Common problems that travellers encounter, such as stomach upsets and those from insect bites, can be prevented by taking . . . → Read More: Preventing Medical Problems]]>

Common problems that travellers encounter, such as stomach upsets and those from insect bites, can be prevented by taking simple precautions.

These include such things as good hygiene and safe food preparation practices, drinking (and using) only treated or clean water, avoiding being bitten by various insects and worms, and getting vaccinated and taking pills to prevent diseases.

Clean water and water treatment

Everyone needs a minimum of about two and a half litres or just over half a gallon of clean water a day. In hot climates while doing things like carrying a backpack, hiking or just walking around in the sun, you will need even more, maybe around 4 litres or about a gallon a day, mainly because of loss from sweating.

It is extremely easy to become dehydrated while travelling in hot and unfamiliar climates. It is recommended to take a water bottle with you each day.



Public water in all of the USA, western Europe and some parts of eastern Europe is safe to drink. A lot of countries around the world, however, are not so stringent about the cleanliness of their water supply, which can mean health risks for travellers.

Drinking water can be contaminated with all sorts of infectious agents, ice (for example, in drinks (even in alcoholic ones)) is a major problem, as is finding safe water to use when brushing your teeth, washing (and swimming).

Salads, vegetables and fruits washed in local water should also be avoided, as well as and water-based products such as ice cream.

Check destination information on the Internet to find out in which countries you are at risk from inadequate sanitation and contaminated water.

Sites such as www.tripprep.com and www.cdc.gov are good sources of information. However, the main danger areas are:

- The Indian subcontinent

- Africa

- Mexico, Central and South America

- Russia and the former USSR countries

- Asia

There are five basic ways to get clean water. Buying bottled water, and either boiling, distilling, filtering or purifying water from local supplies.

Robert Sangster’s book here is a good place to find more information.

Bottled Water

Generally easy to find and sold in various sized plastic bottles. Other bottled drinks are somewhat safe and routinely drunk by travellers.

Bottled water can be expensive, but the main problem, though, is availability. It can’t always be found everywhere you go (or when you want or need it), and even if do find it you can’t be sure that it is really safe. Anyone can fill an old bottle with tap water, reseal it and sell it to you.

The worst thing about bottled water, however, is the hundreds of unrecycled plastic bottles that get dumped or left behind.

Boiling

Boiling water for a minute or two is the best method for eliminating infectious agents. Also the best method to use when making tea, coffee, and soups.

While boiled water is safe, it should not be relied upon as the sole source of drinking water as you won’t always have access to a stove or pan.

Distillation

Distillation involves a unit that boils water and then condenses the steam into a clean container, leaving nearly all of the solid contaminants behind.

This will kill and remove bacteria, viruses, cysts, heavy metals, and other particulates, more so in fact than any other system.

Useful if you can’t tolerate or don’t like the taste of iodine, or for long-term travellers (where using iodine for extended periods may cause problems. See below).

Most systems do need electricity to work, however, although there are some non-electric systems out there. They are also quite slow to produce clean water, as well as being heavy and bulky.

They also leave scale behind, which means that the distillation apparatus be frequently cleaned.

Filtration

Water filtration devices work by forcing water through materials which screen out particles. What gets filtered out depends on the size of the pores in the material used.

Filters of about 0.2 microns will remove dirt, bacteria and parasites, but waterborne viruses, such as hepatitis and polio, are 0.04 microns or smaller so may not be removed, and the water will need subsequent boiling or chemical treatment.

Filtering doesn’t change the taste of the water, however, and there is no need to wait. You can clean and reuse filters so it is also cheap.

Again this is a good solution if you are sensitive to iodine or where viruses might not be a problem, such as for backcountry use in the U.S. and Canada. Also can be used where the user has had all the vaccination for local viruses.

Mechanical filters can, however, be bulky, heavy, and hard to use for less experienced travellers. Filters can become clogged and if further chemical treatment is needed the cost per gallon increases.

Purification

Water can be purified with one of a number of chemical additives. The most popular is iodine, either in tablet or liquid form. Chlorine and silver are alternatives.

Iodine is used by putting 2-3 drops or a couple of tablets in water and letting it stand for about 30 minutes.

The dosage must be doubled for very cold water (e.g. from mountain streams).

Tablets and liquids are very compact and are good for short-term use or with filters.

Regular iodine stains badly (if it leaks in your bag) but you can find uncoloured (as well as regular) iodine in some places, for example, in pharmacies around the world.

With iodine the water has a chemical taste (as it does with chlorine) which some find objectionable, and is coloured, although both the colour and taste can be removed by adding vitamin C (orange juice, for example) to the water, but only after the waiting period is over, otherwise the iodine will be neutralised.

There is some debate over the safety of iodine for long-term use and what is a safe maximum dose to ingest over and above the recommended daily amount. Reports of serious side-effects are few and far between, however. A 1998 study published in the Lancet described thyroid problems in a group of Peace Corps workers in Africa which was linked to their use of two-stage iodine-resin filters as their only water purification method for over two years. Then again a study in the 1960′s of Florida prison inmates who were given iodinated water for up to 15 years showed no such problems. Those with thyroid problems, pregnant women, or those with a sensitivity to iodine, might want to consider alternative solutions, however.

Read more about it here, especially the ‘Recommendations for Iodine Use in Water Treatment’ section.

