Tropical medicine and Travel medicine: study assistance, study summaries and student internships abroad

What is bilharzia or schistosomiasis?

• Schistosomiasis is an infection caused by the parasitic worm schistosoma.
• Schistosomiasis was formerly known as bilharzia or snail fever.
• If untreated, schistosomiasis can be fatal due to damage to various organs.
• The schistosoma flatworm is a parasite that lives in freshwater and enters the body through the skin.

Where does bilharzia or schistosomiasis occur?

• Although the parasitic flatworm that causes schistosomiasis occurs in Latin America, the Middle East, and Asia, the risk of infection is by far the greatest in Africa.
• The number of infections is particularly high in freshwater in tropical Africa.

What are the symptoms of bilharzia or schistosomiasis?

• Ingress into the skin itself usually goes unnoticed; travelers' skin often reacts within a day with an itchy or red rash.
• Only after a few weeks do more symptoms usually develop, such as fever, muscle aches, rash, shortness of breath, or an irritating cough.
• When the parasites reach your bloodstream after two to eight weeks, an acute fever (Katayama fever) can occur as your body's immune response.
• The list of nasty conditions grows rapidly if you don't intervene after the first round of symptoms. Depending on the location of the parasites, various organs, your nervous system, and your brain are affected.

What can you do to prevent bilharzia or schistosomiasis abroad?

• Avoid contact with fresh surface water in areas where schistosomiasis is prevalent: do not swim or paddle. Make sure your shower water isn't pumped from open water.
• Have you taken a dip? Dry off quickly to reduce the risk of infection.
• The parasites cannot survive in chlorinated swimming pools.
• There is no vaccine that can prevent schistosomiasis.

Can bilharzia or schistosomiasis be cured?

• Yes, there are excellent treatments available for this parasite.
• Medications only work on adult worms, so taking medication immediately after infection is pointless.

What is Chikungunya?

• Chikungunya is a viral disease caused by mosquitoes that bite during the day.
• The disease is currently spreading rapidly across tropical regions of the world.
• In addition to areas around the Indian Ocean and Africa, the Caribbean has become a major infection area.

What are the symptoms of Chikungunya?

• Besides high fever, rash, and headache, Chikungunya is particularly known for its severe and persistent joint pain.

What to do to prevent Chikungunya while traveling and abroad?

• Preventing Chikungunya means avoiding being bitten by an infected mosquito.
• If you live or work in a (sub)tropical area where Chikungunya occurs, try to avoid stagnant water in areas such as bowls, flowerpots, puddles, and car tires.
• Read more about preventing mosquito bites in tropical areas

What to do if you get chikungunya abroad?

• There are no vaccines for chikungunya.
• The disease generally resolves on its own, but joint pain can sometimes persist for a long time after the fever has disappeared.

What is Dengue Fever?

• Dengue fever is also called "breakbone fever" or just "dengue"
• This virus is also transmitted by mosquitoes, particularly in densely populated areas of the (sub)tropics.
• The dengue mosquitoes are mainly active during the day (so watch your ankles on buses, trains, and even airplanes) and mostly during the rainy season.
• In the past, the virus was rare, but in recent years it has spread rapidly. The disease is becoming increasingly common among travelers.

What are the symptoms of dengue fever?

• Sudden onset of high fever with chills - nausea, vomiting - severe headache - loss of appetite - sore throat - nosebleeds - bleeding gums
• The fever can subside after a few days and then return later.
• Some people experience fatigue and muscle aches.
• Some people experience fatigue for weeks or even months.
• On the other hand, the symptoms can also be so mild that they pass before you even realize you have them.

What can you do to prevent dengue fever abroad or while traveling?

• If you are traveling to a dengue-risk area and are older than 4 years old, you can be vaccinated.
• The most important thing you can do to prevent it is to avoid mosquito bites.
• If you live or work in a (sub)tropical area where dengue fever occurs, try to avoid stagnant water in areas such as bowls, flowerpots, puddles, and car tires.
• Use DEET and mosquito-repellent clothing to prevent bites.
• Not only tropical but also subtropical countries are affected by dengue mosquitoes. So bring sufficient mosquito repellent for your travels to these destinations as well.

Can you get dengue a second time?

