1. Aids and Electives
In many developing countries, the prevalence of HIV infection is high, and you will be “at risk” when taking blood and handling body fluids in anyway. For example, you should be aware that 32% of pregnant women in Zimbabwe are seropositive and obstetric or gynaecological projects may therefore be associated with particular risk of exposure.
However, this risk is likely to be less in well run institutions with good supervision, e.g. MRC and Wellcome Trust units in Africa. You should avoid exposure to blood or other body fluids wherever possible. Gloves or other barriers should be used to prevent contact, and hands should be washed on removing gloves and after any contact if this does occur. Particular care should be taken to avoid exposure of broken skin or mucous membranes to potentially infectious body fluids. Sharps should be handled with extreme care and stored in puncture-proof containers. Guidelines for sterilisation and disinfection should be followed.
1.1 Areas where HIV infection is prevalent
Sub-Saharan Africa, Central America, the Caribbean, South America, South East Asia and the Indian Sub-Continent. Information is available on the FCO http://www.fco.gov.uk/en/ or http://www.nhs.uk/nhsengland/Healthcareabroad/pages/Healthcareabroad.aspx
1.2 Guidance on what to do should an exposure occurs you need to:
Needlestick injuries/cuts etc: Wash under running water with soap, squeezing to encourage bleeding, but do not rub or suck. The risk of HIV infection from a needlestick injury is about 0.3% and is greatest if the injury is deep and from a hollow, blood-filled needle.
Mucous Membrane: Wash with copious water but do not swallow. For eye exposure an eyewash bottle should be used if available and contact lenses should be removed before washing.
Post-Exposure Prophylaxis: Should a needlestick injury occur post exposure treatment with antiviral drugs for one month has been recommended, and may reduce the risk of infection by up to 80%. Recent recommendations suggest combination antiviral therapy (at least two drugs) for post-exposure prophylaxis. Further guidance and information on where you can purchase locally a post-exposure is available here.
Dr Sandy Mackenzie or Dr Rob Laing from the Infection Unit, Aberdeen Royal Infirmary are prepared to discuss HIV avoidance strategies and students who insist on going to areas with high HIV prevalence are strongly advised to avail themselves of this opportunity before their departure.
2. Traveller’s Diarrhoea
This is almost inevitable in some areas. Try to be as careful as possible with high-risk items such as water (including ice in drinks), unwashed and uncooked fruit and vegetables, salads, etc. Rehydration is the mainstay of therapy for diarrhoea. There are a number of potential disadvantages to anti-motility agents and they are probably best avoided. If your daily activities are unaffected by GI symptoms, then rehydration is adequate. If you are symptomatic, unwell and unable to work, Ciprofloxacin (500 m.g. twice daily for 2 days) covers the most common causes of diarrhoea. However, resistance to these antibiotics is increasing and if symptoms persist further local medical advice should be sought.
3. Immunisation and Malaria prophylaxis
It is important that you are properly protected from infection when travelling to high-risk areas. In addition, some countries may demand certificates of immunisation against certain diseases (e.g. Yellow fever) as a condition of entry. Detailed recommendations often change from year to year, so you are strongly recommended to obtain from your GP up-to-date advice for your particular destination. Specific enquiries, especially for countries outwith North America, Europe and Australia should be made 4 – 6 months in advance by writing or telephoning:
Dr R Laing or Dr A Mackenzie
Department of Infectious Disease
Aberdeen Royal Infirmary
Foresterhill
Aberdeen
ext 54731/54732
email:
alexander.mackenzie@nhs.net
Information can also be obtained from The National Travel Health Network and Centre (NaTHNaC) https://travelhealthpro.org.uk/ or NHS Direct www.fitfortravel.scot.nhs.uk/ and www.travax.nhs.uk
Other Major Health Considerations are:
1. Hepatitis B – you should already be immunised. If you are a non-responder you should discuss this with your own general practitioner before visiting endemic areas.
2. Hepatitis A – may be advisable.
3. Typhoid – may be advisable.
4. Polio and tetanus immunisation should be up to date.
5. Malaria – up to date information on prophylaxis is essential for endemic areas.
There are many other possibilities, which may be relevant to specific situations e.g., Meningococcal vaccine, Japanese B encephalitis, rabies etc. Check with Dr A McKenzie or Dr R Laing
Arrange the necessary immunisations with your own GP. If you have any particular clinical problems with immunisation, Dr A McKenzie or Dr R Laing, Infection Unit, ARI will give advice.
7. Sunburn - Take a high factor blocking agent and a hat to tropical countries. Minimise your exposure to direct sunlight.
8. Bathing - Schistosomiasis is endemic in Africa and in some parts of South America and some Caribbean Islands. There is no practical way to distinguish infested from non-infested water, and therefore, it is best to avoid fresh water swimming.
9. Teeth - Have a dental check-up 3-6 months before travelling.
10. If you have a pre-existing medical condition you must ensure you have adequate medication with you and that treatment is available at the host location if required. You should always declare the condition to you travel insurer and ensure that the cover includes travel back to the UK in emergency.
Violence
It is regrettable but fact that students occasionally are victims of violence during electives. A recent incident occurred in Jamaica. Students going to the Caribbean are recommended to go and move around in pairs and to pay particular attention to dress and demeanour to avoid being seen as a potential target for assault.
Responsibilities
It is you, as students, who are responsible for ensuring you have considered potential risks and have strategies in place for dealing with these.
We would ask any student travelling overseas for their elective to read and complete the attached form confirming that you understand the potential risks. Download