Other approaches

A combination of methods works well. Some travellers (including myself) carry personal water purifiers which both purify and filter the water at the same time, and generally does it a lot quicker than with iodine alone.

Most purifiers use iodine as the active ingredient as part of a filter cartridge. The filtration process removes the larger, hard-shelled creatures such as Giardia and Cryptosporidium, then the water passes through an iodised resin bed, where bacteria and viruses are deactivated. Some systems incorporate a carbon filter at the final stage of purification. These filters absorb traces of residual iodine and greatly improve the flavour of the water.

The most convenient method I have found so far, and one which I thoroughly recommend, is the Aquapure Traveller Water Bottle. You can fill the bottle from ANY water source, streams, ponds, rainwater barrels, and obtain safe, palatable, clear, odourless drinking water. It kills viruses and bacteria and removes parasites such as Cryptosporidium and Giardia. Read more about it here, or watch the video:

As a backup I also carry a Steripen (the Adventurer model). This is an amazing product, it is an ultra-light UV water purifier that destroys 99.99% of the bacteria, viruses and Giardia in water. It emits UV light which purifies 16 ounces of water from any source in under 1 minute (32 ounces in 90 seconds). You can use regular camera batteries to power it but I bought the optional solar charger which means I can go anywhere in the world and not worry about drinking the water. I bought both the Steripen and the solar charger in the US but you can also buy them in the UK.

Another device (used by the US military), is MSR’s MIOX Purifier which creates a dose of mixed oxidants (MIOX) that is then added to the water to inactivate bacteria, Giardia and Cryptosporidium, (which iodine won’t kill). It runs on common camera batteries and uses regular salt to operate, and needs no maintenance.

The following is a list of some common and not so common illnesses and diseases to which you may . . . → Read More: Diseases from Insects, Worms, Bacteria, Viruses, etc.]]>

The following is a list of some common and not so common illnesses and diseases to which you may be exposed while travelling.

It is probably not complete and may not even be accurate, so again, make sure you consult a qualified professional before travelling and don’t rely too much on the information contained herein.

The list is in no particular order but commonest health hazards tend to be nearer the top.

For each there is a section listing where in the world it is usually found, what is its cause, symptoms, treatment and prevention.

Most of the diseases and illnesses below can be prevented by either vaccines or pills, good hygiene and safe food preparation practices, drinking and using (e.g. for washing, cleaning teeth, cooking with, swimming, cleaning fruit and vegetables, for ice in drinks, etc.) only treated or clean water, and avoiding being bitten by various insects and worms.

Diphtheria

Found – rare in developed countries due to vaccination, but is still endemic in developing countries and the former states of the USSR.

Vaccine is recommended for those who will be in close contact with infected people in endemic areas.

Cause – a disease of close contact, a bacterial illness transmitted through droplets in the air.

Symptoms – sore throat and fever. Can be life-threatening.

Prevention – by updating your diphtheria vaccine.

Tetanus

Found – rare in developed countries due to vaccination.

Prevention – by the tetanus vaccine. A booster is recommended every ten years, perhaps even every five years for developing world travel. Sometimes can be fatal.

Polio

Found – virtually eliminated in the developed world, but is still a threat to non-vaccinated travellers in developing countries.

Cause – by a virus.

Treatment – there is no effective treatment for polio.

Prevention – with either the oral or injectable vaccine.

Cholera

Found – mostly in the developing world. However, risk to travellers is slight.

Cause – infection is by ingesting food or water infected with the bacteria, but especially from shellfish.

Symptoms – severe water loss due to watery diarrhea and vomiting. Death can result in a few hours from rapid fluid loss.

Treatment – immediate rehydration therapy to prevent dehydration and death. ninety-nine percent of victims recover given adequate rehydration.

Prevention – drink only bottled or boiled water. Be careful with food as possible. There is a vaccine but this is not usually recommended due to its ineffectiveness, expense, and the rarity of cholera in travellers.

Dysentery

Found – bacillary and amebic. Both are prevalent in many developing countries, but rare in travellers.

Prevention – (for both types) eating only cooked vegetables and peeled fruits, and by only drinking boiled or purified water.

- Bacillary dysentery

Cause – from infected food handlers not washing hands and from unclean flies landing on food.

Symptoms – sudden watery diarrhea, abdominal pain, vomiting, nausea, and fever, then passing blood and mucus after a few days.

Treatment – rehydration therapy, with no solid food for the first day or two. Antibiotics can help. Most people start to recover after about a week. Death can be caused by dehydration in vulnerable people.

- Amebic dysentery

Cause – swallowing the histolytica cysts from infected water or food (lettuce, uncooked vegetables, and unpeeled fruit).

Symptoms – range from a few loose stools with rumbling pains in the stomach, to a severe case with high fever and bloody, watery diarrhea. Shaking chills, fever, weight loss, and painful enlargement of the liver.

Treatment – rehydration therapy and drugs (e.g. metronidazole). Doesn’t go away on its own, unlike bacillary dysentery.

Hepatitis type A

Found – worldwide. Most common serious disease among travellers in the developing world where food preparation standards are poor.

Cause – transmitted by a virus through contamination of food or drinks prepared by an infected person with poorly washed hands.

Symptoms – either nonexistent or begin abruptly two to six weeks after exposure. Similar to flu, fever, aches, loss of appetite, nausea, abdominal discomfort, and liver pain, darkened urine, light yellow stools. Four to seven days later the symptoms may become more severe, with diarrhea, vomiting, itching, and jaundice (yellow skin and whites of the eyes).

