Avoiding Monsoon Maladies

Planning a holiday during the rains? Pack your rainwear, but don’t forget to keep that appointment with your doctor...

Travelling during the rains is fun but it comes with its own downfalls. Taking health precautions is mandatory if you don't want to spend your holiday sick and in bed while your family rollicks in the pool. Here are a few usual suspects that hit the unsuspecting traveller.

Influenza

The risk of exposure to influenza (or flu) depends on the time of year, destination and type of travel. Consider this: a single passenger with symptoms of flu can spread the disease to 72 per cent of the passengers aboard an airline and an outbreak of flu infection among cruise ship travellers has an incidence of 48 per cent within two days of exposure. And because the virus has a short incubation period, it can totally disrupt any holiday.

Travellers can be exposed to flu when travelling in large, organised tourist groups consisting of people from regions where flu viruses are circulating. No special prevention measures are recommended by the ACIP (Advisory Committee of Immunization Practices) at this time for travellers who are younger than 50 years of age and in good health. However, persons aged six months or older with chronic medical conditions and unvaccinated persons aged 50 years or more should get flu vaccine.

Precautions

People at risk from complications of flu should consider getting the vaccine before travelling unless they were vaccinated the preceding year. When the vaccine supply is limited, the prescription antiviral medications Amantadine and Rimandine can play an important role in the prevention and treatment of Influenza A. Neuraminidase inhibitors Zanamivir and Oseltamivir play an important role in the treatment of Influenza A and B. Oseltamivir is also approved for prevention of Influenza A and B.

If you develop symptoms of respiratory illness such as cough, sore throat or fever while travelling, contact your tour director, hotel staff or physician. If you have these symptoms limit your exposure to others: Headache, sore throat, blocked nose, chills, high fever, muscular aches and pains and, in severe cases, diarrhea and vomiting. This could mean avoiding activities or indoor places where there is a crowd such as restaurants, bars or movie theaters.

For people planning to travel to Africa, Asia or Latin America, it is important to speak to someone who specialises in travel medicine, as far in advance of your trip as possible.

Malaria

Another disease that is likely to hit a traveller during the rains is malaria. The risk of contracting malaria depends on the destination and the place where travellers spend their evenings and nights. Malaria is transmitted through the bite of an infected female Anopheles mosquito and is caused by infection with one of four species of the protozoa Plasmodium.

Early stages of malaria may be similar to the flu. Symptoms may include fever, chills, headaches, muscle aches, uneasiness, occasional vomiting, diarrhea, and coughing.

Precautions

The risk of malaria can be reduced by regular use of measures that limit contact with mosquitoes. To help travelers adhere to these recommendations, physicians must provide complete pre-travel advice. Even a brief exposure in an endemic area puts the unprotected traveler at risk. Because no preventive regimen is completely effective, travelers also should know to seek medical attention immediately during or after their trip. The approach to malaria prevention should incorporate the following :

• Assess the risk of malaria infection on the basis of the patient's itinerary.
• Discuss the available methods of reducing contact with Anopheles mosquitoes.
• Identify the most appropriate antimalarial agents for chemoprophylaxis (use of a chemical agent to prevent the development of a disease).
• Alert the traveler to seek early diagnosis and treatment if fever develops during or after travel.
• Find out if the destination you are travelling to is malaria-prone.

According to the CDC (Center for Disease Control), drugs recommended for prevention of malaria are Mefloquine, Malarone, Doxycycline and Chloroquine. Strict adherence to the recommended doses and schedules of the anti-malarial drug selected is necessary for effective protection.

Protection Against Mosquitoes

The most effective protection against malaria is to avoid exposure to the Anopheles mosquito that carries the disease. All travellers to malaria-endemic areas should be instructed on how best to avoid bites from these mosquitoes as the risk of contracting the disease is significantly reduced by simply limiting evening exposure to mosquitoes.

To avoid mosquito bites, the CDC recommends that you:

Apply insect repellent to exposed skin. The recommended repellent contains 20-35 percent Deet (diethyl-meta-toluamide).

• Wear long-sleeved clothing and long pants if you are outdoors at night.
• Use a mosquito net over the bed if your bedroom is not air-conditioned or screened. For additional protection, treat the mosquito net with the insecticide Permethrin.
• Spray an insecticide or repellent on clothing as mosquitoes may bite through thin clothing.

Malarial symptoms can develop as early as six to eight days after being bitten by an infected mosquito or as late as several months after anti-malarial drugs are discontinued. It can be treated effectively in its early stages but delaying treatment can have serious consequences.

Diarrhea

The most common complaint among travellers is diarrhea. It is usually a short-term condition caused by consuming new or different foods and beverages and by consuming contaminated food or water.

Travellers' diarrhea typically occurs within the first week of travel, but it can start anytime during the trip and continue even after they return home.

Preventative Measures

• Eat carefully: It is extremely important for a traveler to eat only thoroughly cooked food or fruits and vegetables he has peeled himself.
• Remember: boil it, cook it, peel it or forget it.
• Safe beverages include hot coffee, tea, beer, wine, bottled carbonated beverages and boiled water.

This is particularly true when visiting certain destinations like Africa, the Middle East and Latin America.

Treatment

Treatment for travellers' diarrhea includes:

• Fluid replenishment. Fruit juices, non-caffeinated soft drinks and salted crackers are suggested.
• For those who become very dehydrated, oral rehydration solution (ORS) is highly recommended. ORS can be purchased from travel medicine clinics and is usually part of an ‘antidiarrhea kit’.
• Antibiotics also can play an important role in treating travellers' diarrhea along with anti-diarrhea medication. Both of which are part of a standard anti-diarrhea kit.

Diarrhea can occur with symptoms like abdominal pain or cramping, bloating, urgent need to use the bathroom, nausea, dehydration and vomiting. Depending on the cause, it may be resolved within a few days without treatment but diarrhea caused by certain bacteria or viruses may require medical treatment.

Replacing lost fluids with non-contaminated water is very important when a person has diarrhea as it can be a symptom of other conditions too, therefore, it is advisable not to self-medicate.

(Compiled by Hazel Jain)