Travel Vaccines & Travel Health Advice

travel vaccines photoIf you are planning a trip abroad, you can help to reduce your risk of developing various illnesses by receiving protective vaccinations in advance, whether its a holiday or a business-related trip. You will generally require vaccinations if you are travelling outside the countries of Western Europe, North America, Australia or New Zealand.

For example, favorite destinations in Asia, South America, Africa, Central America and the Caribbean will usually necessitate vaccination, while for some countries it is mandatory prior to entry. For certain areas, antimalarial tablets will also be necessary. A single visit will be sufficient to cover your requirements in many cases.
It is therefore advisable to visit a doctor to discuss these issues. Remember that some vaccines require more than one shot, so try to make your first appointment a couple of months prior to travel if possible. Last minute travellers should still seek advice, as vaccines given late are better than no protection at all.

Please bring to your consultation any information about previous vaccines which you may have received elsewhere, as this will help our doctor to decide which vaccines you will need for your next trip. Please fill in this Travel Vaccination FORM prior to you consultation

The Practice is an approved Yellow Fever Vaccination Centre. We keep all common vaccines in stock and we will provide you with up-to-date information regarding your medical concerns.


To make the appointment with one of our doctors, please contact our reception staff on 051-370057.

If possible, arrange your appointment three months prior to travel. However, it is never too late to obtain vaccines and for some destinations, as late as two weeks before travel can still provide you with sufficient cover.

Please bring to your consultation, any information about previous vaccines which you may have received in the past, as this will help your doctor to decide which vaccines you will need for your next trip.

  • Travel vaccines work by boosting your own immune system, so that your body can overcome the real infection when necessary.
  • Vaccines can sometimes cause minor muscle soreness, which can be alleviated by taking Paracetamol on the day of vaccination.
  • Going to work, playing sports, driving and other regular tasks will not be affected when receiving travel vaccines. Hence you dont need to cancel any of your daily activities on the day of receiving vaccinations.
  • If you develop a high temperature (fever) on return from your holiday, please inform your doctor immediately. The first sign of malaria can sometimes be a fever, which may occur several months after returning to Ireland.

Summary of preventable tropical illness

1. Typhoid fever

What is typhoid fever?

Typhoid fever is a sudden onset, or acute, febrile bacterial infection. It is transmitted through the ingestion of food or water that has been contaminated with the bacterium Salmonella typhi . Although common in the developing world, typhoid affects only 1 in 3,000 travellers to developing countries with the risk greatest for travellers to sub-Saharan Africa, India, Nepal, Indonesia and parts of Latin America. Without treatment the illness can be fatal, with perforation of the gut producing peritonitis or severe bleeding. With appropriate antibiotic therapy the fatality rate reduces to 1% (from 10 – 30 % in untreated cases.) Paratyphoid fever is a similar, but usually less severe, condition. Some people become chronic carriers and continue to shed the bacteria in the faeces without experiencing symptoms.

How do you catch typhoid fever?

This is by ingesting food or water contaminated by the typhoid bacterium: contamination is most likely when cooked food is handled or left un-refrigerated. The bacteria enter the blood stream from the intestinal wall lining after ingestion of contaminated food or water.

What is the incubation period (time from exposure to first symptoms)?

7 to 14 days (range 3 to 60).

How is typhoid fever diagnosed?

This is by laboratory tests to find the typhoid bacteria in the blood or faeces of an infected person. Illness is usually characterised by fever, loss of appetite, lethargy and change in bowel habit. Constipation is common in the initial stages of the disease but diarrhoea can also occur.

What is the treatment?

This is with antibiotics for 10 to 14 days.

How do you prevent typhoid fever ?

Simple food and water precautions. Wash hands with soap and water after going to the toilet; avoid risky foods ( particularly raw fruit and vegetables ) and drinks.

Remember the adage:


Here Are 5 Top Tips that will help do this:

  • Drink bottled, purified or carbonated water for drinking and cleaning teeth. Make sure that bought bottled water is appropriately sealed; regular water ( at sea level ) should be brought to boiling point for one minute before it is safe to drink.
  • Avoid ice in drinks and remember that refreshing ice blocks and flavoured ices may be made with contaminated water.
  • Foods should be thoroughly cooked and served piping hot. Be very wary of food sold by street vendors!
  • Avoid raw seafood and shellfish; even though they may have been preserved with vinegar, lemon or lime juice.
  • Choose raw vegetables and fruits that you can peel yourself. Avoid salads unless they have been made by you! Do not forget to wash your hands with soap or hand cleanser first and do not eat the peelings!

Who is most at risk for developing typhoid fever?

The following are ‘High risk’ groups for developing Typhoid Fever:

  • travellers with individualistic lifestyle and those that are intending prolonged travel to areas where there is typhoid fever
  • former immigrants ( from developing countries ) visiting their parent countries
  • those with no acid ( or low concentrations of acid ) in their stomachs, such as post surgery or with the regular use of antacids and medication to reduce stomach acidity
  • those with severe or ongoing disease may need particular advice about Typhoid Fever and where the intended travel is to be
  • travellers to the Indian Subcontinent
  • medical personnel, foreign aid workers and military personnel assigned in developing countries

Is there an adequate and protective vaccination / immunisation against typhoid fever?

