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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."


HepA and HepB shortage - an opportunity?

Posted on July 31, 2017 at 10:20 AM

Like many of us in travel health I am concerned about the the shortage of these vaccinations, especially when HepA is considered high risk in so many places. Upon reflection and following national guidance (UK) does this present a golden opportunity for travel health professionals to demonstrate the kind of assessment and rationalising that we have trained for? In a perfect world many will routinely follow the guidance issued by the respective agencies, but how many of us stop to question the risk of exposure the traveller of these diseases. Consequently this provides an opportunity to sharpen and hone the individual skills of risk assessing each traveller for the vaccines in relation to previous history, but more importantly to the risk of the disease.

Take for example HepA- widely recommended for all travellers to many destinations by the likes of Travax and NaTHNaC. The aetiology of the disease is that it does not manifest itself for 3-4 weeks post infection. Therefore for the traveller undertaking a 2-3 week trip to a risk area they will probably have returned home before the infection becomes apparent and medical care can be sought. It stands to reason when assessing risk these travellers could be considered low risk and an alternative source of avoidance would be to good food hygiene and possibly a water purification system which would also cover other non-vaccine preventable infections such as Campylobacter, Shigella and Giardia.

Likewise I often see patients referred to me for HepB rapid courses as they claim this is not supported by the NHS, and the staff experience is based on GUM clinic advice. Again a traveller needs to be assessed according to risk, a couple travelling together may be considered at lower risk for sexual transmission; likewise those who have no intention of being tattooed or having acupuncture. Therefore this leaves the risk (assuming no elective surgery) from an accident that may require a blood transfusion or the use of unclean needles. I receive many students attending school projects lasting a few weeks and requesting hepB, because they were advised by another health care professional. I do wonder if we are considering this as checklist vaccination or really investigating the true and real risk of exposure of this disease.

Whereas there is no correct or wrong way to manage these patients, there is a need to assume each is individual and therefore their risks will differ. However no course of vaccination is 100% effective and as we have often said before it is about the awareness of avoiding the risks which is more persuasive than any vaccination.

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