This viral infection is transmitted by the day-time biting Aëdes aegypti mosquito typically found in urban, suburban, and rural areas.
A Yellow Fever vaccination certificate is only required for travellers coming from a country with risk of Yellow Fever transmission. The vaccination requirement is imposed by this country for protection against Yellow Fever since the principal mosquito vector Aëdes aegypti is present in its territory.
Risk of Yellow Fever transmission exists in these countries:
AFRICA - Angola, Benin, Burkina Faso, Burundi, Cameroon, Central African Republic, Chad, Republic of the Congo, Democratic Republic of the Congo, Côte d'Ivoire, Equatorial Guinea, Ethiopia, Gabon, Gambia, Ghana, Guinea, Guinea-Bissau, Kenya, Liberia, Mali, Mauritania, Niger, Nigeria, Rwanda, Senegal, Sierra Leone, South Sudan, Sudan, Togo, Uganda.
AMERICAS - Argentina, Bolivia, Brazil, Colombia, Ecuador, French Guiana, Guyana, Panama, Paraguay, Peru, Suriname, Trinidad and Tobago, Venezuela.
Note: A vaccination certificate is required for children over one year of age.
If your medical practitioner has advised you against the Yellow Fever vaccine for medical reasons, a vaccination waiver should be issued. Be aware that problems may arise when crossing borders and your vaccination waiver may not be honoured. See example of a Yellow Fever vaccination waiver.
Your trip is a good occasion for a reminder to keep your routine immunizations updated; more than 80% of adults in developed countries have not maintained their immunization status. The following vaccinations are recommended for your protection and to prevent the spread of infectious diseases.
Tetanus, Diphtheria, Pertussis, Measles, Mumps, Rubella, Poliomyelitis should be reviewed and updated if necessary. Note: Many of these vaccine preventable illnesses are making a resurgence due to non-vaccination, incomplete vaccination, and waning immunity. It is important to keep your routine immunization up-to-date.
Seasonal influenza vaccination is recommended for all travellers over 6 months of age, especially for children, pregnant women, persons over 65, and those with chronic health conditions such as asthma, diabetes, lung disease, heart disease, immune-suppressive disorders, and organ transplant recipients. Note: In the northern hemisphere the flu season typically runs from November to April and from April to October in the southern hemisphere. If the flu vaccine is not available at the time of departure, contact your doctor or travel health clinic regarding influenza anti-viral protection.
Pneumococcal vaccine is recommended for persons over the age of 65 and persons of any age suffering from cardiovascular disease, diabetes, renal disorders, liver diseases, sickle cell disease, asplenia, or immuno-suppressive disorders.
The Hepatitis A virus (HAV) is primarily transmitted from person to person via the fecal-oral route and through contaminated water and food - such as shellfish, and uncooked vegetables or fruit prepared by infected food handlers.
The virus is present worldwide, but the level of prevalence depends on local sanitary conditions. HAV circulates widely in populations living in areas with poor hygiene infrastructure. In these areas, persons usually acquire the virus during childhood when the illness is asymptomatic (but still infective to others) or mild, and end up developing full immunity. Large outbreaks in these countries are rare. In contrast, a large number of non-immune persons are found in highly industrialized countries where community wide outbreaks can occur when proper food handling or good sanitation practices are not maintained including in daycare centres, prisons, or mass gatherings.
In many cases, the infection is asymptomatic (persons do not exhibit symptoms). Those with symptoms will usually get ill between 15 to 50 days after becoming infected. Symptoms include malaise, sudden onset of fever, nausea, abdominal pain, and jaundice after a few days. The illness can range from mild to severe lasting from one to two weeks or for several months. Severe cases can be fatal especially in older persons. Most infections are asymptomatic in children under six years of age, but infants and children can continue to shed the virus for up to six months after being infected, spreading the infection to others. Many countries are now including vaccination against Hepatitis A in their childhood vaccination schedules.
Prevention: Practice good personal hygiene, including washing your hands frequently and thoroughly, drink boiled or bottled water, eat well cooked foods, and peel your own fruits.
All non-immune persons, especially travellers, should be vaccinated. Two vaccines are available for persons over one year of age. Two doses are needed for full protection (the second dose is given 6 to 12 months after the first dose (HAVRIX) or 6 to 18 months after the first dose (VAQTA). TWINRIX is a vaccine against Hepatitis A and Hepatitis B. It is available for persons over 18 years of age. Three doses are needed for full protection. The second dose is given 1 month after the first, and the third 6 months later. For an accelerated schedule four doses are needed at 0, 7, 21, 31 days and the last dose 12 months later.
