What is cholera and what causes it?
Cholera is commonest in Africa, Asia and Central America. It’s also found in places where there has been a natural disaster, war-torn regions where the medical infrastructure has broken down and in particularly poor, crowded places.
Cholera is a bacterial infection found in contaminated food and water. It is common in places with poor sanitation, for example where sewage comes into contact with drinking water. It also arises in the developed world where seafood like shellfish and plankton have been contaminated, but this is rare.
Cholera is often mild and some people don’t experience any symptoms at all. Around 10-20% will develop severe symptoms, which can be fatal. People with severe cholera can experience really bad diarrhoea and vomiting. If left untreated it can lead to chronic dehydration, a drop in blood pressure and, eventually, shock. In very serious cases it can be fatal.
Cholera signs and symptoms:
- Large amounts of watery diarrhoea containing small rice-sized flecks of white material made of mucus and skin cells, with a fishy smell
- A fast heart rate and low blood pressure
- Lost skin elasticity, slightly wrinkly
- Dry mucous membranes, for example in your nose
- Low blood pressure
- Thirst and muscle cramps
- Feeling restless and irritable
People who should consider vaccination:
- Those going to work in an area with an outbreak – aid workers, health workers, emergency relief workers
- Those staying long term in an area where there is high risk of cholera and limited access to medical care
Don’t have the vaccination if you’ve had a previous bad reaction to the vaccine or its ingredients, which include formaldehyde.
How to minimise the risk of catching cholera?
While it’s essential, this vaccine doesn’t always provide full protection. Some strains are not affected and a bad case can still make you very ill indeed. The best strategy is prevention, which is mostly common sense. Keep away from people infected with cholera. Stick to bottled drinking water, avoiding ice at all costs. Maintain high levels of hygiene and steer clear of suspect, grubby-looking restaurants and street food vendors.
Cholera is given as a drink and is given in two or three (depending on age) separate doses, taken from one to up to six weeks apart and completed at least a week before travelling.
Two doses of the vaccine will help protect against cholera for two years. The level of protection gradually reduces over time, so you’ll need a booster if you continue to travel to areas where there is a risk.
What is rabies and what causes it?
Rabies is a viral disease transmitted to humans usually by a bite or scratch from an infected animal, or through bodily fluids such as saliva coming into contact with the eyes, nose, mouth or broken skin. It’s most often associated with dogs, but is also common in cats, cattle, monkeys, foxes and bats. While it can occur on all continents (apart from Antarctica), it is most commonly found in Africa, Asia, Central America and South America.
The virus attacks the central nervous system causing, progressive damage to the brain and spinal cord. Once symptoms are present, rabies is almost always fatal. Although rabies cases are rare in travellers, animal bites and scratches are common. It is important that travellers visiting areas where rabies occurs are aware of the risk and know what to do if they are bitten or scratched. The disease is preventable if the correct post exposure prophylaxis (PEP) is provided quickly. PEP can be expensive and difficult to obtain in some areas.
Rabies signs and symptoms:
The virus attacks the nervous system, causing inflammation on the brain and spinal cord.
Symptoms usually appear after three to 12 weeks. They include:
- High temperature of 38°C or more
- Feeling anxious or unwell
- Difficulty swallowing or breathing
- Muscle spasms
- Frothing at the mouth
Once symptoms appear the disease is almost always fatal, but treatment before this happens is very effective.
How to minimise risk of Rabies?
It’s important you’re aware of the risk and consider the following preventative tips:
- Don’t go near animals
- Don’t pick up animals, even if they appear to be tame or unwell
- Don’t attract strays with food or by being careless with litter
- Be aware of activities that may attract dogs, such as running and cycling
The course consists of three vaccines. The second dose is given seven days after the first dose. The third dose should be given three weeks after the second dose and this protects you for 10 year. If you are working with animals or at higher risk then a further booster maybe required after 1 year.
