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...two travellers in search of the world's wildlife

25 July 2010

On diseases

Happily, our habit of holidaying in exotic places means that we have a head start in inoculations – we already have most of them. They are: Diphteria, Tetanus, Hepatitis A, Thyphoid, Polio, Yellow Fever, Tuberculosis, Hepatitis B and Cholera. That’s a lot of stabs! But there were several more that we needed to consider before we travel.

Rabies

These are the facts of rabies:

  • Once you have developed rabies symptoms, there is only one outcome: death
  • Pre-exposure vaccination is a series of three injections over 28 days. It does NOT immunise you against rabies. After being bitten by an animal, you should still seek treatment as soon as possible. You will then receive two further injections of the vaccine over 3 days.
  • If you had not been previously vaccinated, however, your treatment will involve one injection of HRIG (the human anti-rabies immunoglobulin) which will provide you with immediate protection from the disease, and a further 5 injections of the vaccine over the course of 28 days. HRIG is expensive, and may be of limited availability in some parts of the world.

There isn’t much data available on the risk to travellers of contracting rabies. In a study conducted in Kathmandu, over a period of three years (1996-8), 56 tourists presented themselves at a clinic with possible rabies exposure after being bitten or scratched by an animal. That’s 1.9 per 1000 tourists per year. Only 21% of them had been pre-immunised against rabies.

Of course, that is statistics from just one clinic. But it would seem that the risk of being bitten by an animal is fairly low, and the risk of being attacked by a rabid animal must be lower still. In fact many travellers don’t bother with the vaccination, saying that you are more likely to suffer from a road accident than get bitten by a rabid animal. Besides, the vaccinations are expensive.

We thought long and hard about this, but in the end decided to get the vaccination. Although the risk of getting rabies is very small, in actively looking for wildlife, we are exposing ourselves to slightly more risk. If we did get unlucky and got bitten by an animal, and I sincerely hope not, the hassle involved (the availability of HRIG, five injections over a month) makes the pre-departure expenditure worth it.

If you are deciding whether or not to get a rabies vaccination, you will need to weigh up the risk according to your personal situation. You might make the decision based on where you are going and the activities you are planning to take part in. Of course, you can minimise the risk (and we intend to) by not petting animals, and making sure that that friendly person removes his monkey from your shoulder pronto.

Malaria and other mosquito-borne diseases

Regretfully, we are not taking a mosquito net – they are bulky and we just do not have the space for one. But we are taking mosquito coils and plenty of DEET. Also, because we are not planning on camping or staying in very basic accommodation, we will be choosing hotel rooms with either air conditioning or a mosquito net.

People I have spoken to have said that the best way of avoiding malaria and other mosquito-borne diseases (and there are many of them) is to avoid getting bitten in the first place. This is very sensible! Unfortunately, past holidays have shown us that mossies are resourceful; even when wearing a long-sleeve top, with DEET sprayed liberally over wrists and neck, I would always manage to get bites on my body (some of them on top of each other).

So for this reason, we are going to be taking anti-malarial drugs (prophylactics), at least for parts of our trip. We looked at the malaria chart for each destination, and where there is a high risk, decided if medication would make sense in our case. Even though we will be dipping in and out of malaria-risk areas, there is just no way we would, or want to, take the drugs for the whole year.

For example, although South Africa is generally free from malaria, there is a substantial risk in the north east, including the Kruger national park which we plan to visit. Luckily, this is towards the end of our trip in South Africa, so we have decided to take the drugs for this period, and continue to do so through our two weeks in Madagascar, where malaria is endemic.

In Indonesia, we are planning to stay mostly in Bali, which does not present a substantial risk. So it’s not really worth while taking anti-malarial tablets. If we did visit the Komodo islands or explore any other parts of Indonesia, we will simply take extra special care.

There are several different anti-malarial drugs, but they are not inter-changeable. There are a few things to consider if you are looking into what is the right drug to take. The first is to make sure that you take the appropriate drug for the region you are planning to visit. Some malaria parasites have become resistant to certain drugs, so it is important to do some research first. Secondly, find out for how long you must take a drug before and after the risk period. Some, such as chloroquine, must continue to be taken for four weeks after you leave the risk area, whereas you can stop taking malarone after seven days (this is all to do with the stage at which the drugs kill malarial parasites). Third, consider the side effects. If you have an existing medical condition, you may be restricted in what you can safely take.

That’s it for malaria.

Other mossie diseases

We also considered taking vaccination for meningococcal menigitis and Japanese encephalitis, both mosquito-borne diseases. As with malaria, avoiding bites is the best defense, and the advice suggests they’re much less common unless you are living and working in local communities. And unlike rabies they are not absolutely deadly if you do catch them. So we decided on balance of risk, we would get these vaccinations.


2 Responses to “On diseases”

  1. Christel says:

    Remind me why you’re doing his again?? :)
    Bon voyage! Cx

  2. Christel says:

    Sorry I meant ‘doing this’… Cxx

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