Heidelberg Travel Clinic

10/06/2014

Malaria prophylaxis: to take or not to take?

Many travellers do not take malaria prophylaxis because they believe that the symptoms will be hidden and thus the disease will not be diagnosed in time. This is not true.

The current recommended malaria prophylaxis actually kills the malaria parasite before it enters the liver (before getting ill). If taken correctly the efficacy ranges between 90% and 98%. In combination with mosquito avoidance measures this can be as high as 100%.

Depending on what you plan to do (camping/outdoors vs. corporate travel) a suitable option can be prescribed offering piece of mind and making it possible to enjoy your holiday. Remember that most malaria areas do not offer nearby medical services and one should take the distance to the nearest medical help into consideration.

Side effects are a real concern and it should be discussed with someone with experience in travel health. It differs from medication to medication and most people should be able to take one type of medication. It is wise to drink the medication before departing to see if the side effects are unbearable.

Many tourist routes have a risk of malaria. At the Heidelberg travel clinic the risk can be calculated for each individual traveller.

10/05/2014

Health Advice when travelling
You can avoid a lot of problems and inconvenience by taking appropriate precautions whilst abroad. Matters of hygiene can be neglected in some countries. It is therefore important to pay attention to the following:

Personal hygiene
Infectious diseases are mainly spread as a result of poor hygiene. The most important rule is the simplest: always wash your hands after using the toilet and before preparing food or eating. Make sure you have antibacterial hand soap and/or gel with you as well as clean, dry towels. Your body will also be exposed to external risks. Do not walk barefoot in long grass. We also recommend wearing clothes that cover the entire body and that you do not swim in stagnant or slow-moving water.

Meals
The most common health problems experienced by travellers are diarrhoea and intestinal infections. In most cases, contaminated food, drinking water and beverages are the cause. The most important things you can do to avoid infection are:

• do not eat cooked food that has been stored for several hours at room temperature;
• only eat food that is thoroughly cooked and still warm, or raw fruit and vegetables that have not already been peeled and are not damaged;
• do not buy food from street vendors;
• do not eat ice cream if you do not know its origin;
• ask locals which fish are safe and which could be poisonous;
• boil unpasteurised milk before use;
• if you are in any doubt as to the quality of the drinking water be sure to boil it before use;
• do not have ice cubes in your drinks: they are often made from water which is not drinking water;
• Brush your teeth using safe (??bottled) water;
• only drink bottled water if the seal has not been broken or if the bottles are sealed with a metal cap/crown;
• Try to choose hot drinks because they tend to be safer.

The standards of hygiene practised by locals when preparing food are a good indication of whether or not it is safe to eat and drink there. The risks of getting an infection or diarrhoea are much higher in a country where hygiene standards are low. Poor infrastructure and poor quality tap water contribute to the level of risk. In countries where such conditions exist it is advisable to take extra precautions when it comes to hygiene - even in expensive hotels and restaurants.
Hepatitis A and E, cholera, giardia and typhoid are all diseases which are spread through contaminated drinking water. In addition, various viruses, bacteria and parasites can cause traveller's diarrhoea. Eighty per cent of the people who travel to areas where the water is contaminated are affected. Toxins in seafood and fish are also well known causes of intestinal disorders.

Bathing, showering and swimming
Please note that water used for bathing, showering or swimming is not always safe. It can be contaminated with bacteria and viruses which cause intestinal infections. You should always ask about the quality of the swimming water in advance and avoid locations near to where sewage is discharged. Always try not to swallow water when swimming or bathing.

Infectious diseases
various infectious diseases are commonly experienced by people who travel to less developed countries. It is important to be aware that you could be affected by one of these infections if you are visiting such countries. You can learn more about specific diseases from the Diseases section of our website.

Insects and animals
when travelling to a sub-tropical country you run the risk of contracting one of the diseases transmitted by mosquitoes. These include malaria, dengue fever, Japanese encephalitis and yellow fever. You may also be exposed to the risk of infection from ticks which transmit diseases such as tick-borne encephalitis.

