Japanese encephalitis, yellow fever – that’s what threatens you on an exotic vacation

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The world announces the end of the pandemic, and tourists eager for exoticism are already planning their vacation trips. However, each long journey is also the possibility of contact with diseases unknown in our country and the need to comply with different sanitary regulations, about which we know little or nothing at all. Therefore, before we purchase additional health insurance, we should consult a travel medicine specialist. Maciej Pawłowski, MD, PhD explains why such a visit is for and why it is worth making an appointment.

1. Tourists planning a vacation in Equatorial Africa or in selected South American countries are required to get vaccinated against yellow fever
2. Travel medicine specialists advise tourists to vaccinate against diphtheria, tetanus and whooping cough, typhoid, rabies, hepatitis A and B, and measles
3. Continuous anti-malaria prophylaxis should be used in most countries in sub-Saharan Africa. We can choose between two preparations: Malarone or doxycycline
4. Before we complete the first aid kit for the trip, let’s check whether the drugs we constantly take can be brought to the country where we want to rest
5. However, before departing to Japan and South Korea, it is worth considering vaccination against Japanese encephalitis
6. More current information can be found on the Onet homepage.

Travel medicine, or emporiatry, deals with the prevention of health problems that may await people going to countries with different climatic or sanitary conditions. Specialists in this branch of medicine provide, inter alia, advice on health risks, provide a list of mandatory and recommended vaccinations and qualify for them. They also help to complete a first aid kit for a long trip.

Monika Zieleniewska, Medonet: Let’s start with the increasingly popular direction of Africa. Even during the coronavirus pandemic, many Poles decided to travel, for example, to Zanzibar, North Africa still enjoys unflagging recognition …

Dr. Maciej Pawłowski: Africa is a large continent, so we should focus on the country we are going to. It is worth making an appointment to a certified travel medicine center eight weeks before departure, where a specialist doctor will provide comprehensive advice on vaccinations and prophylaxis. A list of such centers is available on the Internet. Most often these are facilities located in large cities, but there are quite a lot of them.

We go to the doctor and say: am I going to Kenya?

Yes, the most important country is the country we are going to, because health regulations, even in countries within one region, may differ, let alone across the continent. After all, Africa is Tunisia, Egypt or Morocco, as well as Kenya. If you want to first look for reliable information yourself, it is worth visiting the CDC (Center of Disease Control) website. We will find all the necessary information in English there. Coming back to Kenya, I would like to point out that a large part of the countries of Equatorial Africa require vaccinations, without which we will not enter their territory; I mean the yellow fever vaccination. They are compulsory in several African countries. The CDC website also includes detailed maps showing the risk of developing yellow fever in individual countries or regions. If someone goes to Kenya to a beach near Mombasa, the risk of infection is not high, but in the hinterland, where the safari takes place – much higher.

You can find the yellow fever vaccine at Medonet Market.

What is this disease?

It is an infectious disease transmitted by mosquitoes, incl. Egyptian mosquito. Mosquitoes living in Africa spread both malaria and yellow fever, which manifests itself in high fever (up to 40 degrees C), chills, headache and muscle aches, and in the next phase jaundice. There may even be hemorrhagic diathesis, renal failure and uremic coma. The disease can be mild in some cases, although if left untreated it can also lead to death.

So we have to get vaccinated.

Yes, the vaccine is single dose and protects us for life. If in five or 10 years we want to go to Africa, we don’t have to fix ourselves anymore. The doctor should issue us with the International Certificate of Vaccination, the so-called a yellow booklet with an entry regarding the vaccination, which we receive in English. It is the only compulsory vaccination in many countries of Equatorial Africa and several countries of South America. As an interesting fact, people who make pilgrims to Mecca are still required to receive a vaccine against meningococcus. When it comes to yellow fever, you should also remember to get vaccinated at least 10 days before departure, because the certificate is valid only on the 10th day after vaccination. If we get vaccinated the day before departure, we may not be allowed to enter the country of destination.

And what vaccinations are recommended for people going to Africa?

Vaccinations against diphtheria, tetanus and pertussis are recommended, which should be repeated every 10 years, as in Poland. Tourists often get vaccinated against typhoid fever (formerly called typhus), which can be infected through dirty water or unwashed fruit. They are given one intramuscular vaccine – Typhim Vi – containing purified capsular polysaccharide (Vi) from the Salmonella typhi bacterium – the rod that causes the infection. Immunity appears about 2-3 weeks after vaccination and lasts for about 3 years, so you need to remember to vaccinate. Vaccination against rabies is also popular, because wild animals are known. It is pre-exposure prophylaxis. We give two or three doses of Verorab, but I would like to emphasize that vaccination does not exempt from post-exposure prophylaxis, i.e. the prophylaxis applied after an animal bites. However, then you no longer need to administer immunoglobulin, which is not available everywhere in Africa. Following pre-exposure vaccination, a booster is given at 12 months, followed by booster doses every 5 years.

Is that all there is?

I would recommend hepatitis A and B (hepatitis A and B) vaccinations, but here you need to take several doses. For type A jaundice, we usually give two doses, and for type B – three. Vaccinations can be carried out using an accelerated schedule, there is a preparation of Twinrix that immunizes against hepatitis A and type B. We administer three doses at an interval of 0 – 7 – 21 days. If someone reports 6 – 8 weeks before departure, we will be able to follow this pattern. There is also a possible vaccination against cholera. Hardly anyone vaccinates here, rather people who want to travel around Africa longer. We give two doses, it is an oral vaccine that protects for two years. It is also worth getting vaccinated against measles (currently a combined vaccine against measles, mumps and rubella is available) – at least one dose (or preferably two), especially for people born before the era of compulsory vaccination against measles in Poland – not everyone was sick as a child at that time. .

