Vaccination Before Travelling

Of Honesty, Travelling, and the Spectre of Illness

Let us be honest with ourselves.

Satiation of our wanderlust is one of the most fulfilling things we can do in life. Yet, at the same time as we traverse the globe, we are exposed to a multitude of illnesses.

Vaccination, is our protection.

Vaccinations

Travel vaccines or travel immunizations, simply put, are injections taken by travelers whose intended destinations may prove to be biologically ... unsavory.

These vaccinations expose the body to deactivated germs or particles thereof, thereby causing the body to produce immunity against the targeted pathogen and conferring protection against future infections if exposed.

Because the germs are deactivated and or are only particles thereof, the vaccination process does not cause the body to fall ill.

In truth, travel vaccines are safe and effective.

When does One Need Vaccinations?

Broadly speaking, there are three types of vaccinations:

Routine Vaccines

These are the standard child and adult immunizations recommended for the general population as recommended by the Ministry of Health.

Recommended Vaccines

These are travel vaccinations that are recommended when there is intention to travel to countries with intermediate to high risk profiles for certain diseases that might otherwise not be endemic in the patient’s country of origin.

Required Vaccines

These are vaccinations that are mandatory by law prior to legal entry to the intended destination. Examples include the yellow fever vaccine prior to traveling to parts of Africa or South America, and the meningococcal vaccine when traveling to Saudi Arabia during the haji.

So, Which Travel Vaccines Will I Need?

Here’s a list of vaccinations that are not routinely covered by standard immunisation schedules:

• Hepatitis A
• Hepatitis B
• Typhoid and paratyphoid fever
• Meningococcal disease
• Yellow Fever
• Rabies
• Japanese Encephalitis

Do you require all of the above? Or only some of the above?

It is best to consult a health professional before making such decisions and more importantly, to do your research prior to travel simply because a traveler that intends to backpack or go camping in a country will have a very different risk profile compared to a traveler who intends to stay in a 5-star hotel throughout their stay.

Note also that some travel immunisations might require a series of innoculations over a period of time - eg Hep B. Hence, it is best to be aware of the timeline prior to traveling and consult your health professional early.

Also, always inform your health professional of the following:

Your current health

If you are taking any chronic medications or have existing illnesses, it is important that your health practitioner be made aware prior to administering any vaccines. 

Also inform of any allergies you might have - some vaccines cannot be administered if you have an allergy to egg white, for example. 

Immunization history

Your immunisation history will prove invaluable - some vaccines only require booster shots instead of having patients undergo the entire protocol if there has been previous vaccinations. 

Itinerary

Where you’re travelling, duration of travel, time of year, accommodation arrangements, and or other special activities should all be made known to your health professional. 

Ultimately, it's up to you to decide whether or not to see a doctor about recommended vaccinations.

What Steps Should I Take to Protect Myself While Traveling?

Common sense about basic hygiene would form the very foundation of self protection. Basic sanitation, drinking bottled water, and avoiding food from dubious sources, keeping insect repellants handy etc all protect against illnesses while traveling. 

The important thing is knowledge about the target destination. Forewarned is forearmed. Educate yourself. 

Where Can I Get More Information About Travel Vaccinations?

Most center for disease control websites in developed countries will have the standard recommendations for travel vaccines specific to different countries. Visit your local website today.

About The Author

Dr Lau Tzun Hon is a resident housecall doctor at CMY Medical. He received his MBBS (Hons) from Sydney University in 2001 and has served in the both private and government restructured hospitals prior to commencing his practice in Home Care.

While in the Government Restructured Hospitals, Dr Lau served primarily in the Department of Accident & Emergency Medicine and Anaesthesia. Upon entering the Private sector, Dr Lau worked in both public and private A&E departments before venturing into Home Care.

Over the years, he has developed a strong passion to maintain and  enhance the quality of life for patients under his care.  A strong believer that healthcare does not need to be financially straining, Dr Lau often delivers more value beyond expectations.

Chronic Cough

Common causes of chronic cough include asthma, allergic rhinitis, sinus problems,esophageal reflux, medications eg ACE inhibitors, and whooping cough. In rare cases, inhalation of foreign objects into the lungs (usually in children) can also cause chronic cough. It is important to see a doctor when a chronic cough is present. The following are common causes of chronic coughing.

