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- Diarrhoea is caused by contaminated food and drinking-water. You must therefore becareful if your are travelling in poor hygiene conditions.
- Malaria is transmitted by mosquitoes, so the first thing to do is to protectyourself against these mosquitoes.
- In order to prevent accidents during travelling, it is wise to apply the sameprecautions as those taken at home. In addition, it is very important that allwounds should be thoroughly disinfected in order to avoid infection.
TRAVELLER S DIARRHOEA
Many intestinal infections are attributable to infections picked up by mouth orhands. With a little care most of these illnesses can be prevented. Hepatitis A,typhoid fever, polio and cholera still occur in countries with poor hygiene, butthese diseases are easily prevented.
However, the chance is rather large that you will still contract a light and/ornondangerous form of traveler s diarrhoea. Traveler s diarrhoea almost alwaysspontaneously clears up after a few days, but can nevertheless be irritating. And arisk to your overall and travel health.
In the first place measures must be taken against dehydration. Likewise, treatmentof the symptoms must be considered in order to reduce the number of bowel movementsand relieve other symptoms such as fever, vomiting and stomach cramps. Sometimes amore serious form of diarrhoea occurs, for which specific treatment with antibioticsis indicated or where hospitalization or fluid replacement appears unavoidable.
It takes only a few basic preventive measures to make your trip a success : Totalprevention of traveler s diarrhoea is impossible and it is obvious that preventivemeasures can seldom be strictly followed at all times. But following preventivemeasures do significantly reduce the risk of contracting serious diarrhoea: In orderto maintain good travel health wash your hands before eating and avoid (ifpossible):
- raw vegetables and fruits that you have not peeled yourself- uncooked or unpasteurized dairy products- insufficiently cooked sea foods (+ Hepatitis A !) and meat- local meals which do not smell fresh- ice-cream bought from street merchants (industrial ice straight from thedeep-freeze is probably safe).
Cooked meals should be served hot. The place where you eat is also important. A mealtaken from a stall presents a greater risk than a meal taken in a restaurant. Avoidrestaurants where there are a lot of insects.Avoid tap water and ice-cubes. Bottled water and soft drinks are safe. Watch out forbottle caps that have already been used.
It is very important to disinfect drinking-water on adventure trips. Totalsterilization of drinking water is impossible. The following measures considerablyreduce the contamination risk and safeguard your travel health:
- Boiling the water is very effective.- A good alternative is chemical disinfection with chlorine drops (e.g. Hadex ,Drinkwell chloor ; available in sport shops specialized in outdoor activities) orchlorine tablets (Certisil Combina ; chloramines tablets; available at thepharmacy). Their effect can be improved by first filtering unclear water. Silversalts (Micropur , Certisil Argento ) are not very suitable to disinfect water, butthey keep disinfected water germ-free for a long time.
For adventurous travelers conscious to travel health it is best to buy a portablewater-filter. The use of antibiotics in order to prevent diarrhoea before it occurscan be dangerous + Also the use of other preventive medications is not recommended.
. How to treat diarrhoea?
It is extremely important to consume sufficient liquid and salt in order to preventdehydration. You can do this by taking salt solutions, but tea with lemon, broth,soft drinks and fruit juice, supplemented with salt crackers are tastier. Commercialsalt products are available on the market (ORS-solution).
Taking an anti-diarrhoea preparation (loperamide, e.g. Imodium ) can greatly reducethe number of bowel movements, with a considerable reduction of the complaints as aresult. Imodium may only be used by adults and older children and only for treatingordinary watery diarrhoea: 1 capsule after every loose movement up to a maximum of 4per day.
Antibiotics are indicated :
1. If blood, mucus or pus are present in the stools.2. If after 24 to 48 hours, there is no sign of improvement and the diarrhoea isaccompanied by fever (above 38.5 C) or severe abdominal cramps, or if there are morethan six stools per 24 hours and especially when these also occur at night.3. Or if because of travel circumstances a quicker solution is absolutely desirable. Appropriate antibiotics are only to be used on doctor s prescription
SEXUALLY TRANSMITTED DISEASES
Casual sexual contacts tend to be higher while on holiday abroad. Sexuallytransmitted diseases, particularly AIDS, form therefore an important risk fortravellers. Quite often unintentional and unsafe sexual contact takes place underalcohol influence. Prevention while on holiday abroad is no different from theprecautions you take at home. Adequate use of a condom, preferably bought at home,is absolutely essential. Only a water-soluble lubricant should be used, but it onlyoffers a partial guarantee (e.g. KY gel). Vaccination against hepatitis B isadvised. Always consult your doctor if you think you are at risk, even when thereare no symptoms.
MALARIA (swamp fever, malaria)
Malaria is an infectious disease caused by a parasite (called Plasmodium)transmitted by the bite of the Anopheles mosquito. There are four different types ofwhich Malaria falciparum is the most dangerous and the most widespread. Theincubation period the time between an infecting bite and the appearance of thedisease varies from ten days to four weeks (rarely several months).
The symptoms include attacks of fever, but can initially be quite similar toinfluenza. If adequate treatment is not started in time, an attack may sometimesresult in death within a few days.
. Where does malaria occur?
Malaria only occurs in those areas in which Anopheles mosquitoes are present : inthe tropics and in a large number of subtropical areas. From a height of 1.500 to2.500 m onwards, depending on temperature and climate, Anopheles mosquitoes areeither rare or non-existent.
In most big cities there is little or no risk at all of infection, except in Africawhere a real risk exists.
Risk also exists in the suburbs of the big cities in Asia (e.g. in India). In anumber of areas the risk varies according to the season.
. How can malaria be prevented?
It is very important for travel health to avoid mosquito bites : the Anophelesmosquito only bites between dusk and dawn, is rather small and hardly makes anynoise.
- In the evening wear light-colored clothing which covers your arms and legs as muchas possible. Apply repellent cream with a DEET basis (20 to 50%, for children andpregnant women preferably 20 to 30%) to the uncovered parts of your body. Repeatthis every four to six hours (it will not protect you all night).
Non containing DEET repellents were less examined; Autan-Active. and Mosegor. arehowever excellent safe products.
- Sleep in rooms that leave no access to mosquitoes, (mosquito nets on the sills,electrically-warmed anti-mosquito plates, air-conditioning) or sleep under amosquito net impregnated with permethrine or deltamethrine hung over the bed withthe edges tucked under the mattress.
If these measures are carried out correctly, the risk of malaria will be reduced by80 to 90% and travel health is maintained
. The intake of pills as prevention
There is no drug efficient enough to prevent malaria 100%, which means that quiteoften a combination of measures is preferable. Also the drugs used have changed overthe years. Moreover, the advantages and disadvantages of drugs should be consideredagainst the risk of malaria infection. These risks are dependent on the visitedcountry, and on the region, the season, the duration of your stay and the kind oftrip.
Some people might be troubled by the side effects while taking antimalarial drugs.These are usually mild and are not always a reason to stop taking the pills.Sometimes it may be necessary to change to another type of medication due tointestinal problems, allergic reactions or other intolerance symptoms.
Therefore it is the doctor who can best decide for each individual which drug touse. This explains why individuals from the same group may end up taking differentdrugs.
Finally, as no drug is 100% effective in preventing malaria, it is important that ifan attack of fever occurs in the first three months after your return from thetropics, a malaria infection should be considered as a possibility despite thecorrect use of the drug prescribed.
However, it is reassuring to know that malaria, provided it is recognised in time,is easy to treat without any danger of recurrent attacks. The belief that "oncemalaria always malaria" is totally untrue.
