JCGCHINA 2014

Lead Practice Nurse

Jacquie Coates

Dr Chris Cook

Travel Risk Assessment

HAZARDS

INTERVENTIONS

POTENTIALEXPOSURES

HOST FACTORS

RISK

• Strokes and heart problems

• Accidents

What do Travellers die from?

What are the mostcommon infections inTravellers?

Safe drinking water

Avoid high risk foods

Wash your hands

Wash hands frequently

Avoid crowds

‘Flu jab’ if recommended

CHINA

General Information

• Location: East Asia • Capital: Beijing • Population: 1.359 billion (2013) • Climate: Extremely diverse; tropical in south to sub arctic

in north; southern China wet season (Jun-Sep), central China rainfall all year

• Seasonal Risks: Japanese encephalitis (most cases reported Apr to Oct), Tick-borne encephalitis, spring to early autumn. Influenza (Nov-Apr)

• Peaks/elevation: Mount Everest 8848m (29 029ft) Nepal/Tibet Autonomous Region border

Outbreaks Avian Flu

• 'bird flu', is a contagious disease of animals caused by viruses that normally infect only birds

• Humans are usually infected through close contact with live infected birds

• Not vaccine preventable

Vaccination Advicefor China (Travax 2014)

Vaccines Usually Advised (for all travellers at risk)• Hepatitis A

Vaccines Sometimes Advised (for travellers at higher risk)• Hepatitis B

• Japanese Encephalitis

• Rabies

• Tetanus

• Tick-borne encephalitis

• Typhoid

Vaccines Selectively Advised (for travellers at highest risk)• Cholera

• TB

Hepatitis A

Disease prevalence is considered

moderate to high in this country

Typhoid

• Spread most commonly through ingestion of food and drink that has been contaminated with faeces or urine from a human case or carrier

• Schedule: 1 X injection – boost after three years, efficacy 55-75%

• Schedule: 3 X oral capsules - boost after one year, efficacy 50-60%

Scrupulous food, water and personal hygiene encouraged at all times when travelling to an endemic area

Hepatitis B

Carriage of the virus in the local population in this country is considered to be high (>8%)

Rabies

• Spread through the saliva of an infected animal, usually through a bite or scratch

• China is classified as a high risk country for rabies

• Pre-travel vaccination removes the need for rabies immunoglobulin (RIG) and reduces the number of post exposure doses of rabies vaccine required

• Course = three injections given over a period of 21-28 days

Wash saliva out of wound under running water immediately

Wash out wound with antiseptic or alcohol

Seek immediate medical help

Tick-borne encephalitis

– Transmitted through the bite of infected tick or consuming unpasteurised dairy products

– Infected ticks found in woodland habitat, deciduous forest and grassland

– Transmission more common during the warmer months of Apr-Nov when ticks are most active

AVOID TICK BITES - wear protective clothingAvoid consumption of unpasteurised dairy productsApply insect repellents containing DEET to exposed skinInspect body for ticks after outdoor activities and remove with tweezers or forceps

Japanese EncephalitisSpread through the bite of an infected culicine mosquito that normally breeds in rice paddies • Most short stay travellers and those only visiting cities and urban

areas will be at low risk• While the disease occurs the whole year round, most cases are

reported from April to October

Avoid bites – wear suitable clothing

Use repellents – DEET at least 30-50%

Malaria Zones

MalariaFemale anopheline mosquito

• A - Awareness: Malaria risk including malignant P.falciparum occurs in Yunnan. Risk to the traveller is influenced by factors including length of stay, itinerary, accommodation etc.

• B - Be aware of the risk and take precautions to avoid mosquito bites, including the use of repellents, nets and suitable clothing

• C - Chemoprophylaxis: High risk areas -atovaquone/proguanil OR Doxycycline OR Mefloquin

• D - Diagnosis and treatment, prompt diagnosis and treatment is essential. Fever occurring at least 7 days after exposure but illness can develop up to 1 year later

Resources for thetraveller

• www.nathnac.org• www.fitfortravel.scot.nhs.uk• www.malariahotspots.co.uk• www.fco.gov.uk

PROPOSED TRAVEL CLINIC DATES19TH February

5th March26th March

@16.00hrs

Lead Practice Nurse

Jacquie Coates

Dr Chris Cook