A recent poll found that, while nine out of 10 international travellers took luggage insurance, only one in four got health information or vaccinations. If you’re travelling in Southern Africa, you should know about the most common travel illnesses and how to avoid them.
The most usual travel-related illness is also one of the most difficult to prevent. Depending on your destination, there’s a 20 to 50 per cent chance you’ll get travellers’ diarrhoea (TD). It’s thought that poor hygiene in restaurants is the biggest contributor to TD, although primitive sanitary conditions and untreated water are chiefly responsible for outbreaks in wilderness areas. Most of Africa is considered a high-risk area, while South Africa is an intermediate-risk country.
You can lower your chances of getting ill by drinking safe water only (if bottled, sparkling is better than still), eating only well-cooked, piping hot food and avoiding seafood and unpasteurised milk. Travelan, an oral vaccine taken with every meal, can prevent infection with E.coli, the single biggest culprit. The real danger is dehydration, so replace electrolytes by mixing a litre of boiled, cooled water with eight teaspoons of sugar and one of salt (for children use half a teaspoon of salt). If symptoms don’t disappear after three to five days, visit a doctor, as it could be a more serious illness.
‘People need to be aware of rabies if they’re travelling in Africa for any length of time, particularly in rural areas,’ says Dr Pete Vincent, president of the South African Society of Travel Medicine. Most cases in South Africa occur in KwaZulu-Natal. The disease is spread to man by a bite, scratch or lick on a skin break from an infected animal. Treatment is highly successful if it’s administered promptly – preferably the same day – but once symptoms appear, rabies is always fatal.
Check that your travel insurance covers medical evacuation to a treatment centre in case of possible infection. A vaccine makes post-exposure treatment much easier, but is expensive. Avoid direct contact with dogs, bats, monkeys or any wild animals, alive or dead. If you’re travelling with pets, keep them away from other animals. Be particularly cautious on hiking or camping trips – keep your tent closed and don’t leave food out.
Hepatitis A is one of the most frequent vaccine-preventable infections acquired during travel. This acute liver disease is usually caught from contaminated food or drinking water, and early symptoms can be mistaken for ‘flu. Travellers to developing countries are at higher risk, but the virus is common all over the world, especially in warm climates. There’s no effective treatment and patients may be incapacitated for several weeks.
As with TD, the risk of Hepatitis A can be lowered by good hygiene, avoiding raw or undercooked food, shellfish and untreated water or unpasteurised milk. However, your best bet is vaccination. The vaccine is more than 95 per cent effective and a booster dose after six months gives protection for up to 20 years.
Schistosomiasis, or bilharzia, is the second most common tropical disease and Africa is the highest risk area, particularly Lake Malawi, Kariba and the Nile. You can get it by exposing your skin, even briefly, to fresh water infested with snails carrying the parasite. Left untreated, it causes chronic illness with nasty complications.
It’s unwise to swim or wade in dams, rivers, lakes, canals or streams almost anywhere in Africa (the sea and chlorinated swimming pools should be safe). Boil or filter drinking water and heat bath water for five minutes at 66° C, or keep it in a tank for at least 48 hours.
If you have to cross a river or enter a lake, find a clear area with moving water and no vegetation. It’s also helpful – but not reliable – to put Tabard on first and dry yourself with a towel immediately afterwards.
‘Malaria is the single biggest health risk for travellers who take no precautions,’ says Dr Vincent. Obviously, if you don’t get bitten, you can’t get malaria, so use repellent that contains DEET, sleep in rooms with screened windows, hang a net around your bed and wear long sleeves and pants after sunset. Travellers to Indian Ocean islands can also use these techniques to avoid chikungunya, a mosquito-borne disease that causes terrible joint and muscle pain, for which there’s no preventative medicine.
Most travellers who get malaria use inappropriate anti-malarial drugs, don’t take them properly, or take none at all. The right prophylaxis depends on many different factors, so visit a doctor or travel clinic to get a prescription and ensure you follow the dosage instructions. (For more information on anti-malarials, see Getaway March 2009, p16.) On long journeys, carry test kits – the ones specifically for Plasmodium falciparum are best – and a supply of Coartem, so that you can self-diagnose and medicate if necessary.