What is Hepatitis A and what causes it?
Hepatitis A is found throughout the world but it’s common where sanitation is poor, mostly across Africa, Asia, the Middle East and South America.
Hepatitis A infects the liver and affects its function. People catch it by coming into contact with anything contaminated by faecal matter – poo – including food and water. Very rarely, it can be transmitted via blood. It causes several problems including jaundice, where you turn yellow, plus nausea, fatigue and fever. It can last for anything between a few weeks and several months.
There is no cure for Hepatitis A so treatment is usually supportive, which means the medical profession simply treats the symptoms. Most people make a full recovery, but it can be more serious for older people and those with existing liver problems.
Hepatitis A signs and symptoms:
- Flu-like symptoms, general aches and pains
- Tiredness, nausea, sometimes actually being sick
- An aching liver, located in the upper right part of your stomach just below your ribs
- Yellowing skin (jaundice) and eyes, where the whites of your eyes turn yellow. They clear slowly, usually within 3 weeks, even without treatment
- You will feel tired and weak for a few weeks afterwards, sometimes for several months
- It’s very rare to experience serious problems
Vaccination is recommended for people who:
- Travel to or live in parts of the world where the disease is common, especially where hygiene standards are low
- Have any kind of long term liver problem
- Have haemophilia, are homosexual or inject illegal drugs
- Work with sewerage
- Work in a place with low standards of hygiene
- Work with monkeys, apes, baboons, chimps or gorillas
- Have regular close contact with someone who is already infected
How to minimise the risk of catching hepatitis A?
Good personal hygiene helps prevent hepatitis A from spreading. It’s also important to avoid:
- Drinking any water except boiled or bottled water, also avoiding juice drinks mixed with water
- Sharing towels or toothbrushes
- Raw or under-cooked shellfish
- Salads, fruit and vegetables washed in water – if in doubt buy your own, wash them in bottled water and peel them yourself
- Ice cubes
- Cleaning your teeth with unsafe water
- Unpasteurised dairy products
- Food from street traders, food left out at room temperature and food exposed to flies
The course consists of one dose and this protects you for one year. If you have another booster after 6 -12 months, you won’t need any further boosters for 25 years thereafter.
What is TBE and what causes it?
Tick-borne encephalitis (TBE) is a viral infection usually transmitted through the bite of an infected tick. The disease occurs in parts of central, northern and Eastern Europe, Siberia and parts of Asia. Ticks are found on forest fringes within adjacent grassland, forest glades, riverside meadows and marshland, forest plantations with brushwood and shrubbery. Ticks can also be found in parks and gardens.
Typically, the disease occurs in two stages: a mild flu-like illness and a potentially serious infection of the central nervous system (brain and spinal cord). TBE is rarely fatal in Europe: however in Asia it can be fatal in up to 20 percent of cases. Long-term neurological complications are common.
TE signs and symptoms:
Tick-borne encephalitis initially causes symptoms such as fever, headache, tiredness and muscle pain. As the infection develops, patients tend to develop additional symptoms, including nausea and a heightened sensitivity to light. If the inflammation spreads to the brain and its surrounding tissue, seizures and speech or coordination difficulties may arise.
There is no cure or treatment for tick-borne encephalitis. Patients who only experience first stage symptoms usually recover with the help of painkillers and anti-inflammatories. Patients who develop second stage symptoms require hospital treatment, as TBE can cause serious complications. If you are likely to be exposed to ticks carrying the TBE virus, you should consider a tick-borne encephalitis vaccine.
How to minimise risk of TBE?
When hiking or working in an area with infected ticks, you should try to avoid being bitten by ticks. Most importantly, you should wear long-sleeved tops and long trousers. It is also best to avoid having a gap between your socks and trousers. You should check yourself regularly and make sure you know how to remove ticks correctly. In addition, there are insecticides which are suitable for repelling ticks.