Travellers to endemic or epidemic area can reduce the chance of getting the disease by 70 – 90% with vaccines. Travellers should leave plenty of time for immunisation before they go. Typhoid vaccine (injectable or oral) is recommended for adults, and children over the age of two years, travelling in conditions of doubtful hygiene. The vaccination may not be expected to protect against 100% of susceptible bacteria. Breast-feeding is likely to protect infants. Children under 5 years of age may be more likely to have a mild illness of typhoid than older children.

2. Hepatitis
There are 4 types of Hepatitis that travellers may be particularly exposed to. They occur world-wide and are all due to different viruses: Hepatitis A, Hepatitis B, Hepatitis C and Hepatitis E.

Hepatitis A and E are caught by ingesting food and water contaminated with human faeces. Both are common in areas where sanitation and water are inadequate. Hepatitis B and C are caught through contact with blood and body secretions of infected persons.

Hepatitis A

What is Hepatitis A?

It is a virus infection of the liver. The course is variable. It is usually a mild illness, particularly in children, lasting 10-14 days, but sometimes it can be more severe, lasting some months. In adults over the age of 40 years, up to 2% of cases are fatal.

What is the risk of developing Hepatitis A?

The risk of getting Hepatitis A is 1 in 200 per week of travel for off-tourist routes and backpackers: this approximates to a 1 in 50 chance. For those on tourist route or resort routes the risk is: 1 in a 1000 per week or, approximately a risk of 1 in 300.

How do you catch Hepatitis A?

Hepatitis A is spread through the oral-faecal (mouth-anus) route and through contaminated food and water. Shellfish such as oysters and mussels are frequently responsible but milk, cold meats and other food contaminated during preparation are potential sources. Rarely, it may be obtained through contaminated blood products.

What is the incubation period (time from exposure to first symptoms)?

21 – 30 days (range 14 – 60 days).

How is Hepatitis A diagnosed?

The following signs and symptoms are an indication of the disease: initially loss of appetite, tiredness and lethargy, nausea, and abdominal discomfort. This may be followed within a few days by jaundice (yellow eyes and skin), orange urine, pale bowel motions, and yellow “whites of the eyes”. A blood test for specific Hepatitis A antibodies is necessary to confirm the diagnosis.

What is the treatment?

There is no specific treatment. Cases usually either recover spontaneously or, very rarely, they may die.

How do you prevent Hepatitis A?

Food and water precautions are important, and good long-term protection is available from Hepatitis A immunisation.


A course of Hepatitis A immunisations provides virtually 100% protection for 30 years. Adult dose is either 0.5 mls or 1.0 ml intramuscular with a booster dose 6 to 12 months later, depending on the type of vaccine. Time to immunity is 15 to 30 days after the primary injection and duration of cover is twenty to thirty years.

All children who are going to high risk areas should be immunised. It is suggested to commence this vaccination from 1 year of age. After 2 vaccinations protective efficacy is considered to be 100%. To date, many authorities would give immunoglobulin only to children under 2 years who are at significant risk for Hepatitis A. Hepatitis A immunisation is indicted for children from 1 year of age onwards. (See notes on Hepatitis A & B combined for children aged 12-24 months ). It should be noted that Hepatitis A in children under 2 years is usually mild, and only a minority become jaundiced.

Hepatitis A & B combined Vaccination.

A 3-dose primary series of intramuscular injections at months 0, 1 and 6. An accelerated dose series is available, for those who are travelling urgently and will not have time for the routine series: at 0, 7 and 21 days, with a blood test at 1 year followed by a final booster dose.if required. Immunity is approximately 95% for both diseases at one month after the second dose. Duration of cover is 20-30 years for Hepatitis A and 15 years to life for Hepatitis B.

Hepatitis B

What is Hepatitis B?

It is a virus infection of the liver. The course is variable. Recovery from the acute infection usually takes 28 days but is sometimes more prolonged.

Children under 1 year of age usually have no symptoms but virtually 100% of such children remain infected with the virus (i.e. are Hepatitis B carriers) for years, often for life. About 5% of adults remain carriers after getting the disease. hepatitis B carriers can infect other people, and are at risk of death from cirrhosis of the liver and liver cancer, years after the initial infection.

How do you catch Hepatitis B?

Hepatitis B may be acquired by: contact with contaminated blood (e.g. transfusion with infected blood, sharing needles and syringes with intravenous drug users, body piercers and tattooists); sexual intercourse (homosexual and heterosexual) with an infected partner; from other body fluids and secretions e.g. the virus can be found in saliva, or may be transmitted from an infected mother to her baby.

What is the incubation period (time from exposure to first symptoms)?

45 – 180 days.

How is Hepatitis B diagnosed?

