Tag Archives: Travel Clinics


When anyone hears this name they immediately associate it with death and tradegy. It is not surprising that on several occasions I have seen a child in surgery with a fever and they have been unusually fearful because they are frightened they have contracted Ebola.
We can reassure, act appropriately and educate our children in so many ways:-

* Remind our children that we live in a country that has clean running water and an excellent sewage system which saves countless lives especially from infections. Did we not see the adverts on the TV at Christmas asking us to contribute to a provision of a pump in a bush village which had no running water?

* Educate our children to wash their hands before meals and after using the toilet and put our hands to our mouths or turn away when we have cough?

* Make sure you are up to date with immunisation and seek advice when travelling for recommended immunisations and health care with the practise nurse or local travel clinic

Travel clinic

* Encourage healthy living especially with regards diet and exercise.

* Appreciate and treasure our health service and not take it for granted that we have a service which is accessible, free and can offer a comprehensive range of treatments comparable to any country in the World.

Expectations are high – I can be sure that at least 50% of patients attending on Monday morning will have minor ailments which could be treated with Over The Counter remedies or just reassurance. If I sit in out of hours clinics the story is much the same!
Nevertheless, when I have had to admit or refer a patient with a serious illness for the most part I am pleased with the prompt response and standard of care. Moreover, if the outcomes are not satisfactory as a GP I have a voice to be able communicate dissatisfaction and facilitate change and as a patient there is also the same opportunity through PALS our Patient Liaison Service (details obtained at the surgery or on the website NHS choices)

More about Ebola
Nearly 40 years after Peter Piot was first dispatched to investigate a mysterious new virus.

He was 27 and still in training, he had one of the greatest opportunities an aspiring microbiologist could dream of: the chance to discover a new virus, investigate its mode of transmission and stop the outbreak. It all started when his laboratory at the Institute of Tropical Medicine in Antwerp received a thermos from what was then called Zaire. It contained the blood of a Flemish nun who had died of what was thought to be yellow fever.

From that sample, however, his lab isolated a new virus, confirmed by the Centers for Disease Control in Atlanta and subsequently called Ebola, after a river about 100km north of Yambuku, the centre of the epidemic. It turned out to be one of the most deadly viruses known.

In early September 1976, Mabalo Lokela, the headmaster of the local school, had died with a high fever, intractable diarrhoea and bleeding. His death sent a shockwave through the small mission community. Soon the hospital was full of patients with a similar illness and nearly all died within a week.
There have been several outbreaks since that time but the present outbreak is the worst.

How is it transmitted?

It is believed that the virus originates in fruit bats. It circulates in populations of wild animals including gorillas, fruit bats, monkeys, antelopes and even porcupines.
It is transmitted through contact with bodily fluids. Eating fruit collected from the forest floor, that an infected fruit bat had bitten, could spread it. So could contact with the blood of an infected animal that had been butchered for bush meat.


Monkeys, apes and antelopes are commonly eaten in the areas where the outbreak began. If someone were handling the raw meat and had an open cut on their hand, that could transmit the virus.

Once the virus is in human circulation, it becomes far harder to contain. Health care workers have been at particular risk because they have come into direct, close contact with victims.

Traditional burial ceremonies among many of the communities affected involve direct contact with the body of the dead, and this is believed to have been a major factor in the early spread of the virus, before public safety messages began to get through to people.

The virus can also be transmitted through sex. The WHO says that even men who have recovered from the virus can still transmit it through their semen for up to seven weeks after recovery.

Signs and Symtoms of Ebola

Severe headache
Muscle pain
Abdominal (stomach) pain
Unexplained hemorrhage (bleeding or bruising)
Symptoms may appear anywhere from 2 to 21 days after exposure to Ebola, but the average is 8 to 10 days.

Recovery from Ebola depends on good supportive clinical care and the patient’s immune response. People who recover from Ebola infection develop antibodies that last for at least 10 years.

The latest advise from NHS England is illustrated below:-



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imageDengue is widespread in Brazil, which many travellers will visit this year for the football World Cup and in 2016 for the Olympic Games.Dengue fever

Dengue is a flavivirus infection transmitted by the bites of female mosquitoes, mainly of the species Aedes aegypti and Aedes albopictus, which are daytime biters. It is only the female mosquito that feeds off blood to provide protein for the eggs;the males feed off plant nectar.

