Rabies is a viral infection acquired from the saliva of an infected mammal, usually a dog. The disease can also be transmitted by cats, foxes, bats and racoons.
Infection is usually from a bite but scratches or licks on broken skin or mucus membranes can also carry risk. If not treated before symptoms appear, the virus is fatal.
What to do if bitten
Wash the site thoroughly with soap and running water for 5-10 minutes.
Apply iodine if available. Neat gin or whiskey can also be used in an emergency.
Encourage limited bleeding.
Seek medical assistance immediately.
Do not allow the wound to be stitched.
Consider tetanus booster (if not already covered) and antibiotics.
Pre-exposure immunisation should be considered by all travellers going to areas where rabies is endemic, especially if on a long stay or travelling away from medical facilities.
The vaccine doesn’t protect you against rabies, but it means you don’t have to have a such a specific vaccine (immunoglobulin) after being bitten. It also affords you more time after being bitten to obtain medial help and have the post exposure vaccine.
* There is a worldwide shortage of immunoglobulin at present.
An animal doesn’t have to look rabid or be foaming at the mouth to carry the disease!
Malaria and Bite Prevention
Many tropical diseases are transmitted by insects such as malaria, yellow fever and Japanese encephalitis.
Insect bites can be reduced by trying to avoid highly infested areas. Many species of mosquitoes bite between dusk and dawn and they are attracted to several factors such as heat, odour, movement and dark coloured clothing (especially blue). Mosquitos carrying dengue, yellow fever and zika, bite during the day. Those wishing to have a baby, should not become pregnant for 3 months after leaving a zika zone.
Mosquitoes don’t like cold breezes, but don’t assume there will be none present in an air conditioned room.
There are many brands, but evidence suggests DEET based products are the most effective. A concentration of 50% should be used for the most effective, long lasting protection. DEET containing products should never be used on babies less than two months old, but may be used in pregnant or breastfeeding women.
When travelling in malarious areas try and wear loose fitting clothes, long trousers and sleeves.
Travellers staying in basic accommodation without screening should consider a mosquito net.
Plug-in devices release insecticide vapour and coils should only be used in well ventilated areas (very useful for camping).
Bites generally appear as small, red, raised areas that are very itchy. Any local swelling can be reduced by application of an insect bite cream with a mild steroid component. Antihistamine tablets may be helpful to relieve itching.
Ticks need to be removed carefully from the skin using tweezers. Grasp the tick close to the skin and gently pull whilst twisting slightly. The head of the tick needs to be completely removed.
A be Aware.
B avoid Bites.
C Compliance with malaria tablets, always complete medication.
D seek medical advice for any feverish illness on return for prompt Diagnosis.
Water, Food and Hygeine
Many illnesses such as diarrhoea, hepatitis A, typhoid and cholera are contracted from contaminated food and drink. Travellers diarrhoea is the most common illness contracted abroad, affecting up to 60% of travellers.
Drink bottled water only (buy only when the seal is unbroken) and don’t have any ice in drinks.
Try to clean teeth with bottled water.
Try not to eat salads (you don’t know if it has been washed or what it has been washed in).
Don’t eat fruit unless you can peel it.
Don’t eat raw or undercooked shellfish.
Don’t buy food from street traders. Even if it looks clean, it probably isn’t!
Don’t eat unpasteurised cheese, milk or ice-cream.
Boil it, Cook it, Peel it or Forget it!
Clean water, clean food, washing you hands before you eat and after you’ve been to the toilet is the best protection.
If you are unsure of what the toilet/hand washing facilities will be, take along alcohol hand gels or wipes. Those who travel rough and are adventurous in their eating habits are at much higher risk.
Travellers Diarrhoea (T.D)
Generally T.D lasts between one and several days. The effects are usually greater in the very young, the elderly and those with specific health needs. The most important aspect of management is maintaining hydration.
Mild cases of T.D can be treated by taking oral re-hydration sachets. Powders, e.g. Dioralyte, Electolade, can be diluted in bottled water to remedy electrolyte imbalance.
As improvement occurs bland foods such as bread, potatoes, rice and bananas can be reintroduced. Milk containing products should be avoided for several days after recovery.
Loperamide (Immodium) may be taken if diarrhoea is inconvenient, for example when travelling on a long journey. Travellers should avoid excess alcohol and unfamiliar foods as both can contribute to diarrhoea.
Deep vein thrombosis (DVT)
DVT is a term used to describe the formation of a clot in one of the deep veins, usually the lower leg. DVT can occur during periods of immobility, for example following surgery, but can also occur in otherwise healthy persons. DVT has been known to occur following long haul air travel (flights longer than 8 hours) and for up to two weeks later.
Several factors have been identified as increasing the risk to travellers. These include:
History of DVT or pulmonary embolism
Recent heart attack or congestive heart failure
Blood disorders (e.g. thrombocythemia)
Oestrogen therapy (e.g. oral contraceptive pill)
Ways to reduce the risk of a travel related DVT:
Avoid dehydration and excessive consumption of alcohol
Walk around the cabin as much as possible at regular intervals during the flight
Do not wear constrictive clothing around the waist or lower extremities
Regularly flex and extend the ankles when sitting to encourage blood flow
Avoid stowing hand luggage under the seat as it restricts movement
Always ensure you take out insurance adequate to cover all your needs including medical repatriation in the event of serious illness. It is vital you inform the insurance company of any pre-existing medical conditions as failure to do so could invalidate your policy.
Diseases spread through blood and body fluids
Diseases such a hepatitis B, hepatitis C and HIV are life threatening and can be transmitted by medical and dental procedures performed using unclean equipment, sharing needles and unprotected sexual contact. Avoid casual sex and always use a condom, avoid sharing of needles, tattooing and body piercing.
A suntan is often the goal of many travellers, however, it should be remembered that a tan is the visible effect of damage to the skin from ultraviolet (U.V) rays from the sun. This damage may ultimately lead to skin ageing and cancer. The highest levels of UV light are when the sun is at its highest, usually between 11:00-15:00. Always remember to use a high factor sun cream and cover up.
Some useful websites:
www.medex.org.uk (High altitude advice)
www.nathnac.org (Yellow Fever advice)
www.fco.gov.uk/travel/ (Government site for current security status)