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Special to The Globe and
Mail
http://www.theglobeandmail.com/servlet/story/LAC.20071128.MALARIA28/TPStory/?query=podolsky
November 28, 2007 TRAVEL HEALTH ALLISON DUNFIELD
Spoiler alert
Before heading off this winter to a tropical destination, check
with your doctor or a travel-medicine specialist to find out what
danger lurks in that lush forest - or that fruity drink
The glossy brochures have begun arriving in the mail and you're
already picturing yourself, cerveza in hand, lounging beachside.
Where to this year? Jamaica? Dominican Republic? Mexico seems like
fun.
But before you get on the plane, travel-medicine doctors urge you
to consider where you're going and to take the proper precautions
to prevent illness. After all, you don't want to make your return
flight in an air ambulance.
The most alarming illness for anyone headed to the Caribbean to
be aware of is malaria.
"The bottom line is that we're fighting malaria in places we
haven't seen for a long time," says tropical-disease expert
Jay Keystone, director of the Medisys Travel Health Clinic and a
University of Toronto professor of medicine.
The mosquito-borne disease has popped up on the island of Hispaniola,
which includes the Dominican Republic and neighbouring Haiti. The
U.S. Centers for Disease Control also recently warned that there
are pockets of malaria showing up in Mexico and the Bahamas. And
the Public Health Agency of Canada is advising people to beware
of the disease in Jamaica; two cases were reported in October and
there were 340 cases last year. Travel physicians recommend that
if you spend time outside resort areas, including in the city of
Kingston, it might be a good idea to take anti-malarial pills.
Of all the illnesses that a vacationer is likely to get, it's the
most frightening because it can be deadly. "Malaria can kill
you, as opposed to the most common problem, which is travellers'
diarrhea," Keystone says.
The worldwide mortality rate for malaria is 20 per cent or higher.
The best advice is to seek guidance on anti-malarials from either
a travel clinic or your physician. Canada's Committee to Advise
on Tropical Medicine and Travel recommends Malarone (the most expensive
but with the fewest side effects), doxycycline or mefloquine.
And because malaria is carried by night-biting mosquitoes, experts
also recommend using insect repellants containing 30 per cent DEET
and sleeping under mosquito nets.
The main symptoms are high fever, headaches and vomiting. Symptoms
can occur within 10 days to several years. An estimated 400 cases
of malaria are reported in Canada each year, according to the Public
Health Agency of Canada, with a high of 1,036 cases in 1997.
Jacinthe Perras, a spokeswoman for the PHAC, says travellers should
check the agency's health-advisory website before leaving. Foreign
Affairs also places the PHAC's outbreak warnings on its online travel
advisory section.
Jason Dudek, 26, of Winnipeg, says his experience with malaria made
him aware of how serious the illness can be. "Your head just
feels like someone's drilling into your brain, and your body aches
so bad it's excruciating, I felt like my body was going to break
in half or something."
Mr. Dudek got the illness while living in Sierra Leone and working
for the aid agency AEGIS. He was taking the proper medication but
ended up contracting the illness all the same.
But he says he would still take anti-malarial pills if he was travelling
in a risky area, including the Caribbean. Doctors say the vast majority
of people who take malaria precautions will be protected against
the disease.
The dreaded TD
Of course, even if you've taken precautions against malaria, there
are still numerous other maladies in southern climes.
The most common isn't deadly, but it's not fun either. Up to 50
per cent of all visitors to Mexico, Cuba and the Dominican Republic
contract travellers' diarrhea, says Gary Podolsky, a travel-medicine
specialist with Skylark Medical Clinic in Winnipeg.
Although it makes for humorous commercials, TD is nothing to laugh
at when you're stuck in your hotel room washroom instead of on the
beach.
Many doctors, including Podolsky and Keystone, now recommend that
vacationers take Imodium and a prescription antibiotic with them
so they can treat themselves if they begin having runny stools.
It's especially important for people with medical issue such as
diabetes, colitis or even anyone who takes antacids, which make
your stomach less able to ward off TD.
"I wouldn't leave home without it [the antibiotic]," Keystone
says.
Unfortunately, while most people have seen the commercials and posters
advising them to avoid drinking tap water or eating ice cubes and
salads, taking these precautions alone may not prevent TD. "Any
food [even cooked] can have a contaminant on it, but so can money,
so can doorknobs," Podolsky says.
He recommends washing your hands with soap and water or using an
antibacterial gel before eating.
Hepatitis A can also be contracted from contaminated food. A recent
study found that 40 per cent of the hepatitis A in Quebec came from
Mexico or the Caribbean.
Typhoid and yellow fever are two other current concerns in both
locales.
But although typhoid exists on Hispaniola and in Mexico, it's relatively
rare for tourists to contract it unless they veer off the beaten
path, Keystone says. "At a one-week resort, there's always
a risk, but the risk is low," he says.
He recommends a new vaccine on the market, designed to protect against
typhoid and hepatitis A, called Vivaxim.
Yellow fever exists mainly in South America, but sometimes crops
up in Trinidad and Tobago. Keystone says an excellent vaccine exists,
but it should be taken with care by senior citizens, who may have
a severe reaction because it contains a small amount of the live
disease.
However, there is no vaccine for dengue fever, and it can be serious.
Vacationers should be aware that it exists throughout the Caribbean
and Mexico. The precautions are the same as for malaria - dengue
is transmitted by a day-biting mosquito - so use a product with
at least 30 per cent DEET, even on babies two months or older.
"It can make you feel horrible," Keystone says, and it
can be deadly.
Common sense
Vaccinations and insect sprays aside, there is still another important
vacation precaution: condoms.
"The big reasons people go to the Caribbean are sun, sand,
surf and sex," Keystone says.
For some reason, vacationers throw caution to the wind in terms
of condom use, he says, even though 1 to 5 per cent of people in
the Caribbean, especially on Hispaniola, are infected with HIV.
And the prevalence of sexually transmitted diseases such as hepatitis
B is an excellent reason to be vaccinated.
"There are 12 [Caribbean] islands with more than 2 per cent
of the population carrying the virus in their blood, which puts
you at risk if you have sex with them," Keystone says.
Get the shot
Last but not least, Podolsky says don't underestimate the lowly
flu shot. It's the last thing you want to contract on your vacation.
"The flu virus is amplified when people go through airports
and are in planes, etc. You might get the flu three or four days
after you get into the resort from the airport, so there's some
benefit for getting that."
And comprehensive travel insurance is a must, he adds, along with
evacuation insurance if you have serious illnesses such as cancer
or heart disease.
"When I worked on a cruise ship, we had to ship people off
with $20,000 evacuation bills. ... It's an awful situation to be
in if you're on vacation."
***
Before you go
Preparation
Make sure your regular vaccinations - tetanus and rubella - are
up to date.
Most travel doctors recommend a hepatitis A and B shot (Twinrix
is popular) or the hepatitis A/typhoid combo.
Even your family doctor can give you a flu shot.
Carry condoms.
For travellers' diarrhea, carry Imodium or a prescription antibiotic.
Travel reports and warnings
Public Health Agency of Canada www.phac-aspc.gc.ca/tmp-pmv/pub_e.html
U.S. Centers for Disease Control and Prevention http://www.cdc.gov
Foreign Affairs and International Trade Canada http://www.voyage.gc.ca/dest/ctry/reportpage-en.asp
World Health Organization http://www.who.int/en
Products and services
Travel Medicine http://www.travmed.com (doctor-recommended site)
International SOS www.internationalsos.com/demo/malariademo/index.html
(online malaria-prevention course)
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