevers. Infection can be fatal, vaccination is essential for life long immunity. The vaccine takes at least 10 days to work, so make sure you visit your travel health clinic well in advance.

Brazil carnival vaccines: The World Health Organisation http://who.int/ith/updates/20180116/en/advises all travellers heading to Rio, Brazil for carnival have the vaccine against yellow fever. Don’t forget to take a mosquito repellent with you (DEET 50% or higher) https://travelhealthpro.org.uk/disease/194/yellow-fever

In London, the vaccine is given privately, only a limited number of GP practices offer it. Clinics must be registered as the yellow fever vaccination centres in order to legally offer the vaccine.  Yellow fever vaccine at the London Vaccination Clinic costs only £70 and comes with the vital yellow fever certificate.  Visit the clinic here http://www.londonvaccinationclinic.co.ukfor a comprehensive consultation and yellow fever vaccine (given on the same day).

Sources:  https://www.gov.uk/foreign-travel-advice/brazil

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Rabies in India. Our Lead Nurse Kamila Soltysik has published an article in the Journal of British Global and Travel Health Association.  Read the full article below: Every year more than 59,000 people in the world die of rabies. It... The post Rabies in India: Why is it still not eradicated? appeared first on London Vaccination...

Rabies in India.

Our Lead Nurse Kamila Soltysik has published an article in the Journal of British Global and Travel Health Association.  Read the full article below:

Every year more than 59,000 people in the world die of rabies. It remains an under-reported,
neglected disease ranking the 10th biggest cause of death due to infectious diseases globally.
It is a viral zoonotic disease spread via a bite, scratch or a lick from an infected animal, present
in more than 150 countries and poses a real threat to about 2.5 billion people. Despite Pasteur’s
discovery of the rabies vaccine 131 years ago, and the post-exposure treatment available,
thousands of people still die of rabies every year. Many countries have gained an efficacious
governmental control over rabies, mainly by vaccinating a wide number of human and dog
populations, and by implementing other interventions and policies. Only a few countries have
managed to completely eradicate the disease.
Unfortunately, this is not the case with India. Here the situation has not changed for a decade.
Almost 36% of rabies deaths worldwide happen in India. According to ‘End Rabies Now
Campaign every year 20,847 rabies deaths occur in India; while only 6002 deaths were
recorded in China, a neighbouring country with a similar number of human population. The
number accounts for one third of the world’s total. Despite many international and local
governmental initiatives to control rabies, India still struggles to ameliorate the situation.

Rabies disease

Rabies is probably the oldest recorded infection affecting humans, first documented in Babylon
in 2300 B.C. Rabies virus can be found globally in domestic animals (dogs, cats) as well as in
wildlife (e.g. foxes, racoons, mongoose, skunks and bats). Humans are only accidental hosts.
They become infected when bitten or scratched by a rabid animal. After the exposure, the virus
enters the nerve or the muscle cells and thus reaches the spinal cord, where it replicates.
Subsequently the virus travels up to the brain and infects all its regions, causing death due to
the dysfunctional changes of neurons. It then runs down via the peripheral pathways to the
salivary glands, adrenals and skin. Infected patients suffer periods of uncontrollable shakes and
panic attacks, then fall into coma and eventually die of respiratory or cardiac failure.

Although fatal if not treated in time, rabies is 100% vaccine-preventable. Humans can receive
protection as a pre-exposure prophylaxis, given intramuscularly or intradermally. Animals can
also be vaccinated in a form of an injection (domestic) or orally, as bait in food (wildlife). For
previously vaccinated people who have been exposed to a rabid animal, the World Health
Organisation (WHO) recommends a post-exposure treatment that includes washing the wound
with soap and water and receiving boosters of the rabies vaccine. This is usually enough to
save the lives of victims. However, previously unvaccinated individuals that had been bitten or
scratched should be treated in a timely fashion with human rabies immunoglobulin (HRIG) and
vaccinations. This intervention can be very expensive, or even unavailable at the time in
particular region or country.

What is the problem and how big is it?