The following signs and symptoms are an indication of the disease: tiredness and lethargy, loss of appetite, abdominal discomfort, dark yellow-orange urine, pale bowel motions, followed within a few days be jaundice ( yellow “whites of the eyes” and yellow skin ). The diagnosis is also suspected when there is a history of possible contact. Specific blood tests for Hepatitis B are necessary to confirm the diagnosis.

What is the treatment?

There is no specific treatment. Interferon may be used in some cases.

How do you prevent Hepatitis B?

Avoid risky behaviour (see above “How do you catch Hepatitis B?”) and get vaccinated.

Vaccination / Immunisation

A complete course of Hepatitis B immunisation protects more than 95% of persons vaccinated. Hepatitis B vaccines are highly immunogenic, but have decreased immunogenicity associated with increasing age, obesity, smoking, male gender, older adults, presence of chronic disease. Once sero-conversion has been shown to occur it is not considered necessary to have any further doses. Memory seems to last for at least 15 years in immunocompetent individuals. To date there are no data to support the need for booster doses of Hepatitis B vaccine in immunocompetent individuals who have responded to a primary course on immunisation.

 . The adult vaccination course is a 3 primary series of 1.0 ml intramuscular: at 0, 1 and 6 months. . It is considered that this will last for life. An accelerated dose series is available, for those who are travelling urgently and will not have time for the routine series: at 0, 7 and 21 days, with a blood test at 1 year followed by a final booster dose.if required. Time to immunity is after the primary 2 doses and after boosters. Duration of cover is at least 15 years, and probably life.

Children who live in areas where Hepatitis B infection is highly endemic for 6 months or more, or who visit such areas for shorter periods during which close contact with local people is likely, should be immunised. Children infected with Hepatitis B at an early age are at high risk of becoming carriers, with the attendant risk of long-term complications. Almost all (90%) of infected new-borns, nearly 25 % of children and 0.2% – 2% of adults become chronic carriers. Chronic carriers have a lifetime risk of 5-15% of hepatocellular carcinoma and a 5-10% risk of chronic hepatitis or cirrhosis.

Hepatitis C

What is Hepatitis C?

It is a virus infection of the liver. Symptoms are usually not as obvious as with other types of hepatitis but the following signs and symptoms are an indication of the disease: general tiredness and lethargy, dark yellow-orange urine, pale bowel motions, yellow “whites of the eyes” and yellow skin, and pain in the liver area of the abdomen. Most infected persons have no symptoms.

It is estimated that about 0.3% of all blood donors in developed countries are infected with hepatitis C virus and thus are carriers. Hepatitis C carriers can infect other people and are at risk of death from cirrhosis of the liver and liver cancer years after the initial infection, however the natural history of Hepatitis C virus infection is not fully understood.

How do you catch Hepatitis C?

Hepatitis C is caught the same way as you catch Hepatitis B, although Hepatitis B is much more easily transmitted than Hepatitis C. Cases of Hepatitis C in most developed countries are in intravenous drug users, but some countries have high rates in the general population also.

What is the incubation period (time from exposure to first symptoms)?

30 – 150 days. (Average 45 – 65 days.)

How is Hepatitis C diagnosed?

Specific blood tests for Hepatitis C are necessary to confirm the diagnosis.

What is the treatment?

There is no specific treatment. A medication called interferon may be used in some cases.

How do you prevent Hepatitis C?

Avoid risky behaviour, as with Hepatitis B.

Vaccination / Immunisation

Currently there is no vaccine available.

Hepatitis E

What is Hepatitis E?

It is a virus infection of the liver. The following signs and symptoms are an indication of the disease: tiredness and lethargy, dark yellow-orange urine, pale bowel motions, yellow “whites of the eyes” and yellow skin.

How do you catch Hepatitis E?

HepatitisE is spread through the oral-faecal (mouth-anus) route and through contaminated food and water.

What is the incubation period (time from exposure to first symptoms)?

15 – 65 days; average range 30 -40 days.

How is Hepatitis E diagnosed?

Specific blood tests for Hepatitis E are necessary to confirm the diagnosis. These are often only available in special reference laboratories.

What is the treatment?

There is no specific treatment.

How do you prevent Hepatitis E?

Food and water precautions, as for Hepatitis A.

Vaccination / Immunisation

Currently there is no vaccine available.

3. Yellow Fever
How do you catch Yellow Fever?

Yellow Fever is a serious viral haemorrhagic fever transmitted from monkey to monkey by mosquitos’ bites in the forest canopy. Humans can get ‘into’ this cycle and become infected by mosquitoes as well. Transmission between humans can occur when a person with the yellow fever virus enters an area where there are also susceptible mosquitoes.

What are the signs and symptoms of Yellow Fever?

Many infections present mildly as a flu-like illness or, in its severe form, may cause headaches, nausea and vomiting, abdominal pain, bleeding, shock and collapse and signs of kidney and liver failure. The liver failure causes ‘yellow-jaundice’ hence the name ‘Yellow Fever’. Yellow Fever is mainly a disease of jungle areas but there are occasional outbreaks in towns and cities. The death rate is around 30%.

