Travel without insurance at your peril

Travel Summer 2014Travellers risking medical claims running into tens of thousands of pounds as a poll shows that nearly a quarter (24%) of adults who take out travel insurance would not do so if they were going on a round-the-world trip of up to six months.

ALC Health’s Prima Travel plan has been created exclusively for residents of all European Union (EU) countries regardless of nationality and where our choice of world class cover options offer not just peace of mind, but great value for money.  To find out more, visit our dedicated travel web site at today

French health system the best for expatriate retirees

imagesThe 2014 International Living Global Retirement Index has ranked France as number one in its health care category. The study, which ranks destinations on their suitability for retired expats, praised France’s “affordable and great quality” healthcare writes of

The benefits highlighted in the report include the fact many doctors and healthcare professionals speak English, especially in major cities. Treatment in public facilities is available to those who pay, or used to pay, into the social security system. Fees for services in the public system are set, with the state paying around 70 percent of the costs. The remainder is paid out-of-pocket or by supplementary health insurance plans. The government may pay 100 percent of the costs related to serious illnesses.

In general, if you visit a doctor you pay the fees directly to them and are then reimbursed by the insurance company. Hospitals work on a direct reimbursement system, whereby patients only pay the portion which isn’t covered.

For non-EU citizens thinking of retiring in France, private health insurance is mandatory. Private insurance bought in France usually covers hospital fees but under some plans patients must pay the cost of doctor consultations themselves. Other plans refund 75 percent of doctor’s fees. The US embassy in France can help expat retirees find an English speaking health insurance provider, advises International Living.

The report, aimed at US expat retirees, places Uruguay second in the healthcare category. Uruguay’s cheap (compared to the US) private care and modern, high-quality facilities make it a good choice for expats.

Malaysia came in third place. A popular medical tourism destination, its modern private facilities and range of insurance options means healthcare needn’t be a drain on your budget. The report noted the majority of dentists are UK or US trained and can speak English, and prescriptions costs are a fraction of what you would pay in the States.

Regardless of where you decide to retire, healthcare provision must be a priority. If you don’t have private medical insurance then ensure you are aware of the costs you will be required to pay out of pocket.

10 diseases you need to watch out for when travelling overseas

As an increasing number of destinations worldwide open their arms to international travellers, which infectious diseases could you be exposed to?

Dengue Fever

Locations: Caribbean, Central and South America, Western Pacific Islands, North Australia, South and South-East Asia, West and Sub-Saharan Africa.

This mosquito-spread virus can be found in many parts of the world and with no treatment or vaccine available yet, your only protection is to cover up and use insect repellent to keep the mosquitoes at bay. This species of mosquito, Aedes aegypti, bites throughout the day. Symptoms can take up to two weeks to develop and are flu-like, including fever, headache, nausea, vomiting and pain in the eyes, muscles and joints, and generally last for one week.

There are four different serotypes of the dengue virus, all of which are now found globally and whilst infection with one can give you immunity to that type in the future, infection with a second, third of fourth serotype can lead to more severe illness than the first exposure — such as Dengue hemorrhagic fever.


Locations: Africa, the Middle-East, and some parts of South America, the Caribbean and South-East Asia.

Freshwater snails carry the schistosoma parasitic worm that causes this disease — also known as bilharzia. The snails release the worms’ larvae into contaminated freshwater rivers, lakes, ponds or wetlands, which then penetrate through skin, such as the soles of your feet.

According to the World Health Organization (WHO), the worm is endemic in 52 counties where water is contaminated with the feces of people infected with the worm, which contains parasitic eggs. Symptoms can take up to two months to develop and whilst some people never develop symptoms, others experience fever, chills, cough, and muscle aches within two months of infection. The extent of symptoms depends on the amount of parasite you have inside your body.

You can evade infection by avoiding swimming in freshwater and by heating water if needed for bathing. There is no vaccine available, but there is an effective and fast-acting treatment: The drug praziquantil will kill parasites within one to two days of treatment.


Locations: Africa, Central and South America, parts of the Caribbean, Asia, and the South Pacific.

