Dengue Fever is a viral illness which is common in tropical areas.
Symptoms of Dengue Fever can range in severity with a mild case feeling like a dose of the flu. In extreme cases, Dengue Fever can be fatal.
Some estimates suggest that there are approximately 100 million cases of Dengue Fever each year. There are 4 types of Dengue viruses known to cause illness in humans. These are known as DEN-1, DEN-2, DEN-3 and DEN-4. Infection with one type of dengue leads to lifelong immunity – but only to that type. It is therefore possible to contract Dengue Fever more than once. A person who has previously contracted the virus is at higher risk of suffering more severe symptoms if they get infected again.
How do you get it?
Dengue Fever is caused by a virus carried by certain types of mosquitoes. Typically, it is spread by the Aedes aegypt and Aedes albopictus species. Both species are more active during daylight hours.
To catch this illness, you must be bitten by an infected mosquito. Usually a mosquito becomes infected if they have previously bitten a person who is suffering from Dengue Fever. After an incubation period of 8-12 days, an infected mosquito can transmit Dengue Fever. The mosquito will be infectious for its lifetime.
Dengue Fever cannot be transmitted from human to human – to contract it, you must be bitten by an infected mosquito.
Where in the world is it?
Dengue Fever is common in tropical and sub-tropical areas. Most notably, it is found in Asia, the Pacific, Africa, Central and Southern America.
It is endemic in approximately 100 countries around the world. This means the virus is always present and easily spread to the human population.
Whilst it is not endemic in Australia, there have been cases in north Queensland. This is typically in circumstances where a person has become infected overseas and then, following their return to Australia, has been bitten by a mosquito. In turn, that mosquito has bitten another person and spread the virus.
What are the symptoms?
Typically it takes 3-14 days for an infected person to feel unwell. The most common symptoms include:
- High temperature
- Severe headache (especially behind the eyes)
- Joint and muscle pain (often ankles, knees and elbows)
- Loss of appetite
- Nausea, vomiting and/or diarrhoea
- Red skin rash (on arms and legs)
- Flushed skin (on face and neck)
- Itchy skin
- Malaise (generally feeling unwell)
- Extreme fatigue
- Abdominal pain
In most cases, symptoms subside in 1-2 weeks. In severe cases though, dengue haemorrhagic fever can occur which is a potentially lethal complication. Usually this only occurs in people who have previously suffered Dengue Fever but it is also known to occur in children. This complication can cause the following additional symptoms:
- Bruising following minor bumps
- Nose bleeds and bleeding gums
- Breathing difficulties
- Persistent vomiting / diarrhoea (often with blood present)
- Restlessness / drowsiness
- Stomach pain
- Cold, clammy, blotchy and/or pale skin
- Collapse or signs of shock
Dengue Fever can be fatal so it is important to seek medical attention if you have any of these symptoms and have been in areas where the illness is prevalent.
How is it diagnosed and what is the treatment?
Diagnosis usually involves clinical assessment where a doctor will examine you, discuss your symptoms and medical history. The doctor may also order a blood test to confirm the diagnosis. This blood test will detect the presence of the virus or antibodies in your blood.
Unfortunately there is no specific treatment. Symptoms can be alleviated with rest, increasing fluid intake and taking pain relief medication such as paracetamol. Medical advice is to avoid painkillers such as asprin, ibruprofen and other NSAIDs as they increase the chance of bleeding.
In cases of dengue haemorrhagic fever, it is most likely that treatment will necessitate hospitalisation.
How can you minimise the risk of contracting it?
There is no vaccination available to guard against Dengue Fever.
The best form of defence is prevention. Dengue-carrying mosquitoes tend to bite during the day – especially during the morning and early evening. Despite this, you can still be bitten at night.
Here are our top tips to help minimise the potential of infection if travelling to high risk areas:
- Cover as much exposed skin as possible at all times – day and night. Preferably wear socks with closed in shoes and wear light coloured long sleeve shirts and long pants.
- Stay and sleep in accommodation which has fly screens on the windows or air conditioning.
- Use mosquito nets if you cannot secure your room against mosquitoes or are sleeping outside.
