2017 HCHB_digital

Travel Health (including Vaccinations)
With some forward planning and sensible precautions, New Zealanders can
reduce their risk of getting sick while overseas.
Medicines
Medicines should only be taken overseas if they are for a customer’s personal
use, or the personal use of someone travelling with them. All medicines should
be left in their original packaging, and a note from the prescriber explaining what
the medicine is for, together with a copy of the prescription (if applicable) should
be carried. Since some medicines may not be legal in certain countries, customers
should check with the Embassy or High Commission of that country before departing.
Customers should also be wary of purchasing prescription medicines over the counter
overseas since counterfeit or substandard products are rife.
Mosquito-borne illnesses
Several life-threatening illnesses are transmitted by mosquitoes and travellers
need to be aware of which ones they may be at risk from during their trip.
Malaria is more common in Central and South America, Africa, Asia, Indonesia
and Eastern Europe. Symptoms occur anywhere from seven days to one year after
infection and include fever and flu-like illness, chills, headache, muscle aches and
tiredness. Customers should consult with a doctor aware of current, country-specific,
anti-malarial recommendations, as these are always changing. If anti-malarial tablets
are prescribed, these need to be taken exactly as directed, and precautions also taken to
avoid getting bitten (see also Bites and Stings).
Dengue fever is a mosquito-borne viral illness that has seen a dramatic rise in
incidence in tropical and subtropical parts of the world in the past few decades.
Outbreaks have been reported in Burkina Faso, Egypt, Fiji, Hawaii, Queensland,
Samoa, Tonga, and Uruguay in the past three years. Symptoms of dengue fever
are usually mild and flu-like and include a high temperature, headache, pain
behind the eyes, joint pain, muscle and bone pain, rash and mild bleeding such
as nose bleeds. Some people are at risk of developing severe dengue which
can be fatal without immediate medical attention. Symptoms of severe dengue
include a decrease in temperature (below 38°C), severe abdominal pain and
persistent vomiting, rapid breathing, bleeding gums and blood in vomit, fatigue,
and restlessness. Several dengue fever vaccines are in development. The first,
Dengvaxia is approved for use in Brazil, Mexico and the Philippines but has
limited availability elsewhere. Travellers must still protect themselves from
mosquito bites during the day and night as the vaccine is only 60% effective
against dengue; however, it does prevent more than 80%–90% of severe cases.
Zika is another mosquito-borne viral illness that is becoming more prevalent.
The 2016 outbreak that started in Brazil rapidly spread to other tropical and
sub-tropical countries. Zika is typically a mild disease; four out of five people
experience no symptoms. The remainder develop a low-grade fever, headache,
a rash, joint pain and conjunctivitis. Hospitalisation is uncommon and symptoms
usually resolve within a week. Significantly, outbreaks have been associated with
an increase in the number of cases of Guillain-Barré syndrome, and a twentytimes
higher rate of microcephaly (abnormally small head, incomplete brain
development) in babies born to mothers infected with Zika. Other mosquitoborne
illnesses include chikungunya and Japanese encephalitis.
Vaccinations
Advise customers to see their doctor or travel vaccination clinic ideally eight to 12
weeks before departure to discuss what vaccines they will need and to allow time
to begin the course before their departure. Whether vaccinations are required or
not depends on age and:
• duration of visit and planned activities (eg, cycling, caving, trekking)
• how the person plans to travel (eg, car, bus, safari truck, on foot)
• if they are a woman who is pregnant or breastfeeding
• long-term health conditions (eg, asthma, diabetes) or regular medicines
• possible contact with animals and type of accommodation
• previous vaccinations (including completion of childhood immunisations).
Most travel vaccinations are not free and can cost from $20 to over $250 per
dose. Yellow fever vaccinations can only be given by an approved vaccination
centre which will issue an International Certificate of Vaccination, which certain
countries require before entry is granted. Commonly encountered diseases for
which vaccinations are available, are summarised in the table. Because no vaccine
guarantees complete immunity, good hygiene and self-protection measures (eg,
applying insect repellent, safe-sex) should still be practised.
Traveller’s diarrhoea
Diarrhoea affects over half of all travellers. Causes are numerous including
changes in food or drinking water, bacteria, viruses or other microbes (eg, E. coli,
rotavirus, Giardia). Treat with electrolyte solutions to replace fluids lost through
PHARMACY TRAVEL ESSENTIALS
Category Examples Comments
Vaccines
Other products
[PRESCRIPTION MEDICINE] – except in the
form of an oral liquid when sold in a pharmacy
by a registered pharmacist eg, Dukoral
eg, MicroCleanz
eg, 1Above, No Jet Lag
eg, Blis K12 Travel Guard, Colloidal Silver
Oral vaccine. Provides approximately 85% protection against Vibrio cholerae and at least
50% protection against enterotoxigenic E. coli. Follow recommended algorithm to assess
customer suitability.
Hand sanitisers may be used if hygienic hand washing facilities are unavailable.
Products are available that may help alleviate the symptoms associated with jet lag.
Other products may help support our body's natural immune defence system.
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Page 152 HEALTHCARE HANDBOOK 2017-2018 Common Disorders