Vaccinations and Health for Travel in East Africa
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COVID-19, Common diseases, some fatal, and preventing infection
You’re East Africa bound! Flights booked to Tanzania, Kenya, Uganda, Rwanda, or South Sudan? Or even still in the planning phase and want to know before you book what vaccinations you might need for East Africa?
We have compiled a list of the most common vaccinations, some compulsory to give you an idea what you might need.
The countries of East Africa have responded effectively and efficiently to the pandemic. All are open to regional and international. The tourism industries of each has adopted as a minimum the World Health Organisation guidelines on sanitation, hygiene and social well-being. It is strongly adivsed that all travellers exercise good hygiene; washing of hands frequently, the wearing of masks if social distancing is not easy to practise and a sense of heightened awareness.
The vaccinations required are strongly dependent on your personal circumstances and holiday plans. This overview should not by be used instead of a visit to a relevant travel doctor.
Vaccinations needed depend on which vaccinations you received as a child, which vaccinations you may have already been given for a previous trip, on whether you’re an expectant (pregnant) mother and sometimes even on your age. It also depends on the exact area you go to, how long you intend to stay in certain areas and even what the purpose is of your visit.
Make sure you visit your (travel) doctor preferably 8 weeks before you travel. If you are leaving sooner, schedule a visit as soon as you can. Allow enough time to get the required vaccinations done as some might need a second, and sometimes even a third booster.
Prevention and Care
Many of the more common diseases are easily avoided. Some tips.
- Prevent against mosquito / fly / insect bites through using a repellant, wearing light coloured clothing (insects and especially flies are attracted to darker colours), covering arms, legs and feet in the late afternoons / early evenings when mosquitos make their appearance.
- Do seek professional travel clinic / doctor’s advice at least 6 weeks before travel.
- Carry a small pack of sanitary wipes / hand sanitizer.
- Drink only bottled water and from sealed bottles.
- Wipe off the parts of any container that will make contact with your lips and mouth.
- Ensure fruits and vegetables are washed well before preparation and consumption.
- Ensure street foods are freshly cooked in front of you.
- Do not approach animals, escpecially ‘stray’ cats and dogs.
Some general advice to stay healthy. Travelling is about experiences, including new foods. Some health issues can start with consuming contaminated food and drink.
Be meticulous about your personal hygiene and make sure your hands are always washed before eating. Use antiseptic wipes or hand gels if you can’t use soap and water.
In East Africa it is usually safe to drink bottled, purified, or boiled water. Check the seal on the bottle isn’t broken.Water from the taps is usually not ok to drink, but in some places will be fine for brushing your teeth – ask. If in doubt, use bottled, boiled or purified water for brushing your teeth as well.
Cans of soft drink, local beer, wine and spirits are low risk. But don’t order your drink ‘on the rocks’ unless you know the ice is made from safe water. The alcohol in your drink will not kill any germs if there are any in the ice!
Trying out the local cuisine is part of the fun of going on holidays. But don’t eat:
- uncooked, undercooked or reheated food
- food exposed to flies
- un-peelable fruit and vegetables
- salads that you do not know have been thoroughly washed
Eating in ‘local’ busy restaurants where food is served on clean plates with clean cutlery should be ok. But if in doubt, don’t risk it unless you want to end up with ‘Delhi Belly’, a common name for traveller’s diarrhoea, or even giardia or dysentery.
Below a list of common diseases, many of which can be prevented through vaccinations.
Your doctor, or a travel clinic, will discuss your personal situation for your holiday plans and advise on any vaccinations and / or medication that might be recommended, or is compulsory for you.
Along with Malaria, the most commonly asked about vaccination. Is only compulsory for travellers 12 months and older to have a Yellow Fever vaccination if you are arriving direclty from a country classified as having a risk of YF transmission. This includes a stop over of more than 12 hours in transit in that country. There are numerous websites where those countries are listed, for example https://www.fitfortravel.nhs.uk/advice/disease-prevention-advice/yellow-fever/yellow-fever-risk-areas
Yellow fever is a viral disease transmitted by mosquitos. Symptoms start 3-6 days after being bitten and include fever, abdominal pains and vomiting.
This illness is very serious and if not vaccinated, the death rate is higher than 50%. Vaccination is very effective and this might be the only vaccination you need which is compulsory under international regulations. There is no specific treatment for yellow fever.
Hepatitis A is a viral disease of the liver, spread through contaminated food and water. If traveller’s diarrhoea is common, then hepatitis A is as well. Preventable by a vaccine which provides long-term protection.
If sanitation and personal hygiene are poor the risk is high, and travelling ‘5 star’ does not exclude you from this risk.
Is an infection of the liver. It is transmitted by blood and body fluids. It is most prevalent amongst those having unprotected sex and people who inject drugs.