• Cigarette smoking - the most common cause of chronic cough.
• Asthma - a disease of the airways that result in difficulty breathing or wheezing. Some asthma sufferers have chronic cough as their only symptom. Some may even have normal lung functions tests. This is often referred to as cough-variant asthma. Asthmatic symptoms can be aggravated by cold air, exposure to air pollutants, pollen, smoke, or perfumes.
• Gastroesophageal reflux disease (GERD) refers to acid reflux, or backward flow, of stomach acid and other contents into the esophagus. This can result in spasms of the airways that in turn can cause shortness of breath and coughing. In some instances, acid reflux can be so severe that substances can be inhaled (aspirated) into the lungs and cause similar symptoms as well as damage to lung tissue. In some individuals, no sensation of heartburn is felt and their only symptom may be chronic cough.
• Sinus problems and postnasal drip also causes chronic cough due to the backflow of mucus down the back of the throat. This condition can be difficult to detect. Sometimes a CT scan of the sinuses is necessary for diagnosis. Affected individuals often complain of a "tickle in their throat" and frequent throat clearing.
• Infections such as bronchitis or pneumonia can cause acute cough or a chronic cough. These infections can be caused by viruses, bacteria, or fungi. For asthmatics, viral upper respiratory infections often result in a prolonged cough even after the infection has cleared. 
• Bronchitis is also a common cause of a chronic cough and is often associated with coughing up blood (hemoptysis).
• Whooping cough (pertussis) is an acute, highly contagious respiratory infection caused by the bacterium Bordetella pertussis. It can cause violent, rapid, constant coughing and be fatal in young children. Whooping cough commonly affects infants and young children, but can be prevented by immunization with the pertussis vaccine. In adults, whooping cough can be a cause of chronic cough.
• Chronic cough in children is uncommon. Foreign materials obstructing the airways of the lungs, asthma, and allergies are the usual suspects and patients need to be evaluated by a pediatrician.
• Certain medications, notably ACE inhibitors (enalapril [Vasotec], captopril [Capoten] etc.) used in treating high blood pressure can cause chronic cough.
• Less common causes of chronic cough include allergies, tumors, sarcoidosis, congestive heart failure, and/or other lung diseases such as chronic obstructive pulmonary disease (COPD) or emphysema. Lung diseases also can cause coughing up blood.

If chronic cough persists, it is important to be evaluated by a doctor. 

What Are The Different Types Of Chronic Coughs?

There are several different types of chronic (or persistent) cough.

• A persistent dry cough is a cough that does not produce any mucus, irritating to the lungs and throat, and may be a sign of a viral infection or sinus problems.
• A chronic wet cough is a cough that produces mucus (sputum), and depending on the color, may indicate a bacterial infection or fluid in the lungs (congestive heart failure).
• A stress cough is a reflexive spasm of the airways caused when you are under stress. It usually produces no mucus and is not generally related to infections.
• A 'barking' cough is usually found in children, and may be associated with croup or other viral illness. The harsh, barking sound of a croup cough is caused by a swollen windpipe (trachea).
• A cough that causes a 'whooping' sound after the cough may be indicative of a serious infection and should be evaluated by a doctor. Whooping cough (pertussis) is a highly contagious respiratory disease that can be deadly for babies under 1 year of age.

What Kinds Of Doctors Treat Chronic Coughs?

Family practitioners in the primary care sector or internist will be able to diagnose the cause of your chronic cough. 

Patients suffering from constant cough may be referred to different specialists if the underlying cause of the chronic cough is severe or cannot be found.

A pulmonologist is a lung specialist who treats diseases of the airways. An allergist is an allergy specialist who may treat chronic cough due to allergies. Gastroenterologists specialize in diseases of the digestive tract and can treat chronic cough due to conditions such as gastroesophageal reflux disorder (GERD). Cardiologists specialize in diseases of the heart and circulatory system and may treat persistent cough that can be a secondary symptom of heart disease.

How Is Chronic Cough Treated?

The treatment of chronic cough is directed at the underlying cause. 

In severe cases of chronic cough a healthcare professional may prescribe codeine or other similar narcotic medications - these act as cough suppressants.

The following are examples of treatments for chronic cough caused by medications, conditions, or diseases.

