Diseases

Diphtheria

Diphtheria is an infectious bacterial disease that can cause difficulties in breathing. In severe cases, without a diphtheria vaccine, the disease can cause respiratory failure, heart failure or a build-up of toxins in the nervous system, all of which can be fatal. It is usually spread through coughs and sneezes.

Countries at risk

Cases of diphtheria are most frequently reported in India, Indonesia, China, Papua New Guinea, Russia, sub-Saharan Africa, the Middle East, and several countries in Central and South America. While there are certain areas for which we always recommend vaccination, it is advised that you check with us for the very latest on the status of your destination.

Travel precautions

Diphtheria can affect people of all ages, but the groups who are most at risk include unimmunized children and older adults who may not have been vaccinated as children. All travellers who have not had the diphtheria vaccine are at risk, so the most important precaution to take is to ensure that all travellers are vaccinated. You can also avoid Diphtheria by planning to take your holiday in the warmer months of the year.

Signs and symptoms

Diphtheria attacks the respiratory system and occurs in the throat, so many of its symptoms are related to this area of the body. Sufferers may complain of difficulty in breathing or swallowing, sore throats, headaches, chills and fever. More outwardly visible symptoms include a heavy cough, bluish skin colouration, rapid and/or shallow breathing.

Prevention

Diphtheria is preventable disease with a simple diphtheria vaccine. Travellers to areas at risk may be recommended a single course injection of Revaxis, to cover against tetanus, diphtheria and polio.

In the UK, vaccination against diphtheria infection is part of the childhood immunisation schedule.

Hepatitis A

Hepatitis A is a viral infection spread through contaminated food and water, which causes inflammation of the liver. According to the World Health Organisation, there are an estimated 1.5 million new cases of illness due to Hepatitis A each year worldwide.

Countries at risk

Hepatitis A occurs worldwide but is most commonly found in parts of Africa, Asia (see Central, South East and East), Central and South America, and it is most prevalent in areas with poor sanitation.

For most travellers, exposure to Hepatitis A comes from eating contaminated food or water. Contamination can also be passed from person to person via poor hygiene.

Travel precautions

When travelling only drink water either from a sealed bottle or a source that you are sure has been treated by filtration tablets or boiling. Avoid ice from unknown water sources. Avoid uncooked food and only eat fruit that can be peeled. Ensure that food is freshly cooked and served hot. Use common sense around personal hygiene and hand washing.

Signs and symptoms

It can take up to two weeks for any signs or symptoms develop and the severity of the virus ranges; in young children, infection may show mild or no symptoms, but it can be a serious illness in older people. Common signs and symptoms of Hepatitis A include: fever, muscular aches, nausea, vomiting, diarrhoea, weight loss, abdominal pain and yellow discolouration of the skin and eyes.

Prevention

Hepatitis A is a vaccine-preventable disease. Travellers to areas at risk may be recommended one of the following vaccination courses:

• A single course injection of Havrix Monodose to cover against Hepatitis A
• A course of three injections of Twinrix to cover against Hepatitis A and Hepatitis B
• A single dose of Hepatyrix to cover against Hepatitis A and Typhoid fever

A single injection followed by a booster can provide long-term protection. Ideally, travellers need to be vaccinated at least two weeks before travel. The initial injection will offer short-term protection for a single trip, while a booster will provide long-term cover and should preferably be taken within 6-12 months of the first vaccine.

Hepatitis B

Hepatitis B is a viral infection that is spread through infected blood or bodily fluids. It can lead to severe liver problems and is often fatal. Hepatitis B is 100 times more infectious than HIV.

Countries at risk

Hepatitis B occurs worldwide. Areas where there is a higher risk of exposure to hepatitis B include Eastern Europe, Russia, India, China, South and Central America, Africa, South East Asia and many islands in the South Pacific.

Travel precautions

If you are a tourist or short-term traveller, your risk is low. Risk is linked to behaviour - any activity causing contact with blood or body fluids can put you at risk.

Travellers may also be exposed when receiving medical or dental treatment while abroad. Infection can be spread via sexual intercourse, needle sharing, blood transfusions and injections, as well as through tattooing, body piercing and acupuncture.