- If safe to do so, use mosquito coils and/or plug in repellent devices.
- Use insect repellent that contains DEET or picaridin.
- Apply insect repellent in the morning and make sure you re-apply it frequently.
- If using sunscreen, apply repellent after you apply your sunscreen.
- Stay indoors when mosquitoes are particularly active.
- Dengue mosquitoes breed in containers and junk so don’t allow water to pond or collect around your accommodation. Mosquitoes breed in still water (eg pot plant bases, coconut shells, tyres, containers such as vases, tubs and buckets).
Many travellers will be exposed to dengue-carrying mosquitoes will travelling. Fortunately there are measures you can take to minimise the risk of infection. If you do suffer the misfortune of contracting Dengue Fever – or think you may have – seek medical attention as soon as possible. Early detection will increase the chance of a quick recovery.
Deep Vein Thrombosis (DVT) is a serious risk for travellers.
Whilst it is thought that long haul travel increases the risk of DVT, it is not confined to air travel. The risk increases in proportion to the duration of travel and can be exacerbated by a traveller’s pre-existing medical conditions.
So, what is DVT, how do you know if you’ve got it and what can you do to prevent it? Let’s take a look.
What is it?
Deep Vein Thrombosis is a medical condition where a blood clot (thrombosis) forms in the deep veins of a person’s legs. Prolonged periods of sitting make it difficult for the veins to return the blood to the heart. As a result, blood can pool in the leg veins and this sometimes leads to the formation of a blood clot. Whilst DVT is a serious condition, if part of the blood clot breaks off and travels to the lungs, this can block blood vessels. This condition is known as pulmonary embolism (PE) and is life threatening.
Why does it happen?
Anyone can suffer DVT but if you are travelling for a long period of time, the chances are higher. This is because you are sitting for extended periods of time and in small or confined spaces. When travelling long haul, we typically don’t get up and move around often which further increases the risk.
Pre-existing medial conditions also play a role. Medical conditions known (or suspected) to increase the risk of a person suffering DVT include:
- Cancer – past or current (especially if being treated with chemotherapy)
- Current (or recent) pregnancy
- Previous blood clot or pulmonary embolism
- Family history of blood clots or pulmonary embolism
- Recent surgery, hospitalisation or injury
- Blood clotting disorders
- Congestive heart failure
- Inflammatory bowel disease
- Use of contraceptive pills or hormone replacement therapy which contain estrogen
- Advanced age (the risk increases with a person’s age)
- Impaired mobility
- Varicose veins
What can you do to prevent it?
While travelling, we can all take steps to minimise the risk. If you have any conditions which predispose you to suffering DVT, there are also pre-travel measures you can implement to further safeguard yourself.
While travelling, you can minimise the risk of DVT by:
- Drinking plenty of (non-alcoholic and non-caffeinated) fluids before and during the flight to keep hydrated and prevent your blood from becoming “sticky”.
- Regularly mobilise your ankles / massage, stretch and flex your calf muscles to help your body return blood to your heart. Airlines often have a range of exercises outlined in the inflight magazine or on the safety card. You can find these in the seat pocket.
- If safe to do so, get up and move around the cabin every so often. If possible, choose an aisle seat as this makes it easier for you to be more active during flight.
- Wear loose and non-restrictive clothing and avoid tight underwear.
- Avoid sleeping tablets as they will affect your inflight mobility.
- Use the foot rest to elevate your feet.
If you have a medical condition which increases your risk of suffering DVT, you might like to consider using compression stockings / socks and taking blood thinning medication. Best to check with your doctor to see if these measures are appropriate for you.
What are the symptoms?
Sometimes there are no symptoms.
However, for most people, symptoms include swelling, tenderness and/or pain in the calf of the affected leg. Some people also report red or warm skin in the affected area. If part of the clot has broken away and travelled to the lungs, typical symptoms can include shortness of breath, fast heart rate, coughing up blood, low blood pressure, dizziness, fainting, chest pain and/or collapse.
