Monday, June 15, 2009

To travel or not to travel with a pandemic?

For most of us, this is our first experience with a pandemic. Hence, the many questions on holiday and travel plans. Should we risk travelling under such circumstances? Sunday Star seeks the advice of the experts to answer some of these queries.

IT seems like such a wonderful opportunity – cheap airline tickets to distant destinations and lower fuel surcharge!

Despite this, family and friends are advising against holidays and unnecessary travel because the World Health Organisation (WHO) has declared the influenza A (H1N1) a pandemic.

While the more cautious ones have delayed their holiday plans and are even willing to lose their deposits with the travel agents, many are keeping to their travel plans made months ago. And there are some who are gleefully taking advantage of the low fares and hope the situation remains that way for a few more months.

“I can’t believe that I can get a ticket from London to KL at such a low price. If such prices keep up, I will definitely be travelling between these two cities a couple of times this year instead of just making an annual trip,” says a homemaker with two sons studying in England.

Although WHO has not advised against travelling, even to the 193 infected countries, the Health Ministry recommends that all non-essential travel to those countries be deferred.

However, with the summer breaks in the United States and Europe, many are also expecting friends and relatives over for a holiday in Malaysia.

Thousands of Malaysian students and graduates overseas are also expected to return home with the end of their academic year.

As the world gets into gear to prepare for the worst, Sunday Star has been flooded with queries on the pandemic and its implications on travel.

At hand to answer public concerns are Universiti Malaya senior research fellow and virologist Prof Emeritus Datuk Dr Lam Sai Kit and Health Ministry Disease Control Division director Datuk Dr Hasan Abdul Rahman.

> My son who is studying in Melbourne is due back at the end of the month. Should I ask him to stay back in Australia? Serena Chong, Kuala Lumpur

Datuk Dr Hasan Abdul Rahman: There is no restriction to travel back to Malaysia; he is welcome to return. But if he has symptoms of influenza, he should delay his travel until he is fully recovered.

Prof Emeritus Datuk Dr Lam Sai Kit: This is where the exit screen is important. Don’t get on board a plane if you have any flu-like symptoms. Practise social responsibility and don’t spread the germs. Wear a mask at all times. Don’t offer to shake hands. If there is no travel advisory, then there is no reason not to travel if you are healthy.

However, if you have any symptoms like fever, you run the risk of being put in quarantine, flu or no flu, especially if you are flying in from an endemic country. Why take the risk? Just postpone the trip till you have fully recovered.

> My sister is pregnant and works at an office where someone who just returned from an overseas trip is undergoing tests for H1N1 flu. What are the risks of swine flu for people who are pregnant? Ana Aziz, Alor Star

Dr Hasan: The risk of infection is the same if your sister is in close contact to the person (close contact refers to within one metre of the person having illness). The severity of infection may be higher in pregnant woman, especially if the pregnancy is complicated with other illnesses such as asthma, hypertension or diabetes.

Prof Lam: ‘Don’t get on board a plane if you have any flu-like symptoms’

Prof Lam: The risk of severity is higher in those who are pregnant. If there are cases of flu-like illness in the office, then she will have to take extra precautions. Wear a mask at all times while in office, wash or sanitise hands, avoid transferring the virus to your nose, eyes or any parts of your face (easier said than done, I am afraid).

> If you had another illness such as the common cold or another type of influenza at the time of contracting H1N1 flu, are you likely to become significantly more ill with the virus? Ahmad Idris, Kuala Lumpur

Dr Hasan: Usually, yes. Illness with multiple infections will be more severe than illness caused by a single infection. That is why you shouldn’t travel if you have any flu symptoms.

Prof Lam: Dual infections by similar or related viruses can happen but we are not sure that this will result in a worse clinical outcome. If a person is infected with two influenza A strains, for example, H1N1 and H3N2, then the most worrisome situation is genetic mixing, resulting in a totally new strain of flu A virus that possesses genetic traits of both. This can happen in animals (pigs, poultry) or man. Hopefully, it will not be a cross with the more pathogenic H5N1 bird flu strain. Then we really have grounds for concern.