Only a few countries (Japan, United Kingdom, Australia, New Zealand, Andaman and Nicobar
Islands) have managed to completely eradicate the disease, mainly thanks to their geographical
isolation and excellent governmental initiatives to control rabies. Countries in Western Europe
and the Americas have made great progress in eliminating rabies. They have recognised it to be
a public health concern and acted upon it by improving surveillance, mass dog vaccination,
community engagement and education, pre-exposure prophylaxis for people at high risk and
long term, sustained investment.
Unfortunately, in Africa and Asia it still poses a huge public health threat. Rabies in India is still
not a notifiable disease, therefore the exact figure of rabies bites remains unknown.
Although it has the highest incidence of rabies globally, the true number is presumably grossly
underestimated. Some studies have estimated it to be as high as 17 million dog bites per year.
One of the main reasons for this is that rabies bites occur in the most deprived rural areas,
where access to medical facilities is limited. According to Hampson et al, most rabies victims die
at home (>75%), making the statistics impossible to record.

Even if dog-bite victims do reach hospitals, they can be misdiagnosed as having cerebral
malaria, Guillain-Barre syndrome or other neurological condition. Two studies carried out in New
Delhi and Jodhpur showed many disparities in the knowledge and practices of doctors in
regards to rabies. Less than half of them were unaware of the intradermal rabies prophylaxis
schedule, and only 45% of them knew about HRIG. 81% of them knew of the PEP in
unimmunized patients, but only 40% were familiar with the guidelines for previously immunized
patients. More importantly, public doctors had markedly better knowledge than private doctors in
regards to the PEP. This is very concerning, when taken into account that India has the biggest
private sector of doctors in the world, accounting for 93% of the hospitals and 85% of doctors.

Awareness of the disease among communities is also very limited. According to ‘End Rabies
Now Campaign’ only 54% of survey respondents in Indian urban slums knew that rabies can be
fatal. In another survey 70% of people in India have never even heard of rabies and only 30%
knew about the importance of washing the wounds after animal bites. The majority of the victims
happen to be young children in poor rural areas, who have no resources or knowledge of how to
seek help. With their daily income ranging between $1 to $2 they are unable to pay to be
vaccinated. Post-exposure treatment (HRIG) is simply unaffordable, costing around 30,000
rupees ($447) for an average person. Moreover, India notoriously experiences local and
national shortages of HRIG, causing the patients who are willing to pay, to wait for it, for weeks
or even months, which can eventually lead to death.

Under-reporting of rabies cases, lack of education among Indian healthcare professionals,
unawareness of the disease in the communities and irregular vaccine distribution are not the
only problems the country needs to improve in its fight against rabies. India has an uncontrolled
canine population; some estimate it to be as high as 25 million. Only 15% of dogs have been
vaccinated, but in order to eliminate canine rabies the coverage needs to reach 70%. The
immune coverage must be maintained and protected from spill over from unvaccinated animals
in neighbouring areas. Until now, little has been invested in animal vaccination and great
measures need to be taken to vaccinate such a vast number of dogs.

So what has been done?

At the end of last year WHO launched a global framework with a target to reach zero human
rabies deaths by 203019. For the first time it collaborated with animal health sector, the World
Organisation for Animal Health (OIE), Food and Agriculture Organisation of United Nations
(FAO) and the Global Alliance for Rabies Control (GARC). In its Global Framework for the
Elimination of Dog-mediated Human Rabies, five main pillars were set. They included:

– Socio-cultural aspects (awareness, responsible dog-ownership, bite prevention and
treatment, post-exposure prophylaxis, community engagement)
– Technical aspects (vaccination, logistics, diagnostics, surveillance)
– Organisational aspects (good governance, promotion of One Health approach,
coordination and monitoring)

– Resources (investment and business plans)
– Political aspects (political and international support, regional engagement, legal
frameworks and demonstrating impacts)19

The federal government of India together with the National Centre for Disease Control (NCDC)
has also developed a pilot project to eliminate rabies. In its 12th five year plan, it included
strategies for training medical students and doctors, creating awareness in communities and
minimising animal bites. The NCDC has since collaborated closely with local business
companies to establish and develop more diagnostic facilities for surveillance purposes. This
resulted in increased attendance at anti-rabies clinics and the use of HRIG. Also, thousands of
doctors and nurses have been trained in animal-bite management.

Furthermore, in 2009, the government adopted national guidelines in favour of intradermal
vaccination, which is highly immunogenic and cheaper than intramuscular vaccine. Eight out of
India’s 28 states planned to introduce this regimen that year, yet special training still had to be
implemented across the country to avoid insufficient dosing. Additionally, in 2009, India was
producing around 15 million doses of human rabies vaccine annually – quantities that met the
national requirement in that period.

