By Lisa Ryan, travel nurse.
The world offers any number of travel destinations. But, calls to Travelvax Australia’s free travel health advisory service (1300 360 164) almost always start the same way.
Caller: “I’m off to South America. What shots do I need? Is malaria a risk?”
Me: (Takes deep breath) “Well, South America is a very diverse collection of countries. It’ll depend on just where you’re going, the season, type of trip, and how long you’re there. So, tell me more about your trip…”
Helping prospective travellers is all about judging the likelihood of potential health risks present in a country or region.
While the caller’s age is a factor, it’s the where, when, and how long of a journey that is critical. (We don’t discuss personal medical history. That would amount to a medical consultation over the phone, which we can’t do for legal reasons.)
So what’s the answer to the caller’s questions? I’ll get to that.
First, for anyone heading to South America (or Central America or the Caribbean), there’s been good and bad news regarding mosquito-borne diseases.
First, the good news…
New figures show malaria notifications have fallen by almost 70% in South and Central America since 2000 – from 1.2 million to 375,000 last year – while deaths have dropped by nearly 80% to 89 last year. Brazil, Honduras and Paraguay have led the way in controlling and preventing the disease.
The news has been tempered by a few exceptions: notably Venezuela, which in 2015 has recorded the highest number of cases (106,000) in 80 years, mainly in the southern Amazon Basin states of Bolivar (80%) and Amazonas (13%).
On the most common tourist itineraries in South America, malaria is little or no risk.
But, it may be an issue for people whose stay includes travel within the Amazon Basin, which takes in north-western Brazil, southern Venezuela, southern Colombia, northern Bolivia, and eastern Peru. Outside the Amazon Basin, the risk of malaria is so low that medication to prevent malaria infection is rarely recommended.
Now, the bad …
Unfortunately, national and regional health authorities have not had the same success halting three much more pervasive, if slightly less lethal, mosquito-borne viruses – dengue, chikungunya, and the recently arrived, Zika.
Locally acquired cases of Zika fever have now been diagnosed in various areas of Brazil, Colombia and Suriname, and have also begun appearing on Caribbean islands.
And, the experts say, there is nothing to stop it too reaching epidemic proportions – just like the firmly-entrenched dengue, and another relatively recent arrival, chikungunya which has swept across the region in the past 2 years causing in excess of 1.7 million cases and 270 deaths.
Why is a Zika epidemic certain? Because, like chikungunya, it’s new to the region so no-one has developed immunity and it too is spread by the same mosquitoes – Aedes aegypti and Aedes albopictus. These urban-breeding species have daytime feeding patterns that make them a potential risk for all travellers staying any length of time – even cruise ship passengers spending a few hours in ports of call.
And, there is no vaccine or medication to prevent infection by this trio, making avoiding – or at least minimising – mozzie bites important. Apply an effective personal insect repellent before heading out each day and carry it with you so it can be reapplied when necessary.
Okay, now the vaccines…
Hepatitis A – strongly recommended for travel to South America (and other developing regions of the world).
Hepatitis B – consider vaccination – particularly if the stay is extended (more than 1 month) or for frequent overseas travel. It is a blood and body fluid transmitted infection, so those undertaking adventurous activities that may lead to injury requiring hospital treatment and those potentially at risk of sexually transmitted infections should be vaccinated.
Typhoid – recommended for ‘adventurous eaters’ – especially those expecting to head off the ‘beaten track’ or for an extended stay.
Rabies – Again, the longer the stay, the higher the potential for infection, which results from a bite from an infected animal (usually a dog). Vaccination should also be considered by travellers visiting remote areas where prompt medical care for post-exposure vaccination may not be available.
Yellow Fever – Most human cases involve ‘sylvan’ or jungle transmission (when a mosquito bites an infected monkey and then bites a person). But, the disease is present in a number of South American countries and vaccination may be required for moving between countries or travelling on to another country (including returning to Australia).
Others – Boosters for MMR (measles/mumps/rubella), DTP (diphtheria/tetanus/pertussis), and chickenpox, as needed, as well as pneumococcus and influenza.
Other issues…
Traveller’s diarrhoea: Up to 60% of all leisure and business travellers are laid low by travellers’ diarrhoea (TD), which means at least a day or more of inconvenience and discomfort. Carry treatment medication, plus sachets of rehydration solution – just in case – and avoid the obvious traps: ice made with tap water, undercooked or raw foods, salads washed in tap water, unpeeled fruits, and protein foods kept at room temperature. Read more about avoiding and treating TD.
Altitude sickness or Acute Mountain Sickness (AMS): If high-altitude destinations such as Cuzco /Machu Picchu, Lake Titicaca, and La Paz are on your South American itinerary, it’s important to plan your itinerary carefully to minimise rapid ascent. Around half of all travellers will feel unwell at 3500m and nearly everyone has symptoms at 4300m or higher. At 3400m above sea level, Cuzco is the gateway to Machu Picchu, which is considerably lower at 2400m.Travelvax recommends travellers transfer from Cuzco airport to towns such as Ollantaytambo in the Valle Sagrado to acclimatise. Exploring Machu Picchu before returning to Cuzco will result in far fewer travellers experiencing altitude illness. Diamox (‘acetazolamide’) is the most effective medication for altitude sickness. Read more about avoiding and treating AMS.
Planning a trip to South America? Call Travelvax Australia’s free travel health advisory service on 1300 360 164 for advice on recommended and required vaccinations. You can also make an appointment for a pre-travel medical consultation with a team of medical professionals experienced in travel medicine.