The recommendations for vaccinations outlined above are intended as guidelines only. Your immunization needs depend on your health status, previous immunizations received, and your travel itinerary. Seek further advice from your doctor or travel health clinic.
Schistosomiasis risk is present in the country, areas of risk are specified:
Antigua has only seasonal transmission of schistosomiasis. The intermediate host is present in human-created pools, canals, and reservoirs that are potentially infected with S. mansoni.
Public health authorities report no human cases from known infected areas of Sweet's, Liberta, Bendals, and areas surrounding the settlement of John Hughes.
There is a risk of Schistosomiasis caused by: Schistosoma mansoni
The main intermediate host snail is: Biomphalaria glabrata.
Prevention Guidelines: Rules to prevent Schistosomiasis infection
Outdoor air pollution (a mix of chemicals, particulate matter, and biological materials that react with each other) contributes to breathing problems, chronic diseases, increased hospitalization, and premature mortality. Cities and rural areas around the world are affected by air pollution.
No matter where you travel, you will not be able to escape air pollution. Exposure and concentration of pollutants can affect your health. When planning your trip, consider your health status, age, destination, length of trip and season to help you mitigate the effects of air pollution.
Short term symptoms of exposure to air pollution include itchy eyes, nose and throat, wheezing, coughing, shortness of breath, chest pain, headaches, nausea, and upper respiratory infections (bronchitis and pneumonia). It also exacerbates asthma and emphysema. Long term effects include lung cancer, cardiovascular disease, chronic respiratory illness, and developing allergies. Air pollution is also associated with heart attacks and strokes.
Prevention: Comply with air pollution advisories (ask around and observe what locals are doing) and avoid strenuous activity. If you have asthma or chronic obstructive pulmonary disease (COPD), carry an inhaler, antibiotic, and oral steroid (consult your doctor to see what is best for you). It is recommended that older travellers get a physical exam that includes a stress and lung capacity test prior to departure. Newborns and young children should minimize exposure as much as possible or consider not travelling to areas with poor air quality. Ask your medical practitioner if a face mask is advisable for you.
>> For city and country air pollution levels, see the World Health Organization.
Ciguatera poisoning is caused by eating fish that has been contaminated by a dinoflagellate-produced toxin. Large fish become contaminated with the toxin when they eat reef fish that feed on these small organisms. Ciguatera is the most commonly reported marine seafood toxin poisoning. Any reef fish can cause ciguatera poisoning, but species such as barracuda, moray eel, grouper, red snapper, amberjack, parrotfish, sturgeon, ulua, and sea bass are the most commonly involved. The occurrence of toxic fish is sporadic, and not all fish of a given species or from a given area will be toxic.
Travellers need to be aware of the areas where the toxin exists and of the local fish that have been associated with the toxin. Outbreaks are seasonal but can also occur after major storms. Ciguatoxin does not affect the taste or smell of fish. It cannot be destroyed by cooking, smoking, freezing or any other method of food preparation. Large fish (over 6 lbs or 13.2 kg) are more likely to contain ciguatoxin. It is recommended not to eat large reef fish, as well as not eating fish liver, intestines, heads, and roe, where the toxin is concentrated.
For more information, see Centers for Disease Control and Prevention.
Dengue is a viral infection caused by four types of viruses (DENV) belonging to the Flavivirdae family. The viruses are transmitted through the bite of infected Aëdes aegypti and Aëdes albopictus female mosquitoes that feed both indoors and outdoors during the daytime (from dawn to dusk). Dengue is present in tropical and subtropical areas of Central America, South America, Africa, Asia, and Oceania. It's found predominantly in urban and suburban settings and higher rates of transmission occur during rainy seasons.
All travellers are at risk during epidemics. Long-term travellers and aid or missionary workers going to areas where Dengue is endemic are at higher risk.
In some cases, Dengue infection is asymptomatic (persons do not exhibit symptoms). Those with symptoms get ill between 4 to 7 days after the bite. The infection is characterized by flu-like symptoms which include a sudden high fever coming in separate waves, pain behind the eyes, muscle, joint, and bone pain, severe headache, and a skin rash characterized by bright red spots.
