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Deseases
Spread By: Insect Bites
Also known as African Trypanosomiasis and Human African Trypanosomiasis (HAT), African Sleeping Sickness is a parasitic disease spread by the bite of the tsetse fly, which is about the size of a honeybee and gray-brown in color.
The early symptoms of the disease include fever, skin lesions, a rash and swelling of parts of the body and of the lymph nodes in the neck. Within one to four weeks, the disease progresses to affect the brain, causing coma and death, hence the name "sleeping sickness."
No vaccine is available.
Spread By: Food and/or water
The Disease
Cholera is an intestinal infection. The bacterium is spread through food and water that has been contaminated by the feces of an infected person. One to five days after infection, patients develop severe, painless, watery diarrhea, often called "rice-water" stools. Vomiting also occurs in most patients. Usually, the symptoms are relatively mild and respond to oral rehydratation.
Severe cases of cholera (10-20%) can cause life-threatening dehydration. Treatment involves oral and/or intravenous fluid replacement and antibiotics, which reduce the volume and duration of diarrhea.
Risk for Travelers
Cholera tends to occur in large epidemics, especially in areas where sanitary conditions have deteriorated such as refugee camps and war zones. With the exception of health and relief workers, cholera rarely infects travelers who avoid unsanitary conditions.
Vaccine
An injected cholera vaccine is available in many countries but is rarely recommended; immunity is unreliable and may only last a few months. This vaccine is no longer available in the
Two more effective oral vaccines are available in an increasing number of countries, including
The other, the oral B-subunit vaccine Dukoral, gives good protection against cholera and halves the risk of developing traveler's diarrhea caused by ETEC (enterotoxigenic E.coli). ETEC is one of the more common causes of traveler's diarrhea. However, travelers who use this vaccine should also carry self-treatment remedies in the event that they develop diarrhea that is not caused by ETEC.
Preventive Measures
If visiting an area infected with cholera, drink only boiled or bottled water, water that has been treated with chlorine or iodine, or carbonated beverages. Avoid ice, as it may have been made with unsafe water. Choose food that has been thoroughly cooked while fresh and is served hot. Avoid street vendors, pre-peeled fruit or salad, fish and shellfish. Fruit that you wash and peel yourself is safe.
Dengue
Spread By: Insect Bites
Dengue or "break-bone" fever is a viral disease of the tropics and sub-tropics. It is transmitted by the Aedes aegypti mosquito that bites during the daytime and is found in and around human habitation. Symptoms include high fever, severe headaches, joint and muscle pain and cough. A rash often follows. The acute illness can last up to ten days, but complete recovery can take two to four weeks.
Occasionally, a potentially fatal form of dengue called dengue hemorrhagic fever (DHF) occurs. DHF is mostly seen in persons who have been previously infected with dengue - the fatality rate is about 5%.
There is no vaccine against dengue fever. Wear long sleeves and long pants, and use insect repellents to prevent mosquito bites.
Sporadic cases occur.
Filariasis
Spread By: Insect Bites
Lymphatic filariasis is a parasitic disease caused by microscopic, thread-like worms and spread by mosquitoes. Infective larvae are injected through the skin by mosquitoes and travel to the lymph nodes, where the adult worms develop. The offspring of these adult worms (microfilaria) then migrate farther in the tissues and circulate in the blood causing a variety of symptoms. Initial symptoms consist of redness of the skin and swelling of the lymph nodes of the arms and legs, headache, weakness, muscles pain, coughing, wheezing and fever.
To contract lymphatic filariasis, one would have to endure thousands of mosquito bites over several months or years. Thus, short-term travelers are at low risk, but all travelers should prevent insect bites.
Hepatitis A
Spread By: Food and/or water
Hepatitis A is a viral disease affecting the liver. It is transmitted person-to-person and by contaminated food and water, especially in areas with poor sanitation and overcrowding.
Symptoms begin 15-50 days after infection and can include fever, chills, weakness, loss of appetite, nausea and/or abdominal discomfort followed by jaundice (yellowing of the skin and eyes). The urine may become dark and the stools pale.
Many people infected with hepatitis A, particularly children, suffer only a mild flu-like illness with no specific symptoms. In other cases the jaundice is severe. Occasionally hepatitis A causes life-threatening liver failure; this is more common in the very young, those with underlying health problems and those over the age of fifty. Past infection with hepatitis A virus gives life-long immunity and vaccination is not required.
All non-immune travelers should consider hepatitis A vaccination.
As hepatitis A is more severe in persons suffering chronic hepatitis, both hepatitis A and B vaccination is advised for all infected with hepatitis C. Hepatitis A vaccination is also recommended for all infected with hepatitis B.
Hepatitis A vaccination should be considered for all non-immune travelers.
As hepatitis A is more severe in persons suffering chronic hepatitis, both hepatitis A and B vaccination is advised for all infected with hepatitis C. Hepatitis A vaccination is also recommended for all infected with hepatitis B.
A combined hepatitis A and B vaccine is available in many countries. It requires of a series of three injections given on days 0, 30 and after six months. The first two doses are required before immunity to hepatitis A or B can be assumed. The third dose is necessary to ensure sustained immunity to both diseases.
