In this second article, Lucy Kenyon SCPHN, M.Med. Sci., RGN explores the general issues relevant to the flu season and the how to manage the risks of picking up and transmitting infections while travelling.
Flu (influenza) has been hitting the headlines since 1918, when it spread from America to Europe during WW1. Annual epidemics of influenza typically occur during the winter months, but infections can peak as late as April or May. As this yearâs flu pandemic continues to feature in the international press, there are some salient precautionary messages for frequent travellers, whether one uses air, rail or other public transport services. These messages represent good practice for infection control and apply equally to the other key source of communicable infection â schools. Children use touch to communicate with each other much more than adults, and this leads to a quicker transfer of the virus between children, who also remain infectious for longer.
What is flu?
It is a virus that causes general and upper respiratory symptoms â typically with a high temperature (>37.8Â°C). It is carried by droplets through sneezing and coughing virus particles into the air, onto hands, handkerchiefs and clothes. The typical incubation period for influenza is 1-4 days. Adults are infectious from the day before symptoms begin until 5 (majority) -10 days (children) after the onset of the illness.
Influenza trends in 2013
The late 2012-early 2013 influenza season began relatively early compared to previous years, with flu rates highest in the United States. Based on experience, the CDC (www.cdc.gov) believes that it is likely that flu activity will continue for some time, possibly into May.
Early data from the CDC suggest that this seasonâs vaccine is âmoderately effectiveâ, in that it is reducing the risk of having to go to the doctor for influenza by about 60% for vaccinated people. This is because this yearâs vaccine is protective for most influenza strains currently circulating. There are, however, some new mutations for which vaccines have not yet been produced.
Swine flu is the recent strain of the virus that first caused concern in 2009, affecting more healthy adults than other flu viruses and a large number of people in Western Europe. Swine flu cases have reported by the Beijingâs centre for disease control and prevention as being particularly high in Beijing at present, and cases of Swine flu were recently reported in Poland. Swine flu is one of the strains that have developed some resistance to anti-viral drugs, which makes it more difficult to treat effectively.
This means that travellers in Eastern Europe and Russia should be more vigilant about preventative hygiene measures.
A number of medicines are known to be effective against flu. Here in Russia it is possible to buy some medicines over the counter (see MeL Winter 2012). Some of these are not safe if you have an underlying condition, so you should never take them without a doctorâs prescription.
If you suffer from asthma or bronchitis, ensure that you discuss vaccination with your doctor. The US government is recommending vaccination of all persons over 6 months of age. In the UK the programme continues to protect the elderly and those with other conditions that put them at increased risk from flu e.g. heart disease and lung diseases such as asthma.
New arrivals in Moscow should be particularly vigilant, because chest and gastric infections, including flu can be brought on by being in new surroundings because you will have little or no resistance to unfamiliar viruses. Moscow, like most major cities has a higher reported rate of asthma and bronchitis probably due to poor quality air.
â¢ Wash your hands regularly (especially before and after using public services such as handrails and door handles) to reduce the transfer of bugs to and from hand to mouth
â¢ Stay away from other people during the incubation period (5-10 days after symptoms appear).
â¢ Drink plenty of fluids to flush out the bugs.
â¢ Take fever-reducing medicines on the advice of a pharmacist (see my article in the Winter 2012 issue of MeL for detailed advice).
â¢There are articles circulating in the popular press that recommend treatments other than those listed above, and appear to quote organisations such as the World Health Organisation. If you want to try an alternative medicine, be sure to have read and understood the citation first!
Advice for employers
The following questions may help be useful when considering arrangements against pandemic flu in your business continuity plan:
â¢ Look at how the spread of infections within the business can be prevented. It is important to look at general cleaning routine: hand washing facilities, disposal of hand towels etc.
â¢ Who are your frontline staff?
â¢ Do frontline staff have access to vaccination?
â¢ Do reporting procedures enable early identification of a potential infection risk in an office or depot?
â¢ Have managers been trained in those procedures?
â¢ Is it possible to identify contacts that may have been exposed to infection during the dayâs infectious period prior to a colleague becoming sick?
â¢ Do we need to quarantine any offices or depots during the incubation period following a case of flu?
â¢ If a colleague has recovered from flu but remains infectious, what work can they do and where?
Travel planning and first aid
Travelers should take action before, during and after their trips to protect themselves from influenza. Moscow expats who travel to the Southern Hemisphere should be aware that influenza activity occurs typically between April and September.
If travelling to an area where flu is known to be circulating, check that you have received this seasonâs vaccination in time. People should be vaccinated at least two weeks before travelling because it takes two weeks for vaccine immunity to develop. The vaccine is modified every season to cover known circulating strains, so check that your most recent vaccination is up to date.
â¢ Discuss with your doctor whether you should take prophylactic (preventative) medicines with you.
â¢ Carry antibacterial hand wipes or alcohol-based hand sanitizers containing at least 60% alcohol, a digital thermometer and oral rehydration packs.
â¢ Pack any prescription medications (antibiotics and antivirals) in your carry-on luggage with copies of all prescriptions, including the generic names for medications. NB You may need a note on letter headed stationery from the prescribing physician for some drugs and injectable medications.
â¢ Leave a copy of your prescriptions at home with a friend or relative.
â¢ Check with your embassy or consulate to make sure that your medicines will be allowed into the country you are visiting. Some countries do not let visitors bring certain medicines into the country.
If you know that you have a condition that can be aggravated by flu, consider carrying commercial suture/syringe kits to be used by a local healthcare provider (these items will also require a letter on letter headed stationery from the prescribing physician).
Biography: Lucy Kenyon SCPHN, M.Med.Sci., RGN is a Specialist Community Public Health Nurse, with a background in occupational and environmental health. She has a keen interest and expertise in the relationship between people and their environment. Prior to moving to Moscow in 2009 she was involved in pandemic planning for Tier 2 emergency services in the UK. She has written specialist articles on health matters for Croner Special Reports since 1997. She is also an expat spouse, who understands the challenges of day to day issues when living abroad.