It occurs in exclusively in Africa, and South America. South American infections usually occur in rural workers, from occupational exposure in or near forests. In Africa, the Yellow Fever virus is transmitted in three regions: commonly in the moist savannah zones of West and Central Africa during the rainy season, occasionally in urban locations and villages in Africa, and rarely in jungle regions.

What is the incubation period (time from exposure to first symptoms)?

3-6 days.

How is Yellow Fever diagnosed?

This is based on the typical illness and confirmed by special blood tests or post-mortem tests in fatal cases.

What is the treatment?

There is no specific treatment. Cases either recover spontaneously or die.

Are there any adequate mosquito prevent measure?

Every traveller’s first line of defence is to take personal protective measures against mosquitoes. The vaccine, though excellent, may not protect 100% against the disease. You are advised to wear mosquito repellent containing DEET (20-30% concentration is generally adequate), and stay in air-conditioned or screened rooms. Travellers can reduce the amount of skin exposure with appropriate clothing protection: e.g. socks, long pants and long-sleeved shirts. If you use a repellent containing DEET on children, do so with care – there is some evidence of a potential for neurological side effects associated with overdoses. Do not use strengths more than 10-20% without the advice of a travel health professional.

If you are to travel into rural regions, then take a bednet. We advise aerosol blasting any accommodation room with insecticides to kill indoor mosquitoes. Permethrin (a mosquito insecticide) can be applied to clothing and mosquito netting, for extra protection.

How do you prevent Yellow Fever?

Prevention is by vaccination or immunisation with the Yellow Fever vaccine. This is a live vaccine, which gives almost 100% protection that lasts for 10 years. The vaccine is administered subcutaneously in a single dose. Immunity is attained after 6-10 days.

Regulatory authorities require:

  • A valid certificate 10 days prior to arrival at the destination.
  • Boosters at least every 10 years to maintain up to date protection.

Can the vaccination be given to children?

Yellow fever vaccine should not be administered to any infant under 4 months of age: children 4-6 months should be considered only in unusual circumstances. Infants 6-9 months can receive the vaccine if they cannot avoid travelling to areas of risk and when a high level of protection against mosquito bites is not possible. Over 9 months of age vaccination, if required, is permissible.

Various authorities in many countries can prevent travel, if vaccination for Yellow Fever is not up to date. The international certificate is valid for 10 years, beginning 10 days after vaccination.

Yellow Fever vaccination is available only at designated yellow fever clinics.

What are the risks and side effects of the vaccine?

Reactions to this vaccine are generally mild and include fever, headache, and muscle ache. These reactions occur 5 to 14 days after immunisation. Serious side effects are unlikely, however there is a rare chance that serious problems or even death could occur after receiving any medicine or vaccine.

Side-effects include redness and tenderness at the site of the injection, fever, mild headache, muscle aches, and a flu-like illness 3-7 days after vaccination. Those over the age of 60 years need to discuss particular reactions to the vaccination that could occur, with their travel health professional.

As with any serious medical problem, if the person has a significant or unusual problem after receiving the vaccine, call a doctor or bring the person to a health professional promptly.

Yellow Fever Certificate from the Rowe Creavin Group Practice.

After immunisation, an International Certificate of Vaccination is issued and is valid 10 days after vaccination to meet entry and exit requirements for all countries. The Certificate is good for 10 years. Take the Certificate with you, for travel to certain regions will require proof of having had the vaccination.

It is essential that travellers who have a medical reason not to receive the yellow fever vaccine obtain a medical waiver. Most countries will accept a such a medical waiver for persons with a valid reason not to receive the vaccine. Such a waiver will need a physician’s note clearly stating the medical reason not to receive the vaccine. It is essential that it be written on a surgery letterhead and bear the stamp used by the doctor writing the letter and preferably a stamp from the local health department or official immunization centre. This will assist in the validation of the waiver.

Who Should Not Use The Vaccine?

Children younger than 4 months of age ( as noted above ), people who have had a previous severe reaction to the vaccine and those who are extremely allergic to eggs should not receive this vaccine.

People with AIDS or some other immune-suppression disease need to discuss the risks and benefits of this vaccine carefully with their travel health professional.

The vaccine can be administered in pregnancy only when the risk or contracting the disease far outweighs the risk of any side-effect, and the journey is essential. Wherever possible the travel should, however, be avoided until after the pregnancy is over. The vaccine may be given to nursing mothers

4. Tetanus
What Is Tetanus?
Tetanus is an acute disease caused by a neurotoxin produced by the obligately anaerobe Gram positive, spore-forming bacterium Clostridium tetani. Simply said, tetanus is caused by a toxin released by a common dust or soil bacterium. It has a worldwide distribution.

How Do You Catch Tetanus?
Clostridium tetani spores are ubiquitous in the environment and are a normal inhabitant of soil, and animal and human intestines. After entering the body through a wound, the spores germinate and produce toxins. These toxins interfere with the release of neurotransmitters at inhibitory nerve terminals resulting in unopposed muscle contraction and spasm.