Treatment – there is no treatment for hepatitis A. Most people recover within six weeks. Hepatitis type A does not lead to chronic hepatitis. Rest and abstaining from alcohol until recovered are recommended.

Prevention – take care of what and where you eat. Vaccination with the full, two-dose series of hepatitis A vaccine is the best way to prevent hepatitis A virus infection. Immune globulin is available for short-term protection (approximately 3 months) and must be administered within 2 weeks after exposure for maximum protection. Good hygiene, including handwashing or use of hand sanitizer after using the bathroom and before preparing or eating food is essential.

Hepatitis type B

Found – in body fluids of infected persons. Type B is found worldwide, but is much more prevalent in Asia and Africa.

Symptoms – are the same as for hepatitis A, except sometimes more severe. Many people have no symptoms. About 10% of hepatitis type B cases lead to chronic hepatitis, a severe inflammation and destruction of cells within the liver, leading to cirrhosis.

Prevention – the hepatitis B vaccine, although this is usually only recommended for health care workers, people who have many unprotected sex partners, and drug addicts.

AIDS

Found – worldwide. The hardest hit area is sub-Saharan Africa. Also spreading rapidly in Asia.

Cause – spread primarily through heterosexual sex, blood transfusions. Nearly 20,000 people are infected every day.

Prevention – travellers in Africa should bring their own hypodermic needles for emergencies. Many countries now require HIV testing for long-term visitors of greater than six months, or applicants for work or residency. In most cases HIV testing is not required for visitors of a few months or less. Most HIV carriers don’t know they’re infected, and HIV is thought most infectious the first year after infection.

Typhoid

Found – developing parts of Asia, Africa, and Latin America.

Cause – is caused by the bacteria salmonella typhi. Feces, urine, and contaminated food and water are the principal sources of infection. Again often through a food handler with poor hygiene. Sewage-contaminated shellfish is also a source.

Symptoms – limited to a fever of one week, but can include headache, anorexia, general malaise, and constipation, giving way to diarrhea, a non-productive cough, nosebleed, and raised pink spots on the upper abdomen. Complications may result, and the death rate for serious cases is ten percent for those untreated, one percent for those treated.

Treatment – with antibiotics.

Prevention – by cautious eating and drinking, and by an oral or injectable vaccine, both of which are about sixty-five percent effective for five years. The oral vaccine is four pills taken every other day; the injectable requires two shots one month apart. The oral vaccine has fewer side effects. Antibiotics are not recommended as a preventive since they disrupt normal intestinal bacteria and can facilitate infection with salmonella typhi.

Malaria

Found – Africa and Asia. Poses the greatest health risk to travellers in warm climates, and is in fact the greatest health threat to humanity with up to 300 million cases occurring worldwide each year, with about one million deaths. The tragedy is currently increasing as mosquitoes become insecticide-resistant and forms of malaria become drug-resistant.

Cause – spread by the bite of the Anopheles mosquito, which generally feeds dusk through dawn. It is caused by four types of a single-celled protozoa: vivax, ovale, malariae, and falciparum. These parasites attack and explode red blood cells.

Symptoms – for the first three types may include the classic malarial fever in three stages. First is a cold stage characterized by severe shivering, followed by a high fever stage of up to 105F (40C). Finally there is intense sweating which brings the fever down. The victim may also vomit and have a bad headache. The patient is left weak and tired, and sleeps.

These stages may occur cyclically, either every other day or every third day, but only after the disease is well-established. Malaria can be very difficult to diagnose in early stages.

Falciparum is a more severe type of malaria as all red blood cells are attacked. Death may result a few hours after symptoms begin. The brain may be affected, and liver and kidney failure are common.

Treatment – usually with a big dose of chloroquine. Falciparum malaria is resistant to chloroquine, however, so other drugs must be used. Discuss treatment with your travel clinic before you go, and immediately with local medical professionals if you acquire malaria-possible symptoms.

Prevention – is complicated, so only trust a high quality travel clinic to prescribe the proper medications for your specific destinations and physiology.

Yellow fever

Found – Yellow fever is found east of the Panama canal, in parts of South America, and in much of Africa.

Cause – a virus hemorrhagic (bleeding) disease transmitted in urban areas from person to person by Aedes aegypti mosquitoes, which feed during the day. In jungle areas it is transmitted from monkey to man by various mosquitoes.

Symptoms – begin three to six days after infection, are relatively mild in eighty percent of cases, and include fever, headache, and weakness, which last up to four days. The other twenty percent are more serious, including high fever, chills, nausea, vomiting, bleeding from the gums and nose, and severe pain in the neck, back, and legs. These may last a few days, followed by a remission, and then followed by a more severe illness, including increased fever, vomiting of blood, and jaundice due to liver damage, hence the name yellow fever. Approximately five percent of all victims die within days of the onset of symptoms.

Treatment – maintaining blood volume and fluids. No drug works against this virus.

Prevention – by the yellow fever vaccine, which lasts ten years. A yellow fever vaccination certificate (yellow card) is required for entry into and from countries where the disease is prevalent.

Dengue fever

Found – in tropical and subtropical regions worldwide.

Cause – a viral, hemorrhagic disease transmitted by day-feeding Aedes aegypti mosquitoes.