Malaria is a parasitic disease spread by the bite of the female Anopheles mosquito. Symptoms include high fevers, shaking chills and flu-like illness, and if untreated malaria can progress to severe illness and even death. The WHO estimates there were 207 million cases of malaria in 2012.

No licensed malaria vaccine exists but preventative anti-malaria drugs are available and recommended for people traveling to endemic regions. A range of options is available, from weekly to daily pills. Wearing long clothing, regular use of repellants and sleeping in air-conditioned rooms or under insecticide-treated bed nets can help avoid bites. But if despite all this you still get infected, an effective treatment is available.

Yellow Fever

Locations: Tropical regions of Africa and South America.

The Aedes aegypti mosquitoes continue to wreak their havoc with the yellow fever virus, which can cause fever, chills, headache, backache and muscle aches. About 15% of people infected develop serious illness that can lead to bleeding, shock, organ failure and sometimes death. Some people become jaundiced, which is where the “yellow” comes from. The WHO estimates there are 200,000 cases of yellow fever each year, with 90% of them occurring in Africa.

As there is no treatment, the main method of protection is from a vaccine, which travelers need to receive at least 30 days before travel to get lifelong protection against the virus. If you are a seasoned traveler you will be familiar with the need to prove your vaccination with the yellow card provided after your injection, as countries with the disease, as well as those harboring this mosquito species, aim to prevent the disease spreading or entering their population. If traveling to remote locations, it might be wise to keep that card firmly inside your passport.


Locations: Africa, Asia, Eastern Europe

A third of the world’s population is thought to be infected with tuberculosis (TB), which is the second greatest infectious cause of death globally (after HIV/AIDS). TB can occur in a “latent” state where people carry the bacteria without developing the disease itself. TB occurs in nearly every country but infections are more concentrated in developing countries, particularly in Asia, Africa and Eastern Europe.

This airborne disease is spread from person to person and infects mainly your lungs but can spread to other parts of the body.

There is a vaccination available but its protection in adults is limited. Its greatest protection is in young children yet to be exposed to the TB bacteria. Symptoms include a prolonged cough, weakness, tiredness, weight loss and night sweats. If diagnosed, TB is treatable and curable with an extensive course of antibiotics. However, drug-resistant forms of the disease have emerged globally.

Travelers’ Diarrhea
Locations: Highest risk in Indian subcontinent, North Africa and the Middle East, sub-Saharan Africa and South America.

This is a collective term for diarrhea caused by a range of bacteria, viruses or protozoa.

Transmission is generally through consuming contaminated food or water and though symptoms are usually mild, infections can ruin a vacation or business trip, causing dehydration, weakness and general inconvenience from numerous trips to the bathroom. It can be avoided by sticking to bottled water, making wise food choices and regularly washing your hands, as your immune system simply isn’t ready for those new, exotic micro-organisms.


Ebola has now reached 5 countries in West Africa in the largest outbreak to date.

Ebola has now reached 5 countries in West Africa in the largest outbreak to date.

Location: Guinea, Liberia, Sierra Leone, Nigeria, DR Congo, (Senegal has had an isolated case).

As of March 2014 this once remote and easily contained disease has gained international recognition. To date the current outbreak of Ebola Viral Disease (EVD) has reached five countries and those traveling to affected regions are advised to be aware of the symptoms, which include fever, rash, diarrhea, vomiting and red eyes. Alongside these symptoms, internal and external bleeding are also signs of the disease, which spreads from person to person by contact with infected body fluids, such as saliva, semen or blood. Small outbreaks continue to occur in the Democratic Republic of Congo.

Ebola has no licensed vaccine or treatment and has fatality rates of up to 90% in infected people — but the virus requires very close contact with body fluids to be transmitted and is easily avoided with regular hand-washing and protective clothing — and avoiding contact with bodily fluids.

Typhoid Fever

Locations: Africa, Asia, the Caribbean and Central and South America. Highest risk in South Asia.

This bacterial disease is spread by contaminated food and water and the resulting fever can be life threatening. Symptoms begin as high fevers, weakness, stomach pains, headache, and loss of appetite. Travelers should get vaccinated before travel but as the vaccine only protects 50%-80% of recipients it’s wise to be careful about your choice of food and drink.

