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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."


UK MALARIA CHANGES- impact for travel health professionals with differing online advice

Posted on November 1, 2017 at 9:30 AM

The new Advisory Committee on Malaria Prevention (ACMP) have released the 2017 guidelines based on the results of 2016. Interestingly enough in its summary, the focus is upon the realisation from WHO that nearly 90% of global cases have originated from Africa and this contingent remains the focus for both residents and returning travellers. The report goes on to indicate that ACMP have evidence to suggest that there is a real reduction in other areas such as SE Asia and South America; and the reality now is that the greater risk of being bitten lies with mosquitoes which transmit dengue, chikungungya and zika viruses.

The report continues with endorsement of the use of mefloquine despite the continued negative media press in the UK, as a useful product when considered with a risk assessment. It then raises the question why would this not be a good product without a risk assessment and hence the argument could spiral. In short the public’s memory of harmful properties remains historically for a lot longer than preventative power. One only has to look at the child vaccination rates for MMR and hear again the question from a parents concerning links to autism and nothing regarding the high proportion of children who are not suffering from a life threatening infection.

The guidance refers in several places to the new OTC brand of atovaquone/proguanil available. Not a new concept of deregulating an established POM medication to be more freely available to the travelling public. However it must be considered a thorn in the side of some industry leaders that it can be supplied without a legal requirement to complete an in-depth risk assessment or by staff without accredited levels of advanced training.

The malaria guide goes onto describe the new malaria maps. As these are the latest updates made by a group of specialists they will form the basis of a reference point for many. However other specialists will have alternative interpretations of similar data leading to different recommendations in the same country for example Travax. Both sets of data are considered to be accurate however to the end user, whether it be a travel health specialist or a member of the public, then these online web sources cause confusion and it requires a single online web-based piece of advice for all to work with.

In the world where internet access can be found from a mobile phone, from sites in a multitude of countries, it is not uncommon now to receive patients coming in with preconceived ideas for malaria prophylaxis having done their own research. The difference between travel health advisory services between countries adds further confusion. This author frequently sees patients who have conceived ideas of malaria prophylaxis based on the American CDC site which does not necessarily reflect that of the UK. A clear example recently found was the use of anti-malarials recommended across India by the CDC following the realisation of an increase in faliciparum malaria. Whereas from the UK there are some small recognised pockets of high risk; the majority of the country can receive prophylaxis from bite avoidance measures. To reduce this confusion either the web servers need to highlight the source is from another country and may be different (very unlikely to occur) or within the clinics we need to be informing clients which of the online sources we are using and recording this.

The benefits would be that a traveller reflecting after a consultation would then look at the same site as used by the travel health professional and in the longer term a returning traveller would  reference the same site and have similar expectations. Therefore the question that is raised is how much benefit would be provided and is this something professionals should be adding to records?

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