The course consists of three doses. The second dose is given 1 – 3 months after the first. The third dose is given 5 – 12 months after the second dose. This protects you for 3 years and after this you will require a booster. An accelerated course is available for those travelling at short notice.
What is Hepatitis B and what causes it?
There is a worldwide risk of Hepatitis B. High risk areas are Asia, Africa and South America, but you can also catch it in Europe, North America and Australia.
Hepatitis B is a serious viral disease affecting liver function. It can develop into a life-long chronic condition with very unpleasant effects including liver failure, liver scarring and even liver cancer. Right now there are more than 2 billion people in the world infected with Hepatitis B, one in every three people on the planet.
You catch hepatitis B through contact with infected body fluids. High risk activities include sexual intercourse and sharing drug needles. Tattoo parlours, barber’s shops and nail salons are also risky, especially since the virus can live outside the body for up to seven days, lingering on instruments and surfaces.
Medical facilities in developing countries are high risk places, with more chance of picking the virus up from unsterilised instruments. It’s always wise to carry your own sterile emergency kit with clean needles and syringes, just in case. Blood transfusions in dirty places also increase the risk of exposure to contaminated blood.
Hepatitis B Signs and Symptoms
The signs and symptoms usually appear 1 – 4 months after infection and can be anything from mild to severe. Common hepatitis B symptoms include:
- Abdominal pain
- Dark coloured urine
- Fever and painful joints
- No appetite
- Nausea and vomiting
- Tiredness and weakness
- Yellow skin and whites of the eyes (jaundice)
- When do I need protection against hepatitis B?
Immunisation is recommended for a range of people who are at particularly at risk:
- Those who inject drugs or have a partner who injects drugs
- Those who change their sexual partners often
- Homosexual men
- Babies born to infected mothers
- People whose close family member or lover already has hepatitis B
- Those who need regular blood transfusions or other blood products
- Those with any kind of liver problem or serious kidney disease
- Anyone going to an at-risk country
- Nurses, doctors, dentists, prisoners and prison staff, people who work in labs and those adopting or looking after children from affected areas
How to minimise the risk of catching hepatitis B?
It is wise to take extra precautions even if you’ve been vaccinated. Understand the status of your sexual partners. Practice safe sex and use protection. Avoiding tattooing and body piercing in unregulated places. Never share needles or other drug paraphernalia. And always use rubber gloves when handling blood.
The course consists of three doses. The second injection is given four weeks after the first and the third injection needs to follow five months later.
If travelling at short notice, you may be able to get an accelerated course. You will receive the second injection after seven days, followed by the third injection at least 14 days after the second.
Once you have completed the course, you usually won’t need another booster for five years.
What is typhoid and what causes it?
Typhoid Fever is a bacterial infection that can cause intestinal bleeding, toxic heart disease, pneumonia, seizures and swelling of the brain. It is transmitted when food or water that has been contaminated is ingested. Between 13 million and 16 million cases of typhoid are reported globally each year, of which 500,000 result in death.
Salmonella typhi, the bacterium causing the infection, is related to the bacteria that cause salmonella food poisoning. It can be contracted through consuming food or drink that’s contaminated with a small amount of infected faeces or urine. Without quick treatment the infection can have serious complications that can be fatal, so it’s important to help protect yourself.
Typhoid is uncommon in the UK, most cases are from an infection being picked up whilst visiting countries such as Bangladesh, India and Pakistan. Worldwide, children are at the most risk due to an under developed immune system. However, their symptoms are usually milder than in adults.
- Typhoid Signs and Symptoms:
- High temperature
- Stomach pain
- Constipation or diarrhoea
It’s important to get typhoid fever treated quickly. If the infection goes untreated it could cause complications and increase the risk of developing potentially fatal consequences. If you think you have some, or all of these symptoms during travel or on return to the UK, you should seek urgent medical attention. You should explain to the doctor treating you that you have travelled abroad.
