herald

Tuesday 26 September 2017

Tropical diseases: the truth

You may have the tickets, passports and travellers' cheques but if you're heading for far-flung climes you better not forget the vaccine

A new survey has revealed that Irish travellers are disregarding essential vaccines before travelling, despite one in four admitting that they fell ill on holiday. The Grafton Suite Travel Health Research Survey 2010, conducted on behalf of Sanofi Pasteur MSD, found that 70pc of Irish travellers failed to get their vaccines before travelling, even though 62pc of those surveyed were aware of the dangers of tropical diseases.

In most cases, travellers are ignorant of the risk that tropical diseases pose. Some 92pc of those who decided not to get vaccinated before travelling did so because they felt they would be safe without them.

The Tropical Medical Bureau had almost 20,000 visitors to its branches across Ireland last year. However, clinic manager Miriam Edge says travellers are still woefully unaware of the necessity of seeking medical advice before they travel.

"People do not realise how dangerous malaria is, for instance. In the worst-case scenario, it can be fatal within 24-48 hours and yet it still just doesn't register."

There is no vaccine for malaria, so precautionary measures need to be taken. A visit to a tropical medical doctor isn't just to receive vaccines -- they also offer advice covering everything from insect repellent to practising safe sex.

For instance, clients at the Tropical Medical Bureau who are visiting Sub-Saharan Africa are routinely advised of Schistosomiasis (also known as bilharzia), a parasitic disease found in rivers, lakes, streams and dams. "Take Lake Malawi," says Edge, "while the water might look very inviting, it is full of bilharzia. We advise our clients not to swim in fresh water in these regions."

Dr Paul Mooney, of the Department of Health and Tropical Medicine at the Royal College of Surgeons stresses the importance of individual assessment. "We would be interested in not just the country you are visiting but where exactly in the country you are visiting and what kind of activities you'll be doing.

"Somebody staying in a five-star hotel is going to be in a completely different risk category to someone staying in a beach hut or going off into the jungle. We also look at medical history. For instance, they might be immunosuppressed as a result of medical treatment."

The ideal time to visit a tropical health doctor is six weeks before travel. However, it's a case of better late than never for those with imminent travel plans. "Even if they are going tomorrow, we would still encourage them to come in and see us," Mooney says. "For example, we can give someone the Hepatitis A vaccine the day before travel and advice is just as important."

Tropical health doctors also warn travellers to monitor their health after their trip. Just because you've arrived home doesn't mean you are home and dry. Many symptoms appear months, or even years, afterwards.

"We had an interesting one recently," says Edge. "A chap who was doing charity work in west Africa from June to September presented to us earlier this month. Even though he had his vaccines and took his malaria tablets, we discovered that he had P ovale malaria, one of the less common types. It didn't present itself for nearly 11 months."

Likewise, it's critical that travellers seek medical attention if they have been scratched or bitten by an animal, even if they present no symptoms. Edge recalls the case of Northern Irish woman Lisa McMurray, who died from rabies last year. It is believed that she had been bitten by a dog when she was working in an animal sanctuary in South Africa two years earlier.

Vaccines are precautionary measures but it is just as important to receive the precautionary advice that will precede a consultation. Prevention is better than cure, particularly when you are travelling.

THE DANGERS

>Hepatitis A A viral disease which affects the liver, mainly spread through contaminated food and water. It occurs worldwide, but mostly where sanitation and hygiene is poor. Symptoms include fatigue, loss of appetite, fever, nausea, vomiting, headaches and abdominal discomfort. Jaundice is a classic symptom. Two doses of vaccine will cover you beyond 10 years.

>Hepatitis B A viral disease of the liver. It is highly contagious and can be passed via unprotected sex, blood transfusion or needles. The Hepatitis B vaccine is recommended for long-stay travellers and aid workers. Ideally, the vaccination should be sought six months before your trip.

>Typhoid fever A bacterial disease common in many developing countries, it is spread through contaminated food and water. Symptoms include fever and severe headaches, constipation or diarrhoea, slow heart rate, cough, and weakness. A single injection will protect you for three years.

>Yellow Fever A viral disease spread by mosquitoes, yellow fever occurs in parts of tropical South America and sub-Saharan Africa. Some countries deny entry without proof of vaccination (an International Certificate of Vaccination). This certificate is considered valid for 10 years. Infection can cause symptoms from mild to severe illness and death. Symptoms include fever, muscle pain and backache, headaches, shivers, loss of appetite, nausea, and/or vomiting. After three to four days symptoms abate and most people recover. There is no specific treatment so vaccination is critical. A single dose provides at least 10 years' protection.

>Meningococcal Meningitis A bacterial infection spread through contact such as sneezing and coughing. It occurs worldwide, but is most prevalent in sub-Saharan Africa. Symptoms include stiff neck, fever, sudden severe headache, nausea, vomiting and intolerance of light. You may have a vaccination against meningococcal C disease, but for travel, vaccination against meningococcal strains A, C, W135 and Y may be needed. Vaccination is particularly recommended for longer visits. Immunisation is mandatory for entry to Saudi Arabia in order to attend the annual Hajj and Umrah pilgrimages and proof is required. One dose should provide protection for three to five years, but the certificate should not be older than three years and not less than 10 days before date of arrival. Non-pilgrims may also be asked to produce a certificate when travelling to Saudi Arabia during the yearly pilgrimage.

>Malaria A parasitic disease that occurs in tropical countries. The disease is transmitted by mosquito bites and travels through the blood and into the liver. There is no vaccine so you need to take preventative medication and use insect repellent and mosquito nets. Symptoms include fever, sweating, shivering and headaches. They may not occur until long after the disease is contracted so tell your doctor about any recent travel should you experience fever.

>Diphtheria A bacterial disease that occurs worldwide, transmitted by close contact such as coughing, sneezing or kissing, and also dust contamination. Symptoms, visible two to five days after exposure, include sore throat, nausea, vomiting and difficulty swallowing. The vaccine is given as part of the Childhood Immunisation Programme, but it is important to check with your GP or clinic that your protection is up to date.

>Rabies A virus found in saliva, contracted from the bite or scratch of an infected animal. It is nearly always fatal and tends to occur in countries with limited control over animals. If you are bitten or scratched by an animal in a country where rabies is present, it is important to get immediate medical help, even if you have been vaccinated. A pre-exposure course is recommended consisting of three doses. A post-exposure vaccine is also critical.

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