Map dengue fever

From its origins in south-east Asia, it has spread to many parts of the tropical and sub-tropical world. Aedes mosqitoes are capable of breeding in small quantities of water, such as accumulated rainwater in oil drums and old tyres, as a consequence of which,
dengue often occurs in urban areas.

What are the main symptoms?

The incubation period is usually between two and five days, but may occasionally be longer. This is followed by fever, which may abate after a day or two, only to rise again. This is known as saddleback fever.

Common symptoms are severe arthralgia and myalgia, giving rise to the name breakbone fever, and headache.

Up to 50% of patients develop a maculopapular rash and there may be widespread lymphadenopathy. Recovery may be accompanied by prolonged fatigue and/or depression.

About 2% of patients may develop severe complications
of dengue such as haemorrhagic fever (DHF) or dengue shock
syndrome (DSS).
Warning signs for the rare dengue haemorrhagic fever include:
tiny bloods spots or large patches of blood under your skin, bleeding from the gums or nose, persistent vomiting and severe abdominal pain, vomiting blood or black, tarry stools. If you have any of these symptoms, you must seek immediate medical assistance.

Dengue fever

To establish if the rash is haemorrhagic use the glass or tumbler test as used in meningitis:-
Glass test

Can it be diagnosed by blood test?

Dengue fever can be diagnosed by isolating the virus in the blood during first five days. Also, on examining the blood there can be low white cell count and platelets and a raised alanine amino transferase (a liver enzyme) but this is not specific to Dengue Fever.
IgM antibodies may persist in the blood for two to three months
and a positive test may indicate recent or previous dengue
infection. If a traveller has had no previous exposure to dengue, a positive test is likely to be due to recent infection, but there is also cross-reactivity with other flaviviruses,

Is there a vaccine?
There is no vaccine

How can Dengue Fever be prevented?
It is a viral infection transmitted by mosquitos that bite in the day. It is important to wear clothing that covers as much of the skin as possible and use effective insect repellents such as diethyltoluamide (DEET) from dawn until dusk (in contrast to malaria prevention throughout the night from dusk until dawn)

How can it be treated?

There is no specific treatment for dengue. In most people symptoms can be managed by taking paracetamol (you should avoid aspirin, ibuprofen or other similar drugs), drinking plenty of fluids and resting.
Most people will recover within one to two weeks.

Before travelling it is advisable to attend a travel centre to obtain appropriate immunisations and advice.
Most immunisations can be given by our practise nurse or at one of the local travel clinics
Travel advice for Brazil

Having said this I had an amazing trip to Brazil several years ago to see my daughter who was studying there and absolutely loved Rio de Janeira, swimming on Copacabana beach, sky-diving on to the beach, dancing Salsa and even visited a Favela under escort. Then going on to explore the incredible Amazon river and Amazonian jungle and fortunately remained very well.



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WORLD HEPATITIS DAY – July 28th 2013

The date of July 28 was chosen for World Hepatitis Day in order to mark the birthday of Professor Baruch Blumberg, awarded the Nobel Prize for his work in discovering the hepatitis B virus.
See no evil,hear no evil,as represented by the three wise monkeys, an old proverb that is commonly used to highlight how people often deal with problems by refusing to acknowledge them. The monkeys have been chosen for the campaign to highlight that around the world hepatitis is still being largely ignored.
Hepatitis simply means inflammation of the liver and can be caused by a wide range of things. One of the most common causes of chronic (long-term) hepatitis is viral infection.
Five distinct hepatitis viruses have been identified: A, B, C, D and E. Hepatitis B and C, which can lead to chronic hepatitis, are particularly prevalent.
The five hepatitis viruses have different epidemiological profiles and also vary in terms of their impact and duration. The transmission route depends on the type of virus. Transmission routes that contribute greatly to the spread of hepatitis are exposure to infected blood via blood transfusion or unsafe injection practices, consumption of contaminated food and drinking water, and transmission from mother to child during pregnancy and delivery. Unsafe injection practices, including the use of unsterile needles and syringes, serve as a major pathway for the spread of hepatitis B and C, and reducing transmission of both diseases means changing these practices.
Hepatitis B and C are two such viruses and together kill approximately one million people a year. 500 million people around the world are currently infected with chronic hepatitis B or C and one in three people have been exposed to one or both viruses. Unlike hepatitis C, hepatitis B can be prevented through effective vaccination.

