Totally Tropical Diseases- How To Avoid Serious Travel Illnesses. (Travel Related Diseases in general)

Member Name: jusophine

Product:	Travel Related Diseases in general
Date:	14/05/01 (787 review reads)
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Advantages: Time to prepare for that holiday destination., Many illnesses preventable.

Disadvantages: At best can spoil your holiday., At worst can ruin your life!

It's that time of year when many amongst us are planning to take off for a week or two's summer holiday. The flights are booked, the cases packed, and if your really efficient, you might have even packed a first aid kit.

*Travel Insurance*

It goes without saying that travel insurance is a must have. Don't be put off by the recent exposure of high street travel agents charging way too much, shop around and get the deal that suits you. We go for yearly cover, it appears to be good value for money. Also read the small print and make sure you are covered for proper care and flights home with medical cover. No-one likes to think that they will become seriously ill, but every year, holiday makers from this country require hospitalisation for 'holiday acquired illnesses', and by all accounts, hospitals abroad may not quite match up to the NHS. Of course, medical centres in well established locations may put your local hospital to shame, but go further a field, and you could find yourself in a hospital out of the dark ages. Your insurance should cover you for retrieval home for continuation of treatment. Many travellers going to Africa and Asia, now take first aid kits that include sterile needles, and I would also recommend this.

*Vaccinations*

For those going to tropical destinations, vaccines are recommended. Your GP or local travel clinic can advise you with this, and will be up to date with the current requirements for the area you are visiting. O.K, this is the part of the op thats starts going into the 'don't like to think about it'area. Many vaccines given are classed as 'Live Vaccines', and give active immunisation. They work by stimulating the immune system to produce antibodies without the need for the person to experience the condition. Other vaccines are inactivated(non-live).

Here is a list of currently available vaccines; Tetanus, Diptheria, Typhoid, Hepatitis A, Rabies, Jap
anese Encephalitis, Tick-bourne Encephalitis, Inactivated Polio vaccine, Meningoccal A & C, Hepatitis B(all non-live) vaccine. Yellow Fever, Bacillus Calmette-Gu'erin, oral Polio and oral Typhoid(all live vaccines).

Incredibly, less than 5% of travel related illnesses are preventable by vaccination, therefore it is essential that you follow sound advice when travelling. I thought I would run through some of the more major illnesses, as I know there are several well written ops in this category on common problems.

*Diarrhoea*

You may not consider this a major problem, but think again, you might change your mind after reading this. This is probably the most common illness experienced by the traveller, and is non-discrimating in choosing it's victim. At best, you may have to run to the loo several times, and have gut wrenching spasms as your body seeks to expel the guilty toxin. You think it's all over, then suddenly more pain, more legging it. This of course is never helped by the heat, although you feel cold and clammy momentarily. As fast as you pour fluids back into your body, they seem to be shooting out the other end. Mmm, how does that song go? 'When your running round the block and you feel it in your sock diarrhoa, diarrhoa.'

Diarrhoea is usually caused by toxin producing strains of the common gut bacterium 'Escerichia Coli'(not to be confused with 'E' Coli 0157, of the meat pie fame), but can also be caused by Shigella, Salmonella, Campylobacter and Rotavirus. The risks of diarrhoa associated with Typhoid and Cholera are very small. Amoebiasis, caused by parasitic amoeba, can cause bloody diarrhoa, whilst Giardiasis, another protozoan gut infection, is a common cause of weight loss, abdominal cramps and malabsorption.

I have travelled to some fairly exotic places, I've eaten from the side of a filthy road in Bangkok, and have managed to avoid upsets, but found myself incred
ibly unwell after trips to Andorra and Turkey. Basically, diarrhoa is possible anywhere. They say that it's possible to develop it after travelling to an area of this country and drinking the tap water that you are not used to drinking!

*Avoiding That Feeling In Your Sock*

*Water*
Sometimes there is nothing you can do to avoid diarrhoa, you've basically been poisened. Countries within Africa, the Indian Subcontinent, and countries with a poor standard of public hygiene are the worst offenders. Take special care with the water. That includes care with washing food, ice in drinks, swimming water, and use bottled water that has been opened in front of you. If there is no bottled water available, boil it for 5 minutes or use water purification tablets, such as those that contain Iodine.

*Food*
Cooked food should be piping hot, well cooked and served immediately. You should wash and peel fruit yourself. Risky foods include that which has been reheated, stored food, shell fish, raw meat/fish/vegetables, salads and icecream.

*Personal Hygiene*
You should of course wash your hands and dry them before handeling food. Ensure your utensils are clean, and keep your hands away from your mouth! I know you all wash your hands after visiting the loo, but try telling the chef about it, it'll probably come as a bolt from the blue, but could prevent a protazoan salad dressing or a steak Shigella that will give you heller!

