Problems abroad with health and illness

What do you have to know about malaria, mosquito's and prevention?

• Mosquito stings spread the malaria disease.
• Malaria is one of the most common causes of death in the world and exists in any (sub)tropical area.
• Malaria is caused by parasites, plasmodium, which are being spread from human to human by a mosquito sting (it can also be spread by blood to blood contact of blood transfusion). These parasites first multiple in the liver and then in the red blood cells.
• Not all forms of malaria are equally dangerous. Malaria tropica is the most common form of malaria and, in general, the most serious form. It is caused by a parasite, called the Plasmodium falciparum. If malaria tropica is treated properly a person will recover completely. If this disease is not treated on time a person can die in a couple of weeks (depending on the time of diagnoses, in some cases a person can die within a few hours)
• If you take anti malaria tablets it will reduce the chances of getting malaria dramatically.
• There are no malaria tablets that offer full protection. The chance that you get malaria while taking tablets is still there.
• Avoiding mosquito stings will reduce the chance of getting malaria dramatically. You still have to take anti mosquito measures when taking malaria tablets.
• Malaria is becoming more and more difficult to fight as mosquitoes are becoming resistant to anti-malaria means.
• Cases of malaria usually occur with travelers (and people who mostly stay abroad) who take no (or insufficient) malaria medicine.
• Most fatal malaria cases among travelers are caused by an incorrect or late diagnoses.
• Malaria is extremely dangerous to pregnant women and children. Pregnant women are advised not to go to malaria areas.
• Malaria does not occur above 2500 meters.
• In certain countries there can be different malaria recommendations in different areas (such as Thailand, coastal areas much safer than the northern part)
• Malaria mosquitoes are mainly active at night (although dengue mosquitoes are active during the day).
• If you take a malaria tablet do keep in mind that you will have to take another dosage when you vomit within an hour.
• For more information about Malaria please check the WHO, Malaria en de CDC website.
• Don’t panic; almost every traveler will return home safe and healthy. Take the right precautions and enjoy your trip!

What is Malaria tropica?

• Malaria tropica is the most dangerous form of malaria. If not treated properly it can lead to death in a couple of weeks. Malaria tropica is caused by a parasite, called Plasmodium falciparum. The fever attacks are unpredictable.
• If you take the malaria tablets as prescribed, chances of getting malaria tropicana are very slim. When traveling through resistant areas you have to be aware that that malaria can still strike.
• Malaria tropica is very common in areas such as tropical Africa, South East Asia and South and central America.

What is Malaria tertiana?

• Malaria tertiana is a form of malaria caused by a parasite, called Plasmodium vivax and/or Plasmodium ovale. This disease is characterized by fever attacks that occur in frequent peaks of 48 hours. The parasites can stay in your liver and cause a “delayed first attack” months or even years later. Malaria tertiana can only be prevented by taking profylaxe.
• Malaria tertiana can mainly be found in South East Asia, Central and South America and Ethiopia.

What is Malaria quartana?

• Malaria quartana does not differ from malaria tertiana, except for the characteristic fever attacks that occur every 72 hours (instead of every 48 hours.) Malaria quartana is caused by a parasite called Plasmodim malariae and is a very rare disease.
• At the moment Malaria quartana is prevented by decent malaria tablets.

What are the symptoms of malaria?

• Malaria can occur as a severe attack of cold shivers and fever, but also as a feverish feeling with headaches, but without any clear fever. It usually starts as a fever attack, cold shivers, muscles aches and headaches. This symptoms will return frequently every few days, if the infection is not treated. It can also be accompanied with vomiting, diarrhea, coughing and jaundice.
• It is very important to know that Malaria can spread to different parts of the body in as short as 24 hours!!! Any cold or fever that lasts longer than 2 days should be considered as malaria, until the contrary has been proven. If you think that you might have malaria you have to get your blood tested in the hospital or by a doctor. Malaria can be treated very well as long as it is discovered on time.

What are Malaria tablets (Profylaxe)

• Which malaria tablets are most suitable for you depends on your destination and the period of your stay. There are different forms of malaria in each area and in some areas mosquitoes can be resistant to anti-malaria tablets.
• Main Malaria tablets
  • Paludrine (Proguanil-hydrochloride
  • Nivaquine (chloroquine
  • Lariam (Mefloquine)
  • Malarone: (Combination of Atavaquon-Progunail)
  • Doxycycline:
  • Other
    • Fansidar: Not prescribed against malaria because of the serious side effects, but is still used to cure malaria.
    • Maloprim: Due to the heavy side effects only used as a spare remedy.
    • Halofantrine: Due to the side effects it is not used very often any more.
    • Quinine: Used as a treatment against malaria.
    • Artemesia annua (sweet wormwood) natural product available in many tropical countries. It has very little side effects, but it is not tested enough to pass western tests.
    • Qinghaosu: A natural product
    • Arteflene
    • Artemether
    • Artesunate

What to do during a long stay in a malaria area?