Signs and symptoms

The signs and symptoms of Hepatitis B include mild fever, flu-like symptoms, high temperature, gastro-intestinal upset, nausea and vomiting, diarrhoea and abdominal pain, yellow skin and eyes.

Prevention

Hepatitis B is a vaccine-preventable disease. Travellers to areas at risk may be recommended one of the following vaccination courses:

• Course of three injections of Energix B to cover against Hepatitis B
• Course of three injections of Twinrix to cover against Hepatitis A and Hepatitis B

The vaccine is a course of three injections, which are given rapidly over a one month course or over a standard six month course.

Rabies

Rabies is a fatal viral infection that is spread from animals to humans which causes acute inflammation of the spinal cord and brain.

The virus is carried in the saliva of infected animals so it can only be transmitted by a bite or lick mainly from dogs, cats, primates and bats, but in some cases can be other animals. There is currently no treatment for Rabies, but progression of the disease can be delayed through vaccination.

Countries at risk

Rabies occurs worldwide. Over 15 million people are exposed to potentially rabid animals annually with approximately 40,000 to 70,000 deaths every year. Low-risk areas include mainland Europe and the UK, Australia, North America and Japan; travelling almost anywhere else in the world carries some level of risk of exposure to Rabies.

Travel precautions

Infected mammals can spread the Rabies virus through bites, scratches or even a lick onto broken skin. Travellers are advised to avoid contact with animals in high-risk areas. All mammals are susceptible to the virus, including skunks, jackals, mongooses, foxes, raccoons, dogs, cats, monkeys and bats.

Dogs account for the majority of human deaths, with most of these occurring in South East, East and Central Asia, Africa, and the Indian subcontinent. Bats cause most human Rabies deaths in the USA and Canada, and have recently begun to emerge as a health threat in Western Europe, South and Central America and Australia.

Signs and symptoms

The first symptoms of Rabies are usually similar to the flu, including fever and headaches. There may also be pain at the area of the bite, developing within days, to symptoms of anxiety, confusion and agitation. As the disease progresses further, the person may experience delirium, abnormal behaviour, hallucinations, and insomnia.

Once the clinical signs of Rabies appear, the disease is nearly always fatal. Treatment is typically limited to supportive care.

Prevention

A course of three injections of the vaccine (Rabies BP or Rabipur) will cover against Rabies and is recommended for travellers to high-risk areas who may be exposed to Rabies because of their chosen travel activities and/or limited access to post-exposure medical care.

In the event of possible exposure to Rabies, urgent medical attention should be sought, even in those who have received pre-exposure vaccines.

Cholera

Cholera is a potentially fatal infection of the small intestine that causes acute diarrhoea and vomiting, which in turn can lead to dehydration and electrolyte imbalance.

Countries at risk

Cholera occurs in areas of poor sanitation, with poor water and food hygiene, particularly in areas suffering from natural disasters or war zones.

Cholera is particularly prevalent in Central and South America, Africa, and Asia (see South East, East and Central), and it is estimated that 3-5 million people worldwide are affected every year. The disease caused the deaths of between 100,000 and 130,000 people in 2010.

Travel precautions

While you are travelling, only drink water from a sealed bottle or from sources that have been treated by filtration, tablets or boiling. Avoid ice from unknown water sources. Avoid uncooked food and only eat fruit that you can peel. Ensure that hot food is freshly cooked and served hot. Use common sense concerning personal hygiene and hand washing.

Signs and symptoms

The initial symptoms of Cholera can begin anywhere between 1-5 days after ingesting the bacteria. Sufferers can experience vomiting of a clear liquid, and painless diarrhoea, which is pale and cloudy in appearance. These symptoms can expel a massive amount of fluid from the body, resulting in dehydration and causing the skin to turn a greyish blue colour.

Prevention

Cholera is vaccine-preventable, with the vaccine offering 85-90% protection against Cholera for a 2-year period. Travellers to high-risk areas may be recommended a course of two Dukoral tablets, which is administered orally.

Japanese Encephalitis

Japanese Encephalitis is a viral infection spread by mosquitos that can cause swelling of the brain, resulting in permanent brain damage or death. According to the World Health Organization at least 50,000 people in Asia develop visible symptoms of Japanese Encephalitis each year.