Symptoms – appear five to eight days after a bite from an infected mosquito, and include high fever, severe muscle and joint pain, and rash. They subside and recur about every three days. Recovery takes several weeks, with victims rarely dying.

Treatment – pain killers to relieve symptoms. There is no specific treatment.

Prevention – avoiding mosquito bites. There is no vaccine.

Plague

Found – While a few cases of plague occur every year in the American Southwest, it is mostly a disease of South America, Africa, Southeast Asia, and India.

Cause – transmitted to humans by the bites of rodent fleas. The risk of plague to travellers is almost zero, especially if you make a habit of not handling rats, dead or alive.

Rabies

Found – worldwide.

Cause – a viral disease of the nervous system. Transmitted by animal bites, scratches, or even licks on an open cut.

Skunks, raccoons, and bats are the major carriers in North America. In Central and South America dogs and vampire bats are the primary vectors. Jackals are the primary carriers of rabies in Africa. In Southeast Asia and India dogs are the leading vectors to humans. Note, however, that any mammal bite may transmit rabies. Ireland, Britain, Norway, Sweden, Japan, Australia, and New Zealand do not have the disease, and require an extensive quarantine for pets entering the country.

Symptoms – begin from nine days to many months after exposure. These include fever, hyperactivity, seizures, and often an intense thirst that cannot be quenched since liquids produce violent and painful spasms in the throat. The victim will die within three to twenty days from onset of symptoms.

Prevention and Treatment – passive immunization before symptoms appear, and ideally within two days of exposure. Competent medical advice should be immediately sought after a bite in a rabies endemic country. Clean the wound thoroughly with soap and clean water for at least five minutes, but don’t stitch it closed. The sooner vaccination is begun, the better the prognosis. Today’s vaccines are not so painful, and are no longer given through the stomach.

There are about 30,000 deaths every year from rabies, nearly all in developing countries. Almost invariably fatal if left untreated.

Chagas’ disease

Found – rural Central and South America, but especially Brazil. Also called American sleeping sickness. Can be fatal.

Cause – transmitted by the bite of the assassin bug, which makes its home in thatched roof and adobe huts in This bug prefers to bite on the face and defecate. Single-celled parasites called trypanosomes enter the body, grow to huge numbers, then attack many organs, including the heart.

Symptoms – a hard, purple swelling which appears on the bite site about a week later.

Treatment – effective only if caught early.

Prevention – not sleeping in mud huts, by using mosquito netting, or by at least sleeping in the middle of the room away from walls. This disease is extremely rare in travellers.

Brucellosis

Found – rare in the US but not in Latin America and Mediterranean countries.

Cause – bacteria from unpasteurised dairy products.

Symptoms – high fever, shaking, sweating, and severe depression.

Treatment – antibiotics and rest.

Schistosomiasis (bilharziasis)

Found – is common in tropical regions worldwide, affecting about 200 million people.

Cause – several species of flukes (flattened worms) called shistosomes. They live in fresh water lakes and rivers, where they live part of their life cycle in snails.

Symptoms – vary from none to serious. The first is usually an itchy rash where the parasite has burrowed through the skin. Weeks later flu-like symptoms may begin, including high fever, chills, muscle aches, and diarrhea. The symptoms may go away and recur a month or two later. Long-term damage includes cirrhosis and kidney failure.

Treatment – a single dose of an anthelminthic (antiparasitic) drug, which kills the flukes.

Prevention – avoiding freshwater rivers and lakes in the tropics, but especially the Nile Valley, where schistosomiasis is rife.

Leishmaniasis

Found – the Middle East, South America.

Cause – a single-celled parasite transmitted via sandfly bites.

Symptoms – Some varieties affect mostly the skin, producing large ulcers at the bite area. In the Middle East this is known as the Baghdad boil. South American forms of the disease may cause more severe tissue damage, especially to the face. Another variety, called kala azar, causes internal organ damage.

Treatment – sodium stibogluconate.

Prevention – avoid sand fly bites by wearing shoes, socks, pants, long-sleeves, and by using DEET.

Filariasis

Found – in the tropics.

Cause – larvae or worms, and transmitted to man by insects.

Onchocerciasis (river blindness)

Found – in Central and South America, and Africa.

Cause – a worm infestation. The parasite is transmitted from person to person by the black simulium fly, which is found only near fast-moving rivers and streams.

Treatment – with diethylcarbamazine, which must be administered under close medical supervision since severe reactions to the dead and dying worms may occur.

Prevention – avoid black fly bites.

Giardiasis

Found – in the United States and worldwide, especially in the tropics and the public water systems of the former Soviet Union.

Cause – an intestinal infection caused by a single-celled parasite. Giardia cysts (eggs) are spread from the feces of infected animals.

Symptoms – the cysts hatch two or three weeks after ingestion, causing abdominal symptoms such as violent diarrhea, foul-smelling gas, and cramps. Sixty percent of those infected, however, show no symptoms.

Treatment – giardiasis clears up on its own after two or three weeks, although metronidazole speeds recovery.

Prevention – drink only pure or treated water.

Jiggers

Found – a type of sandfly found in tropical areas of the Americas and Africa.

Symptoms – burrow between toes and under toenails, where eggs are deposited under the skin causing a painful and itchy pea-sized swelling.

Treatment – removing the jigger with a sterile needle, and thoroughly cleaning with antiseptic.

Prevention – wear shoes or at least sandals, and by keeping nails well-trimmed.