If you suspect you may have DVT, seek medical attention without unnecessary delay. If you suspect you have pulmonary embolism, urgent medical treatment should be obtained as it is a life threatening condition and can cause sudden death.
How is it diagnosed?
DVT is usually diagnosed by an ultrasound scan of the leg. If the scan (called a duplex ultrasound) is inconclusive, the doctor may order a further test called venography. This test uses an X ray to track the passage of a special dye which is injected into the leg.
What is the treatment?
If the blood clot has not travelled from the leg, treatment usually involves blood thinning medication to prevent the clot from travelling to the lungs. Medication is usually twofold – injection which takes a more immediate effect and tablets which may need to be taken for several months. Your doctor may also recommend the use of compression stockings and leg elevation.
If the blood clot has travelled to the lung, treatment is more exhaustive as doctors will need to support your heart and lung function and perhaps administer pain relief medication in addition to blood thinning medication.
DVT can happen to anyone and if travelling long haul, there are many things we can do to reduce the risk. If you have pre-existing medical conditions which increase your risk, please speak to your doctor before travel to discuss your situation. Also, check with your travel insurer to see if they need to know about your past medical history.
Ending up is hospital isn’t ideal when holidaying overseas.
But it can happen and a little advance preparation can help – just in case your trip does involve an impromptu trip to hospital.
A trip to hospital while overseas may not be like anything you’ve ever experienced in Australia. Standards of healthcare differ between countries so lets take a quick tour.
In Australia, we are fortunate to enjoy a very high standard of public and private healthcare but this is not necessarily the case overseas.
If travelling to Canada or the United States, healthcare standards are comparable to what we enjoy here at home but the costs can be eye-wateringly high.
In some countries such as the UK, Australians can receive free medical treatment at public hospitals thanks to the Reciprocal Healthcare Agreement between our two countries.
Beware if you find yourself in Europe – in some hospitals, nursing care is not provided for the duration of your stay. It is expected that a patient’s family and friends will provide this.
Asia is a mixed bag – the standard of healthcare in Singapore is very high but this is not the case in less developed countries such as Laos. Poor healthcare standards are also found in many African and South American countries.
Also bear in mind that if you are moving away from the cities and spending time in regional areas, the level of healthcare and standard of facilities will be less sophisticated.
As is always the case, it’s important to choose a good quality hospital that has appropriate facilities.
Preparation is key
Before travelling overseas it’s a good idea to research healthcare at your destination. Ideally, find out the identity and location of medical clinics and hospitals close to where you will be located. That way, if you do need to seek urgent medical care, you have an idea of where to go. It also helps if you can identify a clinic and hospital where English is readily spoken to avoid language barriers.
List your emergency contacts
It is important to have details of key contacts available to you either in hard copy or digitally. This includes your next-of-kin and regular GP in Australia. If you find yourself in need of medical treatment, having these details will help if you or the doctor need to clarify your past medical history.
Equally important is your travel insurance provider’s contact details. Your travel insurer will have an emergency assistance team available to you 24 hours a day, seven days a week. This service can be invaluable if you need medical treatment – they can assist with directing you to suitable medical facilities, translating / interpreting and managing your treatment in consultation with the treating doctor and their own medical team. The assistance team can even guarantee payment of costs once your claim has been approved, keep your loved ones updated with information, arrange accommodation and change travel bookings if you are too unwell to travel as planned.
Summarise your medical history
Record your current medications by name, dosage and instructions. Remember that medications may be known by different names overseas. For instance, we typically refer to paracetamol by the brand names Panadol or Panamax. In the US, this medication is often referred to as Tylenol. If possible, find out the brand and generic name/s of the medications you take – this will help ensure your medication regime is understood by the treating doctor.
Also, take a note of your allergens – it may be that you are unconscious or otherwise unable to advise the doctor about your allergies. If you have a drug allergy, this is something that a treating doctor must be aware of prior to administering treatment.
Similarly, a record of past medical treatment including surgeries could provide the treating doctor with valuable information to assist with diagnosis. For instance, if you present with lower right quadrant pain but have previously had your appendix removed, the doctor will want to know this as this information eliminates the potential you are suffering appendicitis.