There are two options:

• Keep taking malaria pills, especially Lariam is suitable for longer periods, if you don’t suffer from any negative side effects. This can be expensive.
• Stop taking malaria tablets. If you do this you have to make sure to: avoid getting stung by mosquitoes. And make sure that you know where to find a doctor or hospital in case you get a malaria attack.
• PS: Be aware that no matter how long you stay in a malaria area, you do not become immune to malaria. You always run the risk of getting malaria.

What are the main remarks about staying healthy abroad?

• Staying healthy during your trip to a foreign country is very important. For each trip you need to think what kind of medicine you have to bring and which extra measures you have to take to stay healthy.
• Vaccines are not perfect. New vaccines are constantly being released but diseases continue to evolve
• Some vaccines require a long period to take effect, but it is never too late to vaccinate
• Health risks within a country can vary from locality to locality and local authorities may be slow to announce outbreaks of disease
• Common infections contracted by travelers include those which follow contaminated food or water. Find out whether tap water and local food is safe to consume before you depart
• There are a number of mosquito-born illnesses you can contract while overseas particularly in tropical areas. Be sure to take measures to avoid being bitten such as wearing light colored, loose fitting clothing that covers your arms and legs, regularly applying an appropriate insect repellent and staying in mosquito proof accommodation.
• Travel websites, such as Lonely planet or Footprint, have useful health information as well.

How can you plan and organize that you stay healthy abroad?

• The World Health Organization (WHO) recommends that all travelers should be covered from diphtheria, tetanus, measles, mumps, rubella and polio, as well as Hepatitis B, regardless of their destination. Since most vaccines don’t produce immunity until a couple of weeks after they’re given, it is advised to visit a physician a couple of weeks before you travel.
• Make an appointment with your doctor or travel clinic to have a basic check-up and find out if any vaccinations or health checks are required at least 6-12 weeks before you depart.
• Not all travelers to countries where there is a potential risk of infection need to be vaccinated but it is important that you discuss your personal travel plans with a doctor so they can determine the correct vaccinations for your trip.

How can you travel with medicine?

• Before leaving home, you should check that your medications are legal in the country you are visiting. You can do this by contacting the country’s embassy or high commission or by looking at official websites.
• Since the National Health Act was amended in 1999, it is an offense to carry or post Pharmaceutical Benefits Scheme (PBS) medicines overseas unless they are for your personal use, or the use of someone traveling with you.
• There are restrictions on the amount of PBS medicine that can be carried or sent overseas. When planning to travel overseas with PBS medicine it is important that you:
• Talk to your doctor and discuss the medicine you will need to take (if you need to take any medicine at all).
• Carry a letter from your doctor detailing what the medicine is, how much you will be taking, and stating that it is for your own personal use.
• Leave the medicine in its original packaging so it is clearly labeled with your name and dosage instructions.
• If you intend to travel with large quantities of medicine, including over-the-counter or private prescription medications, you should ask your doctor, dentist or pharmacist to provide you with a letter explaining why you need to carry such quantities.
• If you have to inject your medication it might be preferable to carry your own needles and syringes but you should check with the embassy or consulate of the country you are visiting to make sure that this is acceptable. If you buy needles and syringes while overseas, be sure that you buy packs that are sealed and sterile. If you need to carry needles and syringes with you on the plane, inform your airline before you travel and if necessary, arrange a letter from your doctor explaining why you need to carry them.
• It is important to be aware that some items purchased overseas may be packaged under a different brand name to those of the country of your destination. Keep an eye on the strength and active ingredients of similar-sounding medications overseas, they can vary.

When to get vaccinations for yellow fever when you go abroad?

• Yellow fever is a potentially fatal disease carried by certain mosquitoes in parts of South America and Africa. If traveling to these areas you should check with your travel clinic or doctor whether a vaccine is required. Yellow fever vaccine is only available from approved medical practitioners and must be given at least 10 days before traveling to infected areas.
• Yellow fever is contagious and can be spread by infected travelers, so if you are traveling to a country where yellow fever is a risk, you may need a certificate showing proof of yellow fever vaccination. Without this certificate you may be refused entry to some countries, or required to be vaccinated upon arrival.
• If you have stayed overnight or longer in a declared yellow fever infected country in Africa or South America, within six days prior to your arrival, you will require a valid international yellow fever vaccination certificate.
• The World Health Organization closely monitors reports of yellow fever infection and periodically publishes a list of countries where the disease occurs.

When to get vaccinations for diphtheria, tetanus and polio when you go abroad?