As with travelers’ diarrhea, stick to bottled water and avoid unpeeled fruit and vegetables, street food (as delicious as it may look) and ice in drinks. Typhoid fever can be treated with antibiotics but drug-resistant bacteria have begun to emerge so perhaps avoid that cucumber in your salad or that icy cocktail in the sunshine.

Lyme Disease

Locations: North America, Europe, Asia.

Lyme disease is mainly found in the northeastern, north central, and Pacific coastal regions of North America. It is caused by bacteria which spread through the bites of infected black leg ticks.

Symptoms include fever, headache, fatigue, and a characteristic skin rash called erythema migrans. If untreated the infection will spread to the joints, heart and nervous system. So when wandering through the wilderness be sure to protect yourself with insect repellant. But as infected ticks need to be attached for 36-48 hours or more before the Lyme disease bacterium can be transmitted, effective spotting and removal of ticks from your body will also prevent you from getting infected.

If caught early the disease is treatable with antibiotics.

Hepatitis A

Location: Most of the developing world.

The Hepatitis virus has many forms (A, B, C and D) but Hepatitis A is the one most travelers should be aware of as it spreads through contaminated water and uncooked food. The disease is closely linked to unsafe water, inadequate sanitation and poor personal hygiene and is one of the most frequent causes of foodborne infection.

There is a safe and effective vaccine available against the virus, which most travelers are advised to have, but again, wise food and drink choices are recommended to avoid the resulting liver disease and potentially severe illness. Symptoms include fever, malaise, loss of appetite, diarrhea, nausea, abdominal discomfort, dark-colored urine and jaundice. WHO estimates show 1.4 million cases of Hepatitis A each year. There is no treatment for the disease other than rehydration and supportive treatment for the weeks or months of recovery time required.

10 things you need to know about Ebola

1. Ebola virus disease (previously known as Ebola hemorrhagic fever) is a rare but severe disease, which is caused by Ebola virus. It was first recognized in 1976 and has caused sporadic outbreaks ever since in several African countries.

2. More than 1,500 cases have been reported in Guinea, Liberia and Sierra Leone since March 2014, of which there have been more than 900 deaths. This is the first documented Ebola outbreak in West Africa and the largest ever known outbreak of this disease. There are currently no signs that the outbreak is coming under control, with new cases reported daily from both known and new outbreak areas. Cases of virus transmission continue to emerge in both the community and health-care settings. All 3 capital cities have been affected: Conakry (Guinea), Monrovia (Liberia) and Freetown (Sierra Leone). In addition, the situation in Nigeria is currently evolving and the extent to which this country will also be involved in the outbreak is unknown.

3. The continued spread of the disease probably relates at least in part to issues of strong, local cultural beliefs (such as washing the bodies of the dead, and the stigma surrounding the disease); overpopulation and crowding; migration of people across borders; a perception by local people that the healthcare professionals attempting to help are making things worse; and inadequate human resources on a background of deep poverty.

4. The virus is transmitted to people initially from wild animals, and then from person to person via contact with blood and body fluids. In addition, contaminated objects (clothes, needles) can also transmit infection if handled. Airborne transmission is thought to be limited to those viruses carried in large droplets of human secretions.

5. Infection with Ebola virus leads to sudden onset of fever, chills, muscle aches, headache, diarrhea, nausea and vomiting, with sore throat and in some cases a rash. This will develop as early as 2 days after infection and as late as 21 days. This is then followed by impaired kidney and liver function and stomach pain, and in some cases uncontrolled bleeding, both external (such as through puncture sites) and internal (causing vital organ damage). Ebola is fatal in 50 to 90% of cases who develop these signs and symptoms.

6. Many other far more common illnesses in these countries start off like Ebola, such as flu, typhoid, and malaria. This makes prompt and early assessment even more important – especially since survival seems better in those cases identified early.

7. It is very important to remember that you will not be at risk of Ebola infection unless you have been in close contact with people with the above symptoms. You cannot catch Ebola from people who are well, with the exception of close contact of a sexual nature, as patients who have recovered may still be infectious for a considerable period of time.