It is estimated that around 180,000 are affected by hepatitis B in the UK. Around 95 per cent of people with new chronic hepatitis B are migrants, most of whom acquired the infection in early childhood in their country of birth.
Hepatitis C is also a blood-borne viral infection that is transmitted through contact with infected blood. Around 216,000 people in the UK have chronic hepatitis C, and of these 87 per cent are current or past injection drug users. Almost half of the rest are from South Asian descent.


Together hepatitis B and C represent one of the major threats to global health. Hepatitis B and C are both ‘silent’ viruses, and because many people feel no symptoms, you could be infected for years without knowing it. If left untreated, both the hepatitis B and C viruses can lead to liver scarring (cirrhosis). If you have liver cirrhosis, you have a risk of life-threatening complications such as bleeding, ascites (accumulation of fluid in the abdominal cavity), coma, liver cancer, liver failure and death. In the case of chronic hepatitis B, liver cancer might even appear before you have developed cirrhosis.
Will Irving, Professor and Honorary Consultant in Virology, University of Nottingham and Nottingham University Hospitals NHS Trust, and member of the Programme Development Group, added: “It is estimated that around half of the individuals living in the UK with chronic hepatitis B or C infection are unaware of their diagnosis, but they are at risk of developing serious complications of their infection.

While there is a vaccine that protects against hepatitis B infection, there is no vaccine available for hepatitis C
Both viruses can be contracted though blood-to-blood contact
Hepatitis B is more infectious than hepatitis C and can also be spread through saliva, semen and vaginal fluid
In the case of hepatitis B, infection can occur through having unprotected sex with an infected person. Please note that this is much rarer in the case of hepatitis C
While unlikely, it is possible to contract hepatitis B through kissing. You cannot contract hepatitis C through kissing
Neither virus is easily spread through everyday contact. You cannot get infected with hepatitis B or C by shaking hands, coughing or sneezing, or by using the same toilet. There are different treatments for the two viruses. While treatment can control chronic hepatitis B, it can often cure hepatitis C
Even if treatment is not an option it is very important to maintain a healthy lifestyle. Alcohol, smoking, eating fatty foods, being overweight or extreme dieting (eating no food at all) may worsen liver disease.

Hepatitis B

The World Health Organization (WHO) recognises that hepatitis B is one of the major diseases affecting mankind today. Hepatitis B is one of the most common viral infections in the world and the WHO estimates that two billion people have been infected with the hepatitis B virus and approximately 350 million people are living with chronic (lifelong) infections. 500,000 – 700,000 people die every year from hepatitis B.

It is part of our contract as doctors that we have to have been immunised for Hepatitis B and our immunity is checked by blood test. We also do the same for our nurse and phlebotomist.

The hepatitis B virus is highly infectious and about 50-100 times more infectious than HIV. In nine out of ten adults, acute hepatitis B infection will go away on its own in the first six months. However, if the virus becomes chronic, it may cause liver cirrhosis and liver cancer after up to 40 years, but in some cases as little as five years after diagnosis.

The hepatitis B virus is transmitted between people through contact with the blood or other body fluids (i.e. saliva, semen and vaginal fluid) of an infected person.It arises primarily from injecting drug use, heterosexual contact with someone who is infected, travel to countries of intermediate or high endemicity, homosexual contact, and contact with someone in the same household who is a carrier and mother-to-child transmission. Although not all people will have any signs of the virus, those that do may experience the following symptoms:

Flu-like symptoms
Jaundice (yellowing of the skin)
Stomach ache
Diarrhoea/dark urine/bright stools
Aching joints
Unlike hepatitis C, there is a vaccine that can prevent infection. If you think you are at risk, you should get vaccinated as soon as possible.

Hepatitis C

Hepatitis C is different from hepatitis B in that the virus more frequently stays in the body for longer than six months, and therefore becomes chronic. Four out of five people develop a chronic infection, which may cause cirrhosis and liver cancer after 15–30 years. There are approximately 170 million people chronically infected with hepatitis C worldwide. In 2000, the WHO estimated that between three and four million people are newly infected every year.

