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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

DEET 100% - time for a change

Posted on November 24, 2016 at 1:00 PM


 

For some considerable time the use of DEET in concentrations above 50% has been a concern for healthcare professionals when applied directly to the skin. This has followed some reports indicating that there may be an increased risk of systemic toxicity with dermal absorption.

 

Despite this evidence, manufacturers have continued to formulate products with claims of up to 100% DEET and indicated in packaging of its superior protection. When reviewing the activity of insect repellents, often the questions asked by travellers are how much is needed to achieve protection and how frequently does it need to be applied.

 

Like many drug pharmacokinetics there is a linear log dose concentration-dependent relationship between the dose of repellent applied and the percentage protection achieved which follows a standard log dose-response curve. Here the important point is the rate of loss of repellent from the skin which follows an exponential curve (as in first order kinetics). Following mathematical interpretations, in normal use, this would mean strengths of DEET above 50% do not offer a significant increase in protection time and that 30-50% will provide acceptable levels of protection for al least 4 hours, depending on amounts initially applied. (Ref: Goodyer L, 2004. Travel Medicine for Health Professionals. Pp142-149. London. Pharmaceutical Press).

 

From 1st January 2017 the EU Biocidal Products Regulations come into force which restrict the maximum concentration of DEET to 50%. Therefore all products with strengths greater than this will need to be removed from sale before this date. Products containing lemon eucalyptus and picaridin are unaffected by the regulations and remain for sale. The Advisory Council on Malaria Protection in their 2015 report highlight; lemon eucalyptus is equivalent to around 15% of DEET and that picaridin is reported as equivalent to DEET.

 

What of the future for DEET? To continue its use and provide a longer level of of protection, manufacturers are considering new techniques to extend the period of time between applications and ideas such as micro-encapsulation are now being being used in products.

 

Users or requests of higher (>50%) of DEET will now have to be advised that these strengths of DEET can no longer be supplied. The use of 50% applied correctly will give protection for up to 4 hours. The new formulations will give longer time protection whilst the alternative products may provide less dermal absorption.



 

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