• Yes, that is possible. The dengue virus exists in 4 variants, the so-called 'serotypes'. After infection with one of the variants, you are in principle protected for life against that specific variant, but not against the others.
• If someone becomes infected repeatedly, that is, with a different virus variant, the course of the disease can be much more severe, even resulting in bleeding and shock.
• Therefore, in the event of a second infection, you must be extra careful and seek medical help promptly.

What can you do if you get dengue fever?

• The disease usually clears up on its own within a week.
• Treatment is primarily focused on managing pain and fever, for example, with paracetamol. Do not use ibuprofen or other blood thinners to prevent bleeding.
• Prevent dehydration by drinking enough.
• If someone is repeatedly infected with the virus, it can be more serious, even causing bleeding and shock.

What is hepatitis B?

• Hepatitis B is a contagious liver infection caused by the hepatitis B virus.
• The hepatitis B virus is transmitted from person to person through exposure to infected blood or bodily fluids containing blood.
• Some possible routes of transmission include: blood transfusions, unprotected sexual contact, unsterile needles, from mother to child, etc. You also run a risk when getting tattoos, piercings, or going to the hairdresser.

Where does hepatitis B occur?

• Hepatitis B occurs worldwide. Risk areas include: South and Central Africa, South and Southeast Asia, Canada, and Central America.
• The risk is particularly high in places where there is frequent contact with bodily fluids, such as hospitals, in bed, and in tattoo shop.

What are the symptoms of hepatitis B?

• Depending on the body's response to the virus and the degree of liver damage, various symptoms occur. Common complaints include fatigue, yellowing of the skin and whites of the eyes, nausea, decreased appetite, discoloration of urine and stool, and fever.
• Some people experience a spontaneous resolution of the infection without serious symptoms.
• In five to ten percent of people, a hepatitis B infection becomes chronic. This can happen (almost) completely unnoticed; you don't have to go through the acute phase first.
• Ultimately, chronic hepatitis infection can lead to liver dysfunction and liver cancer.

Can hepatitis B be treated?

• An acute hepatitis B infection usually resolves on its own.
• A healthy lifestyle and a good diet usually contribute to a rapid recovery.
• In rare cases, antiviral drugs are used for an acute infection.
• A chronic infection is almost always treated with medication. The medication used varies from case to case. However, almost all medications often require long-term, if not lifelong, use.
• Treatment is usually aimed at combating the virus, thereby eliminating it or at least drastically weakening it.

Are there vaccinations against hepatitis B?

• There is a suitable vaccine against hepatitis B.
• In several countries, certain professional groups are also vaccinated structurally. This primarily concerns people who are required to be vaccinated against hepatitis B, for example, as part of their education or work. Think, for example, of students or healthcare workers. But also people working for the police, fire department, laboratory technicians, etc.
• Travelers are at certain risk for hepatitis B. Vaccination may not be necessary for short trips, but vaccination is recommended for stays longer than three months.
• If a hepatitis B vaccination seems important to you, you can choose between two different vaccination programs. If you have your vaccinations well in advance and you are not leaving for a few months, you can opt for the lifelong vaccination. In that case, you will receive three injections at intervals of one and five months. A simple calculation shows that it is best to start the hepatitis B vaccinations seven months before departure. If you're leaving soon, you can choose the three-week program. You'll receive three injections over three weeks. However, the protection offered in this case is less than with the long-term program.

What else can you do to prevent hepatitis B abroad?

• Because hepatitis B is transmitted through blood, semen, and vaginal fluids, it's important to be careful with things like sexual contact and working in health care.
• Another form of transmission is through unsterile needles. So be careful with vaccinations abroad, as well as with getting tattoos or piercings during your trip.

What is Leishmaniasis?

• Leishmaniasis is a parasitic infectious disease caused by a single-celled parasite.
• These Leishmania parasites are transmitted through the bite of infected sandflies.
• In rare cases, Leishmaniasis can be transmitted via humans, dogs, and rats, for example through blood-to-blood contact or blood transfusions.

Where does Leishmaniasis occur abroad?

• The disease is quite common in tropical and subtropical areas, such as parts of South America, Africa, Southern Europe, and Southwest Asia.
• In areas with severe poverty and malnutrition, the risk of leishmaniasis is higher.

What are the symptoms of Leishmaniasis?

• The symptoms of leishmaniasis can vary depending on the type of infection. Characteristic symptoms include skin ulcers at the site of the bite and ulcers on internal organs.
• Other symptoms include, for example, fever, weight loss, an enlarged liver or spleen, and general malaise.
• On average, it takes two to six months for symptoms to become visible; sometimes this occurs after one or two weeks, and sometimes it takes years.

