IAMAT Blog - Infectious Diseases

Polio No Longer A Real Threat? Think Again

Wed, 23 Jun 2010 14:49:00 -0400

The recent polio (poliomyelitis) outbreaks in Central Asia (Tajikistan, Uzbekistan, Russia) are reminders of how travel and migration can contribute to the re-emergence of a disease in a region previously declared free of infection.

In Tajikistan, for example, the country was declared polio free in 2002, but this year alone 239 children became paralyzed and 15 patients have died of the disease imported from India. The disturbing news is that since 2003 there have been 25 countries - originally declared polio free - that have been re-infected. (Kenya, Uganda, Burkina Faso, Benin, Togo, Cameroon, Burundi, Central African Republic, Cote d'Ivoire, and Guinea are some of the countries that have since taken steps to control the reappearance of polio).

Travellers who are un-vaccinated or under-vaccinated (did not complete the vaccination series) are at risk of infection where polio is still a threat.

Polio is well on its way to being eradicated around the world - since 1988 there has been a 99% decrease in the number of reported polio cases worldwide. Still, parts of Nigeria, India, Pakistan, and Afghanistan remain polio endemic. This year, there is encouraging news from Nigeria where only 3 cases have been reported so far in 2010 compared to 312 cases in 2009 during the same time period.

Polio's continuing presence and re-emergence is largely due to a lack of funding and access to vaccines (the World Health Organization expects a $1.3 billion shortfall over the next 3 years in funding for polio research and vaccination programs). Systemic poverty - crowded living conditions, poor sanitation, high birth rates, malnutrition, little or no access to healthcare - and armed conflicts make it even harder to eradicate the disease, not to mention travel. Unvaccinated Hajj pilgrims, for example, were one of the sources for spreading polio around world; either having contracted the infection in Saudi Arabia and importing it back home or vice versa. However, by implementing strict travel health entry requirements (travellers who are not vaccinated or cannot provide proof of vaccination, get inoculated at the border), Saudi Arabia has been a key player in helping to eradicate the disease.

Polio is a highly contagious childhood disease, mainly affecting children under 5 years of age, although it has repercussions throughout a person's adult life. The poliovirus spreads from person to person through the fecal-oral route (ingestion of contaminated water and food) or through the respiratory system (infected air droplets and saliva). The incubation period (before symptoms show up) can be anywhere from 3 to 35 days, but a person is usually infectious between 7 days before and 10 days after the appearance of symptoms.

The difficulty with diagnosing polio is that some people do not exhibit symptoms or mild cases where patients suffer from headaches, fever, vomiting, neck and back pain, and extremities, including lethargy, are misdiagnosed for another illness. In severe cases (1 in 200 people), the virus attacks the central nervous system and patients see their muscles weakening, have difficulty controlling their movements, and become paralyzed.

The best prevention is to get vaccinated (routinely given as a series of childhood vaccinations, so you may already be protected). However, if you are travelling to endemic areas or where polio is still a risk, you may need additional protection (one booster as an adult). Other prevention methods include washing your hands, eating well cooked foods and drinking bottled water or purifying your water (tablets, purifier). Avoid crowded areas and places with poor sanitation.

See IAMAT's World Immunization Chart or our online Disease List where a polio booster is recommended.

For more information see the Global Polio Eradication Initiative website. GPEI is an initiative by national governments, the World Health Organization, Rotary International, UNICEF, and the Centers for Disease Control and Prevention that funds and coordinates polio eradication programs worldwide.

Measles: Closer To Home Than You Think

Wed, 31 Mar 2010 17:18:00 -0400

Measles continues to be a threat all over the world, even making resurgences close to home. During the last decade we have seen measles outbreaks in places where this disease is considered a rare occurrence. The most recent cases were reported in Vancouver, British Columbia, and San Francisco and Amador Counties in California.

Two factors explain the resurgence of measles in our communities: International travel and lack of immunization. The cases in Vancouver show that people who contracted the infection were not vaccinated or did not follow-up with the second dose required for effective protection. Add travel to the mix and you have the recipe for spreading this highly contagious disease.

Here at home, even if you are not vaccinated you may not be exposed to vaccine preventable infectious diseases because people around you are vaccinated (herd immunity). If you are not vaccinated or only partially vaccinated and are travelling to endemic areas where immunization rates in the local population are low, you are at high risk of getting infected. Since the incubation period (time before symptoms appear) for measles is approximately 8-12 days you may unwittingly bring it back home and spread it to unvaccinated or under vaccinated people in your community.

Measles is a respiratory infection caused by the paramyxovirus and spread through infected air droplets and saliva. Symptoms include fever, cough, runny nose, red eyes, followed by a rash spreading all over the body. Complications may lead to death. Children, teenagers and young adults are at higher risk of contracting the disease.

Before you travel, find out about the health risks at your destination. The latest outbreaks in February and March 2010 were reported from South Africa (Western Cape province), Zimbabwe (Bulawayo), the Philippines (throughout the country), Nigeria (Bayelsa State), Malawi (Blantyre and Lilongwe), New Zealand (Hokianga region), and Afghanistan (North Waziristan).

