High alert – Health pre­cau­tions for first- time African trav­ellers

Health pre­cau­tions for first- time African trav­ellers

RISKSA Magazine - - CONTENTS - An­ton Pre­to­rius

At the risk of prop­a­gat­ing an old cliché – Africa re­mains one of the last fron­tiers of travel. Largely ru­ral, Africa is one of the few des­ti­na­tions where ad­ven­ture and dan­ger lurk around ev­ery bush, scrub or ‘ un­ex­plored’ path­way. While Africa is any quin­tes­sen­tial trav­eller’s dream, dis­ease and sick­ness pose a se­ri­ous threat to trav­ellers. Find­ing out what vac­ci­na­tions and im­mu­ni­sa­tions you need be­fore trav­el­ling into Africa is an im­por­tant part of plan­ning your trip. We con­sulted a travel clinic med­i­cal ad­viser for more in­for­ma­tion.

Im­mu­ni­sa­tions help pro­tect trav­ellers from some of the dis­eases they may be at risk of be­ing ex­posed to on their trav­els. Un­for­tu­nately, there are many more dis­eases one may en­counter while trav­el­ling in Africa that can­not be pre­vented by vac­ci­na­tion ( for ex­am­ple di­ar­rhoea and malaria). Many coun­tries re­quire trav­ellers to have a cer­tifi­cate show­ing valid vac­ci­nated against yel­low fever ( and some­times cholera) be­fore al­low­ing ac­cess into the coun­try. Wher­ever you are go­ing, it would be wise to en­sure all im­mu­ni­sa­tions are recorded on an of­fi­cial cer­tifi­cate – usu­ally is­sued by a doc­tor or travel clinic. This is use­ful for your own in­for­ma­tion and know­ing what you are pro­tected against. Some vac­ci­na­tions, like those for ra­bies, are ad­min­is­tered in a se­ries and trav­ellers need to plan at least a few months ahead of de­par­ture to fit them all in. A gen­eral prac­ti­tioner prob­a­bly will not be able to give you all the vac­ci­na­tions re­quired, so you should con­tact the near­est travel clinic for an ap­point­ment. Doc­tor Pete Vin­cent, med­i­cal ad­viser to the Net­care Group of travel clin­ics in Cape Town, says that it is im­por­tant for trav­ellers to visit a travel clinic. He stresses that trav­ellers need

to get a break­down of po­ten­tial med­i­cal risks and what vac­cines are rec­om­mended. “Most im­por­tantly, you will be told what the malaria risk is and if pro­phy­lac­tic med­i­ca­tion is ad­vised.” A pro­phy­lac­tic is med­i­ca­tion given not be­cause you have a dis­ease, but to try and pre­vent a dis­ease from ever hap­pen­ing in the first place. When vis­it­ing a travel clinic trav­ellers will be asked to fill out a health form de­tail­ing their med­i­cal his­tory and al­ler­gies, as well as past vac­ci­na­tions. “What has been shown is that as we ap­proach adult­hood our im­mu­nity to child­hood vac­cines pre­vi­ously given wanes, and a sin­gle booster of vac­cine given, can pro­vide life­long im­mu­nity for that dis­ease en­tity,” says Doc­tor Vin­cent. He continues, “We ad­vise all trav­ellers to en­sure their tetanus sta­tus is up to date. There is a vac­cine that com­bines tetanus, polio, diph­the­ria and per­tus­sis ( whoop­ing cough) in one vac­cine, and is known as the ‘ trav­ellers’ tetanus’. It of­fers life­time im­mu­nity for three of the dis­eases and 10 years of pro­tec­tion.” The most com­mon prob­lem in Africa is trav­eller’s di­ar­rhoea, which af­fects 27 per cent of trav­ellers within three days of ar­riv­ing at a new des­ti­na­tion. “In Africa, food sup­ply is usu­ally good, with fruit and veg­eta­bles in plen­ti­ful sup­ply.” How­ever, buy­ing meat in the mar­ket place should be avoided. “Don’t drink tap wa­ter when trav­el­ling, only if it’s bot­tled or treated. Re­mem­ber, bring­ing wa­ter to the boil for a minute is enough to ster­il­ize the wa­ter. A tea­spoon of bleach in a litre of wa­ter can be used to ster­ilise veg­eta­bles and sal­ads. Don’t put ice in your drinks un­less it comes from bot­tled wa­ter. “Any fresh­wa­ter ex­po­sure in Africa raises the pos­si­bil­ity of de­vel­op­ing bil­harzia ( schis­to­so­mi­a­sis). If you swim or wade in Lake Malawi for any length of time you are al­most 90 per cent guar­an­teed to have been in­fected with the par­a­site and will need a blood test three months af­ter the ex­po­sure to con­firm the in­fes­ta­tion,” warns Doc­tor Vin­cent.

