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With the increase in international travel to far-flung and
exotic locations, there has been a dramatic increase in the
incidence of previously rare, tropical illnesses. It is imperative
therefore that travellers take appropriate preventative measures
prior to their departure.
Some Practical tips
Plan ahead when travelling and carry sufficient supplies of
medicines and first aid requirements that you may need for
a medical emergency. Remember that some items may not be available
in your chosen destination.
Food and Hygiene
Many travel illnesses are transmitted through contaminated
food or water. As a general rule, travellers should try to
drink bottled water where possible, avoiding local water and
ice. Water purification tablets or boiling water for about
one minute can also be useful when bottled water is not available.
Be aware that food hygiene is critical, the old colonial rule
still holds today; if you can cook it, boil it, peel it-you
can eat it, or otherwise forget it".
See also our travel health
tips.
MEDICINES
Check out your travel medicine requirements
in plenty of time before you leave. (more)
All vaccines are prescription-only medicines. Your doctor
may arrange to have your vaccine available at the surgery
or you may need to bring your prescription to the pharmacy
to collect the vaccine. Remember that if you do need to store
your vaccine, it must be kept in a refrigerator (between 2
oC to 8oC) and it should not be frozen.
It is advisable to ask your doctor to complete a vaccination
record, which is usually available at the surgery. This document
should be carried with you when you travel. Your vaccine record
is a useful reminder of when your booster is due, as immunisation
can be extended with boosters at the appropriate intervals.
While polio vaccinations may not be required for some countries,
as a general rule, international travellers should ensure
that their vaccination schedule is kept up to date. In addition,
international travellers should be aware of their tetanus
vaccination status.
Yellow fever vaccines are only available through authorised
yellow fever centres. Be careful to retain your yellow fever
vaccination certificate as you may be asked to show this,
at port of entry or exit.
Your doctor will discuss with you the most appropriate vaccination
and travel medicine requirements, for you taking into account
your proposed destination, age, medical condition and general
health.
Travel
diseases that can be prevented:
HEPATITIS A
What is Hepatitis A?
Hepatitis A is endemic in developing countries. It is a highly
contagious liver disease, which is easily spread by direct contact
with an infected person, by ingesting sewage-contaminated water
or shellfish or by eating uncooked food. The disease may initially
be very mild, but can become very debilitating and can progress
to headaches, nausea, vomiting and jaundice and can even be
fatal.
Risk to travellers
High-risk areas for the disease are all areas outside North
and Western Europe, North America, Australia and New Zealand.
Those visiting these countries, especially those on longer stays
or intending to visit rural areas should be vaccinated.
Prevention of Hepatitis A
The Hepatitis A vaccines are considered to provide at least
10 years immunity. Hepatitis A vaccine is considered to be effective
from 2 to 4 weeks after injection. A booster dose is usually
given six or twelve months later. Side effects of hepatitis
A vaccine are usually mild and can include reddening and soreness
at the site of injection. More rarely, people have suffered
fever, fatigue, headache, nausea and diarrhoea after vaccination.
For those who require a more rapid immunisation, Normal Immunoglobulins
and the hepatitis A vaccine can be administered at the same
time but at different sites. The Normal Immunoglobulins provide
immediate protection against the virus, but as this is a blood
product, there are currently concerns about its use.
To avoid Hepatitis A
The old colonial rule still holds today; if you can cook it,
boil it peel it you can eat it, or otherwise forget it". Do
not drink water or ice of unknown quality.
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TYPHOID
What is Typhoid?
Typhoid is a serious disease of the gut. It starts like flu-like
symptoms, including headache and fever often accompanied by
nausea, vomiting, diarrhoea or constipation, with a slow pulse.
After about a week, pink spots can be seen on the body and
the patient will delirious and very weak. Risk to travellers
Typhoid is endemic in areas where sanitation is poor. Travellers
to Asia, Africa, and Latin America can be at risk. Prevention
of Typhoid The typhoid vaccine is available as an injection,
Typhim VIÀ or as an oral capsule, VivotifÀ. Typhim VIÀ administered
once give three years protection against the disease. Pain
and swelling at the site of injection can occur. The oral
capsule, VivotifÀ is taken as three doses on alternate days
and confers immunity 10 days later, which lasts one year.
Side effects of the oral vaccine include nausea, vomiting
and diarrhoea. It is recommended that the course of Vivotif
be competed three days before starting the anti-malarial treatment,
LariamÀ (mefloquine).
Risk to travellers
Typhoid is endemic in areas where sanitation is poor. Travellers
to Asia, Africa, and Latin America can be at risk.
Prevention of Typhoid
The typhoid vaccine is available as an injection or
as an oral capsule. The injection is administered as a single
dose to give three years protection against the disease. Pain
and swelling can occur at the site of injection, while systemic
reactions such as fever, headache and nausea are much rarer..
