Jiggers: Staying one step ahead

Sydney couple Keith and Jill Hall were staying in an exclusive lodge nestled on the brilliant white sands beside Lake Tanganyika in southern Tanzania.
“It was one of the most fantastic places we’ve ever visited in Africa,” said Jill.
“The lake is so big it’s like the ocean and because it was so warm, we walked barefooted on the beach. It was only after we returned to Australia that we both noticed we each had a small sore on our toes.”
Their African memento was a living jigger flea that infests countries of sub-Saharan Africa, as well as the Caribbean, Latin America and parts of Asia. Living in the sand, the fleas burrow into the skin of unsuspecting travellers who make the mistake of not wearing shoes.
In this article, we recount the Hall’s experience, explain Tungiasis and its impact, and offer 10 tips for avoiding infection during your travels.
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What are Jiggers?
Tungiasis (commonly known as jiggers) is a parasitic disease of humans and animals caused by fleas belonging to the genus Tunga. Only 2 of the 10 known species – Tunga penetrans and Tunga trimamillata – affect humans or domestic animals.
(Jiggers are often confused with chiggers, which is caused by mites that bite, but do not penetrate the skin.)
Jigger fleas are very tiny; easy to miss with the naked eye. They feed on warm-blooded hosts, including humans, causing inflammation and ulceration at the site.
Typically, the female flea burrows under skin – mainly the feet, but also toenails, fingernails, the knees, and elbows. As its eggs multiply, its abdomen expands enormously relative to its original size, protruding from the host’s skin so it can breathe.
After 2 weeks, it lays its eggs before dying. Once the eggs are on the ground, the cycle is repeated.

Where are they found?
Jiggers are found in many parts or the Caribbean, Latin America, as well as Asia. But, it is sub-Saharan Africa where they are most common.
Hundreds of millions of people are at risk of infection in more than 70 nations, mostly in developing countries.
Tunga penetrans and T. trimamillata originated in Latin America, although the first species is also found in sub-Saharan Africa – between 20° N and 25° S. The latter species has been reported only in Ecuador and Peru.
The fleas normally occur in sandy climates, including beaches, stables and farms.
Despite their prevalence, jiggers are not a common ailment among western travellers returning from short-stay trips to Africa. Infections are even less common among visitors to Latin America.

Millions of Africans infected
However, millions of Africa’s poorest are infected with jiggers.
Many villages have been completely infested, leaving people unable to walk – especially the young and the elderly. More serious infections are fatal.
School children are among the worst affected. Because so many have no shoes, their feet in constant contact with dusty roads and play grounds. Many developed deformities, walking with difficulty because their feet are slowly destroyed by repeated jigger infections.
Ahadi Kenya Trust has opened jigger help and counselling centres in Kenya and neighbouring countries. The Trust’s website has more about the disease its impact.
http://www.jigger-ahadi.org/index.html

“Painful little monsters”
A traveller, who preferred not to be named, recounted his jigger experience in Africa.
“Anyone who has had the pleasure of removing these little monsters will know it’s not much fun,” he said.
“Depending on their size, they can be quite painful. If you’re not careful, the small open wounds left by the exiting flea can become infected and ulcerated – especially on the soles of your feet.”
Jill echoed his sentiments: “The small sore actually became quite irritated and was so painful it kept me awake at night while the flea was expanding in my toe.
“Keith spent a lot of his childhood in Uganda and guessed we might have a jigger. Our local doctors had never seen anything like them before and sent us to tropical disease specialists, who got quite excited because they are so rare in Australian travellers.”

Remove with care
“They cut them out fairly quickly and easily, but had to be careful not to break the egg sack to avoid the risk of secondary infection.
“I can’t imagine what it must be like for the local people: Some of them have scores of infections at a time.”
Secondary bacterial infections are not uncommon with Tungiasis.
Later, on checking the luxury resort’s website, Jill was surprised to find no warning of jiggers.

10 tips for protecting yourself against jiggers
Treat clothes, socks with DEET – A DIY DEET treatment kit lets you treat clothes – especially those you’ll be wearing away from your lodge or camp during the day. Of course, DEET repels other biting insects, too. (You can also treat soft hats and the set/s of clothes you’ll wear in the evening, too. It’s malaria-carrying mozzies you may have to worry about then.) http://travelvax-px.rtrk.com.au/home/products/MosquitoNets.html
Wear boots – If jiggers are present in an area you are visiting, wear boots with sides that finish above the ankle. Rubber boots (Wellies) are even more effective and cheap ones are available in many countries where jiggers are a problem. (They sell in Peru for around $US15.)
Tuck in pants – Boots will only be truly effective if you tuck your pant legs inside your boots. Not too elegant, but who cares?
Spray DEET in boot linings – If an occasional jigger ventures above your boot shaft, this should prevent it from climbing down your boots. Apply insect repellent containing DEET on skin above boots, especially if you are wearing shorts. (That said, long pants are the better option – they offer more protection.) To be effective, your repellent should contain a proven active ingredient, such as DEET, Picaridin, IR3535, or oil of lemon eucalyptus, and be applied to all areas of exposed skin whenever you are outdoors.
Shower soon after returning from an infested area – Scrub your body, dry thoroughly before change into clothing reserved for lunch and dinner. Remember – don’t wear these outfits to areas where jiggers might be present.
Change socks and underwear every day – Get your jocks and socks infested and you will know about it!
Don't wear sneakers or sandals – especially without socks. Don't forget to wash both your feet and your sandals afterwards.
Don't sit down or lie down on the bare dirt or leaf litter – Hopefully, no explanation is needed by now.
Don't put the backpack on the ground – Ditto. (It’s no fun scratching your itching back at night.)

For information on jiggers, vaccinations for travel and other travel health issues call Travelvax Australia’s experienced travel health consultants on 1300 360 164. Our travel health advisory service is toll free from landlines.

Laurie Sullivan.