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.  It can be effectively prevented by a series of two injections, six months apart, to give immunity for ten years.

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 Southeast 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.

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 1000 metres) in the northern part of the country. ( Mpumalanga , Northern Province , north-eastern KwaZulu-Natal ). Occasionally limited focal transmission may develop in the Northwest and Northern Provinces along the Molopo and Orange Rivers .

Infections are very seldom contracted outside the malarious areas and are then possibly a consequences of the importation of infected mosquitoes by motor/air/rail transport.The female anopheles mosquito that carries the malariaparasite 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.

In South Africa malaria transmission is seasonal. During dry seasons the number of mosquitoes may be fewer – often rendering precautionary measures against mosquito bites sufficient – antimalarial drugs are then necessary.

Use of mosquito nets and insect-repellents (as well as ‘cover-all' clothing at sunset/night/dawn) will reduce the risks quite considerably.

Malaria incidence in this country has been shown to be associated with climatic conditions (temperature and rainfall) – as well as influx from neighbouring countries.

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.

TICKBITE-FEVER

Tick-bite fever is transmitted by a hard tick. It is characterised by a primary sore (often having a blackish centre), swollen lymph nodes and, in most cases, by intermittent fever lasting 10 – 14 days.

Incubation period for this disease is about 7 days. There is a sudden onset with significant malaise, deep muscle pain, severe headache and conjunctivitis. A rash, appearing on the extremites about the 3 rd day, soon includes the palms and soles and spreads rapidly to most of the body. Bleeding underneath the skin is common. Blood tests may frequently be negative in the early stages – the diagnosis may therefore be missed if tests are not repeated!! The rash on the palms and sole is also a hot clue ! No vaccine is presently licensed for public use. This disease requires specilic antibiotic for treatment.

Tick-bite fever is widespread in south Africa – but especially common in the bushveld areas of Mpumalanga and the coastal belt from Port Elizabeth to the Mozambique border.

It has been shown that at all stages of development, the common dog tick (larva,nymph and adult) is infective and there is hereditary transmission of the disease through the egg to succeeding generations. (This is believed to continue indefinitely).

Travellers should thus wear long trousers in the bush.

BILHARZIA

A blood fluke infection with adult male and female worms living in certain veins of the patient over a life-span of many years.

These are several forms of blood flukes – and mixed infections are sommon.

The distribution in South Africa includes KwaZulu-Natal and virtually the entire country north of Johannesburg – extending into Botswana , Zimbabwe and Mozambique . Small areas of infection alsooccur near port Elizabeth and East London . In some endemic areas like Mpumalanga nearly 100% of rural school children are infected.

This infection is acquired from contact with water containing free-swimming larval forms which have developed in snails.The bilharzias life-cycle involves the release of the ora in human urine (haematobium) directly into natural surface waters – or in faeces (mansoni) which is then washed by rain into nearby surface waters. In the water, the ora hatch and eventually enter a suitable snail where development takes place.

Eventually fork-tailed larvae emerge and avtively penetrate through healthy intact skin of people swimming or wading in the water.

An immediate consequence of infection might be ‘swimmer's itch' which usually occurs on the day of exposure and then subsides within a few days. People who have never had the infection previously might develop katayama fever between 2 weeks and 2 months of infection. This presents with a fever, Diarrhoea, cough and swollen lymph nodes.

A third stage of blood in the urine and severe fever follows.

Severe liver complications and bladder cancer may result with chronic infections.

The only prevention for travellers is to avoid bathing or swimming in contaminated lakes and rivers.

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.