8. Nevertheless, if you feel unwell with symptoms such as fever, chills, muscle aches, headache, nausea, vomiting, diarrhea, sore throat or rash within 21 days of coming back from Guinea, Liberia or Sierra Leone, you should stay at home and immediately telephone relevant health services. These services will provide advice and arrange for you to be seen in a hospital if necessary, so that the cause of your illness can be determined as quickly as possible. Unless you have had direct contact with sick people in these countries, another diagnosis for which treatment is available (such as malaria) may be made, and you will be treated.

9. For those performing humanitarian work in these countries, the risk of Ebola infection will relate entirely to the quality and consistency of your personal Infection Control procedures and discipline. Perfect and vital barrier technique includes wearing protective gowns, gloves, masks and eye protection or face shields, and the careful removal of these after use. WHO recommendations address direct patient care, laboratory activities, post mortem examinations, movement and burial of human remains, cleaning and waste disposal.

10. In conclusion:
Don’t go to these countries unless you really have to
If you are there, be very careful to avoid crowded public places and close contact with others. If you are there for humanitarian purposes, go prepared, trained, vigilant, and equipped with personal protective equipment

Author: Dr. Vanya Gant


Two vaccines are better than one

New research suggests using two types of polio vaccine is more effective than using just one. The research team found administering an injection of the inactivated polio virus (IPV) alongside the oral dose of activated poliovirus vaccine (OPV) boosts patients’ immunity. It’s hoped the findings could help speed up the eradication of polio reports expat

Currently, the oral vaccine is leading the battle against polio but this new research from India may change the way we fight the virus. The findings, which World Health Organisation calls “truly historic”, will potentially lead to a total eradication of the disease which is now widespread in only three countries.

Fighting polio has been one of the greatest global health success stories. As recently as 1988 there were 350,000 cases of polio in 125 countries. Once the worldwide vaccination programme was launched in 1988, the number of cases fell dramatically to just 291 in 2012. Polio is currently widespread in only three countries – Nigeria, Pakistan, and Afghanistan.

The disease is spread through contact with infected faeces and the oral vaccine is currently the preferred prevention method as it’s cheap and protects digestive tract from lower transmission of the virus. The injected vaccine works largely in the bloodstream. However, the protection offered by the oral vaccine wanes over time, so repeated doses are needed.

In this latest study, reported in Science Magazine, doctors tested the two vaccines on 1,000 children in northern India. The use of both types of vaccine lowered transmission and infection. “They both have an important role to play in the eradication programme,” said Professor Nick Grassly, co-author of the study.

The use of the IPV is more effective as a booster than multiple doses of the OPV, according to the study. However, the biggest challenge facing health workers, is not which vaccine to use, but accessing children in conflict zones.

South Korea to double to price of cigarettes

The Korean government aims to tackle high smoking rates by doubling the cost of cigarettes.
South Korea is looking at doubling the cost of cigarettes in a bid to lower the smoking rate, reports the BBC. Under the proposed changes, the price of a packet of cigarettes would go up to 4,500 won (€3.35), the price is currently 2,500 won (€1.87).

South Korea has one of the highest male smoking rates among OECD member countries. About 41% of men smoke, according to the Organisation of Economic Cooperation and Development, this is higher than the 26% average reports expat

The proposal, which would come into effect next year, is designed to lower the overall smoking rate (23%), which is also higher than the OECD average of 21%. The last increase in price was in 2004 when it went up by 500 won and the smoking rate fell 15%, reports Korean news agency Yonhap.

There have been many studies which appear to confirm a link between raising the price of cigarettes and a drop in the smoking rate. Researchers agree that a 10% increase in prices results in a 3-5% reduction in cigarette consumption.

Reports from Yonhap also said tobacco manufacturers would be required to print graphic warnings on packaging, and some types of advertising would be banned. General warnings on packaging were introduced in 1976, with graphic warnings originally introduced in 2007.