If you have a serious, chronic and/or life threatening medical condition, it’s a good idea to consider wearing a medical ID bracelet or necklace – this could save the treating doctor valuable time in diagnosing your condition and administering urgent medical treatment.
Last words …
If you do find yourself in hospital overseas, here are a few key things to remember.
- Language difficulties may be experienced if you are travelling in a country where English is not widely spoken. Hospital staff may not speak English at all or only to a certain level. Try to remain calm and respectful to staff.
- Contact your travel insurance provider if you are admitted to hospital or are likely to incur significant medical expenses. For most insurers, this is usually considered to be $2,000 or more. Your travel insurer can help you find suitable medical facilities and if you’ve already been admitted, they can help you with the process and provide valuable support.
- If your travel insurer asks you to sign a medical release form, do this without delay as they need this to discuss your situation with the treating doctor, your regular doctor in Australia and your family. If you don’t sign the release, you are compromising the travel insurer’s ability to help you.
- If possible, seek medical treatment at a public hospital in the first instance. In some countries this will be free of charge and if the hospital doesn’t have the facilities you need, your insurer can then look at the option of moving you to another hospital at their cost.
- If you have to pay the hospital upfront, make sure you get a medical report and retain receipts for expenses. That way, the process of making a claim against your travel insurance policy for reimbursement will be a little easier.
Most of us travel overseas without ever seeing the inside of a hospital. This is a good thing! However, a little advance preparation can make the all the difference if you do find yourself hospitalised on holiday.
As Australians, we love to play in and on the water.
Beachside holidays can though present some rather unique hazards.
Throughout our Natural Disaster Survival series, we look at many types of catastrophic events to help keep you in the know. In this article, we focus on tsunami – advising on what to do if one is headed your way to help you survive to tell the tale!
Let’s get started.
A Bit of Background
Tsunami (pronounced “soo-nar-me”) is a Japanese word which means “harbour wave”.
A tsunami is a series of ocean waves that send surges of water. These waves can travel very fast due to the sudden movement of a large body of water. The waves can reach heights of over 30 metres and cause widespread damage when they reach land.
Globally, there are estimated to be only two tsunamis each year. Most of these occur within the Pacific Ocean’s “Ring of Fire”. This region is renowned for its high incidence of tectonic plate shifts and resultant earthquakes and volcanoes. The most notable tsunami to hit this area in living history occurred on Boxing Day 2004 when it is estimated more than 225,000 people perished, mostly in Banda Aceh, Indonesia and Thailand.
A tsunami is typically caused by undersea earthquakes at tectonic plate boundaries. For an earthquake to cause a tsunami, it must cause significant vertical deformation of the seabed.
They are also known to be caused by landslides on the sea floor and volcanic eruptions. Asteroid impact has also been cited as a cause!
A tsunami is not like regular ocean waves. Here are a few key differences:
- A tsunami is a series of very long waves. It has been reported that as it travels through deep parts of the ocean, its length can be up to 150 kilometres (end to end). These waves travel quickly – up to 1,000 kilometres per hour! This means a tsunami can travel across the entire expanse of the Pacific Ocean in less than a day.
- At sea, it may be unnoticeable as it may appear to be only a few centimetres high. As it moves closer to land, its speed slows down and the wave height increases.
- A regular wave moves the top 150 metres of water but a tsunami moves the water right down to the seabed. This means a tsunami moves a lot more water than a regular wave. The waves move faster at the top than the bottom – this causes them to rise to great heights.
It’s important to remember that a tsunami is a series of waves – this means the first one may not be the largest. This series of waves is called a “wave train”.
A tsunami can sometimes look as if the tide is rapidly receding to be quickly followed by a wall of water approaching land. This is because it is a series of waves – if the trough (low point behind the crest) hits land first, it creates a vacuum effect that sucks water back to sea thereby exposing the seabed. This is a key indicator of an impending tsunami – the wave’s crest usually makes landfall roughly 5 minutes later. Bear in mind though, that not all appear as breaking waves – sometimes they present as a rapidly surging wall of water.
