AFRICA TRAVELLER

Hepatitis A & B inoculation
Diarrhoea remedies
Malaria prevention
Rabies vaccine
Cholera, Typhoid, Meningitis inoculations
Yellow Fever inoculation

The list here could be quite long – particularly if you are camping out or back-packing in the rough. However, if you are staying in bigger cities and in fine hotels, the risks are considerably reduced.
Yellow Fever inoculation is required by law for most central African countries and you cannot enter many of them without proof of inoculation.
Malaria prevention is vital virtually all year round in central Africa – and the disease has become resistant to some medications in some areas. In summer travellers are at risk in all of sub-Saharan Africa. Mosquito nets and insect-repellents are also a good idea.
Meningitis occurs in a belt across central Africa (mostly north of the equator) and inoculation is strongly advised.
Hepatitis A, Cholera, Typhoid and Diarrhoea frequently occur where water is anything less than 100% safe.
Hepatitis B is transmitted like the AIDS virus – and the possibility of a blood transfusion or the sexual behaviour of the traveller will determine the necessity of this inoculation.
The bush traveller may be exposed to Tick-bite Fever, Rabies, Bilharziasis, Sleeping Sickness, Filaraisis and other infections or parasitic diseases.

HEPATITIS A

This infection has been known to occur throughout the world – from the sophisticated Western world to the hyper endemic areas of Africa, Asia and South America.
It is a viral infection of the liver and it is generally transmitted through food and water. Outbreaks have been linked to water, ice and shellfish – and to the consumption of salads, fruits and other foods pre-washed with contaminated water.
Patients usually become jaundiced with nausea, vomiting and joint pains that may last many weeks – while the patient is bed resting (often up to 12 weeks). It can be effectively prevented by a series of two injections, six months apart, to give immunity for the rest of your life. (Another option is a combination vaccination with Hepatitis B – a series of three injections).

HEPATITIS B

This is a viral infection of the liver – which is contracted in the same way as the AIDS virus. In much of Africa, South America, China and south-east Asia the level of chronically infected people comprises between 5% and 15% of the population.
This disease may eventually lead to liver cancer.
Sexual transmission is highly efficient – as is percutaneous transmission from needle sharing, blood transfusions and traditional medical procedures (acupuncture and tattooing). Three doses of vaccine constitute the complete series of immunisation. The first two doses are usually given one month apart with the third dose about six months later. A further booster every five years is recommended.
Vaccination is advised for travellers likely to engage in sexual or needle-sharing activities or those that may have to undergo dental or medical procedures while away.

TRAVELLER’S DIARRHOEA

Food in foreign countries is often different from that to which the traveller is accustomed. Food often looks very appealing and the newly discovered tastes contribute to the enrichment of foreign travel. However, food may carry an important menace for the traveller’s health. The reasoning “What is good for the local people cannot be bad”, is only partially correct. The traveller must be aware that the local population may have developed resistance or tolerance to a number of harmful components of their food, such as parasites or other infectious agents.

The most important hazards related to food are infections. They relate mainly to the contamination of food by parasites, but also bacteria or viruses of human origin, present in human excreta. These can contaminate food by dirty hands or through water used in food preparation and which has been soiled by sewage or leakage from latrines used by humans. Human excreta used as fertiliser can carry dangerous parasites or germs. Improper hygiene of food and water leads to traveller’s diarrhoea. Many of these infectious agents can be destroyed by heating, but a number stick to the surface of foodstuffs such as fruit and vegetables which we do not want to cook. The saying “ Cook it, peel it or leave it ! ” carries considerable wisdom. Meat and fish may contain parasites which undergo a biologic cycle ending in the animal. However, the intensive heat of frying, baking or stewing largely destroys these parasites.

HOW TO AVOID TRAVELLER’S DIARRHOEA

Bacteria are responsible for 50%-80% of cases of traveller’s diarrhoea. (E.coli will be the most likely cause). Viruses are an uncommon cause of diarrhoea.

WATCH WHAT YOU EAT! Street vendors and open-air markets are more likely to offer contaminated food. Some street vendors may offer to peel the fruit, but the cleanliness of the merchant’s hands is still suspect. No raw fruit or vegetables should be eaten unless it can be peeled and the traveller peels it him/herself. Don’t eat lettuce, raw vegetables and cut-up fruit salad. Milk and dairy products are not safe unless they have been pasteurised, as heating destroys the organisms. Travellers should avoid any dish prepared in advance and allowed to stand, such as hot sauces sitting on tables in open containers. All cooked food must be served hot. Meat must be cooked. Raw/underdone meat and fish MUST BE AVOIDED.

DO NOT DRINK TAP WATER! Even the amount used to wet a toothbrush contains large numbers of organisms. ALWAYS REFUSE ICE - it is made from tap water! Tea and coffee (not iced!) are low risk. Canned soft drinks are safe , as long as the traveller opens the can. If tap water is the only source, boil for 5 - 7 minutes and let it cool down spontaneously.

MALARIA

• It is estimated that up to 2,7 million people die from malaria every year.
Malaria occurs in almost all of sub-Saharan Africa. In South Africa only in the low altitude areas (below 1 000 metres) in the northern part of the country.

