Not to mention depression from an early return.
Seriously though, good luck :)
---------- Forwarded message ----------
From: <[log in to unmask]>
Date: 11 June 2010 19:08
Subject: URGENT HEALTH MESSAGE: CARE FOR PATIENTS RETURNING FROM
FOOTBALL WORLD CUP IN SOUTH AFRICA
To: [log in to unmask]
Dear Colleagues,
The following information has been issued by the Health Protection
Agency (HPA) on Friday 11 June 2010. It offers guidance for GPs who
are providing care to those travelling back from the Football World
Cup in South Africa with illness.
Our distribution to you is part of the RCGP's commitment to working in
partnership with the HPA in communicating important healthcare
messages to GPs.
Many regards
Dr Maureen Baker
RCGP Health Protection Lead
Email: [log in to unmask]
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Health Protection Agency briefing note for GPs: returning travellers
from the FIFA World Cup in South Africa
The 2010 FIFA World Cup takes place in South Africa in June and July
with more than 20,000 people from the UK expected to attend*. An
additional 35,000 UK visitors are expected to visit South Africa in
June for reasons unrelated to the World Cup. Most of these travellers
would not be expected to experience adverse health events during their
trips. There are however a number of infections that clinicians should
be aware of in assessing travellers returning from South Africa who
are unwell or concerned about their health, and for which this
briefing provides outline information and/or links to further advice,
including:
- Gastrointestinal diseases
- Malaria
- Rabies
- Measles
- Rift Valley Fever
- African tick bite fever
- Sexually transmitted infections and blood borne viruses
- Influenza
- Tuberculosis (including drug resistant forms)
- Meningococcal infection
New information about any outbreaks or infectious disease threats
associated with the World Cup will be posted on the HPA website at:
http://www.hpa.org.uk/web/HPAweb&Page&HPAwebAutoListName/Page/1274089970728
and on the National Travel Health Network and Centre (NaTHNaC)
website, where a searchable database of global outbreaks is also
maintained http://www.nathnac.org/
Clinicians should also be aware that some visitors to South Africa may
also have travelled to other countries and been exposed to other risks
than those included here. It is always important to take a detailed
travel and risk exposure history from any returning traveller who is
unwell and to include this information in requests for laboratory
diagnosis, as this guides the investigations performed. Primary care
clinicians should also seek clinical advice from their local
infectious disease unit as appropriate.
The infections to be particularly aware of in travellers returning
from South Africa are listed below with links as appropriate for
further information.
1. The most common travel associated infections are gastrointestinal,
which are predominantly self limiting. Where symptoms are severe or
prolonged, stool specimens may be taken for diagnosis. In all cases
hygiene advice should be given to prevent secondary spread. For a
pyrexial patient with systemic as well as gastrointestinal symptoms an
infectious disease assessment may be appropriate. For example, enteric
fevers and malaria can both present in this way. Hepatitis A is also
endemic in South Africa.
2. Although malaria is not considered to be a risk in the World Cup
host cities, travellers who have visited malaria risk areas in South
Africa or in other countries must be investigated for malaria.
In South Africa: there is a high risk of malaria in the low altitude
areas of Mpumalanga and Limpopo which border Mozambique and Zimbabwe.
This includes Kruger National Park. The areas bordering these are low
risk. There is also a high risk of malaria in northeast KwaZulu-Natal
as far south as Jozini and a low risk between Jozini and Richards Bay.
A map showing the risk regions in South Africa is available from the
National Institute for Communicable Diseases in South Africa at
http://www.nicd.ac.za/fifa2010/A_Guide_for_World_Cup_Visitors.pdf
Further information on malaria risk in other countries can be found on
the NaTHNaC Country Information Pages
http://www.nathnac.org/ds/map_world.aspx
3. There is a risk of rabies in South Africa. Transmission is via
contact with saliva from infected wild/domestic animals, usually as a
result of a bite, scratch or lick to open skin. Anyone reporting such
exposures should be assessed for their requirement for post exposure
prophylaxis. Please contact the HPA, Centre for Infections, Clinical
Rabies Service for advice.