So how do you know if a tsunami is likely?
Following the tsunami which hit Thailand, Indonesia, Sri Lanka, India and the Maldives on Boxing Day 2004, general awareness of the risk has increased. Many people now recognise that earthquakes can cause tsunamis. The quality and quantity of warning systems has also improved over time.
Based in Hawaii, the Pacific Tsunami Warning Center (PTWC) is one of two warning centres operated by the American scientific agency, National Oceanic and Atmospheric Administration. It plays a key role in the detection of tsunamis and issues warnings to authorities of countries in the Pacific region. The PTWC uses seismic data and water level (tide) gauges to determine if a tsunami has formed and if so, proceeds to forecast its likely development and issue warnings if appropriate.
For anyone holidaying in coastal areas around the Pacific region, understanding the difference between the PTWC warning levels could save your life:
- Tsunami INFORMATION BULLETIN
This merely advises that even though a threat exists, there is no evidence that a tsunami is travelling across the Pacific Ocean.
- Tsunami WATCH
This warning level means an earthquake may have led to the formation of a tsunami. At this stage, the PTWC is advising people to be alert while it waits for further tidal data.
- Tsunami ADVISORY
This warning level means a tsunami has been confirmed and it has strong currents / wave action which could be dangerous to people in or near water.
- Tsunami WARNING
This is the highest warning level and means that the PTWC considers the prevailing conditions serious. The warning will include details of locations likely to be impacted and approximate arrival time of the tsunami.
So, what do you do if you caught in a tsunami emergency?
If holidaying in coastal areas, it is important to remain alert to tsunami risk. The most likely precursor will be an earthquake. If you feel an earthquake, wait until the shaking stops before moving (click here for Earthquake Survival Tips). Although not every earthquake causes a tsunami, remember that if the earthquake was strong, a tsunami could follow.
- If possible, tune in to local media to see if any warnings have been issued. If you are at the beach or near the ocean, evacuate immediately – do not wait for a warning to be issued.
- Keep an ear out for evacuation sirens and warnings.
- Follow the instructions of local authorities at all times – these operatives are trained to help you quickly reach safety and will have undergone extensive training to prepare for this scenario.
- Follow evacuation routes recommended by local authorities – they will have been planned in advance using local knowledge and may differ from what you would do.
- Stay calm but move quickly – it is imperative you reach higher ground inland. Each step takes you further away from danger.
- Do not stop and collect possessions – this could mean the difference between safety and death.
- Do not stop to watch the wave or take photos – get away from the ocean (and even high ground like cliffs near the beach). If you can see the wave, you are too close!
- Avoid downed power lines and other similar hazards.
- Stay inland until authorities advise you that it is safe to return – remember tsunamis are series of waves and there may be more on the way. Tsunami waves can last as long as eight hours so be prepared to wait it out somewhere safe.
And once the threat has passed?
Once authorities advise that the threat has passed, it’s best to avoid disaster areas if possible. Going to take a look at the situation could hamper the activities of emergency response teams.
Stay away from debris in the water – it may pose serious safety risk. Also, be mindful that local drinking water may have been contaminated.
Check yourself and your companions for injuries and if necessary, seek medical treatment.
If able, help others who need assistance. If you identify someone in need of rescue, alert authorities as they are best able to manage such situations.
Stay out of buildings that have been inundated by water. It’s possible the water inundation could cause the floors or walls to collapse. Also, do not energise lights or appliances as they may have been affected by water.
Tsunamis are not an everyday occurrence and it’s likely your trip will not be affected. But, if you are holidaying in coastal areas, be aware that it could happen. Having given some advance thought to what this could involve and what you would do will come in handy should you find yourself in an emergency situation.
Remember, your life is more important than anything else. If you are caught up in a tsunami emergency, get yourself to safety first and then contact the necessary entities to discuss any potential issues you may have. This includes airlines, accommodation providers, your travel insurer and family members.
The Privacy Act 1988 is Commonwealth legislation which regulates the manner in which certain organisations collect, use and disclose personal information. Compliance with privacy legislation is mandatory for insurance companies. … Read More
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