> I suffer from asthma. Am I more at risk and what precautions should I take when I travel? Amril, Ipoh

Dr Hasan: Asthma is one of the risk factors. You should avoid close contact with any person with influenza-like illness.

Prof Lam: People with chronic chest problems can ill afford to get the flu. If you have made holiday plans, postpone the trip unless it is absolutely necessary. Wear a mask throughout the trip and take other precautions as listed above.

> I have a nine-month-old and a four-year-old. We have made holiday plans to visit my sister in Australia. How does the virus affect children of this age? P. Larita, Kuala Lumpur

Dr Hasan: All age groups are susceptible to the infection. The mode of the infection is still the same, which is droplet to the upper respiratory tract. That is why personal hygiene is very important.

Prof Lam: Children have a lower resistance to flu, hence the severity and deaths associated with this age group. Remember that anatomically, the respiratory system (as well as the immune system) is still under-developed and the virus can therefore spread lower down faster.

It is difficult for parents to know whether the child has merely a cold or flu, so parents must really educate themselves to recognise what to look out for. If you are ever in doubt, consult a doctor. If the elder child goes to a playschool or kindergarten, that can be a source for spreading of germs and bringing it back to infect the younger child, and even parents.

> I recently returned from a business trip in New York and I have been exhibiting signs of flu after I returned. However, now my symptoms appear to be decreasing and I feel a lot better. Should I bother to see a doctor at this point? JJ, Penang

Dr Hasan: All persons with symptoms of influenza should seek treatment as soon as possible. By doing so, he will help to control the spread of disease and at the same time get appropriate treatment for the illness.

Prof Lam: Definitely yes. The symptoms are very typical of flu and the authorities must know about it so that they can check out those whom you have been in contact with and give them advice and treatment if necessary. It is a social responsibility you must bear. Remember that you may still be infectious even though your symptoms are subsiding. Keep indoors and avoid infecting others.

Dr Hasan: ‘All age groups are susceptible to the infection’

> We are due to travel to Hong Kong in July to holiday there for two weeks. Is it wise to cancel our holiday or are we just being overcautious? Wong, Klang

Dr Hasan: Currently, Hong Kong does not impose any restrictions on tourists. If you have symptoms of influenza-like illness, however, it is advisable to delay the visit as Hong Kong may place you under quarantine if they find that you have symptoms of influenza on arrival.

Prof Lam: There is no advisory not to travel to Hong Kong, Australia or anywhere else although this can happen overnight if the situation warrants it. Australia, for example, is going into the peak months of flu with the arrival of winter, so the risk of a bigger outbreak of H1N1 or seasonal flu is there. It is also quite obvious with the increasing number of reported cases daily. You travel at your own risk. You are the best judge, to go or not to go, but make sure you know the risks involved.

> I am expecting relatives from the UK for a holiday. Do I ask them to cancel their trip or put them up in a hotel when they are here so that they don’t contaminate my house? Leong, Shah Alam

Dr Hasan: If they are free of influenza-like illness symptoms, they are welcome to come to Malaysia. If any one of them demonstrates any of the symptoms, they should wait until they are fully recovered and cleared of A(H1N1) suspicion before making the trip to Malaysia.

Prof Lam: As mentioned earlier, travelling should be on a need basis to avoid getting infected. Going on holidays means moving in crowded places, making many new friends, many more handshakes, etc. Will you have peace of mind under the circumstances? At Level Six, we should really review our activities.

> I’m going on my honeymoon to Europe in six weeks’ time. Should we get Tamiflu to take with us as a precaution? If yes, where can we get it? Susan, Kuala Lumpur

Dr Hasan: Tamiflu is only for people with symptoms. The best practice is good personal hygiene, including washing your hands after sneezing or coughing. Avoid crowded places, or if unavoidable, wear face masks.

Prof Lam: Tamilfu is not recommended as a prophylaxis if you are just a routine traveller. It is only prescribed to those who have been in close contact with a patient suspected to have H1N1. Do not abuse the use of Tamiflu or we run the risk of virus developing resistance rapidly. Then we will have nothing to use when it is really needed. Remember, Tamiflu is not a flu vaccine!

Source : STAR
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