The South Korean government hopes the price increase will generate an estimated 2.8 trillion won in tax revenue. The opposition have already called it a “deceitful move” which will impact low-income earners as they smoke more than other population groups.

In April this year South Korea’s health agency launched a lawsuit against three of the largest tobacco manufacturers including the local arm of Philip Morris International, to offset the cost of treating smoking-related illness.

What You Should Do If You Feel Sick After Vacation

A great holiday can leave you with lasting memories and souvenirs, not to mention fatigue or jetlag. But what if you’re feeling a little more than just tiredness and a dread of going back to work?

Most post-vacation sicknesses are mild, such as a head cold or upset stomach. But up to eight percent of travelers are sick enough to seek doctor’s care. Following an overseas trip, there are some symptoms the Centers for Disease Control says warrant a trip to your doctor advises the

If you have a fever, chances are good that it is caused by a less serious illness. But if you have a fever within a month after you leave a country with malaria, you should see your doctor immediately. Even if you took antimalarial medicine, your fever could still be a symptom because the medicine isn’t 100 percent effective.

Malaria typically develops within 30 days, but the CDC says there are rare cases that lie dormant for a year or longer. Because of this, you should tell your doctor about any traveling you have done no matter how long ago it was.

Diarrhea usually clears up within a few days. Traveler’s diarrhea is the most common illness when traveling. It’s usually caused by a bacterial infection from exposure to E. coli, Campylobacter, Shigella, or Salmonella in undercooked or raw foods, contaminated food, or contaminated water – including ice cubes!

If you are experiencing diarrhea, treat it by drinking fluids to prevent dehydration; begin a diet with simple, bland foods; and, if possible, drink a solution made with oral rehydration salts.

Most cases of traveler’s diarrhea get better within one to three days without medical treatment. But if it persists for two weeks or more, contact your doctor. Prolonged bouts of diarrhea can cause you to lose nutrients. An illness of this length is typically caused by a parasitic infection that needs to be treated with medication.

Skin Problems
Skin problems such as rashes, bug bites, fungal infections or boils, are the most common illnesses following international travel. In most cases, skin problems aren’t serious. But they could be signs of a more serious illness, especially if you also have a fever.

If you do make a visit to your doctor following a vacation, you should tell him or her about your travel. Most post-travel illnesses appear soon after a trip, but incubation periods vary, resulting in some symptoms not appearing for months to years following the initial infection. The CDC suggests providing your doctor with the following information about your trip:

What you did on your vacation
How long you were away
The accommodations you stayed in
What you ate and drank on your trip
If you were bitten by bugs
If you swam in fresh water
Any other possible sources of exposure, including tattoos and piercings

Japan confirms Dengue Fever Outbreak

Tropical diseases are not only found in poor countries.
Health officials in Tokyo have confirmed 19 new cases of dengue fever, bringing the total to 34 in the country’s first domestic outbreak since World War Two. The disease was found in individuals living in Tokyo and surrounding prefectures. None of the victims has been abroad recently, but all had visited Tokyo’s Yoyogi Park.

Officials said the disease was probably carried by mosquitoes found in and around the park, one of central Tokyo’s major green spaces. The disease is transmitted via Tiger mosquitoes which are endemic to Japan, though dengue fever was effectively eradicated from the country after the Second World War.

Dengue symptoms include high fever, headaches, joint and muscle pain, vomiting and bleeding. Most cases are mild, particularly in people who have never had the infection before. Occasionally, serious problems can develop, leading to complications such as dengue haemorrhagic fever, and dengue shock syndrome.

“It is rare for symptoms to worsen among those who have been infected,” a Japanese health ministry official said. “We hope people will seek treatment at a medical facility as soon as possible after developing a high fever within three to seven days after being bitten by a mosquito.”

The Japanese authorities have sprayed 800 litres of pesticide in the park to kill the mosquitoes and halt the spread of the infection. With the proper treatment dengue fever is fatal in only 1 percent of cases.

This outbreak, in one of the world’s richest countries, highlights the fact that neglected tropical diseases (NTDs) are not the sole preserve of poor countries, reports the Guardian. Governments need to realise that G20 countries are susceptible to the “lion’s share” of dangerous, yet low-profile illnesses, a US expert has warned.