Some of these diseases can develop rapidly and become very serious. Anyone travelling to a (sub) tropical country should take the following precautions to avoid being bitten by mosquitoes or ticks:

• Wear clothing that covers the entire body (long trousers, long sleeves, shoes and socks). This is particularly important in the evening and at night.
• Apply an insect repellent containing DEET to all exposed skin. Products containing DEET are also safe for pregnant women and children. A concentration of 30% DEET is usually sufficient. Do not apply the product to the hands of babies or small children as they tend to suck their fingers which would be unsafe.
• Make sure you are sleeping in a mosquito-free room or under an undamaged mosquito net which has been impregnated with mosquito repellent. This is especially important for children and pregnant women. If there is air-conditioning: use it.
• You can take anti-malaria tablets during and after travel to an area where there is a high-risk of malaria. Heidelberg Travel Clinic can give you a prescription.

Animals can also transmit diseases, be poisonous or trigger allergic reactions. Rabies is common amongst wild animals in many countries and can sometimes be found in domestic animals as well. Mammals can transmit viruses through bites or scratches. To prevent this happening try to remember the following:

• Avoid any unnecessary contact with animals. Do not pet or tease them.
• If you are bitten or scratched by an animal contact a doctor immediately if possible and certainly within 24 hours.
• There are a series of rabies vaccinations available. Consult Dr Siewert Alkema at the Travel Clinic.

The list of poisonous animals includes certain kinds of jellyfish, spiders, scorpions and snakes. It is not possible to be vaccinated against their poisons, but antidotes are often available. If you are bitten or stung by a poisonous animal you should go directly to the nearest doctor, hospital or medical clinic.

Some helpful tips for avoiding such incidents are:

• listen to advice from local people, or people with experience of travelling in the area;
• avoid places where dangerous animals have been seen;
• wear boots or closed-shoes in areas where snakes are common;
• if you are staying in an area where snakes or scorpions are known to be common, take your boots/shoes indoors at night and check inside your shoes before putting them on again;
• Contact a doctor immediately if you have been, or suspect you may have been, bitten or stung by a poisonous animal.

24/03/2014

All international travellers should be up to date on all routine vaccinations and should be vaccinated against vaccine-preventable, destination-specific diseases for which they are at risk. An individualized risk-benefit assessment is given to each traveller at Heidelberg Travel Clinic.

10/02/2014

Yellow Fever is a serious and sometimes fatal viral disease that is spread by mosquitoes in tropical parts of Africa and South America. It occurs in both jungle and urban environments and is particularly common in the rainy season.

COUNTRIES AT RISK

Yellow fever occurs in tropical parts of South America and sub-Saharan Africa, most commonly West Africa. According to the International health regulation (IHR) it is mandatory to have a valid yellow card as proof of vaccination when travelling to endemic countries. The list of countries is updated regularly. Failure to provide a valid certificate can lead to a traveller being quarantined, immunized or denied entry.
TRAVEL PRECAUTIONS

Yellow fever is transmitted by mosquitoes in rural and urban areas. The risk of exposure is influenced by individual factors: the destination, travel itinerary, length of stay and personal protective measures against mosquitoes.
PREVENTION

Yellow Fever is preventable by vaccination. Travellers to areas at risk may require a single dose injection of Stamaril.

03/02/2014

A question that we often get from patients before travelling are:

“What vaccines do I need before I travel?”

Our recommendations/observations are:

* Hepatitis A and Typhoid, since food and water born illnesses are still top of the list.

* Rabies vaccine is desirable, but not a must, since effective preventive treatment is available in the event of an animal bite.

* Japanese Encephalitis (JE) vaccine is recommended if you’re travelling between late July and early October, especially if you’re travelling to the Asia.

* One should be up to date on the Tetanus/Diphtheria vaccine (every 10 years).

* Taking the flu shot annually is a good idea.