How to minimise risk of typhoid?
While travelling through an area with a high typhoid incidence, you should follow some simple rules to avoid an infection with typhoid fever. Avoid eating raw vegetables and fruit, especially if they have been cut. It is also advisable to wash hands frequently, especially before preparing food and eating. The most common source of infection is contaminated water.
In order to prevent typhoid, you should stick to drinking bottled or boiled water. The typhoid vaccine is very effective at preventing the illness. If you are travelling to an area with a high risk of typhoid and hepatitis A, we can offer a combined vaccination course which covers both conditions.
There are two different typhoid vaccines. One is an injection, the other consists of a course of tablets. If you receive the typhoid injection, then this is one dose and the oral vaccine consists of three capsules taken over a course of five days. The vaccine protects you for three years and after that you will need a booster if you travel to high risk areas.
What is Japanese encephalitis and what causes it?
Japanese encephalitis occurs throughout South East Asia and Japan, but has also reached northern Queensland in Australia.
It’s found in areas where pigs and wading birds live and in places where mosquitoes breed. Japanese Encephalitis is a serious illness causing inflammation of the brain. In bad cases it can lead to brain damage and death. A fortunate third of people who get the disease are asymptomatic, which means they don’t experience any symptoms at all. Another third suffer from long-term neurological deficits and the remaining third die.
There is no cure for Japanese Encephalitis and treatment is supportive, which means medical experts simply do everything they can to help you pull through unharmed.
Japanese Encephalitis signs and Symptoms
- Confusion and agitation
- Encephalitis itself, also called inflammation of the brain, which can lead to permanent brain damage or even death
When do I need protection against Japanese encephalitis?
Regular epidemics happen in South East Asia, China and India. The disease is most common in farmed regions and tends to be more widespread in the rainy season when mosquitoes are particularly active. The disease is more common in children than adults.
How to minimise the risk of catching Japanese encephalitis?
Immunisation is the best way to avoid this disease. But it isn’t 100% effective 100% of the time, so it’s important to steer clear of mosquitoes even if you’ve been immunised.
- Sleep in a screened room and keep the windows and / or shutters closed
- Use a mosquito net and make sure it’s large enough to cover you without leaving any gaps. Check for net damage every day and repair any holes
- Spray the bedroom with insecticide at dusk to kill any insects that have sneaked in during daylight
- If you sleep outdoors or in an unscreened room, use mosquito nets impregnated with a safe and effective insecticide like Permethrin
- Burn a mosquito coil while you sleep
- Because the insects carrying the disease are most active during the dusk and evening, stay indoors after sunset
- If you go out, cover every bit of exposed skin. Bear in mind mosquitoes are less attracted to pale colours and use insect repellent. Diethyltoluamide (also known as DEET) is safe and works well, but it’s best to check first because different repellents tend to work better in some areas than others
The course consists of two doses. The second dose needs to be given ideally 28 days after the first. You are protected from seven days after the second dose.
In special cases you can get a faster course where the first dose should be at least 2 weeks before you travel.
The vaccine protects you for 12 months, so you need a booster to remain protected after one year.
What is meningitis and what causes it?
Meningitis is found worldwide. The most risky areas are sub-Saharan Africa, known as the meningitis belt, where epidemics are common. The belt runs from Senegal in West Africa to Ethiopia in the east. If you’re going there, get vaccinated first.
Meningitis C is included in Britain’s national childhood immunisation schedule. Youngsters often have a meningitis vaccination before they go to college, where crowded and often unhygienic student lifestyles take their toll and the disease is spread via respiratory and throat infections. And young adults entering the forces often have the vaccination for the same reason.
Travellers visiting Saudi Arabia and areas of Sub Saharan Africa, India and Asia should consider having this vaccination regardless of whether they have had a childhood Meningitis C jab.
Meningitis is a serious bacterial infection that causes inflammation of the brain and spine. It’s fatal in 5-12% of cases but without treatment, fatality rates can be as high as 50%. The incubation period is 3-4 days.
