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Our World Cup advice: Take your shots, practise defence

Wednesday, 28 May 2014
Our World Cup advice: Take your shots, practise defence

The countdown is on to the 2014 World Cup in Brazil starting on June 13.
If you’ve booked your tickets to see the Socceroos in action (or you’re about to) NOW is the time to get the required and recommended vaccinations.

Most vaccinations can be given at one time but a few may need to be spaced out over a month, so make an appointment for your pre-travel medical THIS WEEK. With time short, a travel medicine clinic can advise just what shots you need for your individual Cup ‘campaign’ and provide them on the spot (no delays having to get prescriptions filled).

Along with that reminder, the ‘coaches’ at Team Travelvax also want to pass on the results of a large, international survey of travellers who returned with an illness from Brazil. The findings offer an accurate and revealing insight into the potential health problems World Cup fans are most likely to encounter during the month-long festival of football, and how to defend against them.

The 16-year study was conducted by members of the GeoSentinel network of specialist travel medicine clinics, which are located around the world, and the data were analysed by internationally recognised leaders in the fields of infectious and tropical diseases. Most of the 1586 travellers were young adults and they were treated by the clinics’ doctors for a variety of skin conditions (40% of cases), acute diarrhoea (25%), or illnesses involving a fever (19%), mainly dengue or malaria.
(It should be remembered that the survey represents the tip of the iceberg: Many more travellers who return with illness would first see their GP, then perhaps a tropical or infectious diseases physician.)

Vaccinations for Brazil

More of the survey's findings later. First, here’s a reminder from an earlier blog of the vaccinations we would typically discuss for leisure travel to Brazil, which fall under 3 headings.

ROUTINE vaccinations such as measles-mumps-rubella (MMR), diphtheriapertussistetanuschickenpoxmeningococcal disease, and seasonal influenza should be up to date for every overseas trip. (Outbreaks of measles have been common in developed and developing countries recently, while flu is the number one vaccine-preventable risk for overseas travellers. Both are a concern when lots of people come together from all points of the globe!) 

RECOMMENDED vaccinations for Brazil (and other developing regions of the world) include Hepatitis A, which can be given on its own or in combination with Hepatitis B. Unlike Hep A, which is spread by eating or drinking contaminated food or water, Hep B is passed from person to person through the transfer of infected blood or bodily fluids. Vaccination is usually suggested for young singles, travellers on longer stays, those heading ‘off the beaten track’, or those who plan to travel regularly in the future (regardless of age). Typhoid, a bacterial disease spread through contaminated food or water, is present in Brazil and throughout Latin America. The disease is usually not considered a significant risk for people on short visits staying in quality accommodation, but vaccination may be suggested if you’ll be staying on to see more of Brazil after the Cup or you plan to visit other countries in the region. (Rabies is also present in Brazil, but vaccination is recommended for longer stays, especially in rural areas.) 

The one REQUIRED vaccine for Brazil (as well as other parts of South America, and much of Africa) is Yellow fever. It is spread by mosquitoes in certain areas of Brazil. However, even if they don’t visit areas where the disease occurs, Aussie travellers may be required to show proof of vaccination if returning home within 6 days of leaving Brazil or if they travel on to the many countries which also require proof of yellow fever vaccination on entry. 

Dengue: a potent striker

That’s because the yellow fever-carrying Aedes aegypti mosquitoes are now found across much of the world – including North Queensland, where they also transmit dengue fever.

Like most travel medicine specialists, Travelvax Australia believes dengue fever is the most likely World Cup health risk, which brings us back to the GeoSentinel survey. 

Among the 297 travellers treated for a fever-causing illness after visiting Brazil, 92 (31%) had dengue fever compared with 25 (8%) who had malaria. (Malaria is more likely to be an issue for Cup fans who stay on to visit Brazil’s Amazon region, where an average 300,000 cases occur each year. Read more about malaria in Brazil. 

Dengue was not only the most frequently identified specific cause of fever, but was the most common reason for post-travel hospitalisation, along with malaria.
The majority of Brazil’s dengue cases are recorded during the Feb-May peak, while June (the World Cup month) sees the fifth highest number of infections. However, in more recent years, cases are increasingly being reported throughout the year.

So, from day one, Cup fans need to take measures to avoid dengue by preventing mosquito bites. Large-scale epidemics of dengue occur each year across Brazil and Latin America and the aggressive Aedes mosquitoes that spread the virus breed in urban areas alongside people. It’s likely they will be around the stadiums where Cup matches are to be played. 
Although they bite at any time during daylight hours, their main feeding times are a couple of hours after sunrise and just before sunset. These are the times when travellers should not only be protected by repellent, but also wear a long-sleeved shirt, long pants, and shoes and socks – especially if they plan to be outside.

Insects a recurring threat

Repellent and some form of footwear are also important if you plan to hit the beaches of Rio and other major tourist destinations on the coast. 
As mentioned, 40% of the survey cases involved skin conditions transmitted by biting insects. They included cutaneous larva migrans (CLM), a disease spread by hookworm larvae living in sand or soil which penetrate the feet, the buttocks, or abdomen. Most travellers are infected while walking, sitting or lying on beaches, including those at popular destinations like Rio de Janeiro, Salvador, Recife, or Fortaleza. Two other skin conditions seen among the returned travellers included Myiasis, an infection where the larvae of the bot fly are rather ingeniously passed on to humans by a mosquito bite, and tungiasis, a disease caused by sand fleas (Tunga penetrans) which burrow into the feet.

Among the travellers with both acute and chronic diarrhoea, no specific pathogen could be identified as the cause in more than half the patients, although campylobacter was found in 4% of cases and giardiasis in 9%. The findings again confirm the importance of making safe food and beverage choices, as well as thorough hand washing after using the toilet and immediately before eating.

Among the sexually transmitted infections, 28 people were diagnosed with HIV. An estimated 600,000 Brazilians have HIV and an average 33,000 new infections are reported each year. 
“Travellers should be reminded to avoid unsafe sexual practices and exposure to potentially contaminated needles and blood,” the authors warned. The also noted that earlier studies had found that between 20%–50% of people had engaged in casual sex while travelling overseas and that that unsafe sex accounted for around half the episodes among travellers.

Guard your personal safety, too

Except for influenza, most vaccine-preventable infections were surprisingly uncommon among the post-travel illnesses that brought the returned travellers to a GeoSentinel clinic. There were relatively few cases of Hep A and typhoid, and no measles, mumps, rubella, pertussis, acute hepatitis B, or yellow fever. 
The authors said the absence of the vaccine-preventable routine infections such as measles, rubella, mumps, or pertussis may have reflected either the high rates of coverage for the so-called childhood diseases in Brazil, or high coverage among the travellers involved in the study. (Around half had a pre-travel medical consultation.)

However, the researchers warned that mass gatherings like the World Cup bring together people and highly contagious diseases such as measles, norovirus, and influenza. They recommended fans be vaccinated with the Southern Hemisphere seasonal flu formula.

A major sporting event held in a large stadium with often volatile fans has the potential for emotional and physical stress, as well as aggression. The authors conceded that their findings may ‘understate the frequency of injury’ at Cup games, and stressed the importance of fans protecting themselves against the tropical sun’s UV rays, drinking water to prevent dehydration, avoiding no-go areas, and not drinking alcohol to excess.

Good advice for all sports fans – even more critical when you’re more than 14,000km from home. 

And, our final pre-game tip: Don’t forget travel health insurance!

Read the full study in the journal of Clinical Infectious Diseases.