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Travel Health: Useful medical information for good health before your departure, during your trip and after your return.

January 1, 0000 1578

The diseases most commonly seen in travellers are diarrhoea, malaria (if you travel in a malaria-infested area), accidents (when travelling by car or swimming), wound infections and sexually transmitted diseases.

- Diarrhoea is caused by contaminated food and drinking-water. You must therefore be careful if your are travelling in poor hygiene conditions.

- Malaria is transmitted by mosquitoes, so the first thing to do is to protect yourself against these mosquitoes.

- In order to prevent accidents during travelling, it is wise to apply the same precautions as those taken at home. In addition, it is very important that all wounds should be thoroughly disinfected in order to avoid infection.

�TRAVELLER'S DIARRHOEA

Many intestinal infections are attributable to infections picked up by mouth or hands. With a little care most of these illnesses can be prevented. Hepatitis A, typhoid fever, polio and cholera still occur in countries with poor hygiene, but these diseases are easily prevented.

However, the chance is rather large that you will still contract a light and/or nondangerous form of traveller's diarrhoea. Traveller's diarrhoea almost always spontaneously clears up after a few days, but can nevertheless be irritating. And a risk to your overall and travel health.

In the first place measures must be taken against dehydration. Likewise, treatment of the symptoms must be considered in order to reduce the number of bowel movements and relieve other symptoms such as fever, vomiting and stomach cramps. Sometimes a more serious form of diarrhoea occurs, for which specific treatment with antibiotics is indicated or where hospitalisation or fluid replacement appears unavoidable.

It takes only a few basic preventive measures to make your trip a success : Total prevention of traveller's diarrhoea is impossible and it is obvious that preventive measures can seldom be strictly followed at all times. But following preventive measures do significantly reduce the risk of contracting serious diarrhoea: In order to maintain good travel health wash your hands before eating and avoid (if possible) :

- raw vegetables and fruits that you have not peeled yourself - uncooked or unpasteurized dairy products - insufficiently cooked sea foods (+ Hepatitis A !) and meat - "local meals" which do not smell fresh - ice-cream bought from street merchants (industrial ice straight from the deep-freeze is probably safe).

Cooked meals should be served hot. The place where you eat is also important. A meal taken from a stall presents a greater risk than a meal taken in a restaurant. Avoid restaurants where there are a lot of insects. Avoid tap water and ice-cubes. Bottled water and soft drinks are safe. Watch out for bottle caps that have already been used. It is very important to disinfect drinking-water on adventure trips. Total sterilisation of drinking water is impossible. The following measures considerably reduce the contamination risk and safeguard your travel health:

- Boiling the water is very effective. - A good alternative is chemical disinfection with chlorine drops (e.g. Hadex�, Drinkwell chloor�; available in sport shops specialized in outdoor activities) or chlorine tablets (Certisil Combina�; chloramine tablets; available at the pharmacy). Their effect can be improved by first filtering unclear water. Silver salts (Micropur�, Certisil Argento�) are not very suitable to disinfect water, but they keep disinfected water germ-free for a long time.

For adventurous travellers conscious to travel health it is best to buy a portable water-filter. The use of antibiotics in order to prevent diarrhoea before it occurs can be dangerous + Also the use of other preventive medications is not recommended.

.How to treat diarrhoea?

It is extremely important to consume sufficient liquid and salt in order to prevent dehydration. You can do this by taking salt solutions, but tea with lemon, broth, soft drinks and fruit juice, supplemented with salt crackers are tastier. Commercial salt products are available on the market (ORS-solution).

Taking an anti-diarrhoea preparation (loperamide, e.g. Imodium�) can greatly reduce the number of bowel movements, with a considerable reduction of the complaints as a result. Imodium� may only be used by adults and older children and only for treating ordinary watery diarrhoea: 1 capsule after every loose movement up to a maximum of 4 per day.