What to do if you have contracted Leishmaniasis abroad?

• Leishmaniasis can be treated, but the effectiveness of the treatment depends on the Leishmania species involved, the type of symptoms, and the severity of the infection.
• Early diagnosis and treatment are important to prevent far-reaching complications.
• There is no vaccine against leishmaniasis.

How to prevent Leishmaniasis, and what to do against sandflies?

1. Use insect repellents and wear protective clothing.
2. Sleep under fine-mesh mosquito nets.
3. Avoid beaches and places known for sandflies.
4. Be careful during twilight and at night, as sandflies are active then.

What are the facts and key points about malaria when traveling?

1. Malaria remains one of the leading causes of death worldwide and occurs in (sub)tropical regions.
2. Malaria is caused by parasites, plasmodia, which are transmitted from person to person through the bite of a female Anopheles mosquito (but also through blood transfusions and other "blood products"). These parasites multiply first in the liver and later in red blood cells.
3. Not all forms of malaria are equally dangerous. Malaria tropica is the most common form of malaria and, generally, also the most serious. It is caused by the parasite Plasmodium falciparum. If properly treated, malaria tropica is completely curable. If this disease is not treated in time, death can occur within a few weeks. Depending on the time of diagnosis, in some cases, death can even occur within hours. Even the non-fatal forms of malaria are anything but pleasant to suffer from.
4. Preventing mosquito bites significantly reduces the risk of malaria, and taking antimalarial pills reduces the risk even further.
5. No antimalarial drug is completely protective. Therefore, the risk of contracting malaria even if you take the pills regularly remains.
6. Malaria is becoming increasingly difficult to control because mosquitoes are becoming resistant to antimalarials and mosquito repellents.
7. Malaria cases are most common among travelers and those staying abroad who do not take antimalarials or take the wrong pills.
8. The most fatal cases of malaria among travelers occur due to misdiagnosis or late diagnosis.
9. Malaria is particularly dangerous for children and pregnant women, who also have a significantly higher risk of being bitten by the malaria mosquito. Although some malaria tablets are harmless to pregnant women, it is still advised not to travel to malaria-carrying areas. The consequences of treatment once you have malaria can be risky for both the mother and the unborn child.
10. The malaria mosquito no longer occurs above an altitude of approximately 2,500 meters.
11. Within a country, there may be areas with different malaria advisories and risks.
12. Malaria mosquitoes are primarily active in the evenings and at night. Especially between 2 a.m. and early morning, the "malaria and dengue mosquitoes" are on the warpath, so be careful when using the toilet at night. For precautions, see: Protection against insects, mosquitoes, and spiders abroad.
13. When taking malaria tablets, be aware that if you vomit within one hour of taking them, you should take another dose.
14. Don't panic, almost all travelers always return home safe and sound. Above all, take the necessary precautions and enjoy your trip!

What is Malaria Tropica?

• Malaria Tropica is the "malignant" and most dangerous form of malaria. If left untreated, it can lead to death within a few weeks. Malaria Tropica is caused by the parasite Plasmodium falciparum. Fever attacks are erratic.
• 99% of fatal malaria cases involve Malaria Tropica.
• If you take the prescribed malaria tablets as directed, the risk of contracting Malaria Tropica is small. However, if you travel through resistant areas, you should be aware that you can still occasionally contract malaria!
• Malaria Tropica is the most common form of malaria and can be contracted in tropical Africa, Southeast Asia, or Central and South America.

What is Malaria Tertiana?

• Malaria Tertiana is a "benign" form of malaria and is caused by the parasite Plasmodium vivax and/or Plasmodium ovale. Fever attacks are characteristic, with peaks every 48 hours (2 days). These parasites can remain in the liver and cause a "delayed first attack" of malaria many months or even years later. Tertiana malaria is only prevented while taking the prophylaxis.
• Tertiana malaria is mainly found in Southeast Asia, Central and South America, and Ethiopia.

What is quartana malaria?

• Quartana malaria is no different from tertiana malaria, except that the characteristic fever attacks occur every 72 hours (3 days). Quartana malaria is caused by the parasite Plasmodium malariae and is not common.
• Quartana malaria is currently completely prevented with effective malaria tablets.

What are the symptoms of a malaria attack, and what should you do?