Symptoms may include flu-like symptoms, general aches and pains, tiredness, loss of appetite, abdominal pain, diarrhoea and feeling / being sick.It is common especially in adults that the symptoms do not show themselves and the body may fight off the virus.
If a person thinks they may have been exposed to the virus, treatment must be sought immediately from a doctor – this may even prevent infection.The disease is treatable with medicines and in extreme cases, may need to be treated long-term and even life-long.
Hepatitis B is preventable through vaccinations
Typhoid Fever commonly results from consuming food and water contaminated by bacteria passed on in the preparation of food stuffs. The symptoms include fever, headache, cough, rash and sometimes diarrhoea. It can cause serious illness and even death if not treated.
Vaccination is strongly recommended for travellers going to areas of poor sanitation.
Polio is an acute viral infection that attacks the nervous system and can lead to paralysis. It is transmitted by faecal contamination of food which can occur through flies, but also due to unhygienic food handling.
Even though you may have been immunised as a child, a booster might be required. Consult with your travel doctor.
Insect transmittable diseases
Any disease transmitted by insects like mosquitoes, ticks and tsetse flies can be prevented by not getting bitten in the first place. Malaria mosquitoes bite during dusk and dawn, but daytime mosquitoes can transmit dengue fever, so prevention and protective measures are required 24/7.
Wear loose-fitting long sleeves and trousers as well as socks. Use anti-mosquito sprays or roll-ons (with DEET or Picaridin) to further deter them from biting and sleep under mosquito nets.
Mosquitos are attracted to dark colours and tsetse flies love black and dark blue so avoid those colours when packing your suitcase.
Different types of malaria exist and there is no vaccination available for any of them. One type of malaria is falciparum malaria which causes cerebral disease. This one is severe and can kill quickly. Your antimalarial drugs are aimed to protect you from the falciparum malaria.
The treatment is usually started before entering the malaria risk area and, depending on the type of drugs prescribed, need to be continued for a certain period after you leave.
No drug is 100% effective, but if you use the correct type for your holiday, you can increase protection 90% over mosquito avoidance measures alone. As drugs can cause side effects in some people, and not every drug is suitable for all people and all destinations, it is important to get advice from your (travel) doctor before your trip.
It is also important to remember that any flu-like illness 7 days after arriving in the malaria area and up to 12 months after leaving the area needs to be presumed to be malaria. If no improvement of symptoms occurs within 24hrs, a doctor must be seen immediately.
Dengue fever is transmitted by daytime biting mosquitoes. It is a viral disease with flu-like symptoms which can include fever, severe headache, joint and muscle pain, rash and strange taste sensations. Symptoms usually appear 5-8 days after being bitten, and a few days after the rash appears, the fever breaks and recovery begins.
Use paracetamol to relieve pain and reduce fever, do NOT use aspirin. Rest in bed to allow your body to fight the disease.
Other insect-transmittable diseases like West Nile Fever, Rift Valley Fever and Chikungunya Fever
There are several other, also serious illnesses that are transmitted by mosquitoes, for example, West Nile Fever, Rift Valley Fever, and Chikungunya Fever. No vaccinations are available for any of these and other viruses that continue to be discovered.
It is important to prevent mosquito bites at all times of the day and night.
This disease, officially called Trypanosomiasis, is spread through the bite of a tsetse fly. If you have a ‘boil like’ sore a few days after being bitten by a tsetse fly, especially if you also have a fever, you should see a doctor for treatment.
There is no vaccination, but treatment is available.
To prevent tsetse fly bites:
- Wear clothing with long sleeves and long trousers, make sure they are not too thin as tsetse flies bite through thin materials
- The tsetse flies loves bright colours and very dark colours, especially dark blue and black. Khaki or olive coloured clothes are the best choice
- Use insect repellent
Bilharzia is caused by a parasitic blood worm which can penetrate human skin when exposed to fresh water that contains certain types of snails. It can cause damage to the intestines, the liver and the urinary tract.
Symptoms can occur weeks after infection and include local irritation of the skin where the worm entered, fever, lethargy, weight loss and blood in the urine or stool.
There is no vaccination, but it can be treated. It is best, but not always possible, to avoid contact with freshwater bodies in which the parasite is known to live.
If you suspect you have been exposed to contaminated water, it is best to see a travel doctor when you return from your trip. There are tests available and treatment is usually successful. Without symptoms, it is best to test 3 months after your expose.
Tetanus is caused by bacteria which enter through a wound and is a painful and serious disease which can be fatal. It is common in burns, and deep or infected wounds, but can also occur from a tiny scratch.
The bacteria grows in dead tissue and poisons all muscles which make them go into spasms. At the very least it requires treatment in intensive care.
It is possible to vaccinate and boosters are usually advised if there is a risk that a wound is likely to be