By Dr Eddy Bajrovic*
Got your sights set on Africa?
It’s one long Kodak Moment, from its vast northern deserts, to massive lakes and rivers teeming with birds, and snow-capped peaks towering above valleys and plains alive with wildlife.
But, this natural abundance comes with health challenges for visitors and these can vary according to the individual, the season, the region, and the length of stay.
You may be advised to take anti-malaria tablets and vaccinations will almost certainly be on the cards, including one that’s required for many African countries. We’ll cover the list later.
First, a couple of recent developments worth noting for travellers visiting Africa…
NEW MENINGOCOCCAL RISK: Outbreaks of Meningococcal meningitis occur during the dry season (December-June) in Africa’s ‘Meningitis Belt’, which stretches across sub-Saharan countries from the Atlantic Coast to Ethiopia. A new and potentially more dangerous Type C strain has emerged recently and experts fear it could cause a dramatic escalation in outbreaks across belt countries during the 2016 dry season. So, if you are travelling to sub-Saharan Africa in the first half of 2016, there could be a higher risk of meningitis than usual – especially if you’re anticipating a longer stay (over a month) and/or consistent contact with local people. Read more about Meningococcal meningitis.
DENGUE WIDESPREAD: Africa is well known for malaria, with 90% of the world’s estimated 584,000 deaths in 2014 occurring in sub-Saharan countries, mainly children aged 5 and younger. But, recent studies have now confirmed long-held suspicions that the dengue virus is also wide-spread on the continent. The main reason for its low profile in Africa until now has simply been a lack of lab testing: For decades dengue infections have been passed off as malaria or simply ‘a fever’. But, travellers to at least 30 different African countries have returned home with dengue – proof the virus is well entrenched across the continent. Of course, that’s hardly surprising: dengue is spread by the same Aedes mosquitoes that transmit the yellow fever virus and, more recently, Chikungunya fever in Africa. The presence of dengue and Chikungunya is just another reason to avoid mosquito bites.
Africa is one of the two continents of the world where vaccines are not only ‘routine’ and ‘recommended’, but also ‘required’. Because several may be needed, it’s best to start any vaccinations you may need at least 6 weeks before departure.
Yellow fever vaccination may be required for entry into many countries of Africa (see map) and South America. Travellers can be asked for proof of vaccination in the form of an International Certificate of Vaccination when travelling within Africa, entering another country, or returning directly to Australia. The yellow fever virus is spread by Aedes mosquitoes in both urban and rural areas and while it’s not a high risk for travellers, it has a death rate of around 50%. Why is vaccination mandatory? Countries with populations of Aedes mosquitoes – including Australia – are concerned the local mozzies might become infected by biting a traveller returning home carrying the virus but not yet showing symptoms.
Australian children are routinely immunised against diseases that still occur in both developing and developed countries among unimmunised kids and adults. Travellers should be covered against them, too. Make sure you’re up to date for measles-mumps-rubella (MMR), diphtheria-tetanus-pertussis, chickenpox, and polio. Influenza vaccination has also become a routine recommendation for travel: it’s the most common vaccine-preventable illness among international travellers.
The following vaccine-preventable diseases may or may not be recommended for a trip to one or more African countries. As mentioned, the recommended immunisation will depend on the destination/s, the time of year, the length of the stay, and for some travellers, their age and/or medical history.
Hepatitis A – Generally speaking, Africa is a high-risk destination for this viral liver infection – virtually every African is infected in childhood, when the illness is usually mild. It’s also a ‘must do’ for travel to virtually any developing region, regardless of the level of accommodation or length of stay as it’s spread by contaminated food or water, or by handling everyday objects that an infected person has touched. The Hep A vaccine is highly effective, as are the Hep A-B and Hepatitis A-Typhoid combination vaccines.