Tetanus occurs worldwide but is more common in hot, damp climates with soil rich in organic matter. Tetanus, particularly the neonatal form, remains a significant public health problem in non-industrialised countries, causing an estimated 400,000 deaths each year. Generalised tetanus occurring in newborns is termed neonatal tetanus, and this form of tetanus is attributable to low maternal immunity in combination with non-sterile delivery and certain traditional umbilical cord care practices. In industrialised countries tetanus has become very uncommon, particularly amongst infants band children, due to effective childhood immunisation programmes

More recently, Tetanus has been described in Intravenous Drug Users (IDU), where potential sources for infection are contaminated drugs, paraphernalia, and contaminated skin. Increased awareness of tetanus in IDUs is therefore extremely important.

What Is The Incubation Period (Time From Exposure To First Symptoms)?
The incubation period ranges from 3 days to 3 weeks, usually around 7-8 days. Longer incubation periods may be associated with more peripheral injury sites.

How Is Tetanus Diagnosed?
The onset of symptoms is gradual, over 1 to 7 days. It is characterised by painful muscle contractions mainly in the neck and face, but also in the trunk. In general, the shorter the incubation period the more severe the disease and the higher the risk of death.

A number of clinical forms of tetanus have been described. Generalised tetanus is the most common and is characterised by increased muscle tone and generalised spasms. These spasms are violent and painful and may threaten ventilation. Sustained contraction of the facial muscles results in the classic sign of risus sardonicus. Sustained contraction of the back muscles produces an arched back ( opisthotonos ). Generalised tetanus occurring in newborns is termed neonatal tetanus . Local tetanus is uncommon and is characterised by persistent contraction in the same area as the injury. Cephalic tetanus is rare and involves cranial nerves, particularly in the facial area.

Clinical evidence of tetanus infection is defined as mild to moderate trismus and one or more of the following: spasticity, dysphagia, respiratory embarrassment, spasms, and autonomic dysfunction.

Because the disease is very rare, a diagnosis of tetanus may not be initially recognised. Laboratory tests are of limited value as the organism may be isolated from a wound in as few as 30% of cases. Furthermore Clostridium tetani can be isolated from patients who do not have the disease. Diagnosis thus relies upon clinical criteria. The current clinical case definition for tetanus is acute onset of:

  • Hypotonia and / or painful muscle contractions (most commonly in the jaw and neck), and which may proceed to generalised muscle spasms.

Clinical signs may also be rather non-specific, particularly in the early stages of the disease and in neonates who may present with apnoea or tonal abnormalities without the classic opisthotonos.

What Is The Treatment For Tetanus?
In general the specialist treatment will involve the following:

  • the cleaning and debridement of wounds
  • the giving of human tetanus immune globulin
  • early ventilation and sedation, as required, and if symptoms progress
  • the control of spasms with diazepam, or phenobarbitone.

How Do You Prevent Tetanus?

Effective individual protection against tetanus can only be achieved through active immunisation. Unlike other vaccine-preventable diseases, there is no possibility of herd immunity and immunity cannot be naturally acquired. Vaccination with tetanus toxoid stimulates production of antibodies which act against the toxin produced by the organism thus providing protection against the consequences of infection rather than the infection itself. Immunisation with a toxoid ought to prevent the disease, but waning immunity and/or increased immigration of non-immunised or inadequately immunised individuals represent a significant cause of cases in developed nations.

Wounds that may permit tetanus spores to germination:

  • classic wounds such as burns, compound fractures, wounds with extensive damage
  • injecting drugs users had contributed to a higher incidence in your adults
  • body piercing

5. Malaria
Malaria is the world’s most prevalent tropical disease. It affects 400 million people a year and kills approximately 2 million, mainly children. Malaria is caused by a parasitic protozoa which is transmitted from person to person by the bite of a mosquito found in tropical areas.

Malaria is an illness caused by a parasite that is transmitted by the bite of a female anopheline mosquito. The CLASSIC symptoms are shivers, called rigors or chills, that alternate with high fevers. As the fever drops there is usually extreme sweating, and occasionally diarrhoea can be a prominent symptom. Malaria doesn’t always present with classical symptoms, however, so anyone who gets a fever in a malarious area should be presumed to have the disease and tested accordingly.

In between episodes of fever the patient can appear deceptively well. As malaria does not always cause the classic pattern of symptoms, the golden rule is that any fever could be malaria, in any person who has been in a malaria area any time in the past 12 months.

There are 4 species of parasite that cause malaria. One is potentially rapidly fatal (sometimes referred to as malignant malaria), often resulting in ‘cerebral’ malaria. This is caused by Plasmodium falciparum . Malignant malaria may progress to life-threatening coma or a severe state of shock.