HEPATI­TIS A

Ac­cord­ing to the good doc­tor, it is also very im­por­tant to be cov­ered against hepati­tis A, which is spread by food han­dlers via the fae­cal- oral route. “This can be done with a very ef­fec­tive vac­cine re­quir­ing two shots six to eight months apart, which will help give trav­ellers life­time im­mu­nity. This vac­cine can be given alone or com­bined with a ty­phoid vac­cine or hepati­tis B ( vac­cine). It’s vi­tal that all trav­ellers be cov­ered with im­mu­nity to tetanus and hepati­tis A, be­fore you ever think of cross­ing our borders,” he adds. To avoid hepati­tis A in Africa, do not eat the fol­low­ing: • Food served at room tem­per­a­ture • Food from street ven­dors • Raw or runny eggs • Raw or un­der­cooked meat or fish • Un­washed or un­peeled fruits and veg­eta­bles • Peel­ings from fruit or veg­eta­bles • Sal­ads • Un­pas­teurised dairy prod­ucts • Bush meat ( mon­keys, bats or other wild game)

RA­BIES

If one is tour­ing Africa for any length of time and camp­ing, then a ra­bies vac­ci­na­tion can be a life- saver, and is well worth the three vac­ci­na­tions re­quired. If you are bit­ten by an an­i­mal, or scratched by a bat, all you re­quire is a sin­gle dose of ra­bies vac­ci­na­tion af­ter the bite. “With­out this pro­tec­tion, you’ll need im­me­di­ate med­i­cal evac­u­a­tion back to South Africa to source ra­bies im­munoglob­u­lin and a se­ries of vac­ci­na­tions to try and give you some chance against cer­tain fa­tal­ity if not treated prop­erly. Al­ways clean a bite im­me­di­ately with soap and wa­ter,” Doc­tor Vin­cent ad­vises.

MALARIA

Malaria is the big­gest threat in Africa and an im­por­tant rea­son to visit a travel clinic as they will be able to tell you the like­li­hood of ex­po­sure you will face and what pre­cau­tions to take. Al­ways re­mem­ber that if you don’t get bit­ten, you won’t get malaria. The fe­male Anophe­les mos­quito bites from dusk to dawn. There­fore, light­weight long sleeves and pants ( with socks) should be stan­dard gear. “There are three anti- malar­ial med­i­ca­tions used for pro­phy­laxis: Meflo­quine, Dox­cy­cline and Ato­vaguone- proguanil, and the travel clinic can as­sess which is the most suit­able choice for the trav­eller. They all have their pros and cons, but are es­sen­tial to take as pre­scribed,” says Doc­tor Vin­cent. Malaria causes fever and a flu- like ill­ness 10 days af­ter en­ter­ing a malaria area, which is an im­por­tant fact to re­mem­ber, as a fever oc­cur­ring be­fore 10 days is un­likely to be malaria. It can strike at any time once bit­ten by an in­fected mos­quito for up to six months af­ter en­ter­ing a malaria area. One should al­ways have malaria ex­cluded first as a cause of headaches and fevers with a blood test, and fol­low up the test re­sults. “For trav­ellers go­ing to re­mote re­gions there are rapid di­ag­nos­tic test kits that the travel clin­ics can pro­vide, as well as stand- by treat­ment, but the ne­ces­sity of get­ting to a med­i­cal fa­cil­ity to have the di­ag­noses con­firmed is al­ways em­pha­sised. Malaria is easy to treat in the first day or two, but [ may] be­come deadly if not di­ag­nosed and cor­rectly treated within 24 hours,” the doc­tor con­cludes.

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