Eeek Typhoid, Hepatitis, Cholera

Many of us would have read or heard about the recent case where a large number of people suffered food poisoning after eating cakes from a certain bakery. Investigations subsequently revealed that some of their employees were carriers of the salmonella bacteria. This case has highlighted once again that we must never take for granted the importance of personal and food hygiene. It certainly serves as a reality check for us not to be over complacent. Just imagine, if this could happen in Singapore, it could happen in other countries. And this brings me to the topics of Typhoid, Hepatitis A, Cholera and travelers diarrhoea.

Typhoid

Typhoid or Typhoid fever is a condition that is spread by contaminated food or water. It is caused by the organism Salmonella enterica. People affected by this usually experience fever, abdominal pain, diarrhoea or vomiting. In Singapore, we commonly group these symptoms together and call it “food poisoning”.

From the recent newspaper reports, you would realize how serious this infection can be. Some of those affected have experienced serious infection which required hospitalisation. The bakery itself has been shut down for disinfection.

Fortunately for us in Singapore, all our food handlers are required to go for Typhoid vaccination every 3 years. We usually do not see this type of outbreak happening, but the fact that it has happened in Singapore highlights how easy it is to be infected when dirty food or water is consumed.

The Typhoid vaccine is available in most GP clinics and it is recommended if you are travelling to any part of the world where typhoid is common. Basically if you are doing any regional travel to less developed countries, you should be vaccinated.

When should I take the vaccine?

For the injection (Typherix), all that is required is a single dose of the vaccine, but this should be done 2 weeks before travel and it will last you for 3 years.

There is an oral version of this vaccination called Vivotif Berna. For this one, it requires singles doses on alternate days for 3 days.

Hepatitis A

Hepatits A is a viral infection of the liver that is also spread by contaminated food and water. It is fairly common in Singapore and is the type of hepatitis that people commonly think is spread by cockles. Cockles are usually found on the sea bed and they basically eat up whatever is in the surrounding water. Now if this water is contaminated by sewage, it would harbor the virus inside. If the cockles are not properly cooked, you can get this infection.

Is it preventable?

Yes, Hepatitis A is preventable. Vaccination is available at most clinics and it usually requires 2 doses separated by 6 months. If you are not sure if you have been vaccinated before, a simple blood test can be done to determine your status to see if you require vaccination.

Cholera

Cholera is terrible infection that is caused by the organism Vibrio cholera and yes it is spread by contaminated food and water. It causes severe diarrhoea, vomiting and leads to dehydration and even death.

Fortunately there also is a vaccine against cholera and it is recommended when you are going to a place where sanitation is bad. I would think that those going to rural areas especially for mission trips should have this vaccination.

In Singapore, the vaccine I have used is Dukoral. It can be given to anyone above 2 years of age. For those aged between 2 to 6 years, 4 doses are required in total separated by 1 week intervals with the 4^th dose at the 6^th month.

For those above 6 years, 3 doses are required separated by 1 week intervals with the 3^rd dose at the 2^nd year for booster. Generally no vaccine is 100%, but It offers a protection rate of 85% at 6 months and about 50% for 3 years.

The other benefit of this vaccine is that it also provides for protection against travelers diarrhoea.

Conclusion

So, in conclusion, if you are going to be doing any regional travel at all where hygiene may be a cause for concern, please do consult your family doctor and find out what precautions you can take in terms of vaccination. The universal precautions of washing your hands frequently, using soap, eating properly cooked food and drinking bottled or boiled water always applies. And take note, no vaccine is 100%, but we can take precautions to minimise our chances of falling ill.

New Home Pics - Off topic

Off topic....

Just moved house and took some photos with my handphone camera. Hope its not too grainy...

MALARIA

I recently saw a 9 year old girl in the clinic when her mother brought her for vaccination before going for a trip with the their church to Cambodia for a mission trip. They had been advised to take a flu jab before going. Only the girl was going and not her parents.
As I talked to her mother, I found out that the church was sending a group of children from the Sunday School to a village in a rural part of Cambodia for exposure to the mission work they were doing there. It was to be a 4 day trip.

I was rather surprised that they had only been advised to take a flu jab. I proceeded to tell them about Malaria. Now many of us in Singapore who have gone through the army would know all about Malaria and Malaria pills. But Singapore is essentially free of malaria and many in the general population are not quite aware of its dangers and prevention.

Basically Malaria is spread by mosquitoes. Specifically the bite of the female anopheles mosquito. It is a parasite(Plasmodium) which infects the red blood cells and then goes on to affect other organs in the body. It can become life threatening if left untreated.