The other form, or benign malaria, may produce recurrent episodes of fever, sometimes over many years. Benign malaria is caused by one of 3 other species – Plasmodium vivax , Plasmodium ovale or Plasmodium malariae . These cause similar symptoms to falciparum malaria, but do not cause brain, or ‘cerebral’ malaria, or shock. Death due to benign forms of malaria is very rare but can occur, usually from trauma to the spleen that causes rapidly fatal loss of blood into the abdomen.

From the bite of a particular species of mosquito (an anopheline mosquito): these mosquitoes bite between dusk and dawn, 2 hours after dusk and 2 hours before dawn are the commonest times. Risk levels for various areas around the world are constantly changing, as are the recommended anti-malaria medications for prevention and treatment.

This is about 10-12 days for malignant malaria (minimum is 7 days) but commonly around 30 days for the benign form. Sometimes the malignant form may not occur until 12 months after the last exposure to infected mosquitoes. The benign form may not appear until 5 years or more after leaving a malaria area.

Malaria is best diagnosed at the time of sweating or fever, by microscopic examination of a blood film. Three to four blood tests collected over a 72 hour period should be taken. Even if still negative, the person could still have malaria and may require further testing to find the organisms in the blood. If there is any doubt it is often best to treat for malaria, as untreated malignant malaria can be rapidly fatal.

Prevention of mosquito bites remains the BEST way to stop malaria. It is recommended that you:

  • Avoid mosquito bites between dusk and dawn.
  • Take anti-malaria preventative medicine. This reduces the risk of getting the disease but none of the medications is 100% effective in preventing malaria.
  • Note that medication should always be used in combination with anti-mosquito measures such as mosquito nets and insect repellent.
  • Consider other preventative measures, such as:
    dressing appropriately in long sleeves and long trousers
    using personal insect repellents with DEET
    sleep in air-conditioned accommodation or under permethrin-impregnated mosquito nets

6. Rabies

What is Rabies?

Rabies is a virus infection. In humans it’s always fatal, once symptoms have developed. Humans usually catch rabies when they are bitten, licked or scratched by an infected pet or by a stray / wild animal. The contact introduces the rabies virus into a wound. Infected animals can often behave unpredictably – a normally friendly pet may turn very aggressive, or a usually timid wild animal may become apparently tame. Such unusual behaviour poses particular dangers for young children, who may become delighted by the ‘friendliness’ of an infected wild creature.

How do you catch Rabies?

Infection is from the saliva of an infected or rabid animal, usually a dog, cat or a monkey. In most cases infection results from a bite but just a lick on an open cut, sore, or even the eyes or mouth could be enough. A human case of rabies can also infect other people in the same way. Some animals, particularly dogs, carry the virus but can appear unaffected for up to 6 months.

What is the incubation period (time from exposure to first symptoms)?

This varies. Usually it takes 2-8 weeks, but can be as short as 5 days, or as longer than 10 years.

How is Rabies diagnosed?

Usually diagnosis is based on the typical symptoms including signs and symptoms like:

  • Fever
  • Headache
  • Vague sensations at the bite site
  • Weakness
  • Paralysis
  • Spasm of swallowing muscles (hydrophobia) leading to fear of drinking water
  • Delirium
  • Convulsions
  • Bizarre behaviour

All the signs and symptoms gradually progress to death, which usually occurs, from the paralysis of breathing, in under a week.

What is the treatment?

Once symptoms develop, death is inevitable in all cases. There is no cure. Treatment consists of first aid management to the initial wound and then and vaccine administered promptly following exposure, and before symptoms develop. This vaccine may have to be given together with a specialised human immunoglobulin immunisation at the first visit following exposure to rabies.

First Aid Management:

1. Vigorously wash and flush the wound site with soap and water, OR detergent OR water alone. This is important.2. Apply either ethanol OR tincture or aqueous solution of iodine.3. Seek the advice of local medical authorities, informing them of any vaccine you have already had.

4. If possible, take the name and address of the owner of the animal or get the local police to trace the animal urgently.

5. If possible, try and find out if the animal is healthy and if vaccinated against rabies.

How do you prevent Rabies?

The only sure way is to avoid getting bitten! Discourage children from contact with unknown animals. Be aware that rabies is in developed as well as developing countries. High risk areas include, but are not specifically limited to: Mexico, El Salvador, Guatemala, Peru, Colombia, Ecuador, India, Nepal, Philippines, Sri Lanka, China, Thailand, Vietnam.

7. Diphtheria
What is Diphtheria?

Diphtheria is a sudden onset bacterial infection that usually affects the tonsils, throat and nose, and may affect the skin. Diphtheria remains a serious disease throughout much of the world. In particular, large outbreaks of diphtheria occurred in the 1990s throughout Russia and the independent countries of the former Soviet Union. Most cases occurred in unimmunized or inadequately immunized people. Control measures have been implemented, but a risk of diphtheria remains in all these areas.

How do you catch Diphtheria?

