Medical Advice for Volunteers

Medical Advice for Volunteers (fwd by Dr Derek Allen)

Malaria prophylaxis; Doxycycline, Mefloquine, Malarone

Japanese Encephalitis. Indonesia, year round transmission. 1/250 people infected develops symptoms after 4-14 days fever muscle aches, severe headache, can progress to neck stiffness, coma, death, and permanent brain damage. No specific treatment, not yet diagnosed in Tello. Up to 50,000 cases worldwide annually, 10-30% fatality and 30-50 % of survivors have long term neurological disabilities. Effective vaccination available an in day 0,7,30 and should be finished 10 days before travel to exclude allergic reactions.
Viral disease transmitted by daytime mosquitoes 300,000 cases / year
Yellow Fever; tropical South America (Amazon basin) and sub Sahara Africa 
Infection may be asymptomatic, most cases have acute flu like illness 3-6 days after being bitten,
fever, chills, muscle aches, headaches, loss of appetite,  nausea +/- vomiting. In mild cases, full recovery in 1 week in severe cases, fever, jaundice, multi organ failure,
bleeding, and death. No specific treatment for disease. Vaccination against Yellow Fever is extremely effective. Single injection given at least 10 days before travel. Lasts 10 yrs.

African Trypanosomiasis; Tropical Africa , north of South Africa to south of Algeria, Libya and Egypt. African Sleeping Sickness. caused by parasite transmitted by tsetse flies.Tsetse fly bite can be painful and develop into red sore (chancre) fever, headaches, fatigue , swollen glands progress to personality changes and daytime sleepiness.
Without treatment eventually coma and death. Up to 70,000 cases per year. Treatment is available, repeated courses of injectable medicine, No vaccine available. Wear protective clothing, long sleeved shirts and pants of neutral colour. Tsetse fly attracted to bright and dark colours.

American Trypanosomiasis;
rural areas Central and South America. (Chagas Disease)
disease caused by parasite transmitted by triatomine (kissing ) bugs. live in palm trees, stone piles, cracks/crevices of poor quality houses. These insects emerge at night to bite
exposed skin, prefer the face. Parasite in faeces gets into wound when person wakes and rubs/scratches bite. 11 million people infected in Latin America with 30%
symptomatic. Usually no symptoms with initial infection, some may develop fever and localized swelling at bite site (chagoma) usually resolves spontaneously. Unrecognized
infection may continue and progress slowly in up to 40 % of those infected. May
present 10-20 yrs later with chronic heart or gastrointestinal disease. Treatment is available for the acute stage but often does not eradicate the infection, No vaccine available.

Leishmaniasis; Africa, India, Central and South America Caused by parasites transmitted by sandflies. Up to 2 million new cases reported  world wide.  Cutaneous Leishmaniasis; sandfly bite leaves non swollen red  ring that over weeks to months turns into a painless ulcer.  This heals over months to years even without treatment but  usually with scarring.  Visceral Leishmaniasis (Kala-azar) parasites spread from the  skin into the lymph nodes spleen, liver and bone marrow.  Person develops fever, low blood counts, becomes emaciated &  without treatment usually dies. No vaccine or preventative  medicine is available and previous infection does not give immunity.  The sandfly typically bites at night, more common in rural  areas. Wear protective clothing, use insect repellents. Insect screens  clothing and bednets are also more effective if treated with  Permethrin as the sandflies are very small and can penetrate  such barriers.

Avian Influenza, (Bird Flu) Highly pathogenic Avian Influenza A virus (H5N1) Asia, Middle East, Africa, Europe. Although rare, can infect humans. Possible for a new strain will evolve with person to person spread. Human Avian Influenza risk increased by prolonged, close, heavy exposure to virus. Symptoms of flu like illness, malaise, sore throat, cough and muscle aches, appear in 3-7 days. may include red, watery eyes, & diarrhoea or other GI symptoms. Disease progresses in days to pneumonia, and respiratory
failure with a death rate of 60 %. Treatment = supportive Intensive care +Oseltamivir (Tamiflu) inhibits the virus. No vaccine currently available. Avoid direct contact with poultry, Ensure poultry/eggs thoroughly cooked. Stay more than 1 metre away
from people who are coughing/sneezing. Regularly clean hands,

Diptheria and Pertussis; highly contagious bacterial infections of respiratory tract, Worldwide. Many adults no longer have immunity against these diseases from
childhood vaccination. A booster dose of Diptheria is recommended if you are travelling and have not had vaccination in the last 10 yrs.Diptheria is usually boosted with Tetanus as ADT. A Pertussis booster may also be recommended especially for adults working with children. An adult booster is available in NZ which covers Diptheria, Pertussis, and Tetanus Polio.