• Malaria can present as severe attacks of chills and fever, but also as flu-like symptoms with a headache without a clear fever. It usually begins with a fever, chills, muscle aches, and headache. These symptoms recur every few days if the infection is left untreated. This can include vomiting, diarrhea, coughing, and jaundice (yellow skin and whites of the eyes).
• It is very important to know that the disease can spread very quickly, and various complications can arise, sometimes within 24 hours! Fever or "flu" that lasts longer than two days should be considered malaria until proven otherwise. If you suspect a malaria attack, have your blood tested for malaria parasites by a doctor or at a hospital. Appropriate treatment can then be given. Malaria is generally curable!

Note:

• The parasite that causes Malaria tertiana can encyst itself in the liver, where it can remain in an inactive state for up to two years.
• This form of malaria can therefore become active and cause symptoms long after returning home.
• Therefore, be aware that if you experience periodic fever attacks (even after returning), this could indicate a malaria attack.

Where can you read more about malaria and malaria prevention?

More about malaria

• Also see the websites of the World Health Organization, the Malaria Foundation International, or the Center for Disease Control and Prevention for the most up-to-date information on malaria and malaria prevention.

Preventing malaria

• Preventing mosquito bites: malaria can be prevented primarily by wearing appropriate clothing, using DEET or another effective mosquito repellent, and using a mosquito net. This is because mosquitoes are most active at dusk and at night.
• Taking malaria pills or vaccination: whether to take malaria pills, and if so, which ones, and which ones to take when traveling.

What is polio?

• Polio (also called poliomyelitis or infantile paralysis) is caused by the poliovirus. This virus can cause muscle paralysis.
• The virus responsible for polio is excreted in the feces of infected people.

How do you get polio?

• Infection occurs through water or food contaminated with feces.

Where does polio occur?

• Polio occurs in regions with inadequate drinking water supplies and unsanitary conditions. These are regions in Africa, South America, and Asia.
• Afghanistan and Pakistan are the only remaining polio-endemic countries in the world
• Due to religious beliefs, vaccination is refused in countries such as Nigeria, Niger, Sudan, and Egypt. As a result, polio is becoming increasingly common in these countries.
• Recent outbreaks in various Western countries have often been linked to communities with low vaccination rates.

What are the symptoms of polio?

• Infection with this virus usually does not cause serious symptoms in 95% of cases.
• About 5% of cases experience some general symptoms such as a sore throat, abdominal pain, or nausea.
• Muscle paralysis occurs in less than 1% of infected people. However, if the muscle paralysis is chronic, permanent symptoms can develop, such as muscle weakness (for example, in the respiratory muscles) or deformities (especially in growing children).

How can you prevent polio?

• Polio is linked to poor hygiene and/or contaminated food. So pay close attention to what you eat and drink.
• Some measures may include: drinking only bottled or boiled water, avoiding raw vegetables, (raw) shellfish, crustaceans, or peeled fruit. Also, pay close attention to hygiene when using the toilet.

Is there a vaccination against polio, and what is the treatment?

• There are two vaccines available that are commonly given to children worldwide. A travel vaccination against polio is only required if no polio vaccination was administered during childhood.
• In the Netherlands, the DTP vaccination is most commonly administered. This combination vaccine provides very effective protection against diphtheria, tetanus, and polio. After a complete series, you are permanently vaccinated against polio. For diphtheria and tetanus, the treatment lasts for ten years.
• There is no official treatment for polio. Medication often focuses on relieving symptoms, such as pain relief.

What is an STD?

• An STD (Sexually Transmitted Disease), STI (Sexually Transmitted Infection) or venereal disease, is an infection that can be transmitted from one person to another through sexual contact.
• An STD can be a bacterial, viral, or parasitic infection.
• Common STDs include chlamydia, gonorrhea, and syphilis.

How do you prevent an STD?

