Travel Reference
In-Depth Information
Leptospirosis
This is found in West Africa, including Morocco. It is spread through the excreta of infected rodents, especially rats. It
can cause hepatitis and renal failure, which might be fatal. It is unusual for travellers to be affected unless they're living
in poor sanitary conditions. It causes a fever and sometimes jaundice.
Malaria
One million children die annually from malaria in Africa. The risk of malarial transmission at altitudes higher than
2000m is rare. The disease is caused by a parasite in the bloodstream spread via the bite of the female Anopheles mos-
quito. There are several types of malaria, falciparum malaria being the most dangerous and the predominant form in
Africa. Infection rates vary with season and climate, so check out the situation before departure. Unlike most other dis-
eases regularly encountered by travellers, there is no vaccination against malaria (yet). However, several different drugs
are used to prevent malaria and new ones are in the pipeline. Up-to-date advice from a travel-health clinic is essential, as
some medication is more suitable for some travellers than for others. The pattern of drug-resistant malaria is changing
rapidly, so what was advised several years ago might no longer be the case.
Malaria can present in several ways. The early stages include headache, fever, general aches and pains, and malaise,
which could be mistaken for the flu. Other symptoms include abdominal pain, diarrhoea and a cough. Anyone who gets
a fever in a malarial area should assume infection until a blood test proves negative, even if you have been taking antim-
alarial medication. If not treated, the next stage could develop within 24 hours, particularly if falciparum malaria is the
parasite. The chain of events is jaundice, then reduced consciousness and coma (known as cerebral malaria), followed
by death. Treatment in hospital is essential and the death rate can still be as high as 10% even in the best intensive-care
facilities.
Many travellers are under the impression that malaria is a mild illness, that treatment is always easy and successful
and that taking antimalarial drugs causes more illness through side effects than actually getting malaria. In Africa, this is
unfortunately not true. Side effects of the medication depend on the drug being taken. Doxycycline can cause heartburn
and indigestion; mefloquine (Larium) can cause anxiety attacks, insomnia, nightmares and (rarely) severe psychiatric
disorders; chloroquine can cause nausea and hair loss; and proguanil can cause mouth ulcers. These side effects are not
universal and can be minimised by taking medication correctly, eg with food. Also, some people should not take a par-
ticular antimalarial drug, eg people with epilepsy should avoid mefloquine, and doxycycline should not be taken by
pregnant women or children younger than 12.
If you decide that you really do not wish to take antimalarial drugs, you must understand the risks and be obsessive
about avoiding mosquito bites. Use nets and insect repellent and report any fever or flulike symptoms to a doctor as
soon as possible. Some people advocate homeopathic preparations against malaria, such as Demal200, but there is no
evidence that this is effective and doctors and even many homeopaths do not recommend their use.
People of all ages can contract malaria and falciparum causes the most severe illness. Repeated infections might result
eventually in less-serious illness. Malaria in pregnancy frequently results in miscarriage or premature labour. Adults
who have survived childhood malaria have developed immunity and usually only develop mild cases of malaria; most
Western travellers have no immunity at all. Immunity wanes after 18 months of nonexposure, so even if you've had mal-
aria in the past and used to live in a malaria-prone area, you might no longer be immune.
THE ANTIMALARIAL A TO D
A - Awareness of the risk. No medication is totally effective, but protection of up to 95% is achievable with most
drugs, as long as other measures have been taken.
B - Bites: avoid at all costs. Sleep in a screened room, use a mosquito spray or coils and sleep under a
permethrin-impregnated net. Cover up at night with long trousers and long sleeves, preferably with permethrin-
treated clothing. Apply appropriate repellent to all areas of exposed skin in the evenings.
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