Student Travel Health Advice – It’s not all about the ‘Jabs’

1. Student Travel Health Advice –It’s not all about the ‘Jabs’ Samantha Gaudion

2. Benefits of a Pre Travel Consultation: • Provide up to date verbal and written advice on a range of travel health issues • Information about recent disease outbreaks • Administer/issue travel health vaccinations, malaria tablets and other medications - NaTHNac

3. Other Travel Health Risks • Environmental Risks • Exposure to Blood and other Body Fluids • Infectious Disease and Potential Risks • Injury and Violence • Psychological Health -WHO

4. Objectives • To highlight student travellers as a ‘Special Risk Group’ • Discuss some common travel clinic scenarios and look at the ‘Non Vaccine’ preventable infections and risks related to each scenario • Highlight 3 key areas related to student travellers • Discuss useful Tools to aid a travel consultation when time is tight!

5. Special Groups of Travellers • Pregnant Women • Children • The Elderly • Travellers with Chronic Illnesses • Those with Disabilities • Immunocompromised Travellers • Visiting Friends and Relatives (VFRs) • Humanitarian Aid Workers • Long-term travellers/Expatriates • Military Deployment • Study Abroad • Mass Gatherings • Expedition Travel • OH risk- Medical Electives - Dawood; CDC

6. Students as a Special Group – Why? • Most have never travelled outside of Europe or the UK • Age and Maturity • Visiting High Risk Destinations • Last Minute Presentations • Lack of Funds • High Risk Activities • Backpacking • Charity work • VFRs

7. Group Work Think about all the ‘Non Vaccine’ Preventable Infections and Risks for your Student Traveller

8. Traveller 1 - Polly Polly, aged 18 yrs. plans to volunteer in a remote Nepalese village undertaking construction work- building a school and teaching children. She will be away for 3 months, 2 months volunteering and 1 month travelling around North India with a girlfriend using local transport. She will be staying with a host family then backpacking. The village uses tap water from a stream and has some electricity. She leaves in 4 weeks. She has a history of depression and is currently taking Citalopram. She has never travelled outside of Europe before.

9. Traveller 2 - Ben Ben, aged 19 yrs. is planning on backpacking around Thailand with 3 mates for 1 month. He has presented last minute and leaves in 6 days. They have no specific itinerary, but fly into Bangkok and will be spending the majority of their time on the South Islands. They will be staying in backpacker accommodation, travelling by bus and boat. He has no PMH and is taking no regular medications. He has travelled to South Africa with his family for a holiday as a child.

10. Traveller 3 - Susie Susie, aged 20 yrs. is planning on a University organised charity climb of Mount Kilimanjaro for 1 week, she will then extend her trip to go diving in Zanzibar. She will be away for 3 weeks in total. Her boyfriend will be joining her for the trip. She will be staying in huts for the climb and will be backpacking thereafter, staying in hostels/budget accommodation and using local buses and boats. She leaves in 6 weeks, has no PMH of note and is taking the COCP. She has travelled around Peru and Bolivia in the past.

11. Non Vaccine Preventable Risks Female Travellers Culture Shock Altitude Sickness Sexual Health Bilharzia Contraception Diving Humanitarian Aid Legionnaires OH Risks Transporting Medications Lone Travellers Avian Flu Hajj Tick Bites Sporting Events/ Dangerous Wildlife • Food and Water Contamination • Personal Hygiene • Travellers Diarrhoea • Personal Protection Measures • Sun and Heat • Accidents • VTE Risks • Dengue Fever • Travel Insurance • Outbreaks • Personal Safety • Rabies Prevention • Motion Sickness • Counterfeit Medications

12. Accidents • Sexual Health • Culture Shock

13. Accidents • RTAs kill more people around the world than malaria • Leading cause of death age 5-29 yrs esp. in developing countries • 1.3 million people are killed on roads and up to 50 million people are injured in RTAs each year • Drowning 2nd leading cause of unintentional injury with approximately 359 000 deaths worldwide - WHO

14. British Behaviour Abroad Report 2013 Brits hospitalised in Thailand has increased by a third RTAs linked to these 285 cases -FCO