Antibiotics are indicated :

1. If blood, mucus or pus are present in the stools. 2. If after 24 to 48 hours, there is no sign of improvement and the diarrhoea is accompanied by fever (above 38.5 C) or severe abdominal cramps, or if there are more than six stools per 24 hours and especially when these also occur at night. 3. Or if because of travel circumstances a quicker solution is absolutely desirable . Appropriate antibiotics are only to be used on doctor's prescription

�SEXUALLY TRANSMITTED DISEASES Casual sexual contacts tend to be higher while on holiday abroad. Sexually transmitted diseases, particularly AIDS, form therefore an important risk for travellers. Quite often unintentional and unsafe sexual contact takes place under alcohol influence. Prevention while on holiday abroad is no different from the precautions you take at home. Adequate use of a condom, preferably bought at home, is absolutely essential. Only a water-soluble lubricant should be used, but it only offers a partial guarantee (e.g. KY gel). Vaccination against hepatitis B is advised. Always consult your doctor if you think you are at risk, even when there are no symptoms.

�MALARIA (swamp fever, malaria)

Malaria is an infectious disease caused by a parasite (called Plasmodium) transmitted by the bite of the Anopheles mosquito. There are four different types of which Malaria falciparum is the most dangerous and the most widespread. The incubation period - the time between an infecting bite and the appearance of the disease - varies from ten days to four weeks (rarely several months).

The symptoms include attacks of fever, but can initially be quite similar to influenza. If adequate treatment is not started in time, an attack may sometimes result in death within a few days.

. Where does malaria occur?

Malaria only occurs in those areas in which Anopheles mosquitoes are present : in the tropics and in a large number of subtropical areas. From a height of 1.500 to 2.500 m onwards, depending on temperature and climate, Anopheles mosquitoes are either rare or non-existent.

In most big cities there is little or no risk at all of infection, except in Africa where a real risk exists.

Risk also exists in the suburbs of the big cities in Asia (e.g. in India). In a number of areas the risk varies according to the season.

. How can malaria be prevented?

It is very important for travel health to avoid mosquito bites : the Anopheles mosquito only bites between dusk and dawn, is rather small and hardly makes any noise. - In the evening wear light-coloured clothing which covers your arms and legs as much as possible. Apply repellent cream with a DEET basis (20 to 50%, for children and pregnant women preferably 20 to 30%) to the uncovered parts of your body. Repeat this every four to six hours (it will not protect you all night). Non containing DEET repellents were less examined; Autan-Active. and Mosegor. are however excellent safe products. - Sleep in rooms that leave no access to mosquitoes, (mosquito nets on the sills, electrically-warmed anti-mosquito plates, air-conditioning) or sleep under a mosquito net impregnated with permethrine or deltamethrine hung over the bed with the edges tucked under the mattress.

If these measures are carried out correctly, the risk of malaria will be reduced by 80 to 90% and travel health is maintained

.The intake of pills as prevention

There is no drug efficient enough to prevent malaria 100%, which means that quite often a combination of measures is preferable. Also the drugs used have changed over the years. Moreover, the advantages and disadvantages of drugs should be considered against the risk of malaria infection. These risks are dependent on the visited country, and on the region, the season, the duration of your stay and the kind of trip.

Some people might be troubled by the side effects while taking antimalarial drugs. These are usually mild and are not always a reason to stop taking the pills. Sometimes it may be necessary to change to another type of medication due to intestinal problems, allergic reactions or other intolerance symptoms.

Therefore it is the doctor who can best decide for each individual which drug to use. This explains why individuals from the same group may end up taking different drugs.

Finally, as no drug is 100% effective in preventing malaria, it is important that if an attack of fever occurs in the first three months after your return from the tropics, a malaria infection should be considered as a possibility despite the correct use of the drug prescribed.

However, it is reassuring to know that malaria, provided it is recognised in time, is easy to treat without any danger of recurrent attacks. The belief that "once malaria always malaria" is totally untrue.
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