Over the years India has received a huge contribution for rabies control from non- governmental
organisations, such as the Rabies in Asia Foundation, the Association for Prevention and
Control of Rabies in India, the Animal Welfare Board of India and the Association for Prevention
and Control of Rabies in India22. With their aim to end rabies in India by 2020, they slowly make
a change for the better. An example of a great success is the Rabies Day established ten years
ago by The Global Alliance for Rabies Control. It comes on the 28th of September and its
purpose is to raise global public awareness about the disease.
After only three such yearly events, GARC has estimated that over 100 million people had been
educated about rabies in over 120 countries and around three million dogs had been vaccinated
during such events. Their annual activities continue to raise awareness about rabies nationwide
including local Indian communities.
Is it enough?

It is evident that India’s main obstacle to rabies elimination is the lack of a good, comprehensive
national programme and the deficiency in coordinating it. Its neighbouring countries, such as Sri

Lanka and Thailand have made tremendous progress by taking a nationally coordinated
approach. By contrast, Bangladesh, with almost 10.000 deaths per year and less than six % dog
vaccination coverage, has adopted a very successful national strategic plan for the elimination
of rabies by 2020. Through the establishment of the District Rabies Prevention Control Centres
in almost every district, they provided facilities for mass dog vaccination, dog population
management, care of bitten patients, all of whom receive anti-rabies vaccine and
immunoglobulin for free. Funding was provided by the Ministry of Health and Family Welfare
(MoHFW) and the Ministry of Local Governance. Furthermore, local champions were appointed
to convince political leaders, policy-makers and stakeholders for political commitment and
technical leadership and partnership for this assignment. As a result, rabies deaths have
reduced by 50% between 2010 and 2013. Such an outcome contrasts with the slow progress
made in India, where rabies remains a non-notifiable disease.

Conclusion

It has been demonstrated in multiple research studies that India’s poor position in rabies
elimination is rooted in a lack of knowledge about the disease, uncontrolled canine population,
the insufficient vaccination programme, irregular supply of vaccines and inadequate training of
healthcare professionals. The government and healthcare authorities seem to know where the
problems lie and are gradually addressing them, but the process to improve the statistics
remains slow. The Indian government needs to take the rabies situation seriously, recognise it
as a real threat to its citizens and act upon it on a national level. To date, public spending on
rabies control in India has been insufficient. As Madhusudana, a rabies researcher and a
Professor of Neurovirology in Bangalore points out, a considerable amount of money in India is
being spent on raising awareness of diseases like tuberculosis, malaria, and HIV. According to
Madhusudana, India’s deaths caused by rabies would be radically reduced, if only a tenth of
that sum was spent on raising awareness about rabies. The World Health Organisation wants to
eliminate rabies from South-East Asia by the year 2020. India has seen some improvement in
its battle against rabies; however with the progress seen so far, it is a goal that India is unlikely
to meet.

Kamila Soltysik RN, PgDip, DipTN (LSHTM), DipTravMed AFTM RCPS (Glasg)

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Vietnam is deservedly popular amongst holidaymakers. Amazing weather, divine scenery, delicious food and ancient cultural charms mix together to create a truly unforgettable destination. If you’re considering a holiday to Vietnam, 2017 is the perfect time to go. There’s good... The post Six reasons to visit Vietnam in 2017 appeared first on London Vaccination...

Vietnam is deservedly popular amongst holidaymakers. Amazing weather, divine scenery, delicious food and ancient cultural charms mix together to create a truly unforgettable destination. If you’re considering a holiday to Vietnam, 2017 is the perfect time to go. There’s good tourist infrastructure but still plenty of sights off the beaten track to for a real Vietnamese experience. Here are six of the best reasons to visit Vietnam this year.

1 – Ha Long Bay

Vietnam’s most popular tourist attraction is still utterly spectacular in 2017. Junk boats float leisurely across this turquoise expanse and vegetation-covered limestone towers rise out of the water. It’s breath-taking – there really is no other word.