15. Thailand • 70% of all road deaths • 12,000 deaths a year vs. 3,000 in UK • 38 people die each day in motorcycle accidents

16. Why? • Poor roads • Bad driving • Speeding • No seatbelts • Poorly maintained vehicles • Under influence of alcohol/drugs • Failure to follow local road rules • Lack of emergency services

17. Road Safety Top Tips • Avoid hiring motorcycles/mopeds • Always wear a helmet • Remember which side of the road to drive on • Check tyres, brakes, lights and seatbelts • Avoid poorly maintained, overcrowded buses, trains • Know the emergency number • Avoid alcohol and drugs • Avoid driving at night • Do not exceed speed limits • Adequate travel insurance • Recommended taxis • Avoid hitchhiking • Pedestrians and cyclists

18. Water Safety Top Tips • Never swim after drinking alcohol or taking drugs • Do not swim alone • Check water depth before diving • Never dive from a balcony into a swimming pool • Check tides, currents, safe places to swim • Avoid a heavy meal before swimming • Low temperature = hypothermia

19. Sexual Health

20. Sexually Transmitted Infections (STIs) • Chlamydia • Gonorrhoea • Trichomoniasis • Chancroid • Syphilis • Donovanosis • Genital Herpes • Genital Warts • HIV • Hepatitis A • Hepatitis B • Hepatitis C • Scabies • Lymphogranuloma venereum

21. Stats: • More than 1 million people acquire a STI every day • Highest rate of new cases in sub-Saharan Africa • 499 million new cases of curable STIs (gonorrhea, chlamydia, syphilis, trichomoniasis) occur every year in adults aged 15-49 yrs • 536 million people living with incurable HSV type 2 • 291 million women have HPV infection • 33.2 million people living with HIV/AIDs

22. Transmission • Unprotected intercourse (vaginal, anal, oral) • Intimate skin on skin contact • Contaminated blood and blood products • Contaminated syringes and needles • Dental procedures • Tattoos, piercing, acupuncture • Mother to child

23. Travellers Risk • 1 in 10 of British travellers have casual sex with a new partner whilst abroad • Highest incidence in 15-30 yr. old age group • Only 75% used condoms on all occasions • Influenced by alcohol or drug use = loss of inhibitions • Increased number of partners • Sex tourism – commercial sex workers • Unscreened blood products and used needles and syringes • Tattoos, piercing, acupuncture, drug use

24. Sexual Health Advice • Condoms with the ‘British Kite’ or ‘CE’ mark • Check Expiry • Check undamaged and intact • Screening on return if UPSI or risks - even if asymptomatic Also: • Avoid sharing needles, open blades • Avoid tattoos, acupuncture, piercings • Avoid blood transfusions/blood products • Take a sterile needle pack

26. A term first created by Oberg (1960) as ‘shock of the new’ • Anxiety and confusion when entering a new culture can affect people • Intellectually • Emotionally • Behaviourally • Physically

27. Aspects associated with Work Related Problems

28. Language and Cultural Differences

29. Facilities and Adaptation to Unfamiliar Environment

30. Sense of Loss about Friends and Family. Loneliness and Isolation

31. Personal Violence and Health Risks

32. Management Strategies • Carefulplanning and support to facilitate safe travel • Consider daily activities • Realistic expectations • Research culture, laws and customs • Adequate rest • Regular contact with family and friends

33. Key Considerations: • Do they understand the risks of the environment they will be staying in? • How close to healthcare will they be in the event of an accident or being unwell? • How capable are they at being able to look after themselves? How will they cope with any minor illness/injury i.e. Travellers Diarrhoea

34. In Polly’s Case: • What are her coping strategies? Are they transferable? • What are her fall back measures?

35. Tools • Websites: http://www.fitfortravel.nhs.uk/home.aspx http://www.nathnac.org/travel - YF, Dengue Fever, JE http://www.nhs.uk/Conditions/vaccinations/Pages/vaccination-schedule-age-checklist.aspx https://www.malariahotspots.co.uk http://www.who.int/topics/malaria/en • Patient Information Leaflets

36. Any Questions?