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Frequently Asked Questions

FAQs

The information provided here is done so in good faith, reflects the personal opinion of Dr. Collins based on his experience and clinical practice and should not be taken as legally binding. The information provided is for guidance only. Information specific to your particular circumstances is best obtained in medical consultation, either at our clinic or with your regular healthcare provider.



Where can I find out more about the Zika virus?

The most up-to-date Zika virus information can be found at these links:


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How soon before my trip should I come to the Clinic?

Six weeks or more prior to travel is ideal, four weeks is often sufficient and two weeks before departure is enough for short trips to many destinations. In cases where you are travelling at shorter notice, it is worth attending, as you will benefit from advice and some vaccinations and a malaria prevention prescription may still be relevant.
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Do you offer a walk-in service?

Consultations are normally by appointment. If you arrive at the Clinic without an appointment and wish to be seen immediately, we will try to accommodate you if we have a gap in the appointment schedule. If you would like to discuss your requirements and book an appointment now, you can phone us on (01) 633 49 77, e-mail us, or complete the contact form and we will reply to you.
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How many shots will I need?

Combination shots that protect against more than one disease are increasingly available. The precise number of shots you require will depend on:

  • the country or countries you are visiting
  • the duration of your trip
  • how soon you are going on the trip
  • the kind of activities you might be undertaking (more cover is likely to be required for those doing hands-on volunteer work or on expeditions, for example)
  • whether you will be spending time in remote areas
  • past vaccinations you might have had that are still working.

A two-week beach holiday to a country like Thailand might require only two shots, done in a single visit. An extended trip doing volunteer work in a remote part of an African country might require nine shots over three visits to the clinic (a doctor's consultation fee is charged for the first visit only; subsequent visits to complete a vaccination course will involve payment for the vaccines only).
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In what part of the body are the vaccinations administered?

Normally at the top of the upper arm, on the outer part, where the most muscle is found.
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Will the vaccinations hurt?

Not really! We pride ourselves at minimising any discomfort you might experience. Receiving a vaccine is less uncomfortable than what you would notice when having a blood sample taken or making a blood donation.
In the case of children, we often apply an anaesthetic cream to the area of skin being vaccinated, a short while before the vaccination is done - this minimises what they will feel.
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Will I have side-effects from the vaccinations?

Most people don't - but a minority will. If side-effects occur, they should last no more than a day or two and most commonly occur within a day or two of the vaccination having been done. They can, however, occur at any time up to 7 days after vaccination. The most common side-effects are:

  • a soreness at the site of injection
  • redness/warmth in the skin at the site of injection
  • a heaviness in the arm
  • mild flu-like symptoms.

It is fine to take paracetamol or another pain-relieving medicine if you need to. If you have any concerns about how you are feeling, don't hesitate to contact us.
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Which countries are classified as being 'Tropical'?

The traditional definition of the 'Tropics' is the area on the world map that lies between the Tropic of Cancer (23.4° North latitude) and the Tropic of Capricorn (23.4° South latitude).
In practice, the work of tropical medicine encompasses an area slightly further north and south than this.
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Why am I prone to being bitten by mosquitoes?

Mosquitoes are attracted to humans by scent. These insects can't see well but are superb at picking up a scent and tracking in to it from long distances. Certain aspects of human breath and sweat are attractive to mosquitoes. The fact that some humans are bitten more than others is probably due to genetic factors - the scent of some humans is particularly attractive to the insects.
Not all mosquitoes are the same - there are many different species. This explains why you may not be bitten much in one country but be bitten often in another.
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What can I do to prevent mosquito and other insect bites?

Applying a brand of repellent that contains the ingredient 'DEET' at a concentration of at least 50% works best. 'DEET' is an abbreviation for the chemical 'di-ethyl-ethyl-toluamide'. This chemical blocks the ability of mosquitoes to smell - and so stops them being interested in biting you. DEET is not dangerous (and should not be confused with 'DDT', a different chemical sometimes used to spray houses and public areas).

The main inconvenience about DEET is that it is a solvent and can stain or partially dissolve plastics. This means that if it spills or is sprayed on to sandals, watch-straps or camera cases, it can stain these items or make the surface of them sticky.

The other problem with some DEET-containing repellents is their unpleasant smell. Some brands do not have a bad smell. Spray a small amount on the back of your hand and check the smell before buying it.

You don't need to apply repellent all the time. It is particularly important to apply it when you feel that you are being bitten. You need only apply repellent to exposed areas of skin, especially to the feet, ankles and lower legs, if they are exposed. DEET-containing repellents can be hard to find abroad in Developing Countries, so it is best to bring some with you from Ireland.