IAMAT recommends that you consult your doctor to determine your immunization status and update your routine immunizations if needed before travel.

For more information: World Health Organization: Measles

Going to Haiti to Help? Health Advice for Aid Workers

Tue, 19 Jan 2010 15:15:00 -0400

We've been getting many online inquiries from people who are getting ready for aid missions in Haiti. Emergency relief efforts are underway to help Haitians recover from the devastating earthquake of January 12.

Prior to the earthquake, Haitians were already struggling with access to health care, clean water, and proper sanitation. Only 11 percent of the population had access to water in their homes and the median life expectancy is 60 years. While the death toll continues to mount and survivors have to rebuild their lives, there is hope that reconstruction efforts can be done in such a way that Haitians affected by the earthquake will have universal access to proper shelter, food, and clean water.

So what do you need to look for if you are going to Haiti?
Malaria: Falciparum malaria (the deadly type) is endemic in Haiti. Malaria is present throughout the country, including urban areas. IAMAT recommends a Chloroquine (ARALEN) regimen in weekly doses of 500mg (300mg base). Start one week before entering the malarious area, continue weekly during your stay, and continue for four weeks after leaving the country. See the IAMAT World Malaria Risk Chart and How to Protect Yourself Against Malaria Chart for prevention and treatment information.

Typhoid, Hepatitis A, Diarrhea: These gastro-intestinal infections thrive in areas with poor sanitary and hygienic conditions. Prevention includes drinking purified water, eating well cooked foods, and peeling your own fruits. Vaccination against typhoid and hepatitis A is also highly recommended. Based on your current health status, consult your healthcare practitioner to see if you need a prescription for medication to prevent diarrhea. Click here for a full list of Food and Water safety risks in Haiti.

Hepatitis B: This viral infection is transmitted through infected blood products, sexual intercourse, or infected items such as needles or razor blades, and may cause severe liver damage. IAMAT recommends this vaccine for your protection. It is usually combined with the hepatitis A vaccine.

Tuberculosis: This air-borne infection caused by mycrobacteria is endemic in Haiti. IAMAT recommends getting a pre-departure TB skin test and to get re-tested upon your return home.

Dengue Fever: This parasitic infection is transmitted by the daytime biting Aëdes aegypti mosquito. IAMAT recommends taking anti-mosquito bite measures, including applying repellent containing DEET on exposed skin and applying permethrin spray or solution to clothing. Risk is present year-round in Haiti, although outbreaks usually occur from April to September.

Post-Traumatic Stress Disorder: Witnessing the devastation may have an impact on your mental health. Burn-out, stress, and trauma is common among aid workers. Click here for information and useful links on this issue.

Rabies: This viral infection is transmitted through the saliva of infected animal bites which affects the brain and the spinal cord, and may be fatal. IAMAT recommends getting the pre-exposure rabies vaccination (three shots).

See IAMAT's complete list of disease risks in Haiti. Unfortunately, we do not have medical contacts in this country at the moment. Your consulate or embassy should be able to help you find appropriate medical care.

If you are looking to donate to, or volunteer for, medical charities operating in Haiti, here is a list to get you started:

Doctors Without Borders | MSF USA

International Committee of the Red Cross

Médecins sans frontières | Canada

Médecins du Monde | Canada

Project Medishare

Partners in Health

For a list of reputable charities:

Information on donating to US groups

Information on donating to Canadian groups

Planning a Trip to Central or South America?

Fri, 20 Nov 2009 16:31:00 -0400

Are you planning a trip to the jungles of South America or doing extended hiking and camping in Central America? You may be at risk of Chagas' Disease.

Transmitted by the Triatoma insect, which typically bites its victims on the face at night, the Trypanosoma cruzi parasite enters your bloodstream and affects organ tissues, most commonly the heart.

Found in forest ecosystems and poorly built homes, including huts and cabins, the Triatoma insect is commonly known as 'vinchuca' in Spanish or 'barbeiro' in Portuguese. In North America, we know it as the 'assassin bug' or 'conenose bug', but here it does not carry the disease.

According to the World Health Organization (WHO), Chagas' Disease affects between 16-18 million people. The disease largely spreads with the rise of migration to urban and suburban populations and increasing deforestation. Many countries in the region now have active health education and eradication programs (Chile and Uruguay have been declared free of Chagas' Disease. Although the Triatoma insect is still present in these two countries there is no evidence that the insect is continuing to transmit the parasite.)

Approximately 10% of persons infected with Chagas' Disease experience an acute phase, but for most it is a silent infection showing up many years later often mimicking chronic heart conditions, or as gastro-intestinal complications.

If you are staying in low standard accommodations, use a bed net to protect yourself (IAMAT sells LaMosquette, a light, free-standing - no ceiling hooks required, permethrin treated bed net). Make sure you thoroughly check the room (behind picture frames, along baseboards, and in furniture cupboards) for any evidence of the insect. You may also want to spray the room with insecticide.

For more information about the best prevention methods as well as the transmission patterns and geographical distribution of Chagas' Disease, see When Hiking Through Latin America, Be Alert to Chagas' Disease.