Countries at risk

Japanese Encephalitis occurs in most countries in Asia (see South East, East and Central), the Indian subcontinent and remote parts of northeast Australia.

Risk for Travellers

Risk is highest for travellers who are visiting agricultural areas or those who are travelling to high-risk countries for more than three to four weeks.

For temperate countries of Asia including Cambodia, India and Thailand, risk is usually highest around the rainy season. In tropical countries like Indonesia, Malaysia and the Philippines, the risk of the disease is year-round.

Signs and symptoms

Symptoms usually occur 5 to 15 days after being bitten by an infected mosquito. Initially, a flu-like illness may occur, which may progress to brain swelling, resulting in symptoms such as high fever, confusion, convulsions, headache, neck stiffness and paralysis. Japanese Encephalitis can result in death or permanent brain damage and disability.

Treatment

There is no specific therapy available for the treatment of Japanese Encephalitis. Intensive care supportive therapy may be required.

Prevention

A vaccination course of two IXIARO injections may be recommended for travellers considering outdoor activities in high-risk areas, especially during the transmission season. The Japanese Encephalitis vaccination is a course of two vaccines over 28 days. While travelling, be sure to use mosquito nets and avoid insect bites between dusk and dawn when the mosquitos are most active.

Tick-borne Encephalitis

Tick-borne Encephalitis is a viral disease that is spread by infected ticks. It can cause a flu-like illness, fever, headache, nausea, muscle pain and general discomfort. This form of Encephalitis is often linked with Meningitis, as the virus can attack both the brain and the meninges.

Countries at risk

Tick-borne Encephalitis is usually found in Central and Eastern Europe, in countries such as Poland, Romania, Lithuania, some parts of Scandinavia, and throughout Russia.

Activities such as camping, walking and working in wooded areas increase the chances of being bitten by infected ticks, so travellers planning on visiting rural areas should be aware of how to avoid tick bites. Unpasteurised milk can sometimes harbour the virus, as it can be passed on from infected cattle.

Signs and Symptoms

The initial symptoms of Tick-borne Encephalitis usually occur one to two weeks after a tick bite and include fever, headache and general flu-like illness. Sufferers may also complain of nausea, muscle pain, lethargy and general discomfort. Some patients may go on to develop Encephalitis, which can cause paralysis and can be fatal in some cases.

Prevention

The risk of acquiring Tick-borne Encephalitis can be reduced by vaccination. Travellers may be recommended a course of two Ticovac vaccines administered 2 weeks apart. For extended protection, a booster at 5 months is recommended. (3 doses in total)

Insect bite avoidance methods should be taken, such as wearing protective clothing and using insect repellent. Ticks are frequently found on protruding branches of trees and bushes, so walkers should stick to the centre of trails to avoid coming into contact with them. Avoid drinking unpasteurised milk in areas at risk.

Tetanus

Tetanus is a bacterial infection that is usually introduced into the body through a puncture wound. The disease causes severe muscle spasms and is often fatal. It is estimated that there are 1,000,000 cases of Tetanus per year, with 300,000-500,000 of these resulting in death.

Countries at risk

The Tetanus bacteria can be found in many areas of the world, and is particularly prevalent in China, India, throughout Africa, and in certain South American countries including Peru, Colombia and Ecuador.

Travel Precautions

Tetanus is the only vaccine-preventable disease that is infectious but not contagious. As the disease is contracted through puncture wounds, burns and intravenous drug use, the easiest way to protect against it is to simply use common sense and avoid sticky situations! Tetanus is commonly associated with rusty nails, and while this may be a slight exaggeration, nails do provide the perfect entry point for the bacterium. Should you receive any injuries on your travels, be sure to seek medical attention - even if the wound doesn't seem too bad, you may run the risk of contracting Tetanus.

Signs and Symptoms

Tetanus symptoms take time to develop, with the incubation period lasting between 4 and 21 days. The earliest symptom is lockjaw, a severe stiffness in the mandibular muscles which makes it very difficult to open your mouth. This stiffness, which is often accompanied by spasms, spreads to the neck and limbs over the following period of up to three days. It can become difficult to swallow, with severe cases causing difficulty in breathing, which can lead to suffocation.

Other symptoms include a high fever, high blood pressure, rapid heartbeat and heavy sweating.

