Travel Advisory: Notable Infections & Vaccinations

 

Living in the States, one thing I usually don’t think of is my need to get certain vaccinations. Prior to my arrival in the States eons ago, I was fully loaded with the latest in vaccinations. My immunization card was impeccable.  Like many, I would have divorced the idea of adult vaccinations after I graduated college if not for my health related job. There exists a lovely person who sends me yearly reminders that I am due for my PPD (Tuberculosis testing) or Flu-vaccination.

However, when it comes to travel, there’s no one to alert me on what I need.  Rarely have I ever traveled to an area when I was concerned enough to get or need pre-travel vaccines. Prior to my trip to India last year, malaria was the big concern for my travel mates. I have battled many mosquito bites in Nigeria without ailment, so unless mosquitoes in India have “special powers”, I wasn’t too worried about malaria. Regardless, I was shoved my sachet of anti-malaria tablets by travel mates who were both pharmacists carrying an arsenal of medications to cover every ailment possible.

Fact: I was definitely non-compliant with my anti-malarial tablets but we stayed in well insulated hotels, road in air conditioned cars…etc.

When traveling, the vaccinations you need greatly depends on your destination and your personal health history.  My travel agenda this year includes Africa, Central America, Asia and Europe.  The CDC website provides general and travel based vaccination recommendations. A few routine vaccinations that are recommended for adults include: Measles-Mumps- Rubella (MMR), Diphtheria-Tetanus-Pertussi Vaccine, Polio Vaccine, a yearly flu shot and varicella (Chicken Pox) vaccine.

Mosquitos

What do you need to know about

Zika Virus- Recently the this virus has been popular in the news, and rightly so especially given the fact that it has been linked to a birth defect- Microcephaly: A defect where the baby’s head is smaller than expected when compared to babies of the same age and sex. Women in any trimester of pregnancy, and women who are trying to be become pregnant are cautioned about travel to areas with Zika; they should consult with their healthcare provider before traveling.

Areas of documented transmission include Africa, Southeast Asia, the Pacific Islands, and the Americas. No local transmission is known within the United States but returning travelers have been found with the infection.  Symptoms of the infection can include: fever, joint pain, muscle pain, redness of the eyes, and headache. These can start and last days to weeks from infection. The virus can be found in the blood and is known to be transmitted by mosquitoesbut there appears to be rare cases of sexual transmissions as well.  Zika is similar to Dengue and Chikungunya infections which are also spread by mosquito bites.

No vaccines exist presently to prevent or treat the Zika virus.

Treatments include staying well hydrated, rest, fever and pain control with Tylenol/Acetaminophen/Panadol medication. You can protect yourself by following instructions below on how to prevent mosquitoes bites. Preventative measures are listed further below.

Hepatitis A– Infection is acquired through contaminated food and water (fecal-oral). It is common in developing countries with poor sanitary conditions. To prevent infection, get the vaccine 2-4 weeks before departure, eat food that is freshly prepared and cooked thoroughly, and drink safe beverages (i.e…bottled water) in addition to practicing great hygiene and cleanliness ( i.e proper hand washing…). You can be infected and have no symptoms. Symptoms include: Fever, tiredness, nausea, vomiting, dark urine, abdominal pain, yellowness of skin (Jaundice) and joint pain. There is a post-exposure vaccine.

Hepatitis B–  Acquired through sexual contact, contaminated needles and blood products. There is a higher prevalence in East Asia and Sub-saharan Africa.  It is recommended if you are getting a tattoo or piercing, might have new sexual partners or have medical procedure. Hep B can cause acute and chronic liver disease- higher risk of cirrhosis and liver cancer. There is a vaccine available. Usually recommended for health care workers. Symptoms of acute infection similar to Hepatitis A.

Unlike Hep B, Hep A is does not cause chronic liver disease and is rarely fatal.  It can cause acute liver failure which is associated a high mortality.

Malaria– This is acquired through mosquito bites-parasites are transmitted via an infected female mosquito. Malaria can cause life threatening illness. Symptoms can start 1-2weeks after infection: fever, headache, chills and vomiting.  Most cases occur in Sub-saharan African but Latin America, Asia and Middle East are also at risk.  There are prescription drugs you can take (before and during your trip) to prevent Malaria. There is no vaccine for malaria but post-infection medication is available. There are preventative practices you can perform to prevent mosquito bites while traveling.

Yellow Fever– Found in tropical regions of Africa and the Americans.  Also acquired from mosquito bites. First symptoms can be noticed it 3-5days: fever, vomiting, chills, loss of appetite. Usually resolves. For a few, 1 day after resolution of symptoms, they enter a “toxic phase”: yellowness of the skin (Jaundice) and bleeding. About 50% of patient who enter the toxic phase die within 10-14days. There is no treatment for Yellow Fever. Vaccination is highly recommended at least 10days before your trip.  Certain countries in Africa and Central America with areas at high risk for transmission will need proof of vaccination with your travel papers.

I remember getting this painful vaccination as a child.

Japanese Encephalitis– Another mosquito related infection. Related to Yellow Fever, Dengue and West Nile Virus. Present in certain areas of Asia. Risk of very low and many have no symptoms, but vaccinations are recommended depending on what specific area you are visiting, the time of the year, planned activities, and length of stay.

Encephalitis is an inflammation of the brain. Symptoms include headache, fever, stiff neck, and disorientation. In those with severe illness, death rate is around 30%. Those who survive may have neurological problems: paralysis, seizures, inability to speak…etc.

Typhoid – This is a bacterial disease. South Asia has highest risk but Latin America and Africa are also at risk. Transmitted through food and water contaminated by those infected with the disease. Symptoms can start 1-3wks after infection: high fever, tiredness, rose colored spots on chest, enlarged spleen and liver. Internal bleeding and death can occur, but rare. There is antibiotic treatment available.  Vaccine is available (injection or pill form). This vaccination is only 50%-80% effective so you still have to be careful what you eat and drink. Get vaccinated if you are visiting smaller rural territories of high risk areas and have an adventurous culinary appetite.

 Rabies– A deadly vaccine-preventable viral disease spread through saliva of infected animals to humans (Zoonotic transmission). Rabies is acquired from bites from dogs, bats and other mammals. Immediate wound cleansing with soap and water can be life saving. Symptoms can start 1-3months after exposure: fever, pain or tingling at bite site. As the virus spreads through the central nervous system, a progressive and fatal inflammation of the brain and spinal cord occurs. Vaccination is needed mostly if you intend to work with animals or travel involves outdoor activities. Rabies is present in all continents but considered higher risk in Asia, Africa, and the Americas. Pre-travel vaccine is usual a series of 3 injections over several days. Effective post exposure treatment can prevent onset of symptoms and death. Prevention is mostly through immunizations of animals and people.

A word on preventing mosquito bites: These mosquitoes are pesky and just “bad news”. You want to avoid them at all cost.

  • Cover up- Wear long sleeve shirts, and long pants. Limit exposed skin.
  • Insect Repellants- Use insect repellents as directed. Do not use on children less than 2 months of age.

 Repellents with DEET, Picaridin, Oil of Lemon Eucalyptus, IR353 are recommended  by the CDC.

  • Stay or sleep in areas with screens or air conditioner
If you are bitten by mosquitoes:
  • Avoid scratching mosquito bites.
  • Apply hydrocortisone cream or calamine lotion to reduce itching.

A directory of travel clinics to visit can be found at www.CDC.gov. It is recommended to get started on this 4-6 weeks prior to your travel.

More information regarding Zika and other travel advisories can be found at www. CDC.gov

Safe Travels

~Citrine