Swine Flu Update
Many countries around the
world have had confirmed cases of H1N1 flu and a world
wide pandemic alert is in effect. A pandemic is defined
as an epidemic of an infectious disease spread through
human populations across a large region.
H1N1 virus is unique
because it is a combination of genes from pigs (swine),
birds, and human flu. People who become infected
with H1N1 flu usually display symptoms such as fever,
cough, sore throat, runny or stuffy nose, body aches,
headache, chills and fatigue. Some people have also
reported diarrhoea and vomiting.
The CDC (Center for Disease
Control and Prevention) recommends that travellers at
high risk of complications from flu should discuss their
travel plans with their doctor prior to departure.
Travellers considered at high risk include children <5
years old, adults >65 years old, pregnant women, and
those with chronic medical conditions or
immunosupression (weakened immune system). For further
information on this and other related topics of H1N1 flu
Top 10 Swine Flu Tips
Now that the flu season has arrived, it is
not surprising this new swine flu is spreading
so quickly. We can all do our bit to stop the
WASH YOUR HANDS / CARRY HAND SANITISER.
Wash hands after using public amenities,
after the toilet and especially before
touching your face or eating. The influenza
virus can survive 2 days on surfaces. A
common way to catch the flu is by touching
something that has been coughed or sneezed
upon by an infected person. For example,
someone who used the shopping trolley before
you may have had the flu.
CARRY TISSUES. Have tissues with you
at all times. Cough or sneeze into tissues
or hankies. If you get caught without them,
cough into your elbow. Tissues are easy
because they can be used once and thrown
straight into the bin. Hankies are okay but
after one use must be washed in hot water.
COVER YOUR COUGH. If you are in
public, and you are coughing you should wear
a mask. This will stop the disease spreading
Masks are not very helpful at preventing
influenza. Using a mask incorrectly may
increase the risk of a well person catching
the disease, rather than reduce it.
PHONE YOUR DOCTOR IF YOU GET SICK. if
you have sudden onset of a fever of over 38
degrees C, with cough, tiredness and lack of
appetite then phone your doctor. If you have
difficulty breathing as well, phone your
doctor urgently, or go to the nearest
casualty department. It is not possible to
test everyone for swine flu at the present
time as the labs are overwhelmed. Do not
arrive at your doctors without calling
OBSERVE QUARANTINE RULES; STAY HOME IF
YOU ARE SICK. Keep children home if they
are sick. Quarantine means staying home from
work or school, avoiding public transport,
the shops, the movies, the EKKA, meeting
friends at their house etc etc. This
quarantine should last for 7 days if you
have swine flu symptoms, and have not taken
medication. For persons who have taken
Tamiflu and are now without a fever, the
recommended quarantine is for 3 days (6
doses of Tamiflu).
GO HOME IMMEDIATELY IF YOU BECOME SICK.
The virus can spread even before you get
symptoms but it spreads much more once you
start coughing the virus into the
environment. Quarantine yourself somewhere
while you wait for transport. Surfaces you
have coughed on should be cleaned.
AVOID CROWDS if you have medical
problems. Persons with medical problems
should not expose themselves to crowds e.g.
go to the exhibition (EKKA) as the virus
will be spreading there and you are more
likely to get severe disease if you get
swine flu (or other flu).
ONLY USE ANTIVIRAL DRUGS IF PRESCRIBED BY
YOUR DOCTOR. Beware of internet
purchases of anti-virals, it is easy to
receive fake drugs, risk your health and
waste your money.
HAVE THE REGULAR INFLUENZA VACCINE –
it won't stop swine flu, but will stop you
looking like you have swine flu.
EAT AS MUCH PORK AS YOU LIKE!
You cannot catch swine flu from properly
cooked pork. The human swine flu virus is
not circulating in pigs.
...prepared by Dr Deb Mills, Travel
Medical Alliance, Brisbane, Queensland
Diarrhoea, vomiting, headaches, muscle
fatigue, unco-ordination ...
Would any of us
make it to the top of Kilimanjaro?