Prevention involves trying to avoid the mosquito bites by wearing covered clothing, minimizing outdoor activity from dusk to dawn (when the mosquito is most active) and taking anti-malarial pills for prevention.

Now there are various anti-malarial pills available in Singapore such as mefloquine(Lariam), malarone, and doxycycline. The type of anti-malarial pill to be taken would depend very much on the location that you are going to. This is because of drug resistant malaria. For some of these anti-malarial pills like mefloquine, you only need to take it once a week, but for the others like malarone and doxycycline, it needs to be taken on a daily basis.
You usually need to continue on the medication for 4 weeks after leaving a malaria endemic area. However for Malarone, it only needs to be continued for 7 days upon leaving the area.

For more information on what type of anti-malarial pill you need, you can refer to this website and counter check the destination of your travel, here

Back to the girl…..

Since she was going to a rural part of Cambodia where there would be questionable sanitation, I suggested the typhoid vaccine, hepatitis A vaccine and an oral vaccination against cholera and travelers diarrhea. We will soon talk about these in future posts.

For the mean time, if you are going to be doing any traveling, do refer to the link that I have given for recommended health vaccinations and consult your family doctor or GP.

Thanks and have a good week ahead.

FLU Vaccine?

Its December and School Holidays are here! Exams are over! Christmas and New Year are just round the corner.

Here in Singapore, we've certainly seen an increase in the number of travelers coming to Singapore. I'm sure many of you have read about the hotel space shortage.
In my practice as a General Practitioner, I have seen an increase in the number of travelers coming to Singapore, be it for holiday, business or even just transiting through for 1 or 2 days.

In addition, many residents of Singapore have also been traveling abroad. Some for business, some for leisure and interestingly enough, I have seen quite a few groups of people going for regional mission trips. So far I've come across church and school groups and these are mainly to the regional countries like Thailand, Cambodia, Vietnam etc.

Now why would I be seeing travelers?

For those of us who have gone on holidays or done any travel at all, you would understand the trouble and inconvenience of falling ill just before your trip or even during the trip. People usually see the doctor if they fall even mildly ill 1 to 2 weeks before their intended travel. They come to the doctor's clinic with the hope that they can recover quickly before the trip or to take some travel medication for standby.

With increasing health awareness, many are starting to realize the importance of prevention and the benefits of vaccinations before travel. I personally think that the scope of health awareness in Singapore has changed ever since we were hit with the SARS. The number of people taking the Flu vaccination has increased and this is what I would like to discuss today.

What is the FLU?

The Flu refers to an infection of the respiratory tract by the Influenza virus which is highly contagious. The symptoms include body aches, fever, lethargy, cough, running nose and sore throat. Generally the symptoms are much more severe than that of the common cold.

What is the Flu Vaccine?

Basically the Flu vaccine contains the inactivated(dead) form of the virus. It is given as an injection usually into the arm and it takes about 14 days for it to confer protection. Now it is important to note that the vaccination will protect you against the influenza virus and not the common cold. That means you can still come down with the usual cough, cold and running nose.

There are a few different brands available for the flu vaccine. The ones I have come across are, Fluarix, Fluvax, Vaxigrip.

So why should I take the vaccination if I can still come down with the common COLD?

Well, the influenza virus infection is more severe with possible hospitalization and it is potentially life threatening.

Do I need Vaccination?

The current recommendations for the Flu vaccination are:

• Travelers to overseas countries where the influenza virus is present
• The elderly
• Patients with chronic medical conditions such as chronic kidney disease, heart problems, diabetes etc.
• Residents and staff of nursing homes
• Medical personnel
• In general anyone who wishes to prevent influenza infection

Basically anyone above 6 months of age can take the flu vaccination, however, those allergic to eggs cannot take it.

How often do I need vaccination?

The viruses change and mutate from year to year and therefore the vaccine is constantly updated. You may have taken the jab and be protected against the active strains of the season, but once the strains change, you will be susceptible to infection again.

Are there any side effects?

With any vaccination, it is always possible to develop fever, but this is generally a low grade fever which can be treated by taking some paracetamol like panadol. Some others may develop muscle aches, usually over the injection site. I usually get this and doing push ups or pull ups are a bit painful for me for 1 to 2 days.

Well, that’s it for now. Feel free to ask me any questions or clarify anything which isn’t clear, or point out any mistakes to me.

Have a good day and in case I forget to wish you people…..

MERRY CHRISTMAS AND A HAPPY NEW YEAR!