Prevention

Travellers to areas at risk may be recommended a single injection of Revaxis, which also covers against Diphtheria and Polio. In the UK, the TDP vaccination against Tetanus infection is part of the childhood immunisation schedule.

Polio

Polio (Poliomyelitis) is a potentially life-threatening acute viral infection. It is a highly contagious disease which may cause permanent nerve damage, leading to paralysis of limbs and respiratory muscles. Polio has been largely wiped out over the last century, but it still poses a threat in certain areas of the world and is particularly dangerous to children.

Countries at risk

Polio is widespread throughout Central Africa and in certain areas of Asia (see South East, East and Central). The only three countries that remain Polio-endemic are Nigeria, Afghanistan and Pakistan.

Travel Precautions

Poor sanitation is a huge factor in the spread of the disease, which is highly contagious and is spread by ingesting contaminated food and water. While you are travelling, only drink water from a sealed bottle or from sources that have been treated by filtration, tablets or boiling. Avoid ice from unknown water sources. Avoid uncooked food and only eat fruit that you can peel. Ensure that hot food is freshly cooked and served hot. Use common sense concerning personal hygiene and hand washing.

Signs and Symptoms

Polio is highly infectious, but symptoms do not typically appear for up to 20 days. Early symptoms include fever, headaches, vomiting, fatigue, chest pains, and stiffness in the neck. In rare cases (1 in 200), the sufferer can be permanently paralysed, usually in the legs. Among these rare cases, 5-10% can be killed when their breathing muscles become immobilised.

Prevention

There is no cure for Polio; it can only be prevented against. In the UK, the TDP vaccination is part of the childhood immunisation schedule - this injection prevents against Tetanus, Diphtheria and Polio. Travellers to areas at risk may be recommended a single injection of Revaxis.

Typhoid

Typhoid Fever is a bacterial infection that is spread through contaminated food and water. It can cause intestinal bleeding, toxic heart disease, pneumonia, seizures and swelling of the brain. Globally there are between 13 million and 16 million cases of Typhoid reported a year, 500,000 of which result in death.

Countries at risk

Typhoid fever is mostly found in areas where standards of personal and food hygiene are low, and sanitation is lacking. The disease is widespread in much of the world, including South Asia and parts of South-East Asia, the Middle East, Central and South America, and Africa. Outbreaks of Typhoid have also been reported from countries in Eastern Europe including Kyrgyzstan, Tajikistan, Ukraine and Russia.

Signs and Symptoms

Signs and symptoms may include mild fever and headache, muscle aches, chills, nausea, and loss of appetite. Some sufferers report abdominal discomfort, constipation and/or diarrhoea.

Treatment

Antibiotic therapy and general medical support may be required. However, some strains of Typhoid are becoming increasingly resistant to antibiotics, especially in Southeast Asia. Severe cases, in which the intestines become perforated, can be treated surgically.

Travel Precautions

While travelling, only drink water from a sealed bottle or water that has been treated using a quality filter, tablets or boiling. Avoid ice from an unknown water source. Avoid uncooked food and only eat fruit that you can peel. Ensure that hot food is freshly cooked and served hot. Use common sense around personal hygiene and hand washing.

Prevention

Travellers to areas at risk may be recommended one of the following vaccines:

• Typhim Vi, single dose injection
• Vivotif, 3 capsules
• Viatim, single dose injection of Hepatitis A & Typhoid combined

It is also advised that travellers take appropriate precautions with food and water.

Yellow Fever

Yellow Fever is a serious and sometimes fatal viral disease that is spread by mosquitoes in tropical parts of Africa and South America. It occurs in both jungle and urban environments, and is particularly common in the rainy season.

Countries at risk

Yellow Fever occurs in tropical parts of South America and sub-Saharan and West Africa.

Nearly all affected countries require proof of Yellow Fever vaccination in the form of an International Certificate of Vaccination before they allow a traveller to enter. Failure to provide a valid certificate can lead to a traveller being quarantined, immunised or denied entry.

Signs and Symptoms

The first phase of Yellow Fever includes symptoms such as fever, muscle pain, headache, shivers, loss of appetite, nausea and vomiting. After three to four days most patients improve and their symptoms disappear. However, within 24 hours of apparent recovery, some patients progress to a more serious stage of the illness involving jaundice, haemorrhagic fever and deterioration of kidney function. Some patients that develop this form of the disease die within 7-10 days after the onset.