Hepatitis B, STDs, & blood-borne diseases
Spread By: Sex/blood/needles
HIV/AIDS, hepatitis B, and hepatitis C are spread by contact with bodily fluids (especially blood and semen). Transmission most commonly occurs through:
- unprotected sex,
- needle sharing during IV drug abuse, or
- unsafe blood or medical/dental instruments.
· Genital herpes (HSV), genital warts (HPV), gonorrhea, chlamydia, syphilis and most other sexually transmitted diseases are spread by genital contact.
Prevention:
- In many countries, hepatitis B is now a routine childhood immunization and need not be repeated. All non-immune travelers should consider vaccination.
- Always use new condoms (preferably brought from your home country).
- IV drug users should not share needles.
- In healthcare settings, make sure that needles and syringes are new.
- Call International SOS or your corporate medical department if you are hospitalized or before having a blood transfusion
Leishmaniasis
Spread By: Insect Bites
Leishmaniasis is a disease caused by protozoa that can infect humans, dogs, rodents and other small animals. It is transmitted by sandflies that bite mainly between dusk and dawn and can occur in both rural/jungle and urban environments. Sandflies breed quickly in unsanitary conditions, and the spread of the disease is exacerbated by the civil war, chronic food shortages and mass population movement. There is no vaccine or drug(s) to prevent leishmaniasis.
Prevention
Avoid sandfly bites by:
- Minimizing outdoor activities from dusk to dawn--this is when sand flies are most active. Note that sandfly bites are painful, so you will know if you are being bitten.
- Using protective clothing and insect repellent.
Consider using a bed net with fine mesh if there are sandflies in your living quarters. The standard bed nets used to prevent malaria are of no use, as sandflies are about one-third the size of mosquitoes.
Malaria
Spread By: Insect Bites
Malaria is transmitted by mosquitoes that bite from dusk to dawn. Symptoms can develop as early as six days or as late as several months after exposure. Early symptoms are usually "flu-like." Vivax malaria typically progresses to cause episodic fever and chills, while falciparum malaria can also have life-threatening complications including anemia, seizures, mental confusion, kidney failure and coma. Travelers sufferer these complications more frequently than local inhabitants.
PREVENTING MALARIA
If visiting a malarial area:
- Focus on preventing mosquito bites
- Use a medication to prevent chloroquine-resistant P. falciparum malaria (as these are not 100 percent effective, preventing mosquito bites is still very important)
Appropriate antimalarial medications include:
- Atovaquone plus proguanil (Malarone®)
- Doxycycline (many brands and generics)
- Mefloquine (Lariam® and generics)
Malaria is present year-round in all of
Meningococcal meningitis
Spread By: Coughing/sneezing
Meningococcal disease is a severe, often fatal, bacterial infection. People can contract the disease if they inhale droplets that have been coughed or sneezed into the air by an infected person. Direct contact with an infected person's throat secretions (e.g. through kissing, sharing drinks) can also spread the disease.
The bacterium invades the brain and its linings (meningitis) and can multiply in the blood (septicemia). A characteristic red, blotchy rash occurs all over the body in most serious cases. Symptoms include fever, intense headache, vomiting, neck stiffness and progress to coma. It is essential that infected people receive antibiotics quickly, as the disease progresses rapidly and can cause permanent brain damage or death.
The risk to travelers is mainly limited to areas of equatorial
Vaccines against some strains of the disease are available. People who have been in close contact with an infected person should be promptly treated with preventive antibiotics.
Angola
Outbreaks occur.
Onchocerciasis
Spread By: Insect Bites
Also known as "River Blindness", onchocerciasis is mainly present in parts of tropical
No vaccine is available. Avoid black fly bites. Wear long-sleeved shirts and long pants. Use an insect repellent containing DEET.
Plague
Spread By: Insect Bites
Plague is found in many areas of the world. Caused by the bacterium Y. Pestis, plague mainly affects rodents but is occasionally transmitted to humans by fleabites. There are three main forms of plague in humans: bubonic, septicemic and pneumonic.
Bubonic plague is the more common form and occurs as the result of a fleabite. The plague bacillus travels through the lymphatic system to the nearest lymph node. The lymph node becomes enlarged and inflamed - a "bubo".
The septicemic form of plague occurs when infection spreads directly through the bloodstream. Without antibiotic treatment, this form of plague is usually fatal.
Pneumonic plague occurs when Y. Pestis infects the lungs. The first signs of illness in pneumonic plague are fever, headache, weakness and cough that produces bloody or watery sputum. The pneumonia progresses over two to four days and may cause septic shock and, without early treatment, death.
Plague vaccine is no longer commercially available.
Rabies
Spread By: Animals
Rabies is a viral disease contracted when bitten or scratched by an infected (rabid) animal, often a dog. The virus travels along nerves from the area of the bite to infect the brain, causing death.
In countries with rabies, ALL animal bites and scratches must be treated seriously. Rabies vaccination is very effective in preventing rabies, even after a bite/scratch by a rabid animal.