People can get meningitis by breathing the air or saliva from an infected person when they sneeze, cough or kiss. The disease spreads quickly in crowds and mass gatherings. Travellers at higher risk include those taking long or short term trips to risky areas, for example health workers, volunteers, those visiting family in or living in places where the disease is a problem.
Meningitis Signs and Symptoms
Meningitis can cause a sudden fever with an acute headache, stiff neck, nausea and vomiting, drowsiness, sensitivity to light, pale and blotchy skin, severe muscle pain, confusion and irritability, even convulsions and seizures leading to a coma. Common meningitis symptoms include:
- Flu-like symptoms
- Tiredness and irritability
- Generally feeling unwell
- Nausea and vomiting
If you have a mild case of viral meningitis, you might only get a few flu-like symptoms before making a full recovery. If you catch a more serious case you will experience nastier symptoms, namely:
- An even worse headache
- A rash of little red or purple spots
- Big, dark bruises that don’t whiten or disappear when you press them
- Light sensitivity
- A stiff neck
- Confusion and drowsiness
How to minimise the risk of catching meningitis?
Meningitis is usually spread via contagious infections. Common bacteria or viruses that cause the disease are spread via coughing, sneezing, kissing, sharing cutlery, toothbrushes and even cigarettes. If you live with someone who has the disease, you’re at risk of catching it yourself.
The course consists of one dose Once you completed the vaccination course, no boosters are currently recommended. However, you can get a booster five years after your last jab if you need it for a meningitis ACWY certificate.
What is Dipetheria and what causes it?
The infection is more common in Africa, South Asia and the former Soviet Union, where vaccinations aren’t widely available.
Diphtheria is a contagious bacterial infection that affects the nose, throat and sometimes skin. It’s highly contagious and is usually contracted through close contact with someone who has the condition or is carrying it. It can be spread by coughing, sneezing or sharing belongings with someone who has the infection, such as bedding or clothing.
Diptheria signs and symptoms:
Typical symptoms of diphtheria are a high fever, sore throat, difficulties breathing and a grey or white membrane in the patient’s throat. Patients diagnosed with diphtheria need to be isolated while undergoing antibiotic treatment.
What is tetanus and what causes it?
Tetanus is a rare but toxic disease caused by bacterial spores that are commonly found in soil, as well as animal manure. If these spores (also called clostridium tetani) enter the blood stream they multiply rapidly, releasing a neurotoxin that attacks the nervous system, causing painful and serious symptoms. The consequences can be fatal, especially for newborn babies.
Tetanus can’t be passed from human to human, but it can enter the body through:
- Cuts, puncture wounds and scratches
- Insect bites
- Piercings, tattoos and injections
- Eye injuries
- The umbilical cord during a non-sterile delivery
Tetanus signs and symptoms:
The most typical symptom of tetanus is the stiffness of your jaw muscles, also referred to as lockjaw. Tetanus patients tend to develop cramps and muscle spasms over 1 – 4 days, which can have an impact on their ability to breathe and swallow. The spasms may be accompanied by fever, excessive sweating and an unusually rapid heartbeat. If left untreated, there is a high risk of sudden cardiac death, pulmonary embolism, aspiration pneumonia and kidney failure.
What is Polio and what causes it?
Thanks to a preventative vaccination, polio is very rare these days – but it used to be common in the UK and worldwide and it could be very serious. Polio is a viral infection that spreads from person to person as a result of coming into contact with the faeces of someone with the infection, or the droplets when they cough or sneeze. It can also be passed on via contact with contaminated food or water.
Polio has very few symptoms, meaning most people carrying the infection don’t know they have it. For up to one in 100 people, polio causes temporary or permanent paralysis, which can be life-threatening.