The female anopheles mosquito that carries the malaria parasite transmits the disease through her bite. The mosquito generally feeds between dusk and dawn, both indoors and outdoors. Bites may be minimised by the following:
• Apply a mosquito repellent to the exposed parts of your body (Wet wipes containing DEET).
• Use mosquito nets in high risk areas
Flu-like symptoms after returning from a malarial area must get immediate attention. Any person returning from a malarial area with these symptoms should immediately consult a doctor and mention that they have been exposed to malaria. Other symptoms include body pain, diarrhoea and vomiting. The usual incubation period for malaria is 14 days but it can take as little as a week to manifest itself – and as long as two months in some cases.

Note that no precautionary measures are 100% effective.

RABIES

Rabies is widely distributed in the world – and South Africa is no exception. Dogs are the most commonsource of human infection. About 20 cases are reported annually in South Africa – mainly in KwaZulu-Natal. There is also growing concern of this disease in the Eastern Province.

This is invariably a fatal disease contracted by virus-laden saliva after a bite from a rabid animal. The disease progresses to paresis or paralysis. Spasms of muscles on attempts to swallow will lead to a fear of water (hydrophobia). Delirium and convulsions follow. After 2 – 10 days death results (often due to respiratory paralysis).

The only areas free of rabies in the animal population (at present) include Australia, New Zealand, Japan, Hawaii, Taiwan, UK, Ireland, Spain, Portugal, mainland Norway, Sweden and some islands in the Atlantic Ocean and West Indies.

NO ANIMAL BITE SHOULD BE IGNORED !

Since the disease in invariably fatal once symptoms supervene,post-exposure treatment is based on the principle of inducing immunity before the virus gains access to the nervous system. Victims must get treatment without delay.

Pre-exposure immunisation (3 injections within 1 month) may be offered to people who are either working in a rabies-infected area or spending more that a short holiday in an infected area (especially when back-packing or bush camping).

In areas of endemic rabies, domestic dogs and the cats should not be petted and contact with wild animals (especially bats, jackals, foxes, shunks, mongooses, raccoons and monkeys) must be avoided.

CHOLERA

This is caused by a bacteria and will usually cause profuse watery stools and vomiting. Rapid dehydration may follow which may lead to the patient’s death within a few hours. The mode of transmission is primarily through ingestion of water contaminated with faeces or vomits of patients or, to a lesser extent, faeces of carriers. It is often associated with flooding, poor water supplies and/or poor sanitation.
Cholera can be prevented by an oral vaccine dissolved in water. It’s effectiveness is from six months to two years.

TYPHOID

This is a systemic bacterial disease contracted when food or water contaminated with faeces or urine of a patient or carrier is ingested. It may cause fever, headache and constipation (more commonly than diarrhoea.
Intestinal haemorrhage or perforation may occur in untreated cases – which can lead to the death of the patient. Inoculation with typhoid injection is advised for international travellers – especially if they are likely to be exposed to unsafe food or water. The inoculation provides immunity for three years.

MENINGITIS

Meningococcal meningitis is an acute bacterial disease characterised by sudden onset with fever, intense headache, nausea and vomiting, stiff neck and frequently a rash.
Delirium and coma often result – and death may occur within a few hours if appropriate antibiotic treatment is not administered.
This disease is spread through droplet infection from person to person – more often from ‘carriers’ than patients. One sneeze on an aeroplane can infect dozens of passengers.
The risk to travellers planning to have prolonged contact with local populations in countries experiencing epidemics will be greatly reduced by immunisation. A single vaccine will give partial protection for three years.

YELLOW FEVER

This explanation is offered here because you may travel to the First World from Africa and that could mean that you will be required to show proof of immunisation at your destination country.

Travellers from South Africa do NOT require such proof, but you cannot argue with a health official at a foreign airport when he insists that you have entered from ‘Africa’ and must produce a certificate…

Yellow fever is endemic in the tropics of Africa and America – it is a virus transmitted by a mosquito. The disease is a much bigger problem in Africa than in America. The disease is responsible for about 200 000 cases and about 30 000 deaths annually in Africa alone! The mosquito flourishes in human habitations especially under slum conditions and is prevalent in the large urban informal settlements in tropical Africa. The closest country to South Africa where the disease occurs, is Zambia.

A single 0.5 ml subcutaneous inoculation provides excellent immunity in over 95% of recipients providing long-lasting immunity, probably for a lifetime. International travel regulations, however, demand that boosters be administered every 10 years.

The risk of infection can be minimised by taking general measures to prevent or reduce mosquito bites, including avoiding being outdoors at dusk and in the early evening. Wearing of long trousers and long-sleeved shirts, using of mosquito repellents on exposed skin, and sleeping in screened rooms or under netting is also advised.

INDEMNITY: This information is offered without charge to potential travellers. It is NOT intended as a complete list of all the risks encountered at these (or other) destinations. Consultation with a qualified doctor at a travel clinic is recommended. Travelsafe Clinic is not responsible for any infection/illness resulting from the use of the information at this site or in any of our published brochures.