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DISEASE RISK

 Malarial
The risk of dying from Malaria in short term travellers (2 - 6 weeks) is around 1 in 4000 if no preventative medication taken.*  A recent German study of travellers spending 2 -6 weeks in Kenya showed that on average 20% had evidence of malarial antibodies (ie. were bitten by malarial carrying mosquitoes)**
*Ref 1..www.who.int\ith\chapter07_02.html** Ref 2/. Travel seminar notes May 2000

Other
Common infections acquired by travellers include those which follow ingestion of contaminated food or water. Most of these are diarrhoeal diseases due to enteric pathogens such as enterotoxigenic Escherichia coli, Salmonella, Campylobacter, Shigella and Giardia species but infections with extraintestinal manifestations, such as typhoid fever, amoebiasis, poliomyelitis, hepatitis A, brucellosis and cysticercosis are also acquired this way.

Mosquito-borne infections, mostly malaria and dengue, are important causes of fever in Australian travellers returning from southeast Asia, Papua New Guinea, the Solomon Islands and Vanuatu. Japanese encephalitis occurs throughout Asia but the risk to most Australian travellers is low. Yellow fever occurs only in parts of Africa and Central and South America.

Vaccine-prevent able infections transmitted via the respiratory tract include diphtheria, pertussis, measles, influenza, and invasive meningococcal diseas e. Tuberculosis is mostly acquired by expatriates who live in high-risk areas for long periods.

Viral infections transmitted by blood transfusion or contaminated needles, such as hepatitis B, hepatitis C and human immunodeficiency virus (HIV), may pose a threat to some Australian travellers. In remote areas of some countries there is the possibility that these viruses are transmitted by health-care workers using unsterile medical equipment.

Travellers may be exposed to other diseases such as rabies from dog (and other animal) bites in countries such as Thailand, schistosomiasis after swimming in African lakes, cutaneous larva migrans after sunbathing on contaminated beaches, hookworm and strongyloidiasis after walking barefoot on contaminated soil and leptospirosis following rafting or wading in contaminated streams. ( p 46. Australian Immunisation Handbook, 8th Edition - 9/2003 )

Relative risks of acquiring infections in developing countries

High : > 1/10 travellers

Moderate: <l/10->1/200

Low. <1/200->1/1000

Very low:<1/1000 travellers

Diarrhoea
Upper respiratory infection

Dengue
EnteroviraI infection Gastro-enteritis
Hepatitis A
Malaria (not taking preventative drugs)
Sexually transmitted diseases

Amoebiasis, Ascariasis
Childhood Infections:- (Poliomyelitis, measles mumps, chickenpox.) Hepatitis B, Hepatitis E TB, Typhoid fever
Leptospirosis
Strongyloidiasis
Trichuriasis
Tropical Sprue

AIDS, Arboviral infections
Diphtheria, Echinococcus
Legionellosis, Meliodosis
Malaria (even whilst taking preventative drugs)
Q fever, Rabies
Schistosomiasis* Trichinosis
Trypanosomiasis
Viral haemorrhagic fevers
Yellow fever,

* Schistosomiasis is on the increase

Malarial Prevention Medication Considerations
Reference 1/. "No drug is devoid of side-effects, and chemoprophylactic drugs should not be prescribed in the absence of a malaria risk. Not all travellers to countries where malaria exists should automatically be prescribed prophylaxis. This is especially true for tourists and business travellers who will visit only urban areas that are malaria-free."
"Both travellers and doctors should be aware that no antimalarial prophylactic regimen gives complete protection. Falciparum malaria, which can be fatal, must always be suspected if fever, with or without other symptoms, develops at any time between one week after the first possible exposure to malaria and two months (or even later in exceptional cases) after the last possible exposure.
The most important factors that determine the survival of patients with falciparum malaria are early diagnosis and appropriate treatment." (International Travel and Health - World Health Organisation 2000 pages72 & 75

Non Infectious Risks Occurring in Overseas Travellers
Although travelling overseas particularly to developing countries poses many potential health threats, it is important to remember that considerable stress will be placed on you by factors such as long airflights, disorientation with time zone changes, unfamiliar countries, roads and cultures. A large Scottish study on deaths in overseas travellers highlights this point in revealing that 60% were due to effects of heart disease, smoking or alcohol, 21% due to traffic accidents and only 4% were due to infectious diseases. Jet lag can slow your reflexes for 24>48hrs. It is best not to drive during this period

 

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North East Valley Division General Practice, Victoria, Australia, Disclaimer 
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Phone: 03 9496 4333, Fax: 03 9496 4349,  Email: nevdgp@nevdgp.org.au
 
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