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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

Evaluation of remerging infectious diseases- Measles

Posted on April 13, 2019 at 12:55 AM

The WHO manages and monitors the universal health coverage and over the past year raised concerns with the increasing numbers of outbreaks of diseases once thought to be eradicated in high income countries, re-appearing.


One of the most frequently seen are the reappearance of measles. In the US there have been 387 cases of measles reported up to the end of March and 140 in the UK. The difference to the number of cases and the rapid spread comes from a complex set of issues, but clearly with improved travel opportunities the transmission of infection can be spread far wider than last in the last century and isolated pockets of non-vaccinated travellers in the community then the risk becomes greater.


Already the Australian authorities are reporting measles in children who are too young (8 and 11 months) to receive the protective vaccination course and this is a major concern to practitioners in this very vulnerable group. This is a further reason to support the endorsement of herd immunity within a community than are old enough and able enough to receive the vaccine; protection of those unable to receive it through age or medical condition.


So is measles really as bad as some people make out? A recent publication from Ottawa, Canada is quite clear with the facts. About 1 in 4 people who contract measles will be hospitalised. About 1 in 1000 will develop brain swelling (encephalitis) that may cause brain damage. One or two in 1000 will dies from measles, even with the best care. The text books will list that the incubation period is 10-12 days with the “rash’ appearing after 2-4 days and the patient being infectious 4 days before and after the appearance of the rash.


Therefore in public health terms this is a serious disease from which US reported numbers this year (2019) have already exceeded the total from 2018. Similar data comes from the UK where in 2018the total number of reported cases was 2599, an increase from the previous year of 906 (53.5%).


In the US the level of concern is now so high that one local authorities ban non-vaccinated children from public areas, and the question has to be asked of the psychological impact to an infant or junior school child not being allowed to mix with children of a similar age and their understanding of the parents choice towards non-vaccination.

 

Much has be discussed about vaccine hesitancy and the impact of the mis-information. This will take generations to be removed from the considerations and thinking of many parents. In order to reduce the amount of “choice” some US states and other countries such as Italy have removed the parental right for non-vaccination due to religious or philosophical grounds. The question that some parents raise is how effective this legislation will be? Another study from Baltimore, US has shown that removal of non-medical vaccine exemptions has improved herd immunity.

 

Therefore the conclusion at this point has to be for an improved public health outcome the freedom of right of choice of the individual needs to be removed or least reduced to improve the protection of the community and this is is unlikely to come from parental persuasion but from legal enforcement.

 

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