Rabies vaccination
In rabies-affected countries, pre-exposure vaccination is often recommended for expatriates and long-term visitors if quality medical care may not be available after being bitten or scratched by an animal. It is especially important for children who may not tell their parents that they have been bitten/scratched.
If bitten or scratched by an animal:
- Immediately cleanse the wound with soap and water and a povidone-iodine solution if available.
- Let the wound bleed freely.
Seek medical advice from a qualified source or your assistance company, and notify local health authorities immediately to assess the need for rabies post-exposure vaccination, even if you have had pre-exposure vaccination. (THIS CAN BE LIFE SAVING).
Schistosomiasis (bilharzia)
Spread By: Swimming/bathing
Schistosomiasis, also known as bilharzia, is a disease caused by parasitic worms that live in freshwater lakes, rivers and rice paddies. The cercariae can penetrate the skin of persons who are wading, swimming, bathing or washing in contaminated water. There is no vaccine.
To prevent infection:
- Avoid swimming or wading in fresh water in countries where schistosomiasis occurs.
- The use of soap during bathing reduces the risk of infection, as does a vigorous rubdown with a towel straight after exposure to contaminated water. Do NOT rely on these methods to prevent schistosomiasis.
- Bath water should be heated for five minutes at 50°C (122°F).
Water held in a storage tank for at least 48 hours should be safe.
Travelers' diarrhea
Spread By: Food and/or water
The Disease
Travelers' diarrhea is the most common travel-related illness. It usually occurs within the first week away from home and affects between 20 and 50 percent of all those who go abroad. Travelers are especially likely to become ill at high-risk destinations such as developing nations in
Travelers' diarrhea is mainly caused by the bacterium E coli, which is spread through contaminated food and water. Other bacteria, especially salmonella, shigella and campylobacter, account for an additional 5-30 percent of all cases. Viruses, such as rotavirus and clacivirus, and parasites are other common causes. Cyclospora particularly impacts travelers to
Choosing safe food and water will reduce the risk of developing the disease.
Management of Travelers' Diarrhea
It is important to treat travelers' diarrhea by replacing lost fluids. Continuously sip clear fluids such as water, soft drinks or weak tea. Avoid dairy products, alcohol and coffee. Most cases of travelers' diarrhea will resolve in one or two days.
Occasionally, intravenous re-hydration is required, especially if there has been significant vomiting or extreme diarrhea. Children are very susceptible to dehydration. Seek medical advice and attention early if children are affected.
Medications
Two main types of medications are used to treat travelers' diarrhea:
- Drugs to slow the diarrhea (e.g. loperamide: Immodium®, Diamode® and many generics) Use according to directions and seek medical attention if there is no improvement within 24-36 hours. Do not use these products if you have a high fever or blood in the stool. Do not give to children.
- Antibiotics Many travelers choose to carry antibiotics with them, since these drugs are relatively safe to use and usually shorten the illness. Three main classes of drugs are recommended:
- Ciprofloxacin (Cipro® and many generics or other quinolone antibiotics) Taken for one to three days. Cannot be given to children.
- Azithromycin: single dose. Safe for children. Adults take 1 gram (1000mg) once; children take 20mg per kilogram once.
- Rifaximin (Xifaxan) Taken three times a day for three days. Should not be used if the patient has a fever or blood in the stool. Can be given to children over 12 years old.
Obtain medical advice:
- If there is no improvement after 24-36 hours, especially in children.
If patient develops fever, bloody stools or become lightheaded or dizzy.
Typhoid
Spread By: Food and/or water
Typhoid fever is a serious infection caused by a species of salmonella bacteria spread by contaminated food or water. Choosing safe food and water will greatly reduce the risk of developing the disease.
The symptoms usually begin seven to 21 days after exposure. The typical feature of the disease is persistent high fevers. While typhoid fever is often called a diarrheal disease, not all patients have diarrhea. Early symptoms are flu-like: body aches and pains, weakness, loss of appetite and a continuous dull headache. A rash with pink spots may appear on the chest and abdomen of some patients. In severe cases, perforation of the bowel can cause severe bleeding or infection in the abdomen, which can be fatal. Paratyphoid is a similar but less severe disease.
Typhoid and paratyphoid can be cured with antibiotic treatment. Safe vaccinations are available only against typhoid.
Yellow fever
Spread By: Insect Bites
Yellow fever is a viral disease transmitted by mosquitoes that only occurs in parts of Africa and South America. The symptoms range from a mild influenza-like syndrome to a severe hemorrhagic fever with liver failure.
Because it is very contagious, many countries require proof of an up-to-date yellow fever vaccination before entry is allowed if any of the following applies:
- You have recently visited an infected country.
- You are visiting a country where the vaccination is required.
- You are visiting an infected region of an infected country.
In these cases, a signed and stamped WHO Yellow Fever Vaccination Booklet is required.
If visiting a country with yellow fever:
- Prevent mosquito bites.
- Consider yellow fever vaccination.
Angola
Yellow fever risk
Outbreaks have occurred.
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