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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

New guidelines for the prevention and treatment of Travellers Diarrhoea(TD)

Posted on July 7, 2017 at 12:25 AM

At the recent CISTM meeting in Barcelona an expert panel reported back on a major review of TD. They concluded that prevention and treatment of TD requires action at the provider, traveller, and researchers. There is now strong evidence to suggest the effectiveness of Antimicrobial therapy in most cases of moderate to severe TD.


So what is classified as moderate TD- diarrhoea that is distressing or interferes with with planned activities. Severe TD is further classified as diarrhoea that is incapacitating or completely prevents planned activities.


The major changes to the supply of antibiotics are a reduction in the use of fluoroquinolones due to resistance and where prophylaxis is required the use of rifaximin is included. Azithromycin is now the antibiotic of choice for treatment of moderate TD and can be used with loperamide as an adjunctive therapy. When considering antibiotic regimes then single dose antibiotic doses can be considered using 1000mg of Azithromycin or 750mg of ciprofloxacin.


In summary providers need to consider the classification of TD and that the importance of using oral rehydration salts remains. Information needs to be given to each traveller when considering the use of antibiotics for TD regarding over use and creating multi-drug resistant bacteria. Loperamide may be used alone or with antibiotics in moderate to severe TD.



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