Travel Medicine Update Nottingham Tuesday 13th & 20th June 2017

Thank you for inviting me!  Dream Island, Whitsundays, Australia!! Dream Island, Whitsundays, Australia!!

Your speaker… Sheffield University Health Service: NICU, PICU, HV 1992 – 2003 Health Promotion Nurse and Practice Nurse at UHS since 2003 (Semi-finalist, MasterChef, 1993!!) (Finalist, Practice Nurse of the year 2006 – Topic - Travel Health!) Sheffield University Health Service: 1st place in the leading “Russell Group” of Universities (Student Barometer survey). Practice population: 30,562 patients 2014 : 655 new travel appts and 1,082 follow up travel appts I am always curious about a speaker’s background….their journey to their specialism….so here’s mine! After a career in NICU, HV’ing and PICU, I tripped over student health! I remember saying….oh no, I wouldn’t be a practice nurse….I’m all about children…and a friend who worked at UHS said…that’s great…student’s are just bigger kids! Without being disparaging to students…that really is true….they are away from home usually for the first time and require a very specific kind of approach to their care… Importantly…..they are by virtue of their age….inexperienced….lacking in knowledge and prone to ‘irresponsible behaviour’ Travel Medicine PGDip

Aim: Update knowledge in Travel Medicine ‘Right hand man’ websites! Consent Zika FGM Polio Yellow Fever Malaria Hajj MMR Mental Health Altitude Sickness INSURANCE INSURANCE INSURANCE!!! How long have you got?! 

‘Right Hand Man’ Websites!

Updated: 15th December 2016

Consent Summary: Consider these Questions when Carrying out a Consultation • Have I understood what the patient’s preferences are? • Have I allowed the patient to read the manufacturer’s Patient Information Leaflet of the medicine or vaccine or have I highlighted a selection of a few common side effects? • Have I enquired about any important engagements happening in the next few days where it may be difficult to manage side effects of a live vaccine? Have I balanced this against time issues if discussing yellow fever certificate validity? • When offering options of anti-malarials, how would I present the traveller with a comparison of side effects to help them make their own decision? • Have I explained the consequences of the decision if the patient declined vaccinations or medicines such as anti-malarials? • Have I checked whether the patient has any questions or needs anything clarified?

Zika Aedes mosquito bite – Day time & Night time Aedes mosquitoes bite predominantly in the day, particularly during mid-morning and late afternoon to dusk. This type of mosquito is unlikely to be found at altitudes over 2,000m. Postpone non-essential travel to areas with current active ZIKV transmission designated as ‘high risk’ until after pregnancy. Consider postponing non-essential travel to areas with current active ZIKV transmission designated as ‘moderate risk’ until after pregnancy. In the event that travel to an area with active ZIKV transmission cannot be postponed, you should make sure you are fully aware of the risks ZIKV may present. Scrupulous mosquito bite avoidance measures both during daytime and night time hours (but especially during mid-morning and late afternoon to dusk, when the mosquito is most active). Public Health England has produced an information leaflet: mosquito bite avoidance for travellers. If your female partner is pregnant, condoms or other barrier methods are advised during vaginal, anal and oral sex to reduce the risk of transmission during travel and for the duration of the pregnancy even if you did not develop symptoms compatible with ZIKV infection. If you are pregnant and you have travelled in an area reporting active ZIKV transmission in the last 9 months (details can be seen on our Country Information pages ‘other risk’ section), you should seek advice from your GP or midwife on your return to the UK, even if you have not been unwell. Your GP or midwife will discuss whether you need further evaluation such as fetal ultrasound scanning, and, if necessary, referral to the local fetal medicine service. If you are currently experiencing symptoms suggestive of ZKV infection, your GP will arrange testing as appropriate. It is recommended you avoid becoming pregnant for a further 8 weeks following the onset of symptoms. For women with a male partner who has travelled to an area with high or moderate risk of ZIKV transmission, effective contraception is advised to prevent pregnancy AND condoms or other barrier methods are advised during vaginal, anal and oral sex to reduce the risk of transmission during travel and for 6 months after his return As of 26 April 2017, 296 travel-associated cases have been diagnosed since 2015. Of these, 200 are confirmed cases including: •150 cases with virus detected [PCR positive] •50 cases with antibody evidence indicating recent infection [seroconversion] and 96 cases with antibody evidence highly indicative of recent infection (Zika-specific IgM) [probable cases]. Of the total 296 travel-associated cases reported, seven have been diagnosed in pregnant women. In addition, one case of likely sexual transmission of Zika virus infection has been reported in the UK.

FGM The WHO estimates that approx 100 - 140 million girls & women worldwide have been affected by female genital mutilation Children born in the UK may be at risk of FGM when they travel with their families to visit friends & relatives in countries where this practice is common It is illegal to perform FGM in the UK or to take girls who are UK nationals or UK residents abroad for FGM Health professionals have a mandatory reporting duty if FGM is identified or a child is thought to be at risk. Failure to do so, may result in disciplinary procedures through the health professional regulatory body under "Fitness to Practise" proceedings. Resources WHO health topic: female genital mutilation,Department of Health. FGM mandatory reporting in healthcare Public Health England. Female genital mutilation (FGM): migrant health guide. HM Government. Multi-agency statutory guidance on female genital mutilation Royal College of Nursing. Female genital mutilation Royal College of Nursing: FGM guidance for travel health services Royal College of Nursing: FGM travel health services pathway

Polio States infected with WPV1, cVDPV or c VDPV3 with the potential risk of international spread: Afghanistan WPV1 Nigeria (WPV1 and cVDPV2) Pakistan (WPV1 and cVDPV2) Travellers who intend to visit these countries for 4 weeks or more should be aware that proof of vaccination [an International Certificate of Vaccination or Prophylaxis (ICVP)], given 4 weeks to 12 months before departure from the country, may be required on exit. Failure to produce this documentation may result in vaccination at the point of departure, most likely with oral polio vaccine. Advice for travellers Polio is transmitted via the faecal-oral route, either by exposure to water contaminated by infected human faeces, or by person to person contact. Practise strict food, water and personal hygiene. Independent of destination, complete a primary vaccination course for polio according to the UK schedule. Travellers are encouraged to carry documentary evidence of their polio vaccination status.