For the ultimate experience you should enjoy a cruise trip out on the bay, ideally on a boat you can sleep on. There are plenty of islands and islets across the bay that hold treasures including sandy beaches, dense forests and caves. Don’t miss Cat Ba, the largest island, half of which is covered by a National Park that is home to the endangered Cat Ba langur.

2 – Nha Trang

A pretty beach resort that has seen plenty of renovations in recent years, Nha Trang might be Southeast Asia’s most underappreciated holiday destination. Diving, snorkelling and other watersports are extremely popular thanks to the favourable conditions in the water. The arch of charming beach backs onto a lively promenade with as seemingly endless array of restaurants and boutiques. And a jaw-dropping backdrop is supplied the picturesque Co Tien Mountain, which intrepid travellers can climb. There really is something here for everyone.

3 – Mekong River

The South of Vietnam is the home of the Mekong Delta, where the Mekong River meets the sea. This is the ideal place to set off on a cruise along the Mekong. This iconic river flows through many of the important towns, including My Tho, Cai Be and Chau Doc where you can find floating markets, charming temples and more.

Cruising options range from small, basic boats to larger cruisers with amenities like air-conditioning. Be aware that as you pass through rural areas and get closer to Cambodia there is a great risk of issues such as malaria and Japanese encephalitis. It’s always best to consult a specialist clinic about the kind of vaccinations for Vietnam you may need.

4 – Cat Tien National Park

In between Ho Chi Minh City (Saigon) and Dalat, Cat Tien National Park consists of lowland tropical forests. It’s a great place to see an incredible diverse array of wildlife including Siamese crocodiles, eagles and families of the rare golden-cheeked gibbon. Hikers and birdwatchers will be in their element here, and if you’re especially lucky you might even catch a glimpse of an Asian elephant or an Asiatic black bear.

5 – Cu Chi Tunnels

Ho Chi Minh City has a range of attractions including the fascinating War Remnants Museum, Notre Dame Cathedral and a variety of pretty pagodas. But a trip to the city would not be complete without a tour of the Cu Chi Tunnels. This vast network of underground passages that served as the base for the Viet Cong during the Vietnam War. You can wander through the tunnels and visit preserved conference rooms where the resistance was planned.

6 – Hoi An

Hoi An is a beautiful city on the central coast. The city has existed for more than 2,000 years and features well-preserved examples of Vietnamese architecture. With virtually no traffic, this graceful city retains a peaceful ambiance.

Navigate the winding streets of the Old Town for a taste of the real Vietnam. This part of the city is listed as a UNESCO World Heritage Site and there are a number of famous sites including the Japanese Covered Bridge and the Quan Cong Temple, as well as museums dedicated to Folk Culture and Trade Ceramics. The city is also renowned for its range of tailors – if you’re staying for a few days and are interested in picking up a high quality tailor-made suit, the prices are fantastic.

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An NHS funding review could mean that a number of travel vaccinations will no longer be available for free. Budget cuts have forced NHS England into cost-cutting measures which could begin to affect holidaymakers and travellers this year. Currently, a... The post NHS funding review to affect vaccinations appeared first on London Vaccination...

An NHS funding review could mean that a number of travel vaccinations will no longer be available for free. Budget cuts have forced NHS England into cost-cutting measures which could begin to affect holidaymakers and travellers this year.

Currently, a number of vaccinations are usually made available for free from your GP. These are vaccinations that protect against the diseases that are considered to present the highest risk to public health if they were brought into the UK, including:

• Cholera
• Diphtheria, polio and tetanus
• Hepatitis A
• Typhoid

However, if the changes suggested by the funding review come into practice, these vaccinations will only be made available in specific circumstances. Most people would no longer qualify to get these vaccinations on the NHS. Unfortunately, these diseases and conditions are common in many destinations across the world, including Africa and Asia, so it is still vital that you are inoculated against them before you go away.

Depending on where you are visiting you may need these as well as other vaccinations, so you should get advice from your GP or a specialist travel clinic in advance of travel.

These potential NHS changes will not affect our services; London Vaccination Clinic will continue to offer a full range of vaccinations at affordable prices to ensure that you are properly protected no matter what part of the world you are travelling to. You can book an appointment with us today for more information on the range of services that we can provide.

Our prices start from as little as £30 per dose for cholera vaccinations and we strive to provide the latest, impartial advice regarding the medicines you need before you travel. Please don’t hesitate to contact us today for more information by calling 020 33229558.

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