The oral capsule vaccine is taken, about one hour before a
meal with a cold or lukewarm drink, as three doses on alternate
days. Protections is usually achieved about 10 days after
administration and lasts one year. Side effects of the oral
vaccine can include nausea, vomiting and diarrhoea. It is
recommended that the course of Vivotif be completed three
days before starting the anti-malarial prevention treatment
mefloquine.
To avoid Typhoid
Avoid areas of poor sanitation. Drink only bottled water from
a reputable source and do not eat any uncooked foods.
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RABIES
What is Rabies?
Rabies is a virus which is transmitted by a bite from an infected
animal or contamination of broken skin by infected salvia,
such as by a lick from a dog.
The virus can incubate for up to 3 months, after which the
infected person can feel generally unwell. This is followed
by hyper-excitability and aggressive behavior. Rabies can
be fatal.
Risk to travellers
Rabies from dogs is considered to be endemic in certain parts
of Africa, Asia (particularly, India, Nepal, Sri Lanka, Thailand,
Philippines, Vietnam), Central and South America (notably
Ecuador, Mexico, El Salvador, Guatemala, Peru, Colombia).
Prevention of Rabies
A course of three injections is required. The dosing schedule
is day 0, 7 and 28, with a booster every two to three years
for those at continued risk. The vaccine is considered to
be effective from about day 30 after first administration.
Side effects of the vaccine can include flu-like symptoms
and general malaise, which occur in the first 48 hours after
injection.
Systemic reactions such as headache fever, vomiting and allergic
rashes have also been reported.
Tips to avoid Rabies
All animal bites and scratches should be cleaned thoroughly.
If there is a risk of rabies, treatment can be started immediately
and medical advice should be sought promptly.
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MALARIA
What is Malaria?
Malaria is a protozoal disease spread by mosquitoes.
The symptoms are described as flu-like with headache, muscle
pain, tiredness and nausea, vomiting and diarrhoea. The disease
can be fatal. The illness can start as early as 8 days after
been bitten. In other cases, patients have developed the disease,
up to year later after being bitten.
Risk to travellers
Malaria is endemic in many parts of the world; Africa, South
and Central America Africa, the Indian subcontinent, Southeast
Asia and the Middle East. Malaria is considered a serious
risk to travellers.
There are many different strains of the infection, some of
which are resistant to the more commonly used anti-malaria
medicines.
It is imperative to take the most appropriate anti-malaria
medicines, when travelling to areas of risk.
Check here to see the anti-malaria medicine recommended for
your destination. A choice of anti-malaria medicines are are
given, as the preferred anti-malaria medicine may not always
be suitable, and in such cases the alternative anti-malaria
regimen will need to be taken (more)
Anti-Malaria Medicines
There is no vaccine to prevent malaria, but anti-malaria
medicines are taken to prevent the development of the disease
should you be infected. The choice of anti-malarial medicine
will depend on the destination), risk and local drug resistance.
Pregnancy, the age of the traveller, medical conditions (such
as epilepsy, depression) and the side effects of the drugs,
themselves, are also considered in the selection of anti-malarial
treatment.
Anti-malaria medicines should be started at least one week,
and usually three weeks, before entering a malarious area,
continued while there and for four weeks after departure.
Long term use of anti-malaria medicines, requires specialist
advice. Some anti-malaria medicines are just taken once weekly,
while others must be taken daily.
The most commonly used anti-malarial medicines are chloroquine,
mefloquine, proguanil, primethamine and a primethamine/dapsone
combination product.
Tips to avoid Malaria.
Exposure to mosquito bites should be minimised by the use
of insect repellants, mosquito nets and wearing long-sleeved
shirts and long trousers, especially in the evenings, when
mosquitoes are most active.
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POLIO
What is Polio?
Polio is a viral infection which affects gastrointestinal
tract and the central nervous system which can paralyse and
even cause death
Risk to travellers
Polio is found in all areas of the world other than Northern
and Western Europe, North America, Australia and New Zealand.
Prevention of Polio
Everybody in Ireland should have been vaccinated against polio
as a child. A ten-year booster is required, before travelling
to a risk area.
The polio vaccine is administered orally and is usually well
tolerated although there have been reports of allergic reactions
to the vaccine and or mild diarrhoea.
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YELLOW FERVER
What is Yellow Fever?
Yellow fever is a viral disease, transmitted by mosquitoes.
It is characterised by fever, headache, abdominal pain and
vomiting and medical attention should be sought immediately
Risk to travellers
Yellow fever is found in Africa and South America, more commonly
in the moist savanna zones of West and Central Africa during
the rainy season. Although the disease is a very rarely experienced
by travellers, many countries require certification that a
traveller has been vaccinated against yellow fever. Such a
certificate can only be obtained from an authorised Yellow
Fever Centre.
Prevention of Yellow Fever
A single injection of the vaccine starts to work about two
weeks after administration and gives protection for 10 years.
