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Before embarking on any holidays or trips abroad, it is always a good
idea to explore any possible medical risks or conditions that you may
encounter on your travels. The many physical and environmental changes
that accompany international travel, can seriously upset our finely
balanced systems. Examples of changes include, humidity, temperature,
altitude, quality of water, wildlife, exacerbated by fatigue and stress
that can lead to unfortunate cases of ill-health abroad. The following
factors will help determine the level of risk you may be exposed to-
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Purpose of travel |
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Destination, Rural/Urban? |
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Duration of Visit |
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Age, Sex & Health of Traveller |
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Accommodation & Food Hygiene Standards |
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Availability of Medical Facilities |
It is important to undertake
advance planning, careful precautionary and preventative measures
to help reduce the
risk of falling sick
on holiday. General information on common illnesses, conditions and basic
precautions have been outlined below.
 Hajj & Umrah
Vaccination Requirements
A yellow Fever Certificate is required only if arriving within 6
days from an infected country. Not required for people who are
in transit
and who do not leave the airport of the infected country in question.
Persons without a valid Yellow Fever Certificate, if required,
will be vaccinated upon arrival and are subject to quarantine.
A
Meningitis Vaccination Certificate is required. Persons arriving
without a Meningitis Vaccination Certificate will also be vaccinated
on arrival
or quarantined.
Food & Water
Safety
A number of diseases like Cholera, Typhoid and Dysentery can
be acquired through the consumption of contaminated food or
water.
They are caused
by bacteria, viruses or parasites usually present in raw food
or water such as meat, poultry, eggs, shellfish and unpasteurised
milk
etc.
Common symptoms can include, nausea, vomiting, fever, abdominal
pain and diarrhoea.
When travelling, especially in developing countries, it is
essential to exercise discretion in the choice of meals and drinks
consumed.
Only eat thoroughly cooked food, and drink either sealed bottled
water, canned
drinks, hot tea or properly boiled, filtered or chemically
disinfected tap water. Furthermore, make sure you wash your hands
thoroughly
before eating and wash all cutlery in clean, hot water.
Deep
Vein Thrombosis (DVT)
Blood clots can form in the legs during long air travel, mainly
due to prolonged immobility. The longer the flight-time
the greater the
risk of developing DVT. Though most blood clots are reabsorbed
into the system, some can break away and travel through
the blood vessels
to the lungs where they may obstruct blood circulation,
causing life-threatening complications. A history of DVT, age,
chronic
swelling of the legs/feet,
varicose veins, obesity, stroke/ heart problems and recent
surgery can increase the risk also.
If you feel you are at
risk or are going on a long plane flight, try and wear loose,
comfortable clothing, walk about
the cabin
at regular
intervals, avoid crossing your legs, periodically contract
the leg muscles and drink plenty of water. High-risk cases
may also
have
to take aspirin
or other anticoagulants to prevent thrombosis. Symptoms
of DVT, are swelling of the calf, ankle or foot sometimes
accompanied
by pain.
Blood clots, which in extreme cases may travel to the
lungs, will cause chest
pain and breathing problems. Anyone experiencing any of
the above should seek immediate medical attention.
Altitude
Sickness
Important for those planning to climb mountains! Altitude
sickness is an adverse reaction caused by the low oxygen
levels at high
altitudes. Common symptoms are nausea, headache, insomnia
and being short of
breath.
Preventative measures include drinking large quantities
of water, plenty of exercise, and acclimatising to higher
elevations
gradually
over a
day or two. Altitude sickness can be extremely dangerous
and life threatening so pay heed to your body signals.
Jet
Lag
Common when a traveller crosses more than four time zones. General
side effects include difficulty in sleeping, nausea, fatigue,
disorientation and loss of appetite. Mental and physical performance
can also significantly
be reduced. Try and get adequate rest before your departure, eat
lightly, drink plenty of fluids and re-adjust your sleeping and
eating pattern quickly. It is recommended not to sleep as soon
as you get to your destination, as this tends to set your body
clock
back to home time. It is better to stay active on arrival to help
your body adjust to the new time zone and to sleep at the appropriate
time.
Meningitis
An inflammation of the meninges, the linings surrounding the brain
and spinal cord usually caused by infection. A number of micro-organisms
can cause meningitis, including viruses and bacteria. They reach
the meninges through the blood, ear, nose, throat or an open
wound. Viral
meningitis is more common than bacterial meningitis. It can be
caused by a number of virus’s spread by people coughing,
sneezing, poor hygiene or sewage-polluted water. It is less
severe and requires
adequate nursing care. Bacterial meningitis however is less common
but is very serious and needs urgent treatment with antibiotics.
It is caused mainly by the meningococcal bacteria, but can also
be caused
by the pneumococcal, Hib and TB bacteria amongst others.
Symptoms
include a strong fever, nausea, vomiting, stiff neck, light
aversion, drowsiness and headache. In babies further symptoms
such
as a refusing food, high pitched crying, muscle rigidity, blotchy
complexion and a dislike of being handled may become apparent.