02/10/2013

Schistosomiasis (Bilharzia)

Introduction:

This is a parasitic worm infection that is acquired by skin contact with infested fresh water. Fresh water snails release microscopic infective parasites into the water that pe*****te skin on contact. The snails usually live on w**d and stones near the surface of water - but not exclusively. Currents can spread the parasites to areas well away from the contaminated water. It causes different clinical illnesses, most commonly blood in urine (haematuria).

Recommendations for Travelers:

Do's
• Avoid activities in affected regions that may involve direct water contact , this includes paddling, swimming, diving, snorkeling, rafting, canoeing, water etc. (even standing in water is not advised).
• Swim only in chlorinated swimming pools or safe sea water in affected areas.
• Check to ensure water facilities (showers, baths etc) at accommodation/recreational facilities are safe (many hotels/facilities draw water directly from nearby lakes, untreated this water can transmit schistosomiasis).
• Avoid drinking tap water when traveling, stick to bottled or boiled water instead.

Don't's
• Rely on other travellers/locals to inform you if a water source is infected or not – try and find out from an official/reliable source.
• Use insect repellent to prevent infection. There is no evidence that this works and most repellent is water-soluble and so will simply wash off.
• Rely on vigorous towel drying of skin after water contact – there is no reliable evidence to prove that this works.
• Buy treatment for schistosomiasis overseas. This is often sold in resorts and is either counterfeit, taken at the wrong dose or taken too early to cure infection – the drug only works when taken 8 weeks after exposure.

26/07/2013

Please keep in mind that you need to get your vaccine against POLIO at least 10 days before you travel.

24/06/2013

POLIO IN AFRICA

Current situation:

Although polio is thought to be extinct by most people (including South Africans) there are still countries with circulating Wild Polio Virus (WPW) and could not be declared polio free by the World health organization (WHO). One of these countries (Somalia) has now caused an outbreak of WPW-1 in the horn of Africa that could potentially affect millions of adults and children.
With the famine political unrest in Somalia there is cross border travel and refugee camps in Kenya and other neighbouring countries causing cross border spread of the disease.
It is recommended to all travellers to be up to date with their immunizations but especially if visiting Somalia, Kenya, and surrounding countries of Djibouti, Ethiopia, South Sudan, Uganda and Tanzania.

What can travellers do to prevent polio?
• GET THE POLIO VACCINE:
o Ask your travel health practitioner to find out if you are up-to-date with your polio vaccination and whether you need a booster dose before travelling. Even if you were vaccinated as a child or have been sick with polio before, you may need a booster shot to make sure that you are protected.
o Make sure children are vaccinated.

• EAT SAFE FOODS:
o Food that is cooked and served hot
o Hard-cooked eggs
o Fruits and vegetables you have washed in clean water or peeled yourself
o Pasteurized dairy products

• DON'T EAT:
o Food served at room temperature
o Food from street vendors
o Raw or soft-cooked (runny) eggs
o Raw or undercooked (rare) meat or fish
o Unwashed or unpeeled raw fruits and vegetables
o Peelings from fruit or vegetables
o Condiments (such as salsa) made with fresh ingredients
o Salads
o Unpasteurized dairy products
o ”Bushmeat” (monkeys, bats, or other wild game)

• DRINK SAFE BEVERAGES:
o Bottled water that is sealed (carbonated is safer)
o Water that has been disinfected (boiled, filtered, treated)
o Ice made with bottled or disinfected water
o Carbonated drinks
o Hot coffee or tea
o Pasteurized milk

• DON'T DRINK:
o Tap or well water
o Ice made with tap or well water
o Drinks made with tap or well water (such as reconstituted juice)
o Flavoured ice and popsicles
o Unpasteurized milk

• PRACTICE HYGIENE AND CLEANLINESS:
o Wash your hands often.
o If soap and water aren't available, clean hands with hand sanitizer (containing at least 60% alcohol).
o Don’t touch your eyes, nose, or mouth. If you need to touch your face, make sure your hands are clean.
o Cover your mouth and nose with a tissue or your sleeve (not your hands) when coughing or sneezing.
o Try to avoid close contact, such as kissing, hugging, or sharing eating utensils or cups with people who are sick.

(References available on request.)

13/05/2013