Travel Precautions

Risk of acquiring Yellow Fever is determined by immunisation status, travel destination and its intensity level of Yellow Fever transmission, season of travel, duration of travel and activities allowing exposure to mosquitoes.

Prevention

Yellow Fever cannot be treated effectively, but is preventable by vaccination. Travellers to areas at risk may require a single dose injection of Stamaril.

Malaria

Malaria is a tropical disease spread by mosquitoes, which can cause fever, headache and, in severe cases, coma or death. The risk of contracting Malaria in affected areas is significant. Approximately 1,500 travellers return to the UK with Malaria every year. In 2015, there were 1,400 cases of Malaria reported among UK travellers, including six deaths.

Countries at risk

Malaria is a large worldwide problem. The World Health Organization estimates that there were 243 million cases and nearly 1 million deaths from Malaria in 2008.

Anti-malarials are available with a prescription. We can provide you with your anti-malarials during your consultation and, unlike other travel clinics, we do NOT charge a fee for writing a prescription.

Travel Precautions

Many cases of malaria can be prevented by the ABCD approach:

• Awareness of risk: know your risk of malaria.
• Bite prevention: avoid bites as much as possible.
• Chemoprophylaxis: take the right anti-malarial tablets.
• Diagnosis: get immediate medical help for symptoms.

Signs and Symptoms

Typical symptoms of Malaria include shivering, fever, joint pain, vomiting, jaundice and convulsions. The classic symptom of Malaria is a sudden coldness followed by fever and sweating.

In severe cases, Malaria can progress extremely rapidly, induce a coma and even death within hours or days.

Young children and pregnant women are especially vulnerable to the disease.

Prevention

If you are travelling to an area with a risk of Malaria you may be recommended to take anti-malarial tablets to prevent you from becoming infected. Be sure to also use repellent and mosquito nets to increase your level of safety. There are a range of different anti-malarial tablets that will be prescribed to travellers based on several factors, including: destination, medical history, family history, current medications, previous problems with anti-malarial tablets, age and pregnancy.

Being aware of your risk is a huge factor in protecting yourself from the disease, so be sure to speak to one of us while planning your trip.

Meningococcal Meningitis

Meningitis (Meningococcal Meningitis) is a serious, potentially fatal, bacterial infection that causes swelling of the lining of the brain and spinal cord, and blood poisoning. It can result in permanent disability and death, particularly if blood poisoning occurs.

Countries at risk

Meningitis occurs worldwide, but particularly in the Meningitis belt of sub-Saharan Africa.

Risk for Travellers

Risk for travellers is highest towards the end of the dry season when the disease spreads rapidly, resulting in large outbreaks within very short periods. Meningitis is spread through coughing, sneezing and close contact with an infected person.

Between 5% - 11% of adults and up to 25% of adolescents carry the Meningococcal bacteria, causing no signs or symptoms of the disease. They can spread it unknowingly to others, resulting in disease for that person.

Signs and Symptoms

Symptoms can appear suddenly and include severe headache, fever, cold hands and feet, vomiting, muscle and joint pain, stiffness of the neck, sensitivity to bright light, sleepiness, confusion, seizures and loss of consciousness.

Babies, children and adolescents are particularly at risk. Symptoms may be hard to identify in babies and young children, who may exhibit the following signs: refusing feeds, unusual crying or moaning, irritability, listlessness, unresponsiveness, jerky movements or becoming stiff or floppy and very rapid breathing.

Blood poisoning caused by Meningitis can cause a red, purplish rash that does not fade when pressure is applied.

Prevention

Meningitis is a medical emergency requiring urgent hospital treatment, as blood poisoning can develop rapidly. Treatment includes intravenous antibiotics. It is always preferable to take measures to prevent the disease rather than treat it after the fact.

Travellers to areas of risk may be recommended a single dose of Menveo to vaccinate against Meningitis ACWY. All travellers who are vaccinated against Meningitis ACWY will also receive a certificate. All Hajj and Umrah pilgrims are required to show certification of vaccination on arrival in Saudi Arabia.