http://www.hpa.org.uk/Topics/InfectiousDiseases/InfectionsAZ/Rabies/
4. There is a large ongoing outbreak of measles in South Africa, with
cases reported from all nine provinces but concentrated in the
northeast. Please inform your local Health Protection Unit if you
suspect a case of measles. You can find your local unit here;
http://www.hpa.org.uk/ . For further information on measles please
see; http://www.hpa.org.uk/Topics/InfectiousDiseases/InfectionsAZ/Measles/
5. Since February 2010, there has been an outbreak of Rift Valley
Fever in livestock in South Africa which covers a wide geographic
area. Human cases have been reported from the Free State and Northern
Cape provinces. Although the risk to most travellers is considered to
be low, travellers may be infected and present in healthcare
facilities in the UK. For further information see:
http://www.hpa.org.uk/Topics/InfectiousDiseases/InfectionsAZ/RiftValleyFever/
6. Travellers whose activities involve walking through brush and
grasslands in southern African countries are at increased risk of
acquiring African tick bite fever, a tick borne rickettsial infection
characterised by fever, rash and vasculitis. Please contact your local
infectious disease unit for advice on an unwell returning traveller
with a relevant exposure history. For more information on rickettsial
diseases please see; http://www.nathnac.org/pro/factsheets/rick.htm
7. Sexually transmitted infections (STIs) and blood borne viruses,
such as HIV, Hepatitis B and Hepatitis C, are prevalent in sub-Saharan
Africa. The World Health Organization (WHO) estimates approximately
20% of South African adults aged 15 to 49 years are HIV-infected**.
The increased risk of acquiring an STI during mass gatherings should
be noted. Any traveller presenting with risk exposures or symptoms
should be investigated as appropriate. HIV seroconversion can present
as a febrile illness.
8. As at 17 May 2010 there was no influenza reported to be circulating
in South Africa http://www.nicd.ac.za/. The influenza season in South
Africa generally starts however towards the end of May and peaks in
June with transmission continuing, but tailing off, to the end of July
and August. The season will therefore likely coincide with the World
Cup and transmission in the general population may be high. Although
the risk of influenza transmission in open stadiums should be low,
influenza outbreaks have been previously reported at outdoor mass
gatherings. It is anticipated that the influenza A (H1N1) 2009
pandemic strain will cause the majority of infections, which are
usually mild; however, severe cases may occur, predominantly in
patients with underlying comorbidities. If a traveller returning from
the World Cup presents with a flu like illness, the HPA would
recommend that the patient is fully assessed, including nose and
throat viral swabs. If influenza is considered likely then
practitioners should follow Department of Health and NICE guidance on
clinical management. For further information on H1N1 influenza please
see: http://www.hpa.org.uk/Topics/InfectiousDiseases/InfectionsAZ/SwineInfluenza/SIProfessional/
If a patient has severe illness or deteriorates other diagnoses should
also be considered including legionnaires disease.
9. South Africa has the highest number of cases of multi-drug
resistant (MDR) and extremely drug resistant (XDR) tuberculosis in the
southern African region***. The risk of contracting TB during travel
to the World Cup tournament is very low, as prolonged exposure to the
bacteria is usually necessary and brief contact carries little risk.
However travellers with a relevant exposure history and consistent
symptoms should be investigated promptly. For more information on
tuberculosis see:
http://www.hpa.org.uk/Topics/InfectiousDiseases/InfectionsAZ/Tuberculosis/
10. Sporadic cases of meningococcal disease occur year-round in South
Africa with a seasonal increase in sporadic cases from May to October.
Serogroup W135 is currently the predominant serogroup.
References:
* Football World Cup in South Africa: travel advice for UK fans Health
Protection Report 4(12): 26 March 2010
http://www.hpa.org.uk/hpr/archives/2010/hpr1210.pdf
** World Health Organization. South Africa: HIV/AIDS epidemiological
fact sheet. December 2005: Geneva, Switzerland. Available at:
http://www.who.int/hiv/HIVCP_ZAF.pdf
*** World Health Organization. South Africa: Country Profile. WHO
Report: Global Tuberculosis control 2007. Available at:
http://www.afro.who.int/en/divisions-a-programmes/atm/tuberculosis/tub-country-profiles.html
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