• When traveling, you are far away from work or studies; you are free and happy and perhaps looking for an exotic adventure with someone of the opposite (or same) sex. You meet many new, interesting people and fall in love more easily. You might drink a little more than usual or use drugs more readily. It is easy then not to worry too much about safe sex. Remember, however, that you will have enormous regrets if you return home after your trip with an unwanted pregnancy, an STD, or HIV.
• Sexually transmitted diseases such as gonorrhea, syphilis, and chlamydia occur all over the world. They can be transmitted through unprotected sex. It is important to know that symptoms of these diseases can sometimes be difficult to recognize in yourself and others. A condom offers protection against the sexually transmitted diseases listed above, as well as against AIDS and Hepatitis B.
• A correctly used condom provides full protection against chlamydia, gonorrhea, HIV, and trichomonas. A condom offers only partial protection against genital warts (HPV), herpes, hepatitis B, syphilis, scabies, and pubic lice.
• It is advisable to bring condoms from home. This ensures the quality and reliability of the condoms, as the correct size is not always available abroad.
• Do not store condoms in direct sunlight, but in a cool, dark place such as in your backpack or suitcase (though not near sharp objects like scissors or a nail file). Pay attention to the expiration date and prevent the condom packaging from getting damaged. It will dry out and tear more easily. It is therefore wiser not to keep condoms loose in your pocket or wallet (unless you are going out for the evening). The pill, of course, offers no protection against sexually transmitted diseases.

What to do about Gonorrhea?

• This condition is better known as "the clap." Infection occurs via the mucous membranes. These are located in the vagina and anus, on the penis, and in the mouth.
• In women, there are few or no symptoms. Sometimes they experience increased discharge that may have an unpleasant odor and is yellow/greenish in color. Sometimes it also causes pain when urinating. In men, symptoms include pain during urination and purulent discharge.
• If you think you have contracted Gonorrhea, go to a doctor or the hospital as soon as possible. If the condition is not treated in time, it can lead to a fallopian tube infection in women. This, in turn, can result in reduced fertility or an ectopic pregnancy.
• In men, Gonorrhea can cause epididymitis. Gonorrhea is treated with one or more injections or pills. A check-up can take place after a short time, for example one or two weeks. During treatment, it is better not to have sex. This prevents you and your partner(s) from continuing to infect each other.

What to do about Syphilis?

• This sexually transmitted disease is transmitted via the mucous membranes.
• Two to twelve weeks after infection, a sore develops on the mucous membranes. This disappears on its own. Lymph nodes in the neck and groin may swell. After a few months, a rash develops on the torso, palms, and soles of the feet. This also disappears on its own.
• However, that does not mean that the condition has disappeared. If you think you have syphilis, take action; go to a doctor or the hospital.
• If syphilis is not treated or not treated adequately, there is a risk of damage to organs and the nervous system.

What to do about Chlamydia?

• This is the most common STD. Chlamydia is caused by a bacterium that settles in the mucous membranes of the genitals. This can lead to inflammation of the urethra, the anus, and the cervix. With an infection in the anus, there are usually no symptoms.
• Sometimes there is some bloody discharge, irritation, itching, and pain during bowel movements.
• If Chlamydia is not treated, it can lead to inflammation of the fallopian tubes or the epididymis. It is therefore wise to consult a doctor if you think you have chlamydia.
• If tests show that someone has chlamydia, a course of antibiotics is usually prescribed. It is best to refrain from having sex during the first week of the course; this can lead to reinfection.

What to do about Herpes?

• Genital herpes is an STI (sexually transmitted infection) caused by a virus. The virus causes an infection of the skin and mucous membranes in and around the genitals. Infection with genital herpes can only occur through intimate sexual contact between individuals where one has herpes and the other does not.
• If you have contracted a herpes infection, you may experience the first symptoms within about a week. Often, there is itching and an irritated, burning, and/or painful sensation. Red spots appear on the skin or mucous membranes. After one to one and a half days, blisters or sores become visible. Usually on or around the penis, the labia, the entrance to the vagina, or around the anus. Sometimes these symptoms also occur inside the vagina, on the cervix, or in the anus. In these cases, the blisters and sores are not easily visible. The severity of the symptoms varies from person to person. Initial attacks may be accompanied by pain, fever, swollen glands in the groin, and sometimes vaginal discharge. Women, in particular, often experience pain when urinating.
• When the symptoms of the initial infection have disappeared, it may seem as if the herpes virus has vanished from the body. Unfortunately, that is not the case. The virus has actually retreated from the skin into a nerve ganglion. It remains present there in a dormant state. However, the virus can multiply again and cause blisters on the skin or mucous membranes once more.
• There is no cure that completely eliminates the herpes virus from the body. Therefore, the virus can resurface repeatedly. Good physical and mental health contributes to a reduction in the number of attacks. If you think you have contracted herpes, see a doctor as soon as possible. Sex is not recommended during an attack. If you do have sex, at least use a (female) condom; that offers some protection.

What to do in case of AIDS?

