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Derek Evans

Welcome to Evans Travel Health

Blog     posted on Wednesday 4th August 2021


       How to prepare for Travel Medicine post-Covid

"We are all aware of that the impact of Covid infections has had on travel and continues to do. With the advent of vaccination programs and sophisticated testing and recording systems in place travel is starting to increase.

However the types of travel such as short haul continues to expand according to the determination of national governments whilst long haul remains dormant. The traveller groups have changed and the emphasis on routine vaccinations being sought by first time travellers going to exotic destinations has shifted to business and essential workers.

With this in mind the marketing of any specific travel medicine services will need to understand these changes. Following lockdowns and extended restrictions many travellers are now attempting to visit families and friends (VFRs) who they have only seen through video links. These VFRs will be a key target group during the revival of travel medicine demands and services.

A key part of the practitioners will be the flexibility to react to short time departures and supply necessary vaccines and medication where required. This parallels with the quick turn around that Covid tests are required for entry into another country before departure from the UK. It seems that a mix of PCR and rapid antigen tests are required within a range of departure times from 24 to 96 hours before departure.

The underlying point here is that this increased cost needs to be allowed for during any travel consultation and also the returning costs of testing and/or isolation. It is unlikely that these costs will be removed in the short term and certainly Covid will become another disease to be routinely covered during a travel medicine risk assessment."


Blog

Common mosquito borne viruses- should they all be considered in pregnancy?

Posted on March 5, 2020 at 12:40 AM


 

In 2015-2016 the world was awakened to the affects of the Zika virus in pregnant women and the devastating risk of microcephaly. Since that time the world has evolved into discussing the risks associated with mosquito transmitted Zika virus with pregnant travellers visiting high risk countries. The levels of risk in some countries has fallen as the attention to bite avoidance and counter-measures has increased. Now in 2020 the attention is currently on coronavirus and what are implications for global public health, yet does the risk from other mosquito borne infections remain consistent?

 

At the time of writing the global number of infections due to coronavirus is calculated around 80,000; yet in one country last year 30,000 cases of dengue were reported last year. The levels of Aedes borne infections (dengue, chikungunya) are increasingly being reported and appear to be rising, although this has to be balanced against a case for improved health reporting.

 

With the risk of these virus infections being spread pregnant women in high risk areas a recent paper has reflected on the levels of risk for dengue and chikungunya infections as well as Zika ( Dengue, Zika and chikungunya during pregnancy: pre- and post-travel advice and clinical management- Journal of Travel Medicine, 2019, 1–13).

 

In this paper the researchers have reviewed the pre and post travel advice of the 3 infections. Their main findings are that dengue may be associated with complications due to its infection risk of post-partum haemorrhage. Zika continues to be teratogenic and chikungunya although of lower risk during pregnancy carries a risk of infection at the time of labour. Therefore the risks from Zika continue and the risks associated with dengue may not be realised fully as the impact of risk from haemorrhage are not fully realised.

 

This impacts on the travel health professional in the advice they provide. Countries reporting a risk of dengue need to be highlighted to pregnant traveller due to the associated risks of potential haemorrhage. Whilst Zika, more importantly, highlights the teratological risks. All viruses have documented evidence of foetal transmission during pregnancy.

 

Therefore, although coronavirus is capturing the headlines currently, there is a need to be increasingly aware of mosquito borne viruses which have higher reported levels and their infection in pregnancy.

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