The illness may progress to Dengue Hemorrhagic Fever (DHF). Symptoms include severe abdominal pain, vomiting, diarrhea, convulsions, bruising, and uncontrolled bleeding. High fever can last from 2 to 7 days. Complications can lead to circulatory system failure and shock, and can be fatal. Exposure to one type of Dengue virus does not provide immunity to the other three types. Contracting Dengue more than once increases the risk of developing Dengue Hemorrhagic Fever.
Prevention: Travellers should take measures to prevent mosquito bites during the daytime. Insect-bite prevention measures include applying a DEET-containing repellent to exposed skin, applying permethrin spray (or solution) to clothing and gear, wearing long sleeves and pants, getting rid of water containers around dwellings and ensuring that door and window screens work properly. There is currently no preventive medication or vaccine against Dengue.
Dengue fever is endemic in Antigua and Barbuda.
Hookworm, also known as Cutaneous Larva Migrans (CLM), is a skin infection caused by hookworms belonging to the Ancylostomatidae family. It is acquired by walking barefoot or sitting on soil or sand contaminated with dog or cat feces containing hookworm larvae. The hookworm eggs hatch in the soil or sand and the larvae migrate through a person's skin forming red burrows or tracks underneath the outer skin layer. This infection is prevalent in tropical and subtropical areas of the Caribbean, South America, Asia, and Africa, but can also occur during the hot months in temperate regions.
Travellers taking beach vacations are at greater risk of acquiring this infection.
Symptoms include itching (which can cause a secondary bacterial infection), mild swelling, and redness at the place of larval penetration, usually on a person's feet or buttocks. The burrows or tracks usually appear 1 to 5 days after exposure, but sometimes can take weeks to show up. In the majority of cases the infection suddenly disappears after a few weeks. Treatment includes applying anti-itch creams and taking anthelmintic drugs such as albendazole.
Prevention: Wear shoes or sandals. At the beach, always sit on a towel (washed after each use) and wash your hands and feet with soap and water after touching sand or soil. There is no preventive vaccine or medication against Hookworm.
>> For Hookworm images, life cycle, and distribution maps, see Infection Landscapes.
Leptospirosis is caused by bacteria belonging to the genus Leptospira. It is a zoonosis (an animal disease that can spread to humans) affecting domestic and wild animals such as cattle, dogs, cats, pigs, and rodents. Humans can become sick when they come into contact with water, food, soil, and mud contaminated with the urine of infected animals. The bacteria can enter through skin abrasions and mucous membranes of the mouth, eyes, and nose. Leptospirosis occurs worldwide, but is endemic (usually seasonally) in tropical and subtropical areas with poor sanitation and in agricultural areas with livestock operations or rodent infestations. Outbreaks can also occur after storms, heavy rainfalls, or floods.
Travellers involved in adventure travel or outdoor activities such as swimming, canoeing, whitewater rafting, kayaking, or camping are at risk. Visiting farms, rice paddies, or sugar cane fields can also increase risk of exposure. Leptospirosis is an occupational hazard for farmers, veterinarians, rescue workers and military personnel.
The infection is characterized by flu-like symptoms which can appear anywhere from 2 to 30 days (usually 7 to 10 days) after being infected. Symptoms include sudden fever, headache, muscle pain, chills, red itchy eyes, difficulty urinating, a skin rash, nausea, vomiting, and diarrhea. A second, more severe, phase of the illness – also known as Weil's disease – may progress to kidney or liver failure, jaundice, cardiac failure, meningitis (inflammation of the brain), and respiratory failure. Treatment usually includes antibiotics. Human to human transmission of leptospires bacteria is rare.
Prevention: Avoid swimming or wading in water potentially contaminated with urine, including in canals, swamps, lakes, and rivers. If this cannot be prevented, wear protective clothing and footwear when coming into contact with potentially infected water, soil, or animals. Outdoor sports travellers and persons with occupational risk may want to consult their healthcare provider about taking preventive medication to avoid infection. In North America, there is currently no commercially available vaccine against Leptospirosis.
Avoid unprotected sexual contact. If you are going to have sex with a stranger, use latex or polyurethane condoms consistently and correctly. Bring your own condoms from home.
Some countries continue to have entry restrictions for travellers with HIV / AIDS. See NAM aidsmap for details on this country.
Diarrhea is the most common cause of illness during travel. The source of illness is the ingestion of contaminated food or water, person-to-person transmission, or recreational exposure to water bodies. The infective agents can be bacteria, viruses, protozoa or toxins found in food. Good personal hygiene practices (including frequent and thorough hand washing), proper food handling, and water purification are the most effective methods to prevent infection.
