Friday, January 28, 2005

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May 2001 saw the official launch in the UK of the newly licensed drug Malarone for use as an anti-malarial. Malarone is a combination drug (Atovaquone and Proguanil), which was licensed in the UK back in 1997 for use as a treatment for Malaria.
Manufactured by the drug company GlaxoSmithKline the drug has been shown to be effective in the prevention of P.Falciparum malaria. The main reported side effects seem to have been headaches and stomach irritation, which can be helped by taking the drug with food or a milky drink.
Malarone is already recognised by the Malaria Reference Laboratory and is currently a part of the various databases used in surgeries and travel clinics up and down the country to advise travellers. The drug will be a good alternative for those not wanting to take Mefloquine (Larium) and will be effective in areas of the world where we are seeing increasing Chloroquine resistance. It is important however that is does not get confused with an alternative anti-malarial called Maloprim.
A simple dosing regime, of one tablet per day, means that the drug needs to be started just 1-2 days prior to arriving in a malaria zone, while away and for just 7 days on leaving the area. This is because Malarone has the ability to act on the liver and blood stage of the malaria infection. This simple regime is believed to increase compliance and will be especially convenient for short holidays and last minute trips to malarial destinations.
It is important that travellers understand that this new drug is yet another choice, among others, that might be recommended by a health professional. Often travellers become concerned if they discover they have been given a different anti-malarial to other people on the same plane going to the same destination.
The Malaria Reference Laboratory is responsible for drawing up the anti-malarial recommendations for the UK. Each recommendation involves looking closely at epidemiology of the disease, resistance to the malarial parasite and of course the number of cases that are coming out of certain areas in a particular country. The guidelines then reflect the best 'recommendations' and alternatives as recommended in the UK. These guidelines are then published and updated on a regular basis and it is up to the travel clinic, practice nurse or doctor to keep up to date with the changes within the UK recommendations.
Now, that is not the whole story - recommending the 'right' drug for each person involves a lot more than just looking at a chart and pulling out a drug name. Making a full assessment of each individual and recommending the right drug for a particular individual traveller is often the difficult part. In the case of Malarone as a general rule it will not be recommended during pregnancy or for those breast-feeding, unless it is the last option and the risk is high. We also have not received any data relating to its long-term use, although at an average cost of £36 for a week's holiday, it is more likely it will only be used for short trips. Malarone is also believed to produce lower blood levels for those taking certain medication and this should be discussed with your doctor prior to using any anti-malarial medication.
It is important that when visiting a health professional for advice on anti-malarials that you give them enough information to work with. They need to know where you are travelling to - and be specific; recommendations can differ within a single country or area. Let them know about any stopovers, are you staying in a rural area or in a city - malaria is less of a threat in the cities. What will your altitude be? Malaria is not often found above 2000 metres, although reports from East Africa would suggest changes are occurring in certain parts of the globe.
The time of year is also an important consideration as malaria is seasonal in some areas. The worldwide climatic variations have brought about changes in the pattern of malaria over the last few years. Your health professional will need to know how long you are going to be away as well as your age, and also of importance is the types of medication you are taking and your past medical history.
And that is not the full story - no anti-malarial, however much media attention it receives, is going to be 100% effective and it is important that you also take into consideration how you can prevent getting bitten by mosquitoes in the first place! Recommendations are as they suggest 'recommendations' which, when discussed with your health advisor, might differ from the person sitting next to you on the plane - but it doesn't always mean they've got it wrong…

Note: This information is designed to complement and not replace the relationship that exists with your existing family doctor or travel health professional. Please discuss your travel health requirements with your regular family doctor or practice nurse.

Deep Vein Thrombosis

First recognised back in 1946, travel related DVT is an added potential problem for 'at risk' travellers who are immobile for extended periods of time. While the problem is often associated with air travel, the risk is equally reported among those travelling by car, coach and train.
What is Travel Related DVT?

A Deep Vein Thrombosis (DVT) is a clotting of the blood in any of the deep veins - usually in the calf. If a clot develops, it usually makes its presence known by an intense pain in the affected calf. Medical attention should be sought immediately if this occurs, especially after a long journey. In some cases this can be fatal, if the clot breaks off and makes its way to the lungs where it can then affect the lung's ability to take in oxygen.