• The virus that causes AIDS (Human Immunodeficiency Virus - HIV) is transmitted through blood-to-blood contact or unprotected sex. The virus occurs all over the world and among all population groups. Therefore, using a condom during sexual intercourse is always recommended. For more information on which procedures you can and cannot safely perform, go to soaaids.nl/en.
• Should you be traveling to areas where little or no medical care is available, you may consider taking a sterile kit containing needles and syringes, among other things. Any interventions would then not need to be performed using the instruments available on-site that may have been used previously and/or are not sterile.
• A few countries ban all foreign HIV-positive people from entering a country. Others have no entry restrictions for tourists but require people to be HIV negative if they apply for a work or residence permit. Read more about HIV and travel and visa restrictions on aidsmap.com

What is tick-borne encephalitis?

• Tick-borne encephalitis (TBE) is a brain inflammation caused by the tickborne encephalitis virus.
• The virus is transmitted by ticks.
• The disease is known by various names and has 3 sub-types
  • European or Western tick-borne encephalitis virus
  • Siberian tick-borne encephalitis virus
  • Far-Eastern tick-borne encephalitis virus, formely known as FSME, Russian spring summer encephalitis

How do you get tick-borne encephalitis?

• An infected tick transmits the virus to you through a bite, which occurs within the first few minutes after the bite.
• Removing the tick has no effect on the infection.

Where does tick-borne encephalitis occur?

• The tick-borne encephalitis virus is found in large parts of Europe and Russia.
• Ticks are mainly found in wooded areas and tall grass. The risk of a bite and subsequent infection is greatest from April to November.
• Due to climate change the virus is slowly moving westward and northward

What are the symptoms of tick-borne encephalitis?

• A large proportion of infected people do not become seriously ill. A minority develops encephalitis or meningitis, both serious, life-threatening illnesses. People over 50 are more likely to develop the severe variant.
• One to three weeks after infection by a tick, you develop flu-like symptoms. In people with the more severe variant, the symptoms worsen with a high fever, stiff neck, and vomiting.
• In cases of infection via raw milk, the first symptoms are noticeable after just a few days.

Can tick-borne encephalitis be treated?

• Unfortunately, tick-borne encephalitis itself is not treatable.
• Only the symptoms of encephalitis, such as a high fever, can be treated.

What to do to prevent tick-borne encephalitis abroad?

• Avoid tick bites. Not only against tick-borne encephalitis but also against Lyme disease, for example.
• Wear long clothing, wear your socks over your pants, and walk in the middle of paths. To enhance this effect, you can use tick-resistant socks or DEET.
• After a nature walk or other outdoor activity, carefully check your body and clothing for ticks. A tick on your backpack or shoe can still bite you the next day!
• Do not eat (products made from) raw milk in areas where the disease is prevalent.
• Depending on the risk level of your destination and your activity (e.g., frequent nature walks), a vaccination may be recommended.

Is there a vaccination against tick-borne encephalitis?

• An effective vaccine against tick-borne encephalitis is available for both children and adults.
• You receive three injections over a period of usually six months, which protect you for three years.
• Didn't start the first injection on time? A quicker injection with a less effective effect is also available. You can also get your third injection after returning home.

What is Tungiasis?

• Tungiasis is a parasitic skin disease caused by the female sand flea, in which the flea burrows into your skin.
• Usually around your feet, toes, and nail edges. The sand flea can also be found on hands, elbows, buttocks, and in the pubic area.
• Tungiasis occurs in South and Central America, the Caribbean, Africa, Pakistan, and India.
• Dogs, cats, pigs, and rats are the main carriers.

What can the consequences of Tungiasis be?

• Tungiasis can cause a lot of pain and itching. You may also have difficulty walking, sleeping, and concentrating.
• If you are not vaccinated against tetanus, you can also contract tetanus through tungiasis.
• An untreated infestation by multiple fleas can lead to life-threatening infections.

What to do to prevent tungiasis when traveling and abroad?

• You prevent tungiasis by protecting yourself against sand flea bites when staying in areas where they live.
• Healthy, well-cared-for feet are at lower risk.
• By regularly checking for fleas, you can prevent things from getting worse.
• Read more about the measures you can take against sand fleas.

What is the treatment for Tungiasis?

