Health Q&A

1053

Yellow Fever

*Which countries require Yellow Fever inoculation?

Most sub-Saharan Central African countries and in Northern and Central South American countries. Many countries will require that you be vaccinated against yellow fever if you are coming from a country where it is present or have been in such a country even if you are in transit. If this is the case you will need to present an ‘International Certificate of Vaccination or Prophylaxis’ to immigration officials. This little yellow booklet will be given to you when you are vaccinated against Yellow Fever for the first time. Carry it with your passport: you’ll typically present them to immigration officials at the same time.

*When should travellers get the vaccination?

It is generally easiest to get a Yellow Fever vaccination in South Africa before you leave on your trip. You need to have the vaccine administered 10 days before departure for it to become effective. Some countries have refused entry until the 10-day waiting period is up, which can prove very costly to the business traveller.

*What exactly is Yellow Fever and what are the symptoms?

A potentially fatal viral disease spread to humans via the bite of an infected mosquito. The Yellow Fever virus causes a sudden onset of fever, which occurs about four days after being bitten by an infected mosquito. Fifty percent of cases are mild with symptoms lasting less than a week, while the rest of the cases will be serious with patients suffering liver damage, which leads to jaundice. It may also cause joint pain and vomiting. Eventually the clotting systems fail, which lead to bleeding and death.

Malaria

* Which malaria medication is best for a business traveller travelling to a malaria area?

There is no best preventative medication for a business traveller entering a malaria area. The decisions rest on length of stay, activities of the traveller, accommodation and personal make up of the individual. There are three medications which are effective against Plasmodium Falciparum malaria. Mefliam [larium], Doxycycline, and Malanil. The first two work outside the liver cycle of the malaria parasite and therefore have to be taken for prior to entering, during, and for four weeks after leaving the malaria area. Malanil on the other hand has to be taken prior, during and only for a week after leaving the malaria area as it blocks the liver cycle and is able to eradicate the malaria parasite quicker than the other two alternatives. It is the best alternative for the short-term traveller who is in and out of risk areas quickly and is generally the corporate’s recommended prophylaxis. However, at R47 a tablet it is quite costly! For the longer-term traveller the other two are much less costly alternatives. If one has any psychological hang-ups or certain cardiac conditions, then Mefliam should be excluded. Doxycycline makes one more sun sensitive.

*What other precautions are there to prevent the contraction of malaria?

Moisture, warmth, carbon dioxide and odour all attract mosquitos. So cover up. Long-sleeved, light coloured clothes should be worn between dusk and dawn. Wear treated long-sleeved lightweight shirts and blouses and long pants with long socks. Dark colours attract mosquitoes. Strong scents also attract them so avoid perfumes and after shave lotions! 30% DEET is clinically proven to be the most effective mosquito repellent to apply to your skin (E.g., Tabard /Peaceful Sleep). Repellents work on the mosquitoe’s antennae which causes the mosquito to become disorientated. In field trials DEET products on the skin were found to be more effective than coils, citronella candles, sonic repellers and UV light lures. 30% DEET needs to be applied four- to five-hourly sparingly around neck, ankles and arms. Never use it over cuts, wounds or inflamed skin. After application wash your hands to avoid inadvertent contact with eyes, mouth and other sensitive areas. Wash the repellent off when you no longer need it.

*What are the symptoms and for how long after returning from the trip, should you be aware of them?

Any flu-like illness, fever, headache occurring 10 days after entering a malaria area must be regarded as malaria and a blood test is mandatory to exclude malaria. Malaria can kill within 48 hours. It is easy to treat in the early stages of the disease, but once complications occur it can be a very costly exercise with sequelae if you survive.

*If a business traveller is travelling to a malaria area for just one day, is it still advisable/necessary to take preventative medication?

Exposure is often zero, but it takes just one bite! The main risk is an unexpected trip to a game park or having an evening meal in the open. They do not need prophylaxsis, but need to take personal protective measures and report any fever should it develop.

Food and water

*When travelling, what advice would you give business travellers in terms of food and water?

Boil it, cook it, peel it or forget it! The safest foods are those which have been recently prepared and are served hot all the way through. Hot food is safe (temperature hot rather than spicy hot!). The common cause of food poisoning is food that has been cooked in advance and then left at room temperatures. Avoid salads. When buying water always check the seal on the bottle and buy from a reputable source. Sparkling water is best! Clean your teeth with bottled water. Don’t have ice in your drinks. Avoid unpasteurised milk. Fruit should be washed and dried by you and then peeled by you. Before handling any food you need to wash your hands with soap and water. Using alcohol-based waterless gel after washing your hands also helps.

*What medication can be taken to prevent/treat an upset stomach?

There is a product called Travelan which stops E. coli from binding in your gut and is taken with each meal. Certainly something to consider when going to places like Egypt. Always have Immodium or equivalent with you and electropak rehydrate sachets. If that does not control things then taking a quinalone antibiotic like Ciprobay should help. Smecta is a new sachet product that one can take instead of an antibiotic, that also binds up the bacteria.

Inoculations

*What inoculations should travellers take when travelling?

All travellers should ensure that their Tetanus Vaccination is up to date. This protects from getting lockjaw (tetanus) should you have a fall, injury or MVA. It lasts for 10 years and for travellers it can be given with a quadruple vaccine, Adacel, and one then gets lifelong cover for Polio, Diphtheria and Pertussis. Polio is still present in Africa, especially in Angola, so all travellers to Africa should ensure that they are revaccinated prior to their journey. India, Pakistan and Afghanistan are the other Endemic Polio countries.

The next vaccine that all travellers should be given is Hepatitis A. This vaccination gives you almost immediate protection and lasts for six months when you should have a booster injection which will give you lifelong immunity. Hep A is a viral infection causing jaundice and is picked up from food handlers. Beware the buffet dinner in five-star establishments in the developed countries!

All travellers should consider the current Influenza Vaccine which will have the H1N1 component in 2010 vaccine considering the HINI pandemic.

All travellers at risk from influenzna virus, with chronic medical conditions such as asthmatics, emphysema sufferers, diabetics, travellers suffering from chronic cardiac conditions, and travellers that are overweight should not only have the seasonal flu vaccination but the Pneumoccocal vaccine as well, which protects for five years.