There is also one more important thing to consider. If someone flies from Poland to South Africa directly, he does not have to vaccinate, but the situation changes when he has stopovers. Many countries require vaccinations against yellow fever, even if a tourist only transfers to another plane there and does not leave the airport. So if someone transfers in Niger or the Central African Republic and waits 12 hours for the next flight there, they will not cross the South African border without vaccination.

And what drugs should we pack in the suitcase?

Of course, we do not give up on constantly taken medications, you must take them with you. However, first you need to make sure that we can bring them to a specific country. It may seem strange, but some countries prohibit the importation of e.g. tramadol or decongestants into their territory, so you need to check this. If we need to take a drug that is on the prohibited list, we should obtain a medical certificate in English saying that we must take it. An important element is antimalarial prophylaxis. It does not apply to North African countries such as Tunisia, but if we are going to Sub-Saharan Africa, we must not forget about it.

Continuous prophylaxis is recommended in most countries. We have two preparations available – atovaquone with proguanil, i.e. the preparation Malarone, and the antibiotic – doxycycline. We take both drugs two days before departure and throughout the stay. Malarone 7 days after arrival and doxycycline for 28 days after arrival. Malarone is easier to use, but it is much more expensive. In turn, doxycycline is phototoxic, i.e. intense sunbathing during its use may cause sunburn, and it is also not suitable for young children and pregnant women. Of course you have to take repellants (mosquito repellants), for example DEET, Moskito Guard; antiallergic drugs, drugs for diarrhea and painkillers. If you suffer from travelers’ diarrhea, it is worth having an antibiotic (azithromycin or ciprofloxacin, or possibly rifaximin) with you.

That’s all?

A separate topic is alpine prophylaxis for climbers who, for example, go to Africa to climb Kilimanjaro, but such patients are rare. From the beginning of my practice, I only had two.

Now let’s move on to Asia. What is the situation with vaccinations there?

Vaccination against yellow fever is not compulsory. However, when it comes to India or Bangladesh, there is more to worry about typhoid, rabies, viral hepatitis, measles and cholera. In India, there is hardly any need for constant anti-malaria prophylaxis, although it is a large country and some areas are more at risk of malaria than others. I usually recommend that my patients go there to obtain Malarone for emergency treatment. If they suspect they have been infected with malaria, they should take four tablets at a time for three consecutive days and see a doctor urgently on the spot.

What other diseases may await us there?

Travelers’ diarrhea, however, we use the same preparations that I mentioned when talking about Africa.

And Japan, a highly developed Asian country – it seems that a tourist is completely safe there.

Not really, because he can get Japanese encephalitis, which also occurs in South Korea.

What kind of illness is that?

It is transmitted by mosquitoes, and the symptoms, in simple terms, resemble the neuroborreliosis known to us (symptoms of encephalitis, paresis, impaired consciousness, mental disorders), although most cases, over 90%, are mild. We have a vaccination preparation – Ixiaro, in the accelerated schedule. Two doses are given 0-7 days apart, possibly followed by a booster dose in a year’s time.

Another continent – Australia.

When traveling to Australia, there is no obligation to undergo additional vaccinations or take anti-malaria prophylaxis. I checked it relatively recently when giving consultations. Although there have been reports of Japanese encephalitis in recent days, it is worth considering such vaccinations. It is also worth checking the CDC website on an ongoing basis, as what was up to date a year ago may become obsolete within a few months.

How is the situation in South America?

Only in French Guiana is there a formal yellow fever vaccination obligation, but I would strongly recommend this vaccination to tourists going to countries located in the equatorial zone, even if it is not theoretically compulsory. I would not insist on vaccinating tourists going to Uruguay, Chile and Argentina, especially to the south of the country.

Mexico is quite a frequent destination for tourists from Poland.

This is a difficult topic because Mexico is a big country. Generally central and northern Mexico is malaria-free, in Yucatan and Cancún I don’t see much risk either, it’s higher in Chiapas state and there I would recommend emergency therapy, rather not continuous. However, there is no yellow fever there. Travelers’ diarrhea and dengue may pose a threat to tourists, but there are no vaccinations for dengue and, unfortunately, no prophylaxis.

Aw Peru?

Contrary to French Guiana, there is no obligation to vaccinate against yellow fever, but it is worth getting vaccinated, especially if you are going to the Amazon. I recommend that you protect yourself against malaria, typhoid fever, rabies, measles and hepatitis.

Another country – Brazil.

It is also a great country, so in the Amazon there is a risk of yellow fever. In this case, the doctor should take a very detailed interview, find out where exactly the patient is going and, depending on this, provide him with a list of suggested vaccinations and medications.

What is the most popular direction that requires a travel medicine doctor consultation?

Certainly African countries where vaccination against yellow fever is obligatory. The vaccine is not standard for us and we are unlikely to get vaccinated by a GP.

Have you come across any accident when a tourist brought an exotic disease from a trip abroad?

I do not have such information, because patients do not come to us after returning to the country. We deal with prophylaxis, we do not treat. Such people go to infectious wards or to the Institute of Tropical Medicine in Gdynia. However, usually nothing happens, it’s not that if we go to Kenya and take no anti-malarial drugs, it’s 100%. we fall ill and die, although of course it is not advisable to take such risks. It is really not worth regretting a few hundred zlotys spent on prophylaxis, because the consequences can be dire.

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