Consult your doctor for the best treatment options tailored to your needs, including taking prescription medication on your trip in case you suffer from diarrhea. Travellers with chronic conditions are more susceptible to infections and should consider taking preventive medication.
See our Guide to Healthy Travel for prevention and treatment tips.
Local water is potable and safe to drink.
Milk is pasteurized and safe to drink. Butter, cheese, yoghurt, and ice cream are safe.
Local meat, poultry, seafood, vegetables, and fruits are safe to eat.
Gastro-intestinal infections are the most common illnesses affecting travellers and can occur in any country you are visiting. Proper food handling, drinking purified water, and maintaining good personal hygiene are key to prevention. Below is a summary of the agents causing gastro-intestinal illnesses.
It is estimated that about 85% of traveller’s diarrhea is caused by bacteria of which the following are the most important agents:
Enterotoxigenic Escherichia coli (ETEC) and Enteroaggregative Escherichia coli (EAEC) account for most cases of traveller’s diarrhea associated with contaminated food and water world wide. They are the cause of large outbreaks in developed countries when food and water sanitation have not been properly maintained. Symptoms include watery stools, abdominal cramps, and possible vomiting lasting three to seven days.
Campylobacter jejuni is more prevalent in developing countries and is associated with contaminated water, undercooked food, and unpasteurized milk. Symptoms include diarrhea, abdominal cramps, and fever lasting from two to ten days.
Salmonella enteritidis is associated with contaminated eggs, poultry, milk, fruits, and uncooked vegetables. Symptoms include diarrhea, vomiting, abdominal cramps, and fever lasting from four to seven days. Infected persons can become asymptomatic carriers and shed the bacteria for years, becoming the source of infection for others through poor hygiene practices.
Shigellosis is a human infection caused by one of four species and transmitted by fecal-oral route due to unsanitary conditions, contaminated food and water, and overcrowded living conditions. Symptoms include diarrhea, abdominal cramps, fever, and may cause bloody diarrhea and mucous lasting four to seven days.
Vibrio cholera is associated with contaminated water, raw and undercooked seafood. Cholera infection in travellers is rare; symptoms include watery diarrhea and vomiting lasting three to seven days, but can lead to severe dehydration and death in undernourished persons. Vibrio parahaemolyticus is also related to the consumption of raw and undercooked seafood. Vibrio vulnificus is associated with contaminated shellfish and raw oysters in particular, and has caused septicemia in persons with liver disorders.
Gastro-intestinal infections caused by viruses account for about 5%. The main agents are Norovirus, associated with outbreaks at large gatherings and on cruise ships, and Rotavirus, which is more prevalent in developing countries. Symptoms include vomiting, diarrhea, fever, and myalgia lasting 12 to 60 hours.
Gastro-intestinal infections with protozoa account for about 10% of traveller’s diarrhea, but may cause prolonged illnesses (lasting weeks) and cause serious complications if not diagnosed in a timely manner.
Giardia lamblia (Giardiasis) and Entamoeba hystolytica (Amebiasis) are the most important agents in this category and both infections are acquired through contaminated food and water, as well as person to person transmission due to poor hygiene practices. Cryptosporidium and Cyclospora cayetanensis are implicated with contaminated food, water, and fresh produce (berries).
Toxins Causing Food Poisoning
Clostridium perfringens is the most important agent causing food poisoning in developed countries. The spores of the bacterium germinate on cooked food that is cooled and stored at room temperature over a prolonged period of time. After ingestion, the spores produce an enterotoxin in the small intestine causing abdominal pain, diarrhea, and vomiting. Foods implicated are meats and poultry.
Staphylococcus aureus enterotoxins are spread by unsanitary practices of infected persons. The foods implicated are custards, creamy desserts, meats, and salads.
Clostridium botulinum bacteria produce a very potent toxin. It is associated with improperly canned food, lightly preserved vegetables, salted fish, and meats. Symptoms include nausea, vomiting, and neurological symptoms such as blurred and double vision, paralysis of respiratory and motor muscles that may progress rapidly.
Fish and shellfish can be contaminated with the toxins produced by marine micro-organisms called dinoflagellates found in all oceans, especially in coral reef areas. Larger fish have usually more toxins accumulated in the skin, musculature, and organs, as these toxins are passed up through the food chain. The toxins are not destroyed through cooking, smoking, or freezing, they are odorless and tasteless, and do not alter the appearance of the fish.