The disease is passed from person to person by droplet transmission, usually by breathing in diphtheria bacteria after an infected person has laughed, coughed, or sneezed the bacterium onto the victim. It can also be spread by handling used tissues or by drinking from a glass used by an infected person. In its worst extreme, diphtheria can lead to breathing problems, heart failure, paralysis and occasionally death.

What is the incubation time of the disease?

The incubation period is quite short: 2-5 days, with a range of 1-10 days.

What are the symptoms of diphtheria?
Early symptoms of diphtheria may mimic a cold: sore throat, mild fever, and chills. Usually, the disease causes a thick coating at the back of the throat, and this can make it difficult for patients to breathe or swallow. Other body sites besides throat can also be affected, including the nose, larynx, eye, vagina, and skin.

How serious is diphtheria?

Diphtheria is a serious disease: from 5%-10% of all persons with the disease die. Up to 20% of cases lead to death in certain age groups of individuals (e.g. in groups older than 40 years or younger than 5 years). U p to 8 out of 10 adults 60 years of age and older lack adequate protection from diphtheria. During the 1990s, epidemic diphtheria broke out in several states of the former Soviet Union, causing more than 150,000 cases and 5,000 deaths.

What is the treatment for Diphtheria?

Diphtheria antitoxin is given as an intramuscular or an intravenous injection as soon as the diagnosis is suspected. The infection is then treated with antibiotics, such as penicillin or erythromycin. Antitoxin does not get rid of toxin that is already attached to the body’s tissues, but will neutralize any circulating poison and will prevent the disease from getting worse. The patient should be tested for sensitivity to this antitoxin before it is given.

People with diphtheria may require hospitalisation for supportive treatment and during the administration of antitoxin. Insertion of an endotracheal tube and/or removal of the obstructing membrane may be required if airway obstruction is present. Intravenous fluids, oxygen, bed rest, and cardiac monitoring (due to the possibility of inflammation of the heart muscle ) are usually indicated.

How long is a person with diphtheria contagious?
The disease usually becomes non-contagious 48 hours after antibiotics are started. Nevertheless, some individuals continue to carry the diphtheria bacterium even after antibiotic therapy, and treatment should be continued until patients have three consecutive negative throat swab cultures.

How do you prevent diphtheria?

Routine childhood immunisations and adult boosters prevent the disease.

Vaccination / Immunisation?

Diphtheria is not available as a single vaccine.
What kind of vaccine is it?

The diphtheria vaccine is an inactivated toxin called a toxoid. It is made by growing the bacteria in a liquid medium and purifying and inactivating the toxin. The diphtheria vaccine is given as a shot in the muscle.

Who should get this vaccine?

All infants and children should receive five vaccine doses as part of their routine immunisation schedule (unless they have a medical reason not to).

How safe is this vaccine?

Most people have no serious reactions from this combined vaccine. The most common reactions are local reactions at the injection site, such as soreness, redness, and swelling. Other possible reactions may include fussiness, mild fever, loss of appetite, tiredness, and vomiting.

8. Japanese Encephalitis

What is Japanese Encephalitis?

Japanese Encephalitis is a mosquito-borne disease of the central nervous system that occurs chiefly in three areas of Asia: (1) China and Korea, (2) the Indian sub-continent consisting of India, parts of Bangladesh, southern Nepal, Sri Lanka, and probably in the Indus Valley in Pakistan and (3) the Southeast Asian countries of Myanmar (Burma), Thailand, Cambodia, Laos, Vietnam, Malaysia, Indonesia and the Philippines.

Japanese Encephalitis is primarily a rural disease and transmission is usually seasonal, following the prevalence of mosquitoes. The chance that a traveller to Asia will develop Japanese Encephalitis is probably very small; the risk is proportional to exposure to the mosquitoes that breed chiefly in rural rice-growing and pig farming regions. Only 5 cases among Americans travelling or working in Asia are known to have occurred since 1981. Among persons who are infected by a mosquito bite, only 1 in 50 to 1 in 1,000 persons will develop an illness.

How do you catch Japanese Encephalitis?

It is spread mostly in rural areas where conditions favour breeding of the mosquito that carries the virus. They are most likely to bite during the cooler hours of the evening, and at dusk and dawn when they are out feeding.

What is the incubation period (time of exposure to first symptoms)?

The incubation period following mosquito bites varies from 5-15 days.

How is Japanese Encephalitis diagnosed?

This is based on the typical illness and confirmed by special blood tests or post-mortem tests in fatal cases.

The course of the disease is divided into three stages:

  • Sudden onset of high fever is common. Also: malaise, vomiting, nausea and headache. Duration: 1-6 days.
  • The acute brain, or encephalitic, stage with: continuous fever, neck stiffness, alteration of consciousness and convulsions. Paralysis may also be noted. Stage 1 and 2 may take up to 2 weeks.
  • The late stage at which point the fever subsides and neurologic signs become stationary. At this stage intellectual impairment is common.