Kilimanjaro is the largest free-standing
mountain in the world. There are many routes,
but all of them have beautiful walks across
savannahs, equatorial rainforest, moorland,
alpine desert, and finally glacial plateau. My
wife and I set off in a party of 9 climbers and
45 (!) support staff to conquer one of the great
non-technical walks of the world, as we wanted
to see Kilimanjaro before the glaciers possibly
melt and disappear.
Whether it is due to climate
change, or whether it is just nature's normal
variability in events, the glaciers at the top
of Kilimanjaro are melting and shrinking, and it
is postulated that they may disappear altogether
sometime in the next 20 to 50 years.
Kilimanjaro is the largest free-standing
mountain in the world
Mount Kilimanjaro's Uhuru Peak at 5,895 meters
is the highest peak in Africa. Fabled stories of
a snow covered mountain near the equator in
Africa were scoffed at by Westerners, as the
idea seemed ludicrous and illogical at the time.
In 1848, the German missionary Johannes Rebman
was the first Westerner to document the
existence of Mount Kilimanjaro. His findings
were submitted to the Royal Geographical
Society, but his description of a snowcapped
mountain in equatorial Africa was still doubted.
More Europeans over the next 40 years were able
to see Kilimanjaro first hand, and many attempts
were made to climb it, with defeats due to the
ice and altitude. Finally in 1889, Dr. Hans
Meyer and his large party of advisors and
porters, on his 3rd attempt, managed to reach
the summit successfully. The intrepid Meyer took
almost 6 weeks to reach the summit, much longer
than the average week it takes current walkers.
9 climbers and 45 (!) support staff
Every year, about 20 000 people from all over
the world attempt to summit Kilimanjaro.
Estimates of success rates range between 40-60%.
Many climbers have to turn back before reaching
the top because of altitude sickness. Worse than
this, up to 10 climbers die on Kilimanjaro each
year, together with an unknown number of local
porters - figures for these are guessed at
There are difficulties in arranging evacuation
should any mishaps occur, as helicopter or other
vehicular access is impossible on parts of the
trails, and then medical care is many hours
But yes, with the right preparation anyone with
reasonable health and fitness can reach the roof
of Africa, and be exhilarated by a stunning
sunrise with magnificent vistas.
Walking on the 'snow' roof of Africa
What tips can I
share with you if you are considering climbing Kili?
There are many routes up the mountain, and
success is more likely if plenty of time is
taken to wander up the trails. Acclimatisation
takes place slowly, and if people rush up, the
reduced amount of oxygen reaching their brain
and their lungs leads to severe repercussions.
Try to choose the longest trip you can afford.
Guides and permits are required to ascend
Kilimanjaro. The well trained guides that came
with us set such an extremely slow pace right
from the beginning that we thought we would take
an eternity to get anywhere, but the benefits of
this were that our party had a 100% success rate summitting Kilimanjaro, whereas the trekkers in
other groups around us who were skylarking and
throwing frisbees succumbed to altitude sickness
and had summit rates of 15-40%. Pole Pole
(slowly slowly) is the catch cry of the guides
on the mountain trails. Ignore them at your own
Keeping well hydrated helps in the
acclimatisation process. Our walking company had
employed amongst the cooks and guides and tent
porters and luggage porters, several men whose
job was purely to lug water from the few flowing
streams to the campsite so everyone could drink
at least 4 litres a day.
Another saviour is to
have some diamox
(acetazolamide) to hand. This medication can
prevent or treat altitude sickness symptoms,
with minor inconvenient side effects such as
having to urinate more (not fun if in subzero
temperatures in the middle of the night), and
tingling in the peripheries (less fun than it
sounds!). The staff at your friendly travel
clinic will be able to inform you on when and
how to use this appropriately.
And for those who feel too unwell, coming down
the mountain is essential. Choice between pride
and being a sad statistic? That should be a much
easier decision than it is for some.