Hepatitis C is mainly spread through blood-to-blood contact and, similarly to hepatitis B, there are often no symptoms but if they are present can include:

Flu-like symptoms
Aching muscles and joints
Anxiety and depression
Poor concentration
Stomach ache
Loss of appetite
Dark urine/bright stools

Although this is considered a global problem we must be aware that this is on our doorstep and now when so many people travel throughout the globe it is imperative that travel immunisation is considered if you wanting to travel or in a high risk occupation.
In 2011 there were 160 reports of acute hepatitis B in London, a 13% increase from 141 in 2010. This corresponds to an incidence rate of 2.06 per 100,000 population, which is nearly twice the national rate (England rate 1.13 per 100,000) and nearly double that seen in any other region. The highest rates of acute hepatitis B infection were in Islington, Brent, Newham, Lambeth, Hackney and Tower Hamlets.

Do you have concerns?
If you have any concerns regarding Hepatitis this can be screened in the practise by an ordinary blood test or it is possible to attend a GUM clinic on Level 8 at Ealing Hospital

GUM stands for genito-urinary medicine. The clinic can help you with any concerns you have about sexually transmitted infections (STIs).

It provides a walk-in and limited appointments based service. To make an appointment call (020) 8967 5555 during clinic opening times only.

Monday 9-11:30am Male and female walk-in
Five male appointments available
4-6:30pm Male and female walk-in
Five female appointments available

Tuesday 4-6pm 19 and under female walk-in

Wednesday 9-11:30am Female walk-in
2-4:30pm Male and female walk-in

Thursday 2-4:30pm Male and female walk-in

Please be aware that waiting times may vary, so please allow a minimum of one and a half hours for your visit.

Your results: Ealing GU clinic operates a no news is good news policy. We only contact you within two weeks of having your initial tests, if a result is positive. You can also get your results from the results line which is ONLY available during 9am-12pm on a Tuesday morning. You must have your clinic number to get your results.
More details are available on the following website
You can use this website to learn more about safer sex, infections or the services offered by the young women’s clinic.
GUM clinics are provided throughout the UK to find a clinic near you simply click on the following

If you are concerned you may have had or you could be in contact with
Hepatitis B. Immunisation is available at the surgery, travel clinic or GUM clinic.
Travel clinics
Our local clinic in Hounslow and Southall

Globetrotters Travel Clinics are one stop shops for all of your Travel Health needs. They provide Travel Health advice and services, as well as premium Travel Health Products.


What does hepatitis B immunisation involve?

For full protection, you will need three injections of hepatitis B vaccine over four to six months.
You will have a blood test taken one month after the third dose to check the vaccinations have worked.
You should then be immune (resistant to the virus) for at least five years. You can have a booster injection five years after the initial injection.

Hepatitis B vaccine on the NHS
GP surgeries and sexual health or GUM clinics usually provide the hepatitis B vaccination free of charge if you are in an at risk group.
GPs are not obliged to provide the hepatitis jab on the NHS if you’re not thought to be at extra risk.
GPs may charge for the vaccine if you want it as a travel vaccine, or they may refer you to a travel clinic so you can get vaccinated privately. The current cost of the vaccine (in 2013) is around £30 a dose.

How safe is the hepatitis B vaccine?
The hepatitis B vaccine is very safe and other than some redness and soreness at the site of the injection, side effects from it are rare.
Read more about vaccine safety and side effects.

Emergency hepatitis B vaccination
If you’ve been exposed to the hepatitis B virus and have not been vaccinated before, you should immediately have the hepatitis B vaccine plus an injection of antibodies called specific hepatitis B immunoglobulin (HBIG). This is because the vaccine doesn’t work straight away. The immunoglobulin works immediately, albeit temporarily, so you’re protected until the vaccine starts to work.
Immunoglobulin should ideally be given within 48 hours, but you can still have the jab up to a week after exposure.

Babies and hepatitis B vaccination
Babies born to mothers infected with hepatitis B can be given a dose of the hepatitis B vaccine after they are born. This is followed by another two doses (with a month in between each) and a booster dose 12 months later.
Some babies also have an injection of immunoglobulin after they are born to help prevent infection.


“see no evil, hear no evil, speak no evil”


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