If your sleeping situation is such that mosquitoes can bite you while you are asleep (i.e. leaving you open to the risk of many, many bites), then it is really important to sleep within a mosquito net; the best kind of net to get is one that is impregnated with the chemical 'Permethrin'.
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Do garlic or vitamin B tablets help to prevent mosquito bites?

No.
More information on this subject is available on pp.22/23 of this excellent publication, updated in 2014 by an expert group of specialists for Public Health England, the UK Government's Public Health agency.
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Do all mosquitoes transmit malaria?

No. There are many kinds of mosquitoes. Only one kind transmits malaria and this particular mosquito is limited to certain parts of the world.
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What is malaria?

Malaria is a tiny parasite, small enough to fit inside a human red blood cell. The parasite is visible if viewed under a laboratory microscope at high magnification. The parasite in carried in one particular type of mosquito - the mosquito is a victim of the parasite. The mosquito bites a human in order to take a small amount of blood from your skin. If the mosquito is carrying the malaria parasite, the parasite may take the opportunity to move from the mosquito directly into your blood. The parasite then travels to your liver, stays there for a couple of weeks and 'breaks out' into the bloodstream, infecting your red blood cells, multiplying and causing some of them to rupture. It is at this point that you begin to feel increasingly unwell.
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What are the symptoms of malaria?

There is a large spectrum of symptoms - a patient may have only some or all of the symptoms, which may or may not include fever, headache, chills/shivering, aches/pains and diarrhoea. If you have been in a malarial area and you are feeling unwell, it is important to contact a doctor without delay, so that they have the chance to assess you and decide if you may have the infection.
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Do malaria protection tablets really work?

Almost always, yes - if you are taking the right tablet (given the region of the world you are visiting) and you are taking them according to the instructions that come with them.
No malaria-protection tablet is 100% effective but it I have encountered very, very few cases of proven malaria (confirmed by specialised follow-up testing) in patients who have been taking the correct protection tablets for the full recommended course.
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Will I have side-effects from malaria protection tablets?

Malaria protection tablets will only be required if you are travelling to an area where malaria occurs.
There are four commonly used kinds of malaria protection tablets (chloroquine, alone or in combination with proguanil, doxycycline, mefloquine (Lariam®) and Malarone®). Some of these tablets do not work in certain parts of the world; your doctor will ensure you are taking the correct kind of tablet, based on the region you are visiting.

Depending on the tablet being used, anything from 5% - 20% of patients may experience side-effects that range from very mild to pronounced enough to make the patient have to stop the tablet.

The tablet that is associated with the most pronounced potential side-effects is mefloquine (Lariam®). It is however still sometimes appropriate to consider using this tablet if one is going to spend a long period of time in a very high-risk region where high-quality medical assistance is not always easily accessible (e.g. living for a year or more in parts of rural Africa). This and other malaria protection tablets should only ever be used following consultation with your doctor.

In practice, it is almost always possible to find a tablet that will not cause side-effects and yet provide the protection required for the area being visited. One way of doing this is to do a short trial (for a week) of a particular tablet while you are still in Ireland, to see if you are comfortable taking it.
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If a person has malaria, will they always remain infected?

No. It is usually possible to eradicate the infection completely. It is important to say however that this should not be interpreted as a reason not to bother taking malaria protection tablets!
It is vital that you do not develop malaria in the first place, as the infection, in some cases, can put you at risk of becoming critically ill in a matter of hours. It is much better to be taking protection tablets and to be almost fully protected against the disease than to develop the disease and be in a situation where you are pinning your hopes on the treatment working before you become even more unwell.
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I've heard of Dengue Fever - what is it?

This is a viral infection. It is transmitted by a particular kind of mosquito found in some parts of the Tropics. Being infected is like having a severe from of flu. Treatment often involves a stay in hospital, on a drip, for a few days, followed by a period of rest that sometimes takes a few months. There is no vaccine against it. There are no protection tablets against it. The best protection is to minimise the amount of mosquito bites to which you are being subjected. The risk of catching it is very low as long as you are doing your best to keep the amount of mosquito bites to which you are being subjected to a minimum (see What can I do to prevent mosquito and other insect bites?).

Dengue is particularly a problem in Indonesia, South Asia, South-East Asia, Central America and parts of South America. It can occur in Africa, but is not as common there. There is no need to live in fear of it! The real message is that Dengue is the best reason to motivate you to be as thorough as you can about keeping mosquito bites to a minimum when you are travelling. If you are careful, you should be fine.

The kind of travellers most at risk of Dengue are those who are receiving a lot of mosquito bites over an extended period of time (i.e. on long trips) - they don't have the right kind of repellent (containing 50% DEET), they're not using mosquito nets when they should be and eventually they are unlucky enough to be bitten by a mosquito carrying the virus.

Dengue, countries or areas at risk.
Dengue, countries or areas at risk, 2013. Map used courtesy of WHO.