As you can see from the pictures, we had
magnificent scenery as we climbed up and down
Kilimanjaro, and had a great sense of
achievement at being able to summit. Having
great guides, walking slowly, keeping hydrated,
having medication available, all were keys to
our success, and yours too, should you choose to
see the snows of Kilimanjaro before they
Dr Stan and friends at the peak
Dr Stan Khoo, Travel
Medical Perth, WA
Disease focus - Ciguatera Fish Poisoning
a toxin produced by marine microalgae
in the tropics, particularly in the
Pacific Islands, Caribbean, and Indian
Ocean Islands. Tropical marine fish can
accumulate this toxin through their diet
by eating algae or smaller fish. As big
fish eat smaller fish, this toxin moves
up the food chain, and can reach toxic
levels in large fish.
eat contaminated fish, they can develop
a condition called ciguatera fish
poisoning. The symptoms may include
nausea, vomiting, tummy pain, diarrhoea,
muscle cramps, and tingling around the
mouth and in the fingers and toes.
Some people also develop abnormal
temperature sensation, where hot things
feel cold, and cold things feel hot.
These symptoms can start within 10
minutes of eating toxic fish, but
sometimes take up to 24 hours. They
usually last for a few days, but can
occasionally persist for weeks or
How is it
usually made based on the history of eating fish in
ciguatera risk areas, and on the above symptoms. If
portions of the fish are available, they can be tested
for ciguatera toxin. In places where this condition does
not occur, doctors may not be familiar with it, and the
diagnosis is often missed. If you think you might have
ciguatera fish poisoning, you should tell your doctor
that you have eaten tropical fish in a risk area.
How is it
There is no
specific treatment for ciguatera fish poisoning, but
your doctor can help you manage symptoms such as
nausea and vomiting. The majority of people recover
spontaneously after a few days, and it is unusual to
have any long-term problems.
How can I
avoid getting it?
You can't tell
whether fish is toxic by looking at it or tasting it.
Ciguatoxin is very heat-stable, so cooking WILL NOT
make the toxic fish safe to eat. The risk of a fish
being toxic depends on where it is caught rather than on
its species, and local fisherman may be also able to
tell you which areas to avoid or which species of fish
to not eat. If in doubt, it is best to avoid large reef
fish such as barracuda and grouper - they are more
likely to be toxic because they can accumulate toxins by
eating lots of smaller fish.
prepared by Dr Colleen Lau, Travel Medicine Alliance,
Information and News
Many countries around the
world that are experiencing outbreaks of dengue fever.
The geographical spread of this disease includes
northern Australia (Queensland), northern Argentina,
south and south eastern Brazil, and the entire
Singapore, Malaysia, Taiwan, Thailand, Vietnam,
Indonesia, Honduras, Costa Rica, Philippines, Pakistan,
India, Sri Lanka, Bangladesh, Mexico, Suriname,
Dominican Republic, Puerto Rico, Jamaica, Bolivia,
Brazil, Guyana, Venezuela, Barbados, Trinidad and Samoa.
Dengue fever is a virus that
is transmitted to humans via mosquito bites.
These mosquitoes prefer to live in urban areas, and are
daytime biters. The signs and symptoms of dengue
fever include a sudden onset of severe headache, muscle
and joint pains (severe pain that gives it the nickname
of break-bone fever), fever, and rash.
There have been reported
cases of measles in New Zealand, specifically in
Christchurch on the South Island. Before travelling to
this area, you should be vaccinated against measles if
you are not immune.
Measles is a highly
contagious viral illness that is spread through
respiratory droplets of an infected person i.e.
breathing, coughing and sneezing. Contact by a
non-immune person with someone infectious leads to a 90%
probability of contracting the illness. The
incubation period for measles is approximately 14 days
(range 9-19 days) after contact with an infected person.
Characteristics of measles
are a runny nose, conjunctivitis (red and sore eyes),
fever and a raised and angry looking rash all over the
with measles include pneumonia, encephalitis (brain
inflammation) and possible miscarriage or premature
labour in pregnant women.
Immunisation with MMR
vaccine is readily available in Australia,
relatively inexpensive, and offers long-term immunity
against measles, mumps and rubella.
Do you have a holiday
story to tell, especially one with a medical
Send it to
and we will send you one of our mini TMA
torches to put on your key ring - a great
help when finding your lock at night.