• Vaccination and validity: always recommended for far away destinations and Eastern Europe (also in East Europe)
• Last minute travelers (=two weeks before departure) who have not received a standard vaccination before: 2 weeks before leaving there are 2 possible injections left. They protect you for a maximum period of 8 months.
• Last minute travelers who are not going to diphteria endemic areas: If the trip is shorter than two months it is not necessary to get a DTP vaccination, except for persons who have never received the vaccination before. If your trip is shorter than 8 months only persons who have received just one DTP vaccination need an extra one.
• Background information: Diphtheria is a common disease in certain countries. This bacteria can cause a seriously swollen throat that makes it more difficult to breathe. If this bacteria gets into the blood it can infect the heart and can lead to death. The bacteria can also cause serious skininfections, although this form of dipthteria is less serious. It is highly recommended get a vaccination against this disease.
• Tetanus is found everywhere around the world. You can get this disease through street dirt, soil, manure or dust getting in a wound. When this happens the poison substances can cause the muscles all over your body to cramp. It can even cause breathing problems leading to death. A vaccination again tetanus every 10 years is recommended.
• The polio virus is highly contagious. It is passed on through faeces, contaminated food or drinking water. Polio is very common in places of less hygienic places, such as certain areas in Asia and sub-Saharan Africa. Contamination with the polio virus can cause permanent paralysis of the muscles. If it has been more than ten years since you have had your last vaccination against polio you need another vaccination before you leave.

When to get vaccinations for hepatitis A when you go abroad?

• Vaccination and validity: Recommended when traveling to almost every far away destination. The gamma globulin injection is only effective for a few months and works passively. Nowadays you can also get a vaccination called Epaxal. It works actively for a minimum of 10 years and maybe longer. You can also get a vaccination of Hepatitis A+B (Twinrix) all at once.
• Background information: Hepatitis is a liver infection caused by bad hygiene or transmitted by infected water or food. It does not only exist in the tropics, but also in Turkey and East Europe.

When to get vaccinations for stomach typhus when you go abroad?

• Vaccination and validity: Often recommended for Asia and Latin America. There is a medicine that you can swallow and an injection.
• Background information: It is a life threatening disease of the gastro-enteric channel. This disease is caused by the Salmonella typhus bacteria. This is an infection related to bad hygienes. If you have had your vaccination, it will only protect you for about 70-90%. Therefore, you still need to be careful with what you take in.

When to get vaccinations for hepatitis B when you go abroad?

• Vaccination and Validity: a form of jaundice. Only high risk groups, (such as doctors, certain expats, and people who have intercourse with different partners) and travelers who are traveling longer than three months in an hepatitis B area need to get this vaccination. It is also possible to get the vaccination for Hepatitis A+B at once.
• Last minute: It is possible to get an accelerated injection, although this does not give similar protection.
• Background information: Hepatitis B is caused by a virus spread through blood to blood or through sexual contact. For example non sterile applied piercings, tattoos etc.

When to get vaccinations for Japanese encephalitis when you go abroad?

• Vaccination and validity: Recommended for people who are going to the countryside in the area between India and Japan.
• Background Information: Japanese encephalitis is a virus infection that is spread by by mosquitoes. People who are staying on the the countryside for a longer period during the season when the disease is spread run a higher risk.

When to get vaccinations for tuberculoses (TBC) when you go abroad?

• Vaccination and validity: sometimes recommended to people traveling for a long time to areas where TBC can reign.
• Details: The procedure is very complicated. Therefore, consult your personal doctor.

When to get vaccinations for rabies when you go abroad?

• Vaccination and validity: Only recommended to around the world travelers and expats.
• Details: expensive vaccine

When to get vaccinations for meningitis when you go abroad?

• Rarely given vaccination and hardly ever recommended

When to get vaccinations for cholera when you go abroad?

• This vaccination is very rarely given, but some countries do ask for a vaccination stamp. This stamp is available at any vaccination institute.

What is heatstroke, and is it dangerous?

• Heatstroke occurs when your body is overheated by the sun's heat. Your body temperature rises above 40 degrees Celsius during heatstroke.
• Heatstroke usually occurs from being active in the sun on a hot day when your head and/or body are unprotected from sunlight.
• The risk of heatstroke is higher if you don't drink enough. In dry conditions, you sometimes lose a lot of fluids without realizing it, and your body can no longer regulate your temperature.
• In high humidity, such as in the tropics, your body can also overheat more quickly.
• If the early signs of heatstroke, such as dizziness, confusion, and nausea, are ignored, heatstroke can be life-threatening.

What can you do to prevent heatstroke?

• Adapt your activities to the temperature and humidity. On hot, sunny days, it's best to avoid exercising or walking in the sun between 12 and 3 PM.
• Covering your head with a cap or hat significantly reduces the risk of heatstroke.
• Drink plenty of fluids. When you sweat a lot, you need extra salts in addition to water to maintain your fluid balance.
• During heatstroke, the person experiencing it is often not very sharp and alert, so it's important to take good care of each other.

How can you treat heatstroke?

• A person with heatstroke has a high body temperature, so the entire body needs to be cooled.
• Remove the person from the sun and remove excess clothing.
• Cool the body with water and/or moving air.
• Heatstroke is also dehydration: give them water, juice, or, if available, an ORS solution.