• In all cases, remove the flea.
• Clean with alcohol or ether, or soap if no alcohol is available.
• Make the opening slightly larger with a sterile needle or tweezers.
• Pry the flea out with the sterile needle or tweezers.
• Clean the wound thoroughly and treat it with Betadine (iodine ointment) to prevent infections.
• An alternative treatment with tea tree oil appears successful in killing the sand flea in the skin, but further scientific research is pending.

What is West Nile Fever?

• West Nile fever, or West Nile fever, is an infectious disease caused by the West Nile virus, which is transmitted by various mosquito species.
• Although West Nile fever is usually relatively harmless, in some cases it can be a life-threatening illness.
• The West Nile virus is common in birds and regularly jumps to horses and humans.
• The West Nile virus is closely related to dengue, tick-borne encephalitis, and Zika, among others, and periodically causes severe local outbreaks.
• The disease owes its name to the first cases in Uganda in the Nile region; however, the disease has since spread far beyond the Nile region.

Where is West Nile virus found?

• The mosquitoes that can transmit West Nile virus are found worldwide, except for the far north.
• The West Nile virus is currently mainly found in Africa, parts of Asia and North America, and around the Mediterranean. In recent years, more cases have been reported in Europe.
• Climate change appears to play a significant role in the spread of West Nile virus in Europe and the US.
• In Latin America and Australia, there are still very few human infections, but the virus is already present in birds. Mutations in the virus could cause a sudden outbreak there as well.

What are the symptoms of West Nile fever?

• The first symptoms appear two to six days after infection with West Nile virus.
• Some common symptoms in a mild case include: flu-like illness with fever, headache, muscle aches, sometimes abdominal discomfort, diarrhea, rash, and enlarged lymph nodes.
• Approximately 80% of infected people experience no symptoms at all, around 20% experience mild symptoms, and less than 1% experience severe symptoms.
• Severe symptoms include: severe neurological problems, such as encephalitis or meningitis. These symptoms can lead to a coma and even death.
• Older or vulnerable people are at greater risk of a severe course of West Nile fever.

Can West Nile fever be treated?

• Once infected, there is no treatment for West Nile virus.
• The disease usually clears up on its own within a week.
• Treatment focuses primarily on managing pain and fever, with medications such as paracetamol.
• Prevent dehydration by drinking plenty of fluids. Seek immediate medical attention if you experience persistent high fever, severe headache, stiff neck, drowsiness, confusion, paralysis, or seizures.

Are there vaccinations against West Nile fever?

• No, there is currently no vaccine for West Nile fever for humans; only a vaccine is available for horses.
• Once you have overcome West Nile virus, whether or not you've been infected, as far as we know, you are protected against future infections.

How can you prevent West Nile fever?

• Stay informed about local outbreaks, especially in Southern Europe and the US, where the virus only occurs periodically with local outbreaks.
• Avoid being bitten by mosquitoes! In many areas where West Nile fever is prevalent, mosquitoes transmit several nasty diseases.
• It is advisable to wear protective clothing that covers your arms and legs and to apply mosquito repellent containing DEET. Air conditioning and window screens also offer partial protection.
• Sleeping under a mosquito net is recommended; the greatest risk of an infected mosquito bite is around sunset, in the evening, and around sunrise.

What is Zika fever?

• Zika fever is an infectious disease caused by a virus.
• This infectious disease has many similarities with dengue fever.
• The disease is transmitted by infected mosquitoes, which are primarily active during the day.
• Outbreaks occur regularly in all tropical regions.
• Zika fever is particularly dangerous for pregnant women because the virus can harm the unborn child. For other adults, it is primarily a "normal" and unpleasant illness.

What are the symptoms of the Zika virus?

• The symptoms of Zika fever are usually mild and short-lived (2 to 7 days). Symptoms include fever, inflammation of the lining of the eye, temporary joint pain, and a rash.
• The most dangerous aspect of the Zika virus is the birth defects that babies of infected mothers can develop.

What to do to prevent Zika abroad or while traveling?

• There is no vaccine available yet, so preventing mosquito bites is the key to preventing the disease.
• Stay informed about local outbreaks, especially during pregnancy.
• If you live or work in a (sub)tropical area where Zika is present, try to avoid stagnant water in areas such as bowls, flowerpots, puddles, and car tires.
• Use DEET and mosquito-repellent clothing to prevent bites.
• Read more about DEET and pregnancy.

What to do if you get Zika?

• The disease usually clears up on its own within a week.
• Treatment focuses primarily on managing pain and fever, for example, with paracetamol.