The majority of infected persons develop mild symptoms or no symptoms at all. However, among persons who develop the disease, the consequences of the illness may be grave with a variety of signs developing. Japanese Encephalitis begins clinically as a flu-like illness with headache, fever, and often gastrointestinal symptoms. The illness may progress to a serious infection of the brain i.e. encephalitis, and in one third of cases, the illness may be fatal. Another one third of cases survive with serious brain after effects such as paralysis or other forms of brain damage, and the remaining one third of cases recover without further problems. If the outcome is fatal this is usually within the first 10 days.

What is the treatment?

There is no specific treatment. After the onset of the infection, and until the illness has run its course, only supportive treatment is available. Cases recover spontaneously, die, or develop permanent brain damage.

How do you prevent Japanese Encephalitis?

This is by avoidance of mosquito bites, however an effective vaccine is available (see below).

Is there an effective vaccination / Immunisation against Japanese Encephalitis?

An effective vaccine is available. It is not generally recommended for all travellers to Asia, but is recommended for persons who plan to live for a month or more, during the transmission season, in areas where Japanese Encephalitis is present. It is also suggested for persons whose outdoor activities in rural areas place them at high risk for exposure.

Vaccination needs to be considered in the following groups:

  • travellers visiting areas where an epidemic is present
  • long tern travellers or residents living in endemic areas
  • travellers spending greater than one month continuously in rice growing areas endemic for the disease.

The vaccine series is three doses of 1.0 ml each, subcutaneously on days 0, 7 and 30. It is about 90% effective. Time to immunity is 10 days and duration of cover is about 3 years; however, the full duration of protection is unknown. A booster dose may be required two years after the primary vaccination if the traveller is still at risk for infection.

JEV and Rabies can be given on the same day/s: 0, 7, 28.

A rapid schedule can be used when the longer schedule is impractical because of time constraints. The last dose should be administered at least 10 days before the start of travel to ensure an adequate immune response, and access to medical care in the event of delayed adverse reactions. A 3-dose schedule on days 0, 7 and 14 will need boosting after 1 year. Two doses administered one week apart will confer short-term immunity among 80% of vaccinees.


What is Dengue Fever ?

Dengue and Dengue Haemorrhagic fever (DHF) are caused by one of four closely related virus types from the same family of viruses. Infection from one type of Dengue Fever virus does provide immunity to that ‘type’, but does NOT provide cross-protective immunity to other ‘types’, so persons living in a Dengue Fever area can have four dengue infections during their lifetime.

Infection with a Dengue Fever virus can produce a spectrum of illness, from a ‘mild viral syndrome’ to a severe and fatal bleeding disorder called Dengue Haemorrhagic Fever (DHF). Important risk factors for DHF include age, (the young are worse off than older people), and an immune status that is compromised or reduced.

Where does Dengue Fever occur?

Dengue Fever is primarily an urban disease of the tropics. There are three areas world-wide that are currently at increased risk for travellers getting the disease: Western Pacific, South East Asia, Eastern Seaboard of Central and South America.

How do you catch Dengue Fever ?

Dengue Fever is transmitted by the bite of an infected mosquito. The viruses that cause it are maintained in a cycle that involves humans and a domestic, day-biting mosquito that prefers to feed on humans. Once infected, a mosquito remains infective for life.

The dengue fever mosquito (Aedes aegypti) is dependent on humans and never lives more than 90 metres from dwellings, thus guaranteeing her meals. The sound of her wings cannot be heard and she attacks from below or behind, e.g. underneath chairs and mainly at the feet and ankles.

The females are very nervous feeders, disrupting the feeding process at the slightest movement, only to return to the same or a different person to continue feeding moments later. Because of this behaviour the mosquito will often feed on several persons during a single blood meal and, if infective, may transmit the dengue virus to many people in a short time. It is not uncommon to see several members of the same household become ill with dengue fever within a 24-36 hour frame, suggesting that a single infective mosquito infected all of them.

What is the incubation period (time from exposure to first symptoms)?

The clinical features of Dengue Fever vary according to the age of the patient. These may develop as soon as 5-7 days after infection.

Signs and symptoms of Dengue Fever.

Infants and young children may have a fever with a rash. Older children and adults may have a combination of any of the following:

  • flu-like illness
  • high fever and chills
  • shaking
  • sweating
  • severe headaches
  • severe pain behind the eyes
  • extreme muscle and joint pains ( hence the name ‘break-bone fever’ )
  • generalised rash over the body
  • ‘bruising’ and bleeding on the limbs, face and trunk of the affected person.
  • vomiting or passing blood.

What is the treatment?

The only treatment is to manage the affected person with fluids and pain relief. There is no other treatment available.

How do you prevent Dengue Fever?

1. Minimise mosquitoes: To minimise mosquito bites it is obvious that mosquito-prone areas (such as vessels holding water, discarded cans and bottles, and old tyres half submerged in swampy water) should be avoided.

2. Understand the basic behaviour and feeding habits of the mosquito carrier. The adult mosquito prefers to live indoors and feed on humans during 2 peaks of biting activity: early morning for 2-3 hours after daybreak and in the afternoon several hours before dusk.

3. Screen or air-condition rooms

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