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I've heard of Chikungunya - what is it?

Like Dengue, it is a mosquito-transmitted virus which can occur in any of the shaded areas in the map below. For now, there is no vaccine or prevention tablet against this disease.

Chikungunya, countries or areas at risk.
Chikungunya, countries or areas at risk, 2015. Map used courtesy of WHO.

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What happens if I become unwell while I'm abroad?

You will have several options, depending on how unwell you are feeling:

  • self-medicate, in the case of mild illnesses (e.g. symptomatic treatment of mild stomach upsets)
  • see a local doctor, if you are in a region where good medical care is available
  • if you are a patient of our clinic, you are welcome to e-mail us if you would like a second opinion or advice. If a case is urgent, I can also try phoning you, if you have supplied a number at which I can reach you. Although e-mail can involve a delay of some hours in replying to you. It has the advantage of allowing me to provide you with a detailed written reply that you can read and re-read and if necessary, print out and keep.

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What do I do if I'm unwell after a trip?

If you are unsure as to whether the illness is connected to your trip, it is always worth asking your GP's opinion. They may be able to treat you there and then or if they require a second opinion, they will have the option of referring you to us or to another medical service specialising in travel/tropical medicine.

If you have been to a malarial region and you develop a fever within three months of returning home, you should contact your GP the same day and tell them that you have recently been to a malarial region. This will allow them to decide if a malaria test is necessary. Malaria cases following travel are not very common in Ireland but they do occur. The infection has the potential to make a patient critically unwell within a matter of hours. This is why it is important to make contact without delay with your healthcare provider, so that they have the chance to act quickly, if the situation warrants it.
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If I'm unwell once I'm home, do I have to have a referral from my GP?

No - but if time allows it, it would be preferable to have a referral note from your GP. They know your medical history best and may be able to provide copies of recent tests done, in some cases saving you and us the time and expense of having to replicate tests.
We will however see you if you do not have a referral note. Once your diagnosis is made and treatment is underway, we will send a summary of the tests, diagnosis and treatment to your GP, (with your permission) so that they can keep your medical records up to date, for when they see you in the future.
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Will a Tropical Screening check-up rule out every possible disease?

No, but in practical terms an 'all-clear' following a Screening covers most likely diseases. It is unusual for a patient who is well and who has had normal test results to become subsequently unwell due to an infection that was missed on screening.

The problem is that some tests are just not 100% dependable; others are very accurate. There is almost no limit to the amount of tests one could have done. What we try to do is to strike a realistic balance between (a) not wanting to miss anything significant and (b) not wanting to subject you to unnecessary and excessive expense. The judgement on what kind of tests are worthwhile doing is based on:

  • where you have travelled to
  • how long you have been abroad
  • whether you were unwell while abroad
  • your current symptoms, if any
  • the kind of activities you were engaged in while abroad.

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I've heard about Schistosomiasis ('Bilharzia') - what is it?

This is a fresh-water parasite present mostly in Africa, along with limited parts of South America and South-East Asia. It can be contracted by swimming or walking through lakes/rivers/streams, by directly penetrating the skin. Most patients who contract it do not know they have it; a minority develop a mild fever, itch and skin rash a few days later. Examples of countries where it is a particularly common problem include Malawi and Uganda.
Diagnosis and treatment are best performed 3 months after possible exposure; a common means of diagnosis is a special blood test that takes about 10 days to process. Treatment, when required, involves some tablets taken for one-two days.

Schistosomiasis, countries or areas at risk.
Schistosomiasis, countries or areas at risk. Map used courtesy of WHO.

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How rapidly can you diagnose an illness I might have?

We have on-site rapid diagnostic tests for the most serious form of malaria (falciparum) and for dengue fever that will produce a result within about 15 minutes, while you wait.
The results of a basic tropical screen will be processed by the lab in 2 - 5 days. More specialised tests can take up to 10 days. Testing for some rare conditions, where samples may be sent to the UK, can take up to 30 days. However, these kinds of tests rarely need to be done.
If you are unwell and the diagnosis is clear, based on the history and physical examination, immediate treatment may be advised, while awaiting the results. The decision to do this will be taken in consultation with you, depending on how you are feeling and a discussion of the advantages and disadvantages of starting treatment.
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What happens if you are not able to diagnose what's wrong with me?

In a case where you are unwell and tests are failing to show up a cause, with your permission, we will arrange an appointment with a hospital-based Consultant in Infectious Diseases or in Tropical Medicine. We will send them a detailed summary of your medical history and copies of your test results, to ensure that you case is progressed as quickly as possible.
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Will receiving vaccines affect my ability to donate blood?

The waiting periods between the various vaccines and being able to donate blood and travel and being able to donate blood are specified by the Irish Blood Transfusion Service.
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