Measles, Mumps, Rubella, Chickenpox
; You are at risk of these common diseases when you travel if you are not immune. If you are uncertain if you had these diseases or were vaccinated against them as a child, it is important to have a blood test to check your immunity. If not immune, you should consider vaccination

Meningitis; Meningococcal Meningitis, can rapidly become life threatening. Transmitted from person to person by droplet spread. Cases occur worldwide with localized outbreaks associated with crowded settings. There are 12 strains of the bacterium with strains A, B, C responsible for most cases worldwide. In sub-Saharan Africa there is an area of high risk stretching across the continent from Senegal to Ethiopia where large outbreaks of mainly the A and W-135 strains occur during the dry season, December-June.most infections do not cause disease. Fever, headache, neck stiffness vomiting, intolerance to light. A rash is common and signifies severe disease. Symptoms may rapidly progress within 48 hrs to coma and death. The disease is fatal in 5-10 % of cases even with prompt antibiotic treatment. Vaccination offers 90 % protection against
meningitis from Meningococcal strains A C Y W-135 for 2-3 yrs. It does not protect you from Meningococcal strain B or from viral or fungal types of meningitis.

Tuberculosis; still a global health problem.8 million new Tb cases and 3 million deaths per year. Especially, Africa, south east Asia and the western Pacific. It is possible to get a Tb screening test done before you travel and repeat this when you return to see if you have been infected with Tb. The screening test is either done by a skin test on the forearm (Mantoux) or a blood test (Quantiferon Tb Gold)

Rabies; a fatal viral infection of the brain that affects animals and humans. Spread in saliva of infected animal through bite scratch or lick of open wound or eyes or mouth. Dogs monkeys bats, cats foxes racoons jackalsmongooses and skunks are commonly infected. Rabbits, squirrels chipmunks, rats and mice are rarely infected. Widespread in most countries in Asia, Africa and Central and South America. 55,000 human deaths annually from Rabies. The time from bite to symptoms is variable from days to years. Usually 2-8 wks. Pain, burning, itching at bite site, fever, headache fatigue,
sleeplessness, anxiety and aggression. Spasms of throat fear of water and inability to swallow saliva. Once symptoms have developed here is no known cure. 3 Strategy; pre exposure Vaccination, Avoid all animal contact, {Post exposure Human Rabies Immunoglobulin)

Tetanus; a booster injection is recommended in NZ at 11, 45 and 65 yrs of age. Or following a deep or dirty wound if it is more than 10 yrs since your last booster, all travellers should update their tetanus vaccination before travel.

Schistosomiasis (Bilharzia); disease caused by parasitic blood flakes found in fresh water. Africa, South America, South East Asia. Most people are unaware they have been infected. Some have rash or itchy skin where larvae penetrate. Some develop illness, Katayama fever,  resembling a chest infection with fever, wheeze and cough. As
parasite passes through lungs and begins to produce eggs. Rarely eggs can travel to spinal cord or brain and produce more serious sympyoms. Chronic disease, fatigue aches & pains, abdominal pain, diarrhoea or blood in bowel motions, polyuria, dysuria or blood on urination. Disease can be detected on your return by a blood test. Treatment is Praziquantrel. There is no vaccine for Schistosomiasis

Travellers Diarrhoea; abrupt onset of uncomfortable crampy watery diarrhoea and occasional fever and vomitting.Caused by bacteria such as E.Coli,
Campylobacter, Shigella, Salmonella and tends to resolve in 2-7 days. It is treated with rehydration and if persistent an appropriate antibiotic.

Giardia; found in tap water in many cities around the world. As well as river water and contaminated food. Protozoal diarrhoea causes chronic or intermittent low grade diarrhoea with increasd gas and gradual development of fatigue and weight loss. Requires treatment with Ornidazole.

Dysentery; severe end of spectrum where organisms invade intestinal wall. Blood, pus or mucus in bowel motions. Bacterial dysentery usually improves with Norfloxaqcin, Amoebic dysentery may respond to Ornidazole.

Hepatitis A; Where Traveller’s Diarrhoea is common so too is Hepatitis A. Most common vaccine preventable disease in travellers to less developed parts of the world. Virus transmitted through contaminated food and water. Those infected will be incapacitated for an average of 2 months, sometimes up to 6 months.

Hepatitis E; Contaminated food and water, Africa, no vaccine or specific treatment available. Particularly severe in pregnant women with high case fatality rate. Practice safe eating/ drinking habits.

Typhoid Fever
; Salmonela typhi, poor sanitation and personal hygiene. Fever headache rash abdominal; [ain, bowel upset, constipation or diarrhoea. Complicaations occur in 10-15 % of patients and if not treated or treatment delayed can cause death. Vaccination recommended

Poliomyelitis; viral infection attacks nervous system and can lead to paralysis. Transmission by faecal conyaminaton of food. The efficacy of childhood vaccine wanes. One adult booster gives lifelong cover. Africa and Asia +ve

Cholera; caused by bacteria vibrio cholerae, transmitted by contaminated food or water,Copious painless watery diarrhoea 1-3 days after exposure. With rehydration disease lasts for 2 days. It affects mainly malnourished people especially children, and in areas with no medical facilities 60% of infected children may die. Cholera is rare in tourists so vaccination is rarely advised.



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