Chiggers

Found – worldwide on grass and weeds.

Symptoms – red mites attach themselves to bare legs and ankles and feed on blood. May cause a painful, itchy swelling about a half inch in diameter.

Prevention – wear socks and pants, and by applying DEET to exposed skin, socks, and pant cuffs.

Bedbugs

Found – worldwide. Small, flat, usually brown bugs found in beds and furniture during the day, and come out at night.

Symptoms – a straight line of red bites across the skin. They rarely spread disease, but the bites should be cleaned with antiseptic to prevent infection.

Prevention – check bedding carefully, look for tiny red splotches on sheets and blankets. If found, take another room or use a hammock.

Sandflies

Found – tiny, nearly-invisible long-legged flies common to tropical areas.

Symptoms – walking at at dawn and dusk stirs up flies and results in bites. Can transmit several diseases to humans.

Prevention – remain indoors or in a hammock during dawn and dusk. Cover exposed skin, especially legs, ankles, and arms, and use DEET. Wear socks.

Lice

Found – tiny, flat, wingless bugs found wordlwide.

Treatment – body lice are killed by washing clothes in very hot water, or by using a hot dryer. Other lice can be killed with lotions and shampoos containing benzene hexachloride.

Scabies

Found – are tiny mites found worldwide that burrow into the skin and lay eggs.

Symptoms – intense itching, especially at night.

Treatment – with an insecticide lotion.

Hookworms

Found – half-inch long worms that live in the small intestines of 700 million people around the world, especially in the tropics.

Cause – burrowing into the feet, or by ingestion.

Symptoms – a red and very itchy rash on the feet that lasts for several days. A cough and pneumonia are also possible when a heavy infestation passes through the lungs.

Prevention – wear shoes or sandals.

Treatment – an anti-worm drug.

Guinea worm

Found – numerous African and Asian countries.

Cause – drinking water containing the cyclops crustacean water flea.

Symptoms – begin a year later when the worm is fully grown and ready to reproduce. It comes to the surface of the skin where a blister forms. Hives, diarrhea, and vomiting often occur at this time. When the blister bursts the end of the worm is exposed, and debilitating pain begins.

Treatment – wrap the exposed worm around a stick, and then gently wind it out over several days. This is dangerous (although impressive) as if the worm breaks an infection can develop.

Beefworm (botfly larvae)

Found – Central America. It is common in the jungles of Belize.

Symptoms – like a mosquito bite that doesn’t go away. After several weeks it resembles a boil, except for a tiny hole in the center. If you look closely with a magnifying glass you will see something pushing to the surface every so often to breathe and expel waste. As it feeds it occasionally delivers a sharp pain like a hot needle stabbing into flesh, which lasts only a few but very long seconds.

Treatment – the traditional Mayan method is to pour tobacco juice into the hole which kills the beefworm in about an hour. You then easily squeeze it out. Another method is to suffocate it overnight by covering the hole with multiple layers of glue and plastic wrap. It becomes poppable if you manage to cut off 100% of its air.

Tumbu fly

Found – in Africa.

Cause – fly lays eggs on clothing left out to dry, which later hatch with skin contact.

Treatment – similar to the botfly.

Prevention – ironing clothes to kill the eggs.

Facilities for keeping clean while travelling vary greatly. Guesthouses and hotels may (or may not) have showers, sometimes you . . . → Read More: Keeping Clean]]>

Facilities for keeping clean while travelling vary greatly. Guesthouses and hotels may (or may not) have showers, sometimes you may get hot and cold running water, sometimes it may be just a tap and bucket of hot water. There is no guarantee that the water you use is clean either.

Keeping your hands clean is probably the easiest way to keep healthy in some countries, although this can be hard to do if you aren’t close to fresh water and soap for most of the day. Keeping your hands away from your mouth and eyes will help (especially after handling well-thumbed bills), as well as stopping any nail-biting habit.

Some countries don’t use toilet paper in the toilets, they just aren’t designed to handle it. If you use it you are supposed to put it in the bin provided. Locals use a tap, a bucket, and their left hand. Whichever method you use, it pays to keep a bar of soap handy wherever you go.



A better way to keep clean is to keep a bottle of hand sanitizer gel with you (and use it) at all times. If you use gel you don’t need soap or water so is really useful where both of these are scarce (you can also use hand wipes but you will go through these quite quickly which can get expensive).

Sanitizing gel should be used before eating and drinking (or after touching suspect surfaces). To be effective gels require a 60% minimum alcohol concentration to kill most harmful bacteria and viruses.

You can carry a small bottle around with you (they come in travel sizes), either in your pocket or clipped to your belt or bag. These clips can be bought anywhere, for example, here.

A far better solution is to buy a purpose-built hand sanitizer gel dispenser (shown right). These are the ones used in hospitals and contain 50ml of 70% ethyl-alcohol gel and are refillable so you can use your own gel if you prefer.

They are light and compact, are easy to carry and use, and are always on hand. You can carry them on a lanyard or clipped to waistbands, belts, bags or pockets.

They can be very hard to get hold of, however, and can be expensive if you want to buy just one. If you can’t find one then email me as I can get hold of them in the US or the UK.

You use them as illustrated below. Just flip the dispenser and push, and a small, measured dose of gel comes out, then rub your hands together for a few seconds and the gel evaporates and that’s it.