Ciguatera Fish poisoning is the most common illness in this category. The most affected fish are amberjack, barracuda, grouper, kahala, parrotfish, sea bass, red snapper, surgeon fish, ulua. Symptoms usually appear within a few hours but can be delayed for a day or more and include nausea, vomiting diarrhea, muscle pain, itchiness, dizziness and temperature reversal (hot feels cold and cold feels hot). Symptoms can last for months. Persons who had a previous episode of ciguatera fish poisoning should avoid a second exposure as symptoms will be more severe. Prevention: Avoid large fish (more than 2.5 to 3 kilos [6 lbs]) or fillet of large fish, avoid head, roe, intestines and liver where the toxin is more concentrated.
Scombroid poisoning is the result of improper handling and refrigeration of fish containing high levels of natural occurring histidine (amino acid in protein). Contamination with bacteria will convert histidine to histamine-causing symptoms similar to allergic reactions, which occur very rapidly and include headache, abdominal cramps, diarrhea, itching, flushed face, and paralysis may occur. Scombroid poisoning occurs worldwide and affects fish from the Scombridae family: yellow tuna, mackerel, skipjack, and bonito. It can also affect other species such as herring, bluefish, sardine, anchovy, amberjack, and mahi-mahi. Prevention: Proper handling and immediate refrigeration of catch.
Shellfish poisoning is associated with the algal blooms (red tides) occurring in temperate and tropical areas. Shellfish – oysters, clams, cockles, mussels, crabs, lobsters – filter or ingest toxins produced by dinoflagellates micro-organisms. Each different toxin produces characteristic symptoms:
- Symptoms of diarrheic shellfish poisoning occur about 30 minutes to hours after ingestion and include nausea, vomiting, and diarrhea. Recovery occurs within two to three days.
- Symptoms of neurotoxic shellfish poisoning appear rapidly after ingestion and include tingling of mouth, arms and legs, stomach upset, and severe muscle pain. Recovery occurs within two to three days.
- Symptoms of paralytic shellfish poisoning appear rapidly after ingestion and include nausea, numbness of face arms and legs, headache, loss of coordination and dizziness, in severe cases respiratory failure and paralysis may lead to death.
- Symptoms of amnesic shellfish poisoning occur within 24 hours of ingestion and include vomiting, diarrhea, and disorientation. Permanent short-term memory loss has been observed, and in severe cases seizures, paralysis, and death may occur. Persons with kidney disease are especially vulnerable.
Puffer Fish poisoning (Fugu) is caused by a tetrodotoxin accumulating mainly in the liver, intestines and ovaries of puffer fish, ocean sunfish, globe fish, and porcupine fish. Symptoms appear between six and 20 hours and include profuse sweating, salivation, headache, hypothermia, and neurological symptoms of paralysis and respiratory failure. The mortality rate is very high.
Travel is enjoyable, but there is no doubt that it can be stressful. Even if you don't have a prior history of mental illness, travel stress, mood changes, anxiety and other mental health concerns can unexpectedly affect you and potentially disrupt your trip. Studies show that psychiatric emergencies are the leading cause for air evacuations along with injuries and cardiovascular disease.
Your mental and physical health prior to, and during, a trip determines how well you will cope with travel stress. Consider the following:
Mental illness is an under recognized public health concern and travellers often have difficulty accessing adequate emergency psychiatric care abroad. While some countries are leading the way in mental healthcare and treatment, 30% of countries do not have a budget dedicated to mental health and 64% do not have any mental health legislation or it's outdated.
Accessibility to a psychiatrist varies from more than 10 per 100,000 to fewer than 1 per 300,000 people. Almost 70% of psychiatric beds are in mental hospitals rather than general hospitals or in integrated community care facilities.*
Persons with mental health concerns have the additional burden of dealing with stigma ? negative attitudes and behaviour towards their illness. Prejudice and discrimination towards mental illness may determine the type of medical care you will receive abroad.
* World Health Organization: Mental Health, Human Rights and Legislation Framework.
April 25, 2013
Do you know if your travel destination country has malaria? If so, would you take medication to prevent a malaria infection?
March 28, 2013
Do you understand how your immune system works to protect you from disease? Do you know how vaccines work?
February 28, 2013
Guest post by Dr. Erik McLaughlin