• Asthma: Inhaled bronchodilators and inhaled steroids are given to decrease inflammation of the airways and reduce wheezing. This reduces chronic cough. In some cases, short-term oral steroids are prescribed to relieve chronic cough.
• Gastroesophageal reflux disease (GERD): Treatment for chronic cough caused by GERD includes avoiding foods that increase reflux, avoiding lying down after meals, elevating the head while sleeping, and taking medication such as famotidine (Pepcid), cimetidine (Tagamet), ranitidine (Zantac) omeprazole (Prilosec, Prilosec OTC), lansoprazole (Prevacid, Prevacid 24-Hour), rabeprazole (Aciphex), pantoprazole (Protonix), esomeprazole (Nexium) to decrease stomach acidity.
• Sinus problems and postnasal drip: Use of decongestants such as pseudoephedrine (Sudafed) or antihistamines such as diphenhydramine (Benadryl) may improve symptoms of post nasal drip, which causes a persistent, nagging, cough. Inhaled nasal steroids are also very effective in treating allergic rhinitis (hay fever), a common cause of cough. Additionally, other nasal inhalers like ipratropium bromide (Atrovent) can relieve post nasal drip. Antibiotics may be prescribed if the cause is determined to be sinusitis.
• Infections: Bacterial pneumonia and bronchitis are typically treated with antibiotics such as cephalosporins, azithromycin (Zithromax), and other antibiotics. If the pneumonia is close to the chest wall, inflammation of the surface of the lung can cause pain. This is known as pleurisy and pain relievers (analgesics) can be helpful. Cough suppressants are used with caution in these situations because clearing the lung of the infected mucus by coughing helps clear the infection and suppressing the cough reflex is counter-productive. Suppressants, however, are given more for symptomatic relief.. Note though that most forms of bronchitis in adults are caused by viral infections. Therefore, treatment is much the same as that of the common cold, inclusive of rest, fluids, pain relievers, and humidification. Expectorant cough medicines containing guaifenesin can be helpful in alleviating discomfort. Sometimes, it is hard to differentiate a viral from bacterial bronchitis, and antibiotics will be prescribed by the doctors as a precaution. In some cases, asthmatics can produce green mucus that looks infected. Your doctor send the sputum sample to a lab to be  examined.
• Medications: Hypertensive patients with chronic cough that are on blood pressure medicines called ACE inhibitors (angiotensin converting enzyme), for example, enalapril (Vasotec), captopril (Capoten), lisinopril (Zestril, Prinivil), etc. should talk to their doctor about switching medications. Patients should not stop taking medicine on their own because a marked elevation in blood pressure can result from discontinuation. A newer generation of ACE inhibitor like medicines called ARBs (angiotensin receptor blockers, for example, valsartan [Diovan], losartan [Cozaar], etc.) can be alternatives as they are less likely to cause chronic coughing. There are also other options available for treatment of blood pressure.

Are There Home Remedies For Chronic Cough?

Certain Home Remedies will be of benefit. These include:

• Staying hydrated. Fluids will thin secretions.
• Gargle with warm saltwater to help cleanse the throat and rid it of mucus.
• Elevate your head with extra pillows at night to ease a chronic dry cough.
• Inhale steam in a shower or use a humidifier to relieve dry cough.
• Cough drops may soothe an irritated throat.
• Do not smoke or use tobacco products.
• Avoid inhaled irritants such as smoke, dust, or other pollutants.
• Honey often can be an effective treatment for a persistent cough. Add honey to hot tea, or even grape juice.
• Ginger, prepared as a tea, is often used to help reduce symptoms of chronic cough and clear the nasal passages.
• Other herbs such as eucalyptus or mint are often used to relieve cough symptoms.

Can Chronic Cough Be Prevented?

• Don't smoke, as smoking is the most common cause of chronic cough.
• Talk to your physician about managing your asthma, postnasal drip, or GERD to avoid chronic cough symptoms.
• Stay away from others known to be sick with bronchitis or pneumonia.
• Eat fruit. Research suggests that diets high in fruit fiber and flavonoids may prevent chronic productive cough.
• Make sure you and your child gets the whooping cough (pertussis) vaccine.

About The Author

Dr Lau Tzun Hon is a resident housecall doctor at CMY Medical. He received his MBBS (Hons) from Sydney University in 2001 and has served in the both private and government restructured hospitals prior to commencing his practice in Home Care.

While in the Government Restructured Hospitals, Dr Lau served primarily in the Department of Accident & Emergency Medicine and Anaesthesia. Upon entering the Private sector, Dr Lau worked in both public and private A&E departments before venturing into Home Care.

Over the years, he has developed a strong passion to maintain and  enhance the quality of life for patients under his care.  A strong believer that healthcare does not need to be financially straining, Dr Lau often delivers more value beyond expectations.

Hand, Foot, and Mouth Disease (HFMD)

What Is Hand, Foot, and Mouth Disease?

HFMD is a highly contagious disease caused by viruses. These viruses can spread via person to person contact either through direct contact via unwashed hands or surfaces contaminated with faeces from an infected individual or it can be transmitted through contact with an infected person’s saliva, stool or respiratory secretions.

HFMD often causes blisters or sores in the mouth and a rash on the hands and feet. The infection can affect people of all ages, but it usually occurs in children under age 5. It is generally a mild condition that goes away on its own within several days.

What Are the Symptoms of Hand, Foot, and Mouth Disease?