Some bacteria which cause meningitis, often cause septicaemia
(blood
poisoning). A sign of septicaemia is a rash which starts off
as tiny red or purple ‘pin-pricks’ anywhere
on the body. They may then develop into what looks like fresh
bruises. The glass test can be used to see if a rash might be
septicaemia.
Press the side of a clear drinking glass on to the spots, if
the rash/spots do not blanch or fade seek medical assistance. Though
many patients
make a full recovery, cases of resultant blindness, deafness,
paralysis, mental impairment and death do occur. To avoid such
scenarios, it
is vital to detect early symptoms/signs and administer correct
treatment.
Children are routinely offered vaccination
against haemophilius
influenza type B (Hib) meningitis and meningococcal meningitis
type C. Though
meningococcal meningitis is less common among travellers,
Meningococcal vaccine against type A and C meningitis, is recommended
for
those travelling to hot spots such as Africa ‘meningitis
belt’.
Immunisation is also required in areas where outbreaks are common,
such as in Saudi Arabia during Hajj. Vaccines for other deadly
forms of meningitis like meningococcal type B are still being
researched.
Malaria
A serious and sometimes fatal infection of the red blood cells
and liver, caused by a parasite that is transmitted to humans
by a malaria
infected mosquito. There are four types of malaria that
can infect people, P. vivax, P. ovale,
P. malariae and Plasmodium falciparum. The female Anopheline
mosquito carries the parasite and tends to bite between
dusk and dawn.
Once transmitted, the parasite travels to the person’s
liver where it enters the liver cells and begins to multiply
and grow. At this
stage the person will not feel sick. The parasites then
leave the liver and enter red blood cells, this can take
up to a week or even
several months. Inside the red blood cells the parasites
multiply and cause the cells to burst releasing toxins from
the parasite
which make the person feel sick. A malaria free mosquito
can uptake this
parasite from an infected person and within one week transmit
the virus again. Certain malaria parasites can lay dormant
in the liver
from several months to several years.
The main symptoms are,
headache, chills, fever, anaemia/jaundice (due to loss
of red blood cells), kidney failure and circulatory
collapse.
Infections caused by P. falciparum are extremely dangerous
and can result in seizures, coma and death.
Malaria occurs
in over 100 countries, in areas such as, Africa, Indian subcontinent,
Middle East, Southeast Asia,
Central
and Southern America.
Visit your GP at least 4-6 weeks before you travel and
obtain necessary vaccinations and anti-malarial drugs.
Always take
your anti-malarial
drugs on time and do not miss any doses. Use insect
repellent on your skin before sleeping. If you do not have appropriate
screened accommodation,
then use mosquito netting around your sleeping area
and
wear long sleeves and pyjamas. If you fall sick with
fever or flu-like
symptoms
anything up to a year after your return, seek medical
attention and inform your doctor about your travels. Typhoid
Typhoid fever is contracted by the ingestion of
contaminated food or water by a type of Salmonella
known as Salmonella typhi. This
particular bacteria, can be passed on if personal hygiene is poor,
during for example the preparation of food. Symptoms include a fever,
headache, muscle cramps, nausea, constipation, diarrhoea, abdominal
pain and loss of appetite. The symptoms may not show for up to two
months after exposure. Treatment comes in the form antibiotics.
Vaccination against Typhoid is usually in the form of capsules and
should be taken as prescribed at least 3 weeks before your departure.
Because so many different forms of disease can be contracted from
contaminated food and water, vaccination for Typhoid should not
reduce your vigilance against suspect food or water.
Cholera
Acquired by consuming contaminated food and water,
Cholera is an intestinal infection caused
by the Vibrio chlerae bacteria. Symptoms
are usually
mild or strong diarrhoea, with vomiting and serious dehydration.
Main form of treatment is rehydration through
the continuous intake of
clean fluids. Incubation period for cholera is anything from 1-5
days. In very serious cases an intravenous
drip may be required. Risk of
cholera has diminished in most parts of the world and the chances
of travellers attaining it are low. However food and water safety
precautions mentioned above should be strictly adhered to.
Yellow
Fever
A serious viral infection which is common
in Africa and South America, it is transmitted
by the Aedes mosquito. It has both an urban
and
jungle life cycle. In the urban setting Yellow fever is a human
problem. The Aedes mosquito breeds in man made jars, water barrels
and discarded
tyres, hence it favours densely populated areas due to which epidemics
of yellow fever can erupt. In the jungle, Yellow fever is common
mainly among primates such as monkeys, from where crossover to
humans can
occur. Primary symptoms may show as just a mild influenza like
illness, fever, headache and muscular pain.
However the preliminary stage
usually passes after some three or four days. Unfortunately approximately
one in every six people then go on to suffer the second phase
of toxic
attack, which includes, fever, severe headaches, muscle aches,
nausea, vomiting, hepatitis, kidney failure,
haemorrhaging and death in
approximately 50% of cases. There is an effective vaccine for
Yellow fever and generally
protects the individual 10 days after vaccination. The vaccination
is strongly recommended for those travelling to areas where this
disease is common and the individual is then protected for some
10 years.
Furthermore always remember to apply insect repellent, especially
before sleeping. Note that there are no medicines that are effective
against this virus and treatment usually entails supportive care.
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