Many tropical diseases, such as malaria, yellow fever, and Japanese encephalitis, West Nile virus, Lyme disease, are transmitted by . . . → Read More: Avoiding Insect Bites]]>

Many tropical diseases, such as malaria, yellow fever, and Japanese encephalitis, West Nile virus, Lyme disease, are transmitted by insect bites, usually through the insect’s saliva.

No antimalarial drug is 100% effective and in the case of some diseases (for example, dengue fever) there is no protection at all, so it is best to avoid getting bitten in the first place.

Luckily, insects aren’t a problem in most countries around the world, just annoying, and in those places where they are, only some of them carry diseases.

For example, there are more than 3,000 species of mosquitoes worldwide, and 420 species of the Anopheles mosquito, of which only about 70 are capable of transmitting malaria. Of those 70 species, only about 30 to 40 species are considered “good transmitters”. For each of these 30 to 40, only 5 to 10 percent of the insect population is capable of transmitting malaria.



These may seem like good odds, but the sheer numbers of the Anopheles mosquito around the world can make them appear less favourable. In parts of Africa, research has shown that some (unprotected) people suffer around 300 to 1,000 infectious bites per person per year, i.e. one to three malarious infections per day.

To get infected, you have to be bitten by a disease-carrying insect, and although it may take more than one bite from that insect to transmit the disease, you can still get infected from just one bite from one insect.

You can greatly reduce the chance of any infection by taking precautions to limit the number of times you get bitten. Even in low-risk or non-malarious areas it pays to do so, as insect bites can be irritating and sometimes painful.

When reading about and comparing repellents, insecticides and netting, remember that a lot are sold for domestic use (in the backyard at home), some just for backcountry use (in the USA), and some for use abroad.

Be careful to choose the right combination for your situation. For example, a close mesh net is ideal for keeping out tiny insects in the forests of the US but would be too hot in the tropics where a more open mesh mosquito net (treated with an insecticide) which lets in the breeze would be fine.

Clothing

One of the best ways to stop getting bitten is to reduce the amount of exposed skin by wearing long-sleeved shirts and long trousers, as well as enclosed shoes and long socks (not open sandals or flip flops).

Covering up in this way also (partially) protects against exposure to the sun.

Fabrics must be either thick or closely woven (not knit) as well as loose-fitting, as insects can bite though thin fabric or can reach your skin through tight clothing.

Luckily, loose clothing is also more comfortable in hot climates.

Also, light colors (khaki, for example) appear to be less attractive to mosquitoes.

The best shirt I have found that meets all of the above criteria is the Craghoppers Nosquito Long Sleeved Shirt. I personally have two of these (in Stone and Khaki) and they are worth every penny. Part of the ‘Bear Grylls’ range of clothing they are practical as well as very stylish. You can read more about them in the Clothing section of this website.

Craghoppers also make the best travel trousers too in the Craghoppers Kiwi Trousers. They are similar in performance to the shirt and are (justifiably) a best seller.

To deter ticks, tuck trousers into socks, and remember to inspect yourself for ticks after outdoor activities.

Spraying or soaking your clothes with an insect repellent or insecticide is also recommended (see below). The Nosquito shirt above is treated like this.

You can find anti-mosquito clothing treatments here or here.

Repellents

The next method for keeping the insects away is to use an insect repellent on your skin.

Humans and animals give off various chemicals that attract insects. Insect repellents are thought to work by blocking the stimulation of the receptors that detect these chemicals.

The most popular (and also the most effective) repellents are those which contain DEET (diethyl-meta-toluamide). Others contain oil of lemon eucalyptus, botanicals, and other chemicals (picardin) but despite their claims, these may not be as protective.

Read more about the alternatives here. There is an update to this information here. Both give recommendations for domestic (USA) use. To find information about overseas travel, read the information here.

When evaluating claims make sure they are comparing like with like (some tests use lower concentrations of DEET, for example, when they claim their product is more effective), and check which insects they protect against (some are only more effective against ticks and certain (non-malarial) mosquitoes).

The U.S. Environmental Protection Agency considers DEET-based products safe when used as directed. This means they should not be used under clothing or on open cuts, wounds, or irritated skin, and shouldn’t be used with sunscreen.

Combination repellents and sunscreens are still being evaluated by the EPA, but because sunscreens are meant to be applied liberally and frequently and DEET products are used sparingly, you will inevitably end up putting on too much of one or too little of the other. Better to use separate products at the same time, applying sunscreen first, then the insect repellent.

DEET-based repellent should be applied following the manufacturer’s instructions to all exposed skin. It should also be kept away from your eyes, mouth and nasal membranes, and definitely should not be swallowed. Spray the repellent onto hands and then apply to face. You should use just enough to cover exposed skin and it should be washed off whenever safe to do so.

Even though you should not use it on your skin under clothing, many people apply it to the outside of their clothes on sleeves, collars, socks, and cuffs as additional protection.

Be aware that DEET can also melt some plastics, such as eyeglass frames, rayon, spandex, and other synthetic fabrics, and can damage leather and painted or varnished surfaces.

DEET products come in different concentrations which can be confusing. In concentrations over approximately 25%, DEET does not work better, it just lasts longer. If you are hiking or sweating a lot it will dissipate much faster and last a lot less.

Products containing 25% to 35% DEET are recommended by the CDC for adults. These will usually repel mosquitos for several hours (read the instructions), and there should be no need to reapply it more often that this. Ultrathon, made by 3M, contains 33% DEET which slowly releases the DEET for an effectiveness of up to twelve hours. Another similar product is Sawyer’s Controlled Release.