*Treatment*

Most causes of diarrhoa are self limiting, you basically 'poo' them out, and antibiotics are not necessary. Sustained diarrhoa should be investigated by stool specimen. Try to get as much fluids in to you are possible. A neighbour was recently hospitalised on holiday not for diarrhoa, but the dehydration that followed. Don't forget that you will also be losing body fluids by sweating, so drink, drink, drink. It will also help to flush the toxin out of your bowel. Eve
n after the toxin has gone, diarrhoa can continue as the inflamed bowel trys to recover. Try resuming a bland diet as the diarrhoa subsides, live yoghurts that contain 'friendly' gut bacteria are very useful for helping your bowel to re-colonate, especially in babies and young children. Rehydration satchets that you mix with water are helpful, but flat lemmonade is just as good.

*Malaria*

There are 200-300 million cases and 2 milion deaths as a result of this illness each year, worldwide. It is a mosquito-borne infection caused by a protozoan parasite that infects the liver and red blood cells. You can't catch malaria from another person. Of the 4 species of malarial parasite, only that causing 'Falciparum' malaria is significant in needing hospital treatment in the U.K(with a 15-20% mortality rate). It is most commonly contracted by travellers to sub-Saharan Africa.

Almost half of the cases treated in this country are amongst U.K residents from African or Asian communities returning from visits to their home countries. Often they mistakenly believe they are immune, however immunity rapidly wanes in the absence of continued exposure.

Just one infectious bite is enough to transmit the disease, indeed, cases have been reported amongst baggage handlers at Heathrow airport. Symptoms are often non-specific, but include fever, muscle pain, diarrhoa, nausea and vomiting, headache, and confusion and drowsiness, which may also be a sign of cerebral malaria. These symptoms can occur up to 3 months following infection.

*Treatment*
There is no vaccine, but chemoprophylaxis is recommended as a protective measure(thats tablets to you and me). Although there are anti-malarial medications with reported bad side effects, plenty of safe ones do exist. These must be taken a week before you travel and for 3 weeks after you return. The most important thing is to avoid getting bitten in the first place! Many strains of
Malaria are becoming drug resistant, but a new anti-malarial drug has recently been launched that will hopefully rectify this.

*Avoiding Mosquito Bites*
-Be vigilant around dusk.
-Wear loose, long sleeved clothing.
-Apply insect repellant to any exposed skin.
-If you are unable to sleep in a well- screened or airconditioned room, use a mosquito net.
-An plug-in device is useful, if not, an aerosol 'knock-down' spray can be used to rid a room of mosquitos.

*Viral Hepatitis*

Hep A, B and C are global illnesses that are heavily undiagnosed as often there are no initial symptoms. In tropical countries at least 80% of the population has been exposed to A and B. In some European countries it is as high as 20%.

*Hepatitis A*
This is spread by the faecal-oral route, either directly or through water or food. It's main acute symptom is jaundice and a general malaise. Most people recover fully and then have life long immunity. I once nursed an Orthodox Jew with Hepatitis A. She was bright yellow with jaundice, and felt highly ashamed. She needn't have, it can effect anyone and it probably wasn't to do with her own food preparations or standards of cleanliness.

*Hepatitis B*
This is a very different disease. It is transmitted sexually, via contaminated needles, or from mother to baby whilst in the womb. 10-15% of people develop what is known as a 'chronic carrier state', leading to cirrhosis and primary liver cancer. Hepatitis C is a similar illness, but little is currently known about it's long term effects. Thankfully a vaccine exists. I was first vaccinated as a student nurse at 19. The more I learn about the disease, the more greatful I am to have had cover over the years through high risk procedures in nursing, and even more now in midwifery.

*HIV*

Although not usually thought of as a tropical disease, there is no doubt that the vast majority o
f cases occur in the impoverished countries of sub-Saharan Africa, south-east Asia, and increasingly in the Indian subcontinent. Transmission is by the same routes as Hepatitis B.

In a holiday atmosphere, or the combination of alcohol and drugs, a normally sensible person can find themselves in a high risk situation. An encounter with a used needle can result in a relationship with HIV that WILL last long after the suntans have faded. For God sake, take care and practice safe sex, and as already mentioned, consider taking an advanced first aid kit with you that includes sterile needles.

*Tuberculosis*

Much in the news in recent months, 'TB', on the increase again, causes more deaths word wide than any other infectious agent. One third of the worlds population is infected and it causes 3 million deaths each year.

TB is nolonger a disease of the past in the 'developed' world. In 1998(the most recent figures I was able to find), almost 6000 cases were notified in the U.K. In London alone, 50 new cases and 2 deaths occured each week(and is now increasing). Part of the diseases major come back has been due to HIV. In 1996, 7.5% of London cases also had HIV.

TB is caused by a slow growing bacterium(Mycobacterium Tuberculosis), and is spread through respiratory droplets released into the air by coughing. Not all cases are contagious, but those whose sputum contains the bacteruim should be isolated. Of course all school children are vaccinated against the disease in this country, but a vaccine shortage has led to a long delay in many recieving primary and booster vaccines.

Many vaccination programs are underway in developing countries, but *you* have to be certain that you still have immunity, so check with your health travel advisor(travel clinic/GP/practice nurse).

*Conclusion*

Well I do hope I haven't put you off travelling overseas. The fact is, if you take preventable measures,
and are careful, you can drastically reduce your risk of becomming ill this summer. Seek advice to ensure that you recieve the appropriate vaccinations for the region you are traveling to, and then relax and enjoy your travels. Bon Vogage!

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