Travelling and Infections by Dr Victor Ti
31 Jan 2018

Just a week ago, I saw one patient who just returned from her vacation in the US.

“This is my worst vacation ever.” She lamented. “The weather was so cold and I was down with a bad flu that was worse than all the previous flu that I had ever experienced. I spent so much money, wasted so much time and suffered the miserable chill and rigours in an unusually freezing cold weather in the US this year. The wonderful vacation that I have been looking forward to, turned out to be a nightmare.”

Incidentally, the outbreak of flu in the United States this year is the worse in 15 years. This year’s flu is mainly caused by influenza A (H3N2) that is known to be causing a more serious type of flu.

In life, we are continuously exposed to risks all around us, everywhere. We are surrounded by invisible enemies wherever we are, regardless of whether we are at home, at work or on vacation. When we travel, we are exposed to more people and places.

We breathe in the droplets that others breathe out. Some of the droplets that they cough or sneeze out may settle on our hands, lips or eyes. These droplets may contain harmful viruses and bacteria that are invisible to our naked eyes.

Apart from the droplets, we also touch things that they have handled. Each day, the door knobs, rails of elevators, keyboards of electric lifts, et cetera at the airports or shopping complexes and the fingerprint biometric sensors at immigration counters are touched by thousands of people. If only one of them has the influenza virus infection, we are exposed because he would invariably wipe his uncomfortable wet nose with his hands.

The precious dollar notes that we carry with us everywhere we go could be some of the dirtiest. They have been passed on and on since the time they were created, from perhaps the beggar to the hawker, influenza sufferer, typhoid carrier, etc. and finally to us.

In the cabin of the airplane, we share the same air with probably 350 other passengers and crews. Some of them have influenza, hand-foot-mouth disease (Coxsackie infection), viral conjunctivitis (sore eyes), chicken pox, etc.

We are exposed and vulnerable at all times. What shall we do? Can’t we defend ourselves against these unseen enemies? Yes. Certainly we can and to a large extent. The war against those dangerous microbes (viruses and bacteria) is ongoing. Our scientists have successfully developed various weapons to protect us from within. We have our immune system that can be trained to recognise and destroy various viruses and bacteria. They produce antibodies that specifically attack those viruses and bacteria that they are familiar with.

These are like the different groups of special commander squads that were specifically trained to defend us against specific enemies with their specific strategies.

Vaccines are specific “dummy enemies” used to train our special squads in the simulation drills to recognise and destroy the targeted enemies that we come in contact with anytime, anywhere. Nowadays we have advanced vaccines that comprise multiple “dummy enemies” to train our immune system to handle multiple strains of viruses or bacteria.

For example Fluquadri is a new 4-strain influenza vaccine that trains our immune system against two strains of influenza A viruses and two strains of influenza B viruses. Travellers need to have it yearly.

Another vaccine that is thought to be essential for the people in Cambodia is the typhoid vaccine.

Two types of typhoid vaccines are currently available. Those who fear needles can opt for the oral capsules. Typhoid is a bacterial infection that can lead to high fever sometimes with accompanying delirium, abdominal pain, diarrhoea, and vomiting. It can be fatal and is caused by the bacteria Salmonella typhi that can remain in human carriers throughout their whole lifetime. These carriers continue to pass on the bacteria to their unvaccinated contacts.

Hepatitis A virus is transmitted through contaminated food or water in Cambodia regardless of where you are eating or staying. Thus, hepatitis A vaccination is also recommended.

Other vaccinations that are helpful include Japanese encephalitis, hepatitis B and rabies. I personally do not recommend the cholera vaccine as it is not very effective. Giving the vaccine may give a false sense of security to the travellers.

Thus, it can be counterproductive. I prefer to advocate good personal hygiene and the avoidance of eating food at dirty outlets.

Apart from vaccines, there is another innovative advanced technology that smart travellers may want to have. Q shield is the latest hand sanitiser that stays on your hands for 24 hours to continuously kill viruses and bacteria.

Q-shield kills the microbes by micro-electrocution and piercing them physically with its tightly packed microscopic sword-like structure. It is non-toxic and is a protective shield equipped with uncountable number of “swords” and electric shocks. What a futuristic star-war technology! This ingenious technology is so good that I have decided to bring some in, for the benefit of some of my faithful friends and patients who strongly requested for it.