Dr Peter Hotez, dean of the National School of Tropical Medicine in Baylor, Texas told the Guardian, northern Argentina, southern Mexico and the southern United States are areas where several NTDs are common. Texas and regions of the Gulf Coast have seen cases of dengue fever, Chagas disease, Chikungunya, and parasitic worm infections. He estimates that 12 million Americans have one or more tropical diseases.

He described his frustration with governments spending millions on HIV, TB, and malaria research while often neglecting NTDs. The UK and USA governments currently provide three-quarters of the development and research budget for NTDs.

“We’re working on the French and the Germans, who, I think are going to be very important. But we need to look even beyond the north and get all of the G20 countries involved – especially the Brics [Brazil, Russia, India, China and South Africa].”

SOURCE : expat

British military sent to tackle Ebola

British military engineers and medics are being sent to Sierra Leone to help fight the world’s largest-ever outbreak of Ebola reports the BBC World News.

They will set up and run a treatment centre near the capital Freetown.

The World Health Organization says more than 2,000 people have now died in the outbreak in West Africa.

Last week, the charity Medecins Sans Frontieres called for a global military intervention in the region.

It said the global response to the outbreak had been “lethally inadequate” with countries turning their back on West Africa and merely reducing the risk of Ebola arriving on their shores.

The UK has announced it will build a centre with 50 beds for people in Sierra Leone and 12 beds for healthcare workers who become ill.

The proposed site will be surveyed this week, with the healthcare worker section of the facility scheduled to be running within eight weeks.

Yesterday, President Obama said the US military would set up isolation units and provide security for public health workers.

International Development Secretary Justine Greening said: “The scale of the problem requires the entire international community to do more to assist the affected countries which is why the UK is working with the government of Sierra Leone to build a new medical treatment facility near their capital Freetown.

“When it is up and running it will enable the UK to provide medical care for local and international health workers, as well as treatment for the wider population.”

The UK government has committed £25m to tackling the outbreak, including running trials for an Ebola vaccine.

The charity Save the Children will eventually take over management of the treatment centre.

Its chief executive, Justin Forsyth, said: “Ebola threatens thousands of people’s lives across West Africa and could set back development many decades.

“The key to combating this epidemic is backing front line health workers and underpinning a fractured health system in Sierra Leone.

“Without urgent action to assist medics, many more children and their families will suffer and die from this most appalling and tragic disease.”

Ebola update from ALC Health

While the outbreak is still not contained and expected to last for the next six months, an increasing number of neighbouring countries have closed their borders with the affected countries during the week.

This week-end, Democratic Republic of Congo has reported several confirmed cases of Ebola in the remote Northern Equateur province. This outbreak is not considered in any way related with the ongoing outbreak in West Africa. Quarantine measures in a radius of 100 km around the location have been announced by the Ministry of Health and no travel advisories for Congo Have been issued.

Health workers are paying a heavy toll to the disease with 240 of them infected and 120 fatalities. This is creating a lack of medical staff in health facilities which are already overwhelmed. WHO is calling for international support from the healthcare professionals.

An experimental treatment (ZMAPP) which had thus far never been tested in humans has raised hopes after the recovery of two US aid workers who were discharged from hospital after being given the treatment. It has not been confirmed that the treatment was the reason for the cure. A Japanese company has announced introduction of an antiviral medication that may help counteract the Ebola virus, but it is in very early stages and untested on animals or humans. Therefore it is important to keep in mind that Ebola remains a disease without available specific treatment.

Locally the risk remains low for (non- healthcare workers) expatriates or travellers who follow strict hygiene rules by avoiding close contact with the patients or contaminated materials in high risk environments. However, expect a heightened state of alert related to the outbreak, resulting in more restrictions on travel. Additionally, expect that transportation entities and government authorities will act very cautiously to enable evacuation of any ill or injured foreigners in Ebola affected areas.

For all above reasons, the general recommendation remains to avoid or interrupt any travel to the countries of Guinea, Sierra Leone, Liberia for non- essential personnel.