While there hasn’t been a case of polio caught in the UK since the 1990s, the infection can still be found in some parts of the world. As there’s no cure, it’s important to make sure that you and your children are fully vaccinated against it, particularly if travelling to high risk areas. These include Afghanistan, Nigeria and Pakistan, with a potential risk of infection in other parts of Africa and some Middle Eastern countries.
Polio signs and symptoms:
Most people infected with polio won’t have any symptoms and will fight off the infection without even realising they were infected. However, sometimes people experience flu-like symptoms three to 21 days after they’ve been infected, with symptoms such as:
- High temperature of 38°C or more
- Sore throat
- Abdominal pain
- Nausea and vomiting
Symptoms usually pass within a week, but in more serious cases polio can attack the nerves in the spine and brain causing paralysis. This isn’t normally permanent, but some people may be left with ongoing problems.
How to minimise risk of catching DTP?
Vaccination is the most effective way to prevent infection. Travellers should ensure they are up to date with their routine vaccines according to the NHS vaccination schedule. In addition to vaccination travellers should ensure good personal hygiene and follow advice on prevention of food and water-borne diseases. It is important to be aware of the risk of accidents while travelling. Travellers should thoroughly clean all wounds and seek appropriate medical attention.
If you have had the vaccination before then you will need one dose, if you have not then you will require three doses. The vaccine protects you for 10 years. You will need a booster to remain protected after 10 years.
What is Yellow Fever and what causes it?
A number of countries require a yellow fever certificate, which is called the International Certificate of Vaccination or Prophylaxis (ICVP). Other risk destinations may not ask you for a certificate, but if visiting a risk area you still need to have the vaccination. Please bear in mind, your yellow fever certificate will only become valid ten days after the injection.
Yellow fever certificates used to expire after a certain number of years. However, they are now valid for life for most people. This includes certificates which were issued before this rule changed in July 2016 and which have an expiry date on them.
The World Health Organisation reports that there are about 84,000 – 170,000 severe cases of yellow fever a year, resulting in 29,000 – 60,000 deaths. The most important step in preventing yellow fever is a yellow fever vaccination prior to travel.
Yellow fever is a viral infection, which is passed on by a particular type of mosquito. The Aedes aegypti mosquito, which carries the virus, occurs primarily in African and South American countries. Yellow fever is not passed from person to person.
The virus causes an estimated 29,000 – 60,000 deaths worldwide every year and affects over 170,000 patients. 20% – 50% of yellow fever patients who suffer severe symptoms die of the infection.
The diagnosis of yellow fever involves a blood test, as the symptoms of yellow fever are very similar to those caused by other tropical diseases. There is no specific yellow fever treatment. In mild cases, patients usually rely on painkillers and anti-inflammatories to alleviate the symptoms. In severe cases, hospital treatment is needed.
If you are planning to visit a country where yellow fever is endemic, you need to visit a Superdrug yellow fever centre for a vaccination. The nurse or pharmacist will assess whether the vaccine is suitable for you.
Yellow Fever signs and symptoms:
The mosquito’s bite leads to infection and the typical symptoms of yellow fever, which include fever, vomiting or nausea, headache, muscle pains and a characteristic yellowing of the whites of the eyes (also known as jaundice). Yellow fever increases the risk of dehydration and can be very dangerous. It can cause haemhorrohagic fever (which causes bleeding from the mouth, eyes, ears and stomach) as well as multi organ failure.
How to minimise risk of Yellow Fever:
Using a mosquito repellent and wearing long sleeved-tops as well as long trousers will deter mosquitoes and reduce your risk of catching an infection. You may also wish to take a mosquito coil or plug-in device with you, to use in your accommodation.
By avoiding swamps and other mosquito breeding grounds, you can minimise your exposure to insect bites. Ideally, you should stay in places with air conditioning or at least insect mesh screening in front of all windows.
The vaccine is one dose and it lasts for a lifetime. The vaccine needs to be administered at least 10 days before travelling.