Some DEET products consist of a 100% formulation for maximum effectiveness of up to eight or ten hours. 100% DEET is probably overkill for mosquitoes, you just don’t protection for 12 or 13 hours. For most situations of casual use (and for a few fours in the morning or evening when mosquitos bite), around 25% should be fine. You can always re-apply it every few hours if you’re in the jungle, too.

There may be circumstances where constant reapplication may be impractical, however, such as where there is a rapid loss of repellent due to rain or heavy sweating. Some people also use higher concentrations when traveling to an area where there is a very high density of biting insects.

As well as being a lower concentration, Ultrathon is also absorbed less through the skin, thus making it safer than 100% DEET. In addition, it is recommended by many health care professionals. If you have sensitive skin you can get it in a spray can at a 23% concentration which lasts up to eight hours.

Insecticides

Whereas insect repellents are designed to keep insects away, insecticides stun or kill insects that come into contact with it. In this way the two methods compliment each other and should both be used (one does not replace the other). Ideally, use a combination of a DEET product on exposed skin, and wear insecticide-treated clothing.

Permethrin is a common synthetic chemical, widely used as an insecticide and as an insect repellent. It is usually applied to mosquito netting (see below) and clothes. Permanone, Coulston’s Duranon, and Sawyer’s are brand names of permethrin.

When applied to clothing by aerosol or trigger spray, Permethrin provides protection lasting up to two weeks or two washings. Clothing soaked in a Permethrin solution is effective as am insecticide for months if it is stored out of the sun.

There should be no problems using it as long as it is used according to the instructions, as it has a low toxicity, is poorly absorbed by skin, and is generally environmentally safe except that it is toxic to honey bees and other beneficial insects, fish, aquatic insects, crayfish, and shrimp.

More recently, Deltamethrin has become more popular and widely used. It is a member of one of the safest classes of pesticides. However, it is still a neurotoxin and should be treated with care. It is used by companies (e.g. Tana Netting and Travel Health Help) to manufacture long-lasting insecticidal mosquito nets.

Mosquito nets

Mosquito nets are a very useful and practical way to prevent insect bites, especially when sleeping at night. There are a number of things to look out for when buying a net.

There are basically two types, circular or rectangular. The circular type hangs from the ceiling by a string, with the net fanning out from a ring at the top and tucked tightly under the mattress on all sides. The rectangular type ties to the ceiling with four strings and hangs straight down on all sides of the bed, with the fringes again tucked under the mattress. Whichever type you choose it should be wide enough not to touch the body while sleeping.

The mesh size should be large enough for air circulation but as small as possible to keep out the mosquitos. For effective malaria protection, the mesh size that is recommended is 120-200 holes per square per inch. This will not keep out some types of sand flies, however, which can also transmit diseases to humans.

‘Noseeum’ netting is a lot finer at 500-600 holes per square inch, but the airflow is greatly restricted which can be stifling. Spraying or soaking mosquito netting in Permethrin or Deltamethrin dramatically increases effectiveness (see above). Store the net in a plastic bag to keep the permethrin effective longer.

Finally, make sure there are no gaps or holes in the netting around you and that there are no mosquitoes already inside the netting before you get inside or got to sleep.

Mosquito head nets may also be useful. Head nets alone are not enough in malarial areas, though.

Other preventative measures

Mosquitoes can bite any time. However, the peak hours of mosquito biting activity are usually at dawn and dusk, so try to reduce the amount of time you spend outdoors at these times.

You can use insecticides in the form of aerosols, vaporizers, candles, smoke spirals or others in living and, most of all, in sleeping areas. Close all doors and windows and spray the walls.

Mosquito coils are spiral-shaped candles that repel mosquitoes and other bugs with the natural chemical pyrethrum. They burn for several hours, and are useful when cooking dinner while camping, or in hotel rooms without screening.

Citronella (in the form of candles, soaps, sprays, etc.), is a natural repellent, useful in backyards in the USA but is not effective in serious biting insect areas.

Avoid wearing perfumes and aftershaves, which attract some mosquitoes. Also, for the same reason, don’t use scented soaps, shampoos, or deodorants. Unscented deodorants are available.

Mosquitoes do not attack as long as you walk quickly or if there is a breeze as they need to land on you to bite. While many hotels in the tropics lack screens, they often have fans which produce enough breeze to prevent mosquitoes from landing as long as the power holds out.

Stay in mosquito-protected rooms after twilight and at night, that is in rooms with air-conditioning or mosquito nets attached to windows and doors and those with fans.

For tours in the country, or if camping out, carefully select sites for sleep. Try to keep away from stale waters, ditches and water barrels. Also try to avoid traveling in high-risk areas during the rainy season.

The Medical pages list the various diseases and vaccinations available. This section gives information on where and when to . . . → Read More: Vaccinations]]>

The Medical pages list the various diseases and vaccinations available. This section gives information on where and when to get them, how long they last, whether you need boosters, possible side-effects, and so on.

Don’t rely on the information given below. Try to get to a specialist travel clinic, or seek advice from a qualified professional.

Some clinics will give you a free consulation, other charge a fee (usually refunded if you then have the vaccinations at the clinic).

In the UK you can get vaccinations from your GP (usually for free), or go to one of the specialist travel clinics, such as the Nomad Travel Clinics, or The Hospital for Tropical Diseases in London.



