1. JCG CHINA 2014 Lead Practice Nurse Jacquie Coates Dr Chris Cook

2. Travel Risk Assessment

3. Strokes and heart problems Accidents What do Travellers die from?

4. What are the most common infections in Travellers? Safe drinking water Avoid high risk foods Wash your hands Wash hands frequently Avoid crowds ‘Flu jab’ if recommended

5. CHINA

6. General Information Location: East Asia Capital: Beijing Population: 1.359 billion (2013) Climate: Extremely diverse; tropical in south to sub arctic in north; southern China wet season (Jun-Sep), central China rainfall all year Seasonal Risks: Japanese encephalitis (most cases reported Apr to Oct), Tick-borne encephalitis, spring to early autumn. Influenza (Nov-Apr) Peaks/elevation: Mount Everest 8848m (29 029ft) Nepal/Tibet Autonomous Region border

7. Outbreaks Avian Flu 'bird flu', is a contagious disease of animals caused by viruses that normally infect only birds Humans are usually infected through close contact with live infected birds Not vaccine preventable

8. Vaccination Advice for China (Travax 2014) Vaccines Usually Advised (for all travellers at risk) Hepatitis A Vaccines Sometimes Advised (for travellers at higher risk) Hepatitis B Japanese Encephalitis Rabies Tetanus Tick-borne encephalitis Typhoid Vaccines Selectively Advised (for travellers at highest risk) Cholera TB

9. Hepatitis A Disease prevalence is considered moderate to high in this country

10. Typhoid Spread most commonly through ingestion of food and drink that has been contaminated with faeces or urine from a human case or carrier Schedule: 1 X injection – boost after three years, efficacy 55-75% Schedule: 3 X oral capsules - boost after one year, efficacy 50-60% Scrupulous food, water and personal hygiene encouraged at all times when travelling to an endemic area

11. Hepatitis B Carriage of the virus in the local population in this country is considered to be high (>8%)

12. Rabies Spread through the saliva of an infected animal, usually through a bite or scratch China is classified as a high risk country for rabies Pre-travel vaccination removes the need for rabies immunoglobulin (RIG) and reduces the number of post exposure doses of rabies vaccine required Course = three injections given over a period of 21-28 days Wash saliva out of wound under running water immediately Wash out wound with antiseptic or alcohol Seek immediate medical help

13. Tick-borne encephalitis –Transmitted through the bite of infected tick or consuming unpasteurised dairy products –Infected ticks found in woodland habitat, deciduous forest and grassland –Transmission more common during the warmer months of Apr-Nov when ticks are most active AVOID TICK BITES - wear protective clothing Avoid consumption of unpasteurised dairy products Apply insect repellents containing DEET to exposed skin Inspect body for ticks after outdoor activities and remove with tweezers or forceps

14. Japanese Encephalitis Spread through the bite of an infected culicine mosquito that normally breeds in rice paddies Most short stay travellers and those only visiting cities and urban areas will be at low risk While the disease occurs the whole year round, most cases are reported from April to October Avoid bites – wear suitable clothing Use repellents – DEET at least 30-50%

15. Malaria Zones

16. Malaria Female anopheline mosquito A - Awareness: Malaria risk including malignant P.falciparum occurs in Yunnan. Risk to the traveller is influenced by factors including length of stay, itinerary, accommodation etc. B - Be aware of the risk and take precautions to avoid mosquito bites, including the use of repellents, nets and suitable clothing C - Chemoprophylaxis: High risk areas -atovaquone/proguanil OR Doxycycline OR Mefloquin D - Diagnosis and treatment, prompt diagnosis and treatment is essential. Fever occurring at least 7 days after exposure but illness can develop up to 1 year later

17. Resources for the traveller www.nathnac.org www.fitfortravel.scot.nhs.uk www.malariahotspots.co.uk www.fco.gov.uk

18. PROPOSED TRAVEL CLINIC DATES 19 TH February 5 th March 26 th March @ 16.00hrs Lead Practice Nurse Jacquie Coates Dr Chris Cook