WESTERN WORLD TRAVELLER

Hepatitis A & B inoculation
Food Poisoning/Diarrhoea remedies
Jetlag remedy
Yellow Fever inoculation ..?

Just when you thought it was safe to venture beyond our borders to civilised destinations like Western Europe, the USA, Canada or Australasia – you find that it’s not entirely plain sailing…..
The World Health Organisation demands that travellers (entering or leaving) any country show proof of valid Yellow Fever inoculation if they have been to central Africa. The disease does not occur in South Africa – but some health authorities may insist that travellers from ‘Africa’ show proof of inoculation – even if they have travelled directly from South Africa. Passengers have been known to be sent home – or given the choice of inoculation at the arrival airport (often at exorbitant rates). So, you might consider inoculation before your departure ...
Some rare diseases also occur – Rocky Mountain Spotted fever (similar to Tick-bite Fever), Plague and Rabies (particularly from bats in the USA). Lyme Disease (also caused by ticks) occurs in the USA and Europe.
And besides the dangers of infections like Hepatitis A (possible virtually everywhere) and Hepatitis B (transmitted like the AIDS virus) there are quite a few food poisons that occur frequently – like salmonellosis (2-3 million cases annually in the USA alone).
Jet-lag tablets help you adjust quickly to new time zones and could save you a few days of lethargy when you want to feel your best.

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.

FOOD POISONING

Foodborne intoxication or food poisoning are generic terms applied to illnesses acquired from the consumption of contaminated food and/or water.

Staphylococcal Food Poisoning

This is one of the principal acute food poisonings in the USA. It is an intoxication of abrupt and sometimes violent onset – with severe nausea, cramps and vomiting. This occurs 2-4 hours after an infected meal. Foods involved are particularly those which are handled by food vendors without subsequent cooking or with inadequate heating or refrigeration (custards, salad dressings, sliced meats etc.)

Vibrio Parahaemolyticus Food Poisoning

Watery diarrhoea and abdominal cramps follow after ingestion of raw or inadequately cooked seafood (or any food cross-contaminated by handling raw seafood in the same environment – or by rinsing with contaminated sea water).

Bacillus Cereus Food Poisoning

A well-recognised cause of food-borne diseases in Europe (rarely in the USA). Outbreaks characterised by vomiting have been most commonly associated with rice. Vegetables and meat dishes mishandled after cooking are often suspect.

Salmonellosis

There are an estimated 2 – 3 million salmonella infections in the USA annually. This is a bacterial disease commonly manifested by an acute enterocolitis with sudden onset of headache, abdominal pain, diarrhoea, nausea and sometimes vomiting. Fever is nearly always present. (Deaths are uncommon except in the very young, the very old or the debilitated).

The mode of transmission is ingestion of organisms in food derived from infected animals – or contaminated by faeces of an infected animal or person. This includes raw eggs, milk and/or meat products – especially poultry.

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.

JET-LAG (MELATONIN TABLETS)

When flying from north to south, the time zones from country to country differ very little – if at all. However, when you travel from west to east or east to west the differences can be considerable. Your body ‘clock’ takes some time to adjust to these changes – and you can find yourself exhausted for a few days after travelling. Sometimes this lethargy spoils a few days of your holiday/business trip when you least want it to do so. Jet-lag capsules (Melatonin) can help eliminate the problem.

Melatonin is a natural hormone that is produced by the pineal gland which is located in the brain. It is secreted at night and sets the internal biological clock that governs our cycles or rhythms. Certain enzymes in the pineal gland are active by darkness, so as the sun goes down melatonin is released and sleep results. As morning approaches and light intensifies, melatonin levels decrease and we awaken after a restful sleep. If adequate levels are not produced or are not produced at the proper time, we cannot experience cycles.

Melatonin helps to set and control the internal clock that governs the natural rhythms of the body. Melatonin may have a powerful role as an antioxidant along with anti-ageing and immune system enhancing properties. Melatonin may also play a role in the treatment of prostate enlargement and as an addition to cancer treatment. Melatonin is an effective tool to prevent or cure jet lag, and an ideal supplement to reset the biological clock in shift workers, and may greatly help people who suffer from insomnia.

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.

USA NOTES

In the USA proof of vaccination against polio, diphtheria, measles and German measles is now required for entry into schools. Some schools even demand tetanus, mumps and whooping cough vaccination certificates.

EASTERN EUROPE NOTES

Outbreaks of diphtheria in Eastern Europe amongst adult people have occurred and travellers are advised to have a diphtheria injection every ten years for protection against the disease. (The problem has persisted for quite some time).

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.