Or do a basic search on the Internet in your country to find one. For example, this website has a list of directories for other countries, including the USA.

Check the Links – Websites page for more links to health information by country.

Remember to start your vaccination programme at least six weeks before departure.

Polio

How – usually given as a childhood vaccine. Recommended every 10 years for travel to areas outside of Europe, Australasia or the Americas.

When – anytime before departure.

Tetanus

How – a routine childhood vaccine. Boosters needed every ten years for travel to areas where immediate treatment may not be available, or after a cut or injury.

When – anytime before departure.

Diphtheria

How – a routine childhood vaccine. Boost every 10 years.

When – anytime before departure.

Hepatitis A

How – vaccination protects initially for one year and then a further injection boosts immunity to 20 years, possibly life.

When – two to four weeks before travel.

Hepatitis B

How – a course of vaccines is required, three injections over six months although more rapid schedules can be done for those leaving with less time available.

When – ideally six months before travel.

Typhoid

How – available as a single shot or as a combined vaccine with Hepatitis A. Provides approximately 80% protection for three years.

When – two weeks before travel.

Yellow Fever

How – vaccine with immunisation lasting for 10 years.

When – 10 days before travel.

Meningitis A, C W135 and Y vaccine

How – vaccine covering four strains of Meningitis.

When – two to three weeks prior to travel.

Japanese Encephalitis

How – a course of three vaccines.

When – six weeks prior to travel.

Rabies

How – a course of vaccines over one month. Further treatment is still required after a bite but both reduces the amount of treatment needed and changes the treatment required. In some developing countries there are no guarantees as to the quality or availability of treatment.

When – four to six weeks before travel.

Tick Borne Encephalitis

When – six weeks prior to travel.

Cholera

How – a course of two oral vaccines. Gives 80% coverage for two years.

When – a minimum of three weeks prior to travel.

Malaria prevention is complicated, so only trust a high quality travel clinic to prescribe the proper medications for your . . . → Read More: Anti-Malarial Drugs]]>

Malaria prevention is complicated, so only trust a high quality travel clinic to prescribe the proper medications for your specific destinations and singular physiology.

Antimalarial drugs are designed to help prevent or cure malaria. Some of them can also be used to treat malaria until you get to a hospital.

However, they are not vaccines, and there is no guarantee of immunity from infection. You must also take other precautions, such as avoiding insect bites (listed above).

You can either get the drugs from your doctor or a clinic at home (expensive), but you can also buy them in tropical and Third World countries. If you can’t find the type you want in one place, try different pharmacies, or wait until the next country and look there.

There are so many types of tablets which you can take. Quinine is the oldest and most famous anti-malarial, however, the discovery of chloroquine has pushed it to the sidelines. Since then quite a few more anti-malarials have been developed and as a result it can get quite confusing without professional help.

For example, here is a list of drugs and brand names found from a basic search on the Internet:

- Quinine

- Chloroquine (Avloclor, Nivaquine)

- Amodiaquine

- Pyrimethamine

- Sulphadoxine

- Halofantrine

- Artemesinin and derivatives

- Doxycycline

- Clindamycin

- Fansidar (Pyrimethamine)

- Maloprim (Dapsone and Pyrimethamine)

- Dariprim

- Paladrim

- Paludrine (Proguanil Hydrochloride)

- Primaquine

- Mefloquine (Lariam)

- Malarone (Atovaquone and Proguanil)

To make it even more confusing you may need to take more than one pill, depending on which areas you are travelling to, as malaria is resistant in some areas of the world to ordinary chloroquinine.



You usually begin taking the medicines from about one week to a few days before exposure, and two to four weeks after your last exposure. Usually you take them only once a week but some you have to take every day.

There are some potentially dangerous, although rare, side-effects associated with all of the above. However, these are far outweighed by the dangers of getting malaria. If you are going to be exposed for a few months you should take pills.

Here are some typical drugs, recommended by the WHO, the UK HPA and the CDC for adults and children aged 12 and over, and the associated regimens and side effects.

Please note these are not recommendations, just information I have found out during my own research. New drugs come out all the time, so do your own independent research as well as reading this:

Chloroquine (Avloclor, Nivaquine, etc.) and Proguanil

What – take both or either, depending on the region you are going to, Chloroquine 300 to 310 mg once weekly, and Proguanil 200 mg once daily.

When – start one week before entering a malarious region and continue for four weeks after returning.

How long – may be taken for periods exceeding five years.

Side effects – can cause nausea, temporary blurred vision and rashes.

Doxycycline

What – 100 mg once daily.

When – start one day before entering a malarious region and continue for four weeks after returning.

How long – can be taken for periods up to six months.

Side effects – risk of photosensitisation (skin sensitivity to sunlight), can make you prone to sunburn.

Mefloquine (Lariam)

What – 228 to 250 mg once weekly.

When – start two and a half weeks before entering a malarious region and continue for four weeks after returning.

How long – can be taken for periods up to one year.

Side effects – can precipitate psychiatric disturbances in patients with a history of these conditions.

Malarone

What – 1 tablet daily.

When – start one day before entering a malarious region and continue for 1 week after returning.

How long – malarone can be used for travel periods up to one year.

Side effects – virtually free of side effects.

For a great website listing the current recommended drug regimens for different parts of the world, plus a list of dosages, advice on long-term use, and so on, click here.