Symptoms of HFMD include:
fever
poor appetite
sore throat
headache
irritability
painful, red blisters in the mouth
a red rash on the hands and the soles of the feet

Fevers and sore throats are usually the first symptoms of hand, foot, and mouth disease. The characteristic blisters and rashes show up later, usually one or two days after the fever begins. Symptoms usually resolve within 10 days or so.

What Causes Hand, Foot, and Mouth Disease?

Hand, foot, and mouth disease is often caused by a strain of coxsackie virus, most commonly coxsackie virus A16. The coxsackievirus is part of a group of viruses called Enteroviruses. In some cases, other types of Enteroviruses have been implicated.

These viruses spread easily from person-to-person. Your child, or even you may contract hand, foot, and mouth disease through contact with an infected person’s:

• saliva
• fluid from blisters
• feces
• respiratory droplets that are sprayed into the air after coughing or sneezing

Hand, foot, and mouth disease can also be transmitted through direct contact with unwashed hands or any surface containing traces of the virus.

Who Is at Risk for Hand, Foot, and Mouth Disease?

Young children have the highest risk of getting hand, foot, and mouth disease. This risk increases if they attend day care or school as viruses can spread quickly in these facilities. Children usually develop immunity to the disease after being exposed to the viruses. This is why the condition rarely affects people over age 10. However, it’s still possible for older children and adults to get the infection, especially if they have weakened immune systems.

How Is Hand, Foot, and Mouth Disease Diagnosed?

HFMD is diagnosed clinically by the bedside. Your attending physician will be able to perform a thorough examination prior to making the diagnosis.

Sometimes, the doctor may take a throat swab or stool sample that can be tested for the virus. This will allow them to confirm the diagnosis via laboratory evaluation.

Is Hand, Foot, and Mouth Disease Treated?

In most cases, the infection will spontaneously resolve within seven to ten days. However, your doctor may recommend certain treatments to help ease symptoms until the disease has run its course. These can include:

• prescriptions of over-the-counter topical ointments to soothe blisters and rashes
• pain medication, such as acetaminophen or ibuprofen, to relieve headaches
• medicated syrups or lozenges to ease painful sore throats

Certain home treatments can also provide relief from hand, foot, and mouth disease symptoms. You can try the following home remedies to help make blisters less bothersome:

• Suck on ice or popsicles.
• Eat ice cream or sherbet.
• Drink cold beverages.
• Avoid citrus fruits, fruit drinks, and soda.
• Avoid spicy or salty foods.

Swishing warm salt water around in the mouth may also relieve the pain associated with mouth blisters and throat sores. Do this several times a day or as often as needed.

Prognosis for Hand, Foot, and Mouth Disease?

Symptoms usually resolve within 7-10 days and immunity against the virus develops with no sequelae.

However, in rare cases, the infection might become complicated and last beyond 10 days. In such instances, you should seek medical advice instead of attempting home therapies.

How Can Hand, Foot, and Mouth Disease Be Prevented?

Good personal hygiene is the best defense against hand, foot, and mouth disease. Regular hand-washing greatly reduces the risk of contracting this virus.

Teach your children how to wash their hands using hot water and soap. Hands should always be washed after using the restroom, before eating, and after being out in public. Children should also be taught not to put their hands or other objects in or near their mouths.

It’s also important to disinfect any common areas in your home on a regular basis. Get in the habit of cleaning shared surfaces first with soap and water, then with a diluted solution of bleach and water. You should also disinfect toys, pacifiers, and other objects that may be contaminated with the virus.

If your child or you experience symptoms such as a fever or sore throat, stay home from school or work. You should continue avoiding contact with others once the telltale blisters and rashes develop. This can help you avoid spreading the disease to others.

How long are you contagious?

Persons with HFMD are most contagious during the first week of the illness. They can sometimes remain contagious, though to a lesser degree, for a few weeks after symptoms go away. Your child should stay at home until her symptoms resolve. They may then return to school, but still needs to try and avoid close contact with their peers, including allowing others to eat or drink after them. They also need to wash their hands frequently and avoid rubbing their eyes or mouth, as the virus can be transmitted through body fluids.

About The Author

Dr Lau Tzun Hon is a resident housecall doctor at CMY Medical. He received his MBBS (Hons) from Sydney University in 2001 and has served in the both private and government restructured hospitals prior to commencing his practice in Home Care.

While in the Government Restructured Hospitals, Dr Lau served primarily in the Department of Accident & Emergency Medicine and Anaesthesia. Upon entering the Private sector, Dr Lau worked in both public and private A&E departments before venturing into Home Care.

Over the years, he has developed a strong passion to maintain and  enhance the quality of life for patients under his care.  A strong believer that healthcare does not need to be financially straining, Dr Lau often delivers more value beyond expectations.