High alert – Health precautions for first- time African travellers
Health precautions for first- time African travellers
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.
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)
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 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.