If you are a snowbird, itching to fly before you hit the beach, climb aboard the silver bird, or even pack the suitcase, it might be worthwhile making an acquaintanceship, via this article, with Dr. Suni Boraston, the Director of the Travel Clinic at Vancouver Coastal Health. We talked recently about many of the health hazards hidden at holiday destinations and how a little awareness will go far to ensure a healthy holiday and safe return.
“I always start with the tetanus vaccine, which everyone should have every ten years whether they’re going anywhere or not,” Dr. Boraston said, “and right now we have a pertussis or whooping-cough outbreak here, so we’re recommending that people get tetanus-diphtheria-purtussis vaccine. This is particularly important for people going to California which also has had a pertussis outbreak, and grandparents breathing on a newborn baby, or anyone for that matter, should be vaccinated against pertussis.”
Dr. Boraston also said that because those born between 1970 and 1996 have not been adequately protected against measles-mumps-rubella (MMR) they need a booster for that.
“They’ve had one dose at a year of age, but now we’re recommending that they get two doses for lifetime immunity,” she said, “so as they are coming to the clinic we’re taking that opportunity of updating their MMR.”
Her next priority is flu vaccine.
“Anyone over sixty-five, or who has a chronic illness qualifies for free vaccine, and should be vaccinated against influenza before they start their travels,” Dr. Boraston said. “Even the younger healthy people who have to pay the $20 – $30 fee, should consider being vaccinated against flu. They’re going to be in airports, on crowded airplanes, they’re much more likely to be exposed to influenza while traveling than they are at home.”
She then pointed to hepatitis-A as the next most important vaccine.
“It’s spread by food and water and it’s world-wide. Tulum, Mexico, just had an outbreak. We even recommend this for anyone just living in Vancouver. We have enough outbreaks right here.”
Hepatitis-B is another dangerous disease for which she recommends vaccination as it is spread by blood and body fluids.
“So sexual contact, IV drug use, even something as simple as emergency medical or dental, in a country where there is a high prevalence of hepatitis-B can transmit it. I discuss it with everyone, certainly with the younger group who are going off to Thailand, I would certainly recommend it.”
One of the things that can ruin your vacation is traveller’s diarrhea and anyone who is a regular traveller knows to protect against it.
“The medicine is called Dukoral and is a vaccine against diarrhea,” Dr. Boraston said. “You take two doses before you leave, then it provides some protection against traveller’s diarrhea, and as much as 20% to 40% protection against the vomiting that can occur with the diarrhea, which is what we’re trying to avoid. The other thing I give everyone too, is a prescription for an antibiotic to treat diarrhea if they get it while they’re travelling.”
Should you be concerned about malaria? It really depends where you’re going, she says.
“Certainly we all know that Africa, South America, Central America and Southeast Asia have malaria, but what some people are surprised to know is that parts of the Caribbean, Haiti and the Dominican Republic have malaria. And depending on where you’re going, such as South America or Africa, you might need a yellow fever vaccine. If you’re going to Southeast Asia at a certain time of year and staying for a certain length of time you might need a Japanese encephalitis vaccine.”
She also added that one should always guard against typhoid fever, as it is another disease transmitted by food and water, and recommends vaccination for trips to the Indian subcontinent or long stays (over four weeks) to other places.
Asked about what’s safe to drink and what’s not, she said one should stick to commercially bottled fluids and make sure water is boiled for one minute. After that chlorine or iodine are the best ways to kill all the organisms in water.
“Always make sure the water is commercially bottled and is still sealed,” said Dr. Boraston, “and although water is a way to have problems, food is still the greater way to become infected. You want to make sure that the food has been cooked and is still hot. I also tell people to avoid condiments like catsup, mayonnaise and mustard because you don’t know how long they have been sitting out. Avoid raw fruits and vegetables. You can peel them or cook them. Don’t eat raw fish or raw meat. Dairy products should be pasteurized before you eat them.”
She was then asked about avoiding infection by parasites. She replied that food and water protections will go a long way with respect to parasite avoidance.
“The other most common way to get parasites,” she responded, “it’s a worm really, is cutaneous larva migrans. It’s a very itchy rash you get from stepping on dog feces. Don’t go barefoot. Also you should stay out of fresh water to avoid shistosomiasis and leptospirosis. We tell everyone to stay out of rivers and lakes. Swim in a chlorinated pool or the ocean instead.”
We mentioned malaria earlier, but there are other mosquito-borne diseases to be aware of, and they come in two guises: mosquitoes that bite in the daytime and those that bite at night.
There are three main diseases occurring around the world; dengue fever, chikungunya, which is a Swahili word meaning ‘that which bends you up.’ It’s a bad flu-like illness which came out of Africa and is now spreading throughout the tropical world, and thirdly, the zika virus. Again, a flu-like illness, high fever and rash. Those three diseases are spread by mosquitoes that bite during the day – as opposed to the malaria mosquitoes and those with Japanese encephalitis, which bite during the night. I talk to everyone about daytime mosquito precautions, put their sunscreen on first, then repellant, then dress in light coloured clothing that covers as much of them as possible.”
In summary, Dr. Boraston emphasized a visit to a travel clinic is important, and all the precautions covered in the interview should be followed. But she was adamant that travellers understand that the one thing that might not show up until you get home is malaria.
“If you’ve been in an area with malaria,” she cautioned, “and you develop a high fever that can’t be explained by something else, like a sore throat, that’s a medical emergency and you need to be seen right away for a diagnosis. It needs immediate attention and should be treated as malaria until proven otherwise. Malaria can kill very quickly.”
For more information seach travelclinic.vch.ca