HEALTH NOTES
Typhoid Fever
Travelers to developing countries should be aware of the risk of typhoid fever. Caused by the bacterium Salmonella Typhi, typhoid fever affects about 12.5 million people in the developing world each year. About 400 cases occur each year in the United States, and 70% of these are acquired while traveling internationally. Over the past 10 years, travelers to Asia, Africa, and Latin America have been especially at risk.
Symptoms include a sustained fever as high as 104ºF (40ºC), weakness, stomach pains, headache, loss of appetite, and sometimes a rash of flat, rose-colored spots. If you suspect that you have typhoid fever, see a doctor immediately. The disease is treatable with antibiotics and deaths rarely occur, but without treatment the fever may continue for weeks or months, and as many as 20% who go without treatment may die from complications of the infection.
The best thing, of course, is to avoid getting the fever in the first place. Salmonella Typhi is carried in the bloodstream and intestinal tract and lives only in humans. The bacteria is shed in the feces of its carriers. Therefore, the fever is usually transmitted through food and drink that has been handled by someone who carries the bacteria or by contaminated sewage that gets into the water you use for drinking and washing food.
In order to protect yourself, it is critical that you watch what you eat or drink when you travel. When traveling, you should make sure that any water you drink is either bottled water or has been brought to a rolling boil. Avoid popsicles, flavored ices, and ice cubes that may have been made with contaminated water. Eat foods that have been thoroughly cooked and are still hot and steaming. Peel all raw fruits and vegetables yourself and avoid any that cannot be peeled, such as lettuce. Avoid foods and beverages from street vendors.
If you'll be traveling to any high-risk areas, you should also consider being vaccinated against typhoid fever. There are a number of different vaccines available, so consult your doctor on which one is best for you. For more information on this or other infectious diseases, contact your local or state health department, a travel clinic, your doctor, or the Center for Disease Control at http://www.cdc.gov/cdc.html.
Cholera
Cholera is an acute intestinal infection. Cholera occurs in many of the developing countries of Africa and Asia, where sanitary conditions are less than optimal. Most recently, cholera outbreaks have occurred in parts of Latin America.
Most infected persons have no symptoms or only mild diarrhea. However, persons with severe disease can die within a few hours after onset due to loss of fluid and salts through profuse diarrhea and, to a lesser extent, through vomiting.
Only a few cases of cholera have occurred among non-travelers in the United States since 1973. Even with foreign travel, the risk of infection to the US traveler is very low, especially for those who follow the usual tourist itineraries and stay in standard accommodations. Worldwide cholera activity is characterized by occasional epidemics in developing countries.
The organism that causes the illness is named Vibrio cholerae type O:1 or O:139. During epidemics, it is spread by ingestion of food or water contaminated directly or indirectly by feces or vomitus from infected persons. Diagnosis is made by culturing the bacteria from the stool of a patient and confirming that the organism produces toxin.
The best protection is to avoid consuming food or water that may be contaminated with feces or vomitus from infected persons. The organism can grow well in some foods, such as rice, but it will not grow or survive in very acidic foods, including carbonated beverages, and is killed by heat.
Treatment for cholera involves rehydration with oral rehydration solution or, in the most severe cases, with intravenous solutions until the patient is able to ingest fluids. Treatment with antibiotics (usually tetracycline or doxycycline) will decrease the duration of illness and the excretion of live cholera bacteria, and will decrease the volume of fluid lost, but is not necessary for successful treatment.
Dengue Fever
Dengue Fever is a relatively mild viral illness found in the tropics, with recent outbreaks in Fiji, India, Vietnam, and the Caribbean. It is transmitted by the Aedes aegypti, a type of mosquito that prefers to feed on humans. Symptoms include a sudden fever, rashes, muscle and joint aches, and headache. Important risk factors of the disease include the strain and serotype of the infecting virus as well as the age, immune status, and genetic predisposition of the patient. Dengue Fever is generally not a fatal disease if treated promptly. It is commonly treatable with plenty of fluids and acetaminophen, but it can progress to shock and become fatal if left untreated. As of yet, no vaccine is available, but there is promising progress and it is expected that one will become available for public use sometime in the next couple of years. For now, the best bet is prevention. As with all mosquito-borne diseases, this involves some combination of long-sleeved shirts and long pants, mosquito netting, mosquito repellent, and common sense.
For questions and comments about Worldtravelcenter.com, its World Travel Health newsletter, or its travel companion jetStream, contact Laura Bauer:
laura@worldtravelcenter.com
Phone: 1-800-234-1862
GlobalNotes
Middle East
Europe
Africa
HealthNotes
Feature Articles
Putting Jetlag to Bed
Nile River Encephalitis
Ear Plugs
jetStream
Travel Stories
Travel
Insurance Primer
Fun and Games
Travel
Health & Safety Quiz