A DVT can occur some days or even weeks after a trip.
Most cases have at least 3 predisposing risk factors - the risk increases as risk factors increase.
Who is at risk?
Very little established research exists in relation to travel. However we do have a wealth of information from hospital research specific to DVT. We already know that the following factors increase the risk of travel related DVT:

Immobility for an extended period of time
An existing history of DVT
Recent surgery or leg surgery
Existing clotting abnormality
Chronic illnesses
Hormones or the oral contraceptive pill
Varicose veins
Pregnancy or 2 months post-partum
History of Cardiac problems

How many people are affected?
It is hard to establish just how many people are affected by DVT after travel related activities, as no official records are kept. However it is important to be aware that it is a potential problem for those with risk factors, due to the evidence we already have.
How can I reduce my risk?
Those in a high-risk category should see their travel health advisor before they travel and discuss prevention.
Those at risk should try to exercise at least every hour on long journeys. Exercise the calf muscles by rotating your ankles, or making use of the commercially available exercise equipment. The risk applies to any form of travel where you are routed to one place for hours at the time.
Good hosiery will encourage circulation. However it is important that you do not wear clothing that will cause a restriction of circulation. Any hosiery should be measured properly to ensure a suitable fit.
For long flights wear loose clothing. Due to the change in atmospheric pressure in a plane, parts of your body can expand due to increased gas! In the dry environment of a plane, it is a well-documented fact that too much alcohol, tea and coffee on flights can add to the problem of dehydration. It is therefore very important to remain hydrated during a long flight by drinking plenty of water and fruit juices.
In-Flight Stockings and Socks

With much attention given over the potential risks associated with Travel Related Deep Vein Thrombosis, it is not surprising that many people are looking for products, which will offer protection. Research has shown that correctly fitting anti-thrombosis stockings increase blood flow, thus lowering the risk of DVT in those at risk. Advice related to stocking/socks should apply to all forms of travel when a passenger is sitting still for a long period of time.
Before buying any products it is essential that you are able to assess your personal risk factors and obtain advice from your own doctor regarding fitness to fly if you are in any doubt. If you are in a very high-risk category you should seek advice from your doctor and consider postponing your travel plans.

There are many different brands on the market at the moment, each expressing their own unique qualities. It is important that any stocking/sock purchased is fitted properly. A stocking that is too tight and worn by a traveller with existing circulation problems can do more harm than good -- cutting into the skin on a long flight and potentially causing ulceration and increased risk of DVT.

Never guess the size stocking or sock you require - ask to be measured properly. A good stocking/sock will come in a variety of sizes allowing for measurement from the knee to the ankle as well as the foot size. If a stocking is too tight around the knee it will prevent essential venous return causing the blood to pool around the knee.
When buying your stockings/socks make sure they are comfortable with your chosen footwear for travelling. Some stockings can be slightly thicker than normal leg covering and can be potentially restrictive with tight foot wear.
Do not think that if you wear tight knee-highs during a flight you will save some money. Any clothing or tight shoes cutting into the skin around will prevent normal blood flow and increase the risk of travel related DVT.

Wear your stockings around the house prior to travel to ensure you have a good, comfortable fitting. On the morning of your travel put them on when you get dressed, especially if you are travelling a distance to the airport. Hurriedly put on stockings in the airport lounge can cause no end of travel related anxiety!
Stockings are just one-way to help prevent travel related DVT - take advice from your doctor as well as preventative advice related to travel.
Related products:
Airogym - inflatable exercise cushion for use on long haul flightsThe "Travel Telegraph" awarded a 5-star rating to the Airogym - a small inflatable cushion that can be easily packed into your hand luggage, which has been shown to improve circulation by up to 500% when used correctly. View product >>
Anti-embolism stockings can be purchased online and come in a variety of sizes and colours View product >>

Note: This information is designed to complement and not replace the relationship that exists with your existing family doctor or travel health professional. Please discuss your travel health requirements with your regular family doctor or practice nurse.

Travel Health Clinics

When looking for a Travel Clinic it is a good idea to check with your own surgery first as some vaccines are available on the NHS - others will need to be purchased from a private Travel Clinic. The list below does not indicate all private clinics in the UK. Your surgery may be able to recommend a local source.
Personal service and advice - Located near London Waterloo station.
UK Travel Clinics
Clinics listed with the International Society of Travel Medicine.
International Travel Clinics
Clinics listed internationally with the International Society of Travel Medicine. Listing by country.
British Airways Travel Clinics
British Airways have two travel clinics in central London:
213 Piccadilly, London W1J 9HQTel: 0845 600 2236
101 Cheapside, London EC2V 6DTTel: 0845 600 223
This useful Travel Clinic Finder will help find a private Travel Clinic across the UK
The Health Station
A travel vaccination clinic in Hitchin, Herts. Click on the name to visit their website.
Nomad Travel Clinics
40 Bernard Street, Russell Square, London WC1H 1LJTel: 020 7833 4114
52 Grosvenor Gardens, Victoria, London, SW1W 0AGTel: 020 7823 5823
3-4 Wellington Terrace, Turnpike Lane, London N8 0PX Tel: 020 8889 7014
43 Queens Road, Clifton, Bristol BS8 1QHTel: 0117 922 6567
Travel Health Line: 09068 633414 (calls @ 60p per min - office hrs only)email:

Travel Health Online
A country-by-country listing of local travel health specialist and clinics.
International Medicine Center
The website of the International Medicine Center in Houston, Texas.
Wish House Clinic
New travel clinic for Brighton & Hove126/128 New Church RoadBrighton and Hove, East Sussex, Bn3 4JDTel: 01273 430022Fax: 01273 430433

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