Hepatitis B – Hep B vaccination is routine for kids these days and worth considering for older travellers who’ve never been immunised. There are high rates of Hep B in Africa and it’s worth remembering that the blood-borne virus can be transmitted during an unplanned medical or dental procedure in a local clinic or hospital, as well as through unprotected sex. (HIV/AIDS is also a high risk in many African countries.)
Typhoid – A bacterial disease found in contaminated food and water, typhoid is also common wherever sanitation and personal hygiene are lacking. Adventurous eaters and travellers staying in local villages or going on safari could be at higher risk of infection.
The following vaccine-preventable diseases occur in Africa, but generally present a low risk for a short stay. They’re more likely to be recommended for anyone working in, or living with, local communities or spending more than a month in a rural area.
Rabies – Rabies is a deadly viral infection transmitted by bites from infected animals – mainly dogs. Infection is uncommon among travellers, but vaccination may be recommended, depending on your itinerary and plans.
Cholera – Cholera is a bacterial disease usually caused by drinking contaminated water and results in severe diarrhoea and rapid dehydration. While large-scale epidemics are not uncommon in Africa, most travellers are at low risk. If vaccination is being considered, discuss the oral cholera vaccine with your doctor, as it provides some protection against one of the main bugs that causes traveller’s diarrhoea.
MALARIA IN AFRICA
A doctor experienced in travel medicine will have the up-to-date resources to advise you about any risk of malaria in the areas you’ll be visiting, the various anti-malaria drugs suitable for you, and any potential side-effects. Read more about the risk of malaria in Africa by country. Remember, it’s just as important to avoid bites from mosquitoes and other insects.
OTHER HEALTH RISKS
Traveller’s diarrhoea: Traveller’s diarrhea (TD) is the most common travel-related illness and Africa is generally considered a high-risk region. TD often clears up without specific treatment: oral rehydration fluids are used to replace lost fluids and electrolytes. But, a traveller who has a high fever or blood/mucous in their stools may need to consider taking a course of antibiotics. Ask about the appropriate medication and dosages during your pre-travel medical. If diarrhoea persists despite therapy, see a doctor – the cause may be a parasitic infection. Learn more about traveller’s diarrhoea. RISK FACTOR: Medium-High
Dengue and Chikungunya: As mentioned, experts believe that these mosquito-borne viruses are under-reported in Africa due to a lack of surveillance and monitoring. Unlike malaria-carrying mosquitoes, the two Aedes mosquitoes that spread them are more often found in urban areas. RISK FACTOR: Medium
Schistosomiasis: Schistosomiasis or ‘bilharzia’ is a parasitic disease caused by a parasite released by snails into fresh water. It burrows into the skin of people who swim or wade in rivers, streams and lakes where the snails are present. Globally, the rate of infection among travellers exposed to infected water is around 10%. But, with the rise in eco-tourism and adventure travel, increasing numbers of tourists are contracting schistosomiasis, according to the WHO. No vaccine or prevention medication is available, but schistosomiasis is treatable. Read more on how to avoid schistosomiasis. RISK FACTOR: Low-medium
There are other health risks from biting bugs: most of them a remote risk for visitors. These include sleeping sickness (transmitted by the tsetse fly), myiasis (Tumbu flies), tungiasis or ‘jiggers’ (fleas), and rickettsial diseases, such as typhus (ticks). However, they provide plenty of reasons not to become blasé about preventing insect bites during your stay. RISK FACTOR: Low
WHAT TO PACK
A travel first-aid kit – The standard of medical equipment and facilities vary considerably in Africa; Insect repellent – Apply repellent whenever you are outdoors and cover up with a long sleeved shirt/top, long pants, and shoes and socks when mosquitoes are most active; Sunscreen – Protect yourself from the African sun.
* Dr Bajrovic is the Medical Director of Travelvax Australia.
For more expert advice on staying healthy in Africa, or to book your pre-travel medical consultation at a Travelvax Australia clinic, please call 1300 360 164 (toll-free for landlines).