The vaccine is suitable for adults and children over 9 months;
there is small risk of encephalitis when infants less than
9 months are vaccinated.
Those who have had serious allergic reactions to eggs should
not receive the vaccine.
Tips to avoid Yellow Fever
Mosquitoes should be avoided by the use of insect repellants,
mosquito nets and wearing long-sleeved shirts and long trousers,
especially in the evenings, when mosquitoes are most active.
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DIPHTHERIA
What is Diphtheria?
Diphtheria is a bacterial infection transmitted by intimate
respiratory and physical contact. It can affect the primarily
the tonsils, pharynx, larynx, nose, and occasionally other
mucous membranes or skin.
Risk to travellers
The areas of greatest risk are the countries of the former
Soviet Union, but can occur in any area where immunisation
levels are low.
Prevention of Diphtheria
Children receive Diphtheria vaccination combined with tetanus
and pertussis. Travellers who have been previously immunised
require a booster dose of diphtheria vaccine, when travelling
to high-risk areas, if their immunisation was longer than
10 years ago.
Unimmunised travellers should receive a complete course of
the vaccine, which involves three injections at monthly intervals.
Adults and children under 10 years of age are administered
a low-dose vaccine.
The vaccine is usually administered combined with tetanus
vaccination.
Side effects include reddening and swelling at the site of
injection, which do not last for long, while headache and
fever have also been reported.
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MENINGOCOCCAL MENINGITIS
What is Meningococcal meningitis?
Meningococcal meningitis is a bacterial disease, characterised
by sudden onset with fever, intense headache, nausea and often
vomiting, stiff neck, and an unusual pink rash. The Meningococca
bacteria is one of a number of causes of meningitis.
Risk to travellers
The high-risk areas include, the African Meningitis Belt,
which is the savannah area, which runs between Mali and Ethiopia,
between the Equator and 15oC North latitude, parts
of the Middle East and parts of the Indian Sub-continent.
It is considered that up to 10% of the population in endemic
countries may be carriers of the disease do not suffer themselves.
Prevention of Meningococcal meningitis
Meningococcal polysaccharide A&C vaccine is effective
against A and C serotypes of the bacteria. No vaccine is available
to offer protection against serogroup B. Vaccination is required
for pilgrims to Mecca, Saudi Arabia, for the annual Haji.
Adverse reactions are normally mild and do not last very long
and can include irritation at the site of injection and high
temperature in young children. It is considered that the vaccine
provides immunity for three years for adults and older children,
but the duration of immunity is much shorter for young children
and infants.
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HEPATITIS B
What is Hepatitis B?
It is reckoned that about 300 million people carry the Hepatitis
B virus. The disease is spread by contact with infected blood,
blood products or body fluids. The disease is more severe
than Hepatitis A and can lead to long term liver damage, and
liver cancer.
Risk to travellers
Short-stay tourists or business travellers are not usually
considered at risk, other than those whose sexual behavior
may put them at increase risk of contracting the disease.
Those who wish to stay in a high-risk area to work in the
health care or long-stay visitors should be vaccinated.
Prevention of Hepatitis
B
Hepatitis B vaccines can take up to six months to give adequate
protect and it is often recommended that a booster be given
every five years.
Three doses of the vaccine are administered over usually administered
over 6 months, with the first two injections at an interval
of one month and the third injection six months after the
first. Where a more rapid response is required, the three
doses are administered over 2 months and a booster administered
after 12 months. Adverse reactions can include reactions at
the site of administration, and rarely a low grade fever,
headaches, dizziness or nausea.
A combined Hepatitis A and B vaccine can be administered,
as three doses over six months.
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JAPANESE ENCEPHALITIS
What is Japanese encephalitis?
Mosquitoes transmit Japanese encephalitis. Encephalitis is
an inflammation of the brain.
In some cases no symptoms are obvious, but the disease can
have as high as a 30% fatality rate. About 50% of survivors
can suffer neurological after-effects.
Risk to travellers
Vaccination is recommended for those going to rural areas
of China, Japan, Korea, the Far East and the eastern areas
of Russia, where infection is endemic, and where the visit
is for longer than one month. In endemic areas, children are
at greatest risk of infection, while the disease is more likely
to be fatal in the elderly.
Prevention of Japanese encephalitis
Travellers should be aware that there is not Japanese
encephalitis vaccine with an Irish product authorisation and
should discuss all associated risks with their doctor.
Japanese encephalitis vaccine is administered in three doses:
Day 0, Day 7-14 and Day 28-30.
Immunity takes about one month to develop and boosters are
normally administered annually. Local reactions, headaches,
fever, headache occurs in about 20% of people.
Allergic reactions have also been reported.
Tips to avoid Japanese encephalitis.
Exposure to mosquito bites should be minimised by the use
of insect repellants, mosquito nets and wearing long-sleeved
shirts and long trousers, especially in the evenings, when
mosquitoes are most active.
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references
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