independent

Saturday 21 September 2019

Save yourself the pain

Deborah Coleman reports on how researching your travel vaccinations before you travel can prevent serious health-problem headaches

TRAVEL VACCINATIONS are an important part of any holiday preparation and if not properly researched and received can open travellers up to all sorts of health problems.

From ticks to insect bites, contaminated water and local wildlife, there are many ways to become ill while on holiday if the correct precautions are not taken.

According to Dr. Graham Fry of the Tropical Medical Bureau many Irish people are simply unaware of these risks as we don't face them on a daily basis at home. 'In Ireland we have a remarkably healthy climate and we frequently don't realise the fairly significant number of diseases and illnesses that can be a risk in other countries,' he says.

Dr. Fry outlines that certain bugs and parasites exist in regions where the temperatures are much higher than in Ireland, which we become exposed to while on our travels.

'In terms of vaccinations there are some which are required and some are recommended. For example you won't get in to some countries without vaccinations for Yellow Fever and Meningitis.

'In terms of recommended vaccines as professionals we can advise in terms of hepatitis, typhoid and tetanus, for example, but it is up to the individual to ensure that they get them before they travel.

'Everybody thinks that it's other people who get sick and while symptoms and reactions vary from person to person it is always advisable to protect yourself against any risks.'

While certain vaccinations will last for more than one trip such as Hepatitis A which once received protects against the disease for 25 years many people still don't pay attention to getting adequate shots and as a result many patients seen at TMB arrive with illness after a trip.

'I spend most of the time seeing people who have become ill abroad. The most common concerns are potential malaria, bowel symptoms, chronic fatigue and skin rash, many of which could be avoided with appropriate vaccines. There are many ways to become infected. It could be from a bite or a worm or parasite you have eaten or drunk because very often advice on what to avoid in terms of food and drink are ignored. That said, what might affect one person in the group might not affect another so individual sensitivity also applies.' TMB advises that appointments should be made at least four to five weeks ahead of travel but eight weeks should be allowed where more exotic trips are planned. For further information log on to www.tmb.ie

DISEASE INFORMATION:

Tetanus: The disease is found throughout the world and Ireland may report one case each year. In the developing regions of the world the rate is significantly higher with the highest proportion showing in Africa and Asia. The bacteria (Clostridium tetani) is held in the soil and animal faeces and gains entry to the human through a laceration on the skin. Deep puncture wounds are usually high risk and need to be treated seriously though in a number of cases the initial wound may be unapparent. In a neonate when a contaminated dressing is placed against the umbilicus following birth. The incubation period is usually one week to 10 days though this can be significantly longer under circumstances. Initial clinical signs and symptoms include muscular spasms associated with neck pains and a sore throat. Full neck spasm may follow with difficulty eating or swallowing and spasms throughout the body. Rapid heart rate with a fluctuating blood pressure and excessive secretions combine to make this a most serious illness. Respiratory obstruction and paralysis of the diaphragm may lead to complete collapse and treatment may involve artificial respiration. A localised form of the disease is also recognised which is not usually too severe though treatment is urgent to prevent dissemination occurring. Up to 50 per cent of patients can die from this condition even with excellent medical care. Typhoid The disease is transmitted through contaminated food and water. Insects may also play a role in transferring contaminated material to food for human consumption. The incubation period is usually between 10 to 14 days after infection. Typically the disease presents with fever and severe headaches. Despite the high fever and the severity of the symptoms many patients will show the characteristic slowing of their heart rate. Patients may also have either constipation or diarrhoea. If diarrhoea is present it may show the characteristic green pea-soup appearance which is so common in both salmonella and shigella infections. The bacteria may escape from the intestinal into the blood stream and cause

either a bacteraemia or a full septicaemia. Enlargement of the spleen, rose spots on the abdomen and a profound state of collapse may also be found. Some patients may perforate their intestinal wall if treatment is not commenced at an early time. Hepatitis A Hepatitis A (HAV) is caused by a small unenveloped symmetrical RNA virus which measures approximately 27nm. Due to its very small size the virus can easily transfer through normal water filtration systems. It invades into liver cells and is excreted in bile and faeces.

The disease is mainly transmitted through the oro-faecal route (contaminated fingers, food and water consumption) but sexual transmission is also well reported.

The virus may be present for a transient time in saliva and so could, in theory, be coughed from person to person. Undercooked bivalve shellfish constitute the greatest single hazard for travellers to many of the tropical regions of the world. If the local population excretes the virus in their faecal material - and this is disposed of into the sea close to shell fish beds - then there is a distinct probability that these shell fish will filter the water and concentrate this contaminated faecal material.

Bivalve shell fish are generally undercooked (steamed for 45 seconds etc.) and thus full sterilisation cannot occur. Malaria For those travelling to many of the warmer regions of our world there may be a risk of contracting malaria. Each year this parasitic disease causes many deaths both in the tropics and among travellers returning to their home countries.

Most of the transmission occurs in tropical Africa (approx. 95%), Asia and Central & South America. Travellers need to remember that there is also a mild risk of the disease when visiting parts of North Africa and some parts of the Middle East. In the majority of cases the disease is transmitted to humans through the bite of an infected mosquito. The parasite enters the blood and passes very rapidly into the liver cells. After an incubation period (usually one to four weeks) the parasite breaks out of the liver and back into the blood stream.

At this stage the infected red blood cell begins to break down and only then does the patient start to develop symptoms. Initially the patient may develop an itchy reaction at the site of the mosquito bite. This is not always present - it depends on the individual's allergic reaction to bites. After the liver phase has passed the patient may go on to develop the classical symptoms of malaria. The individual will usually feel they have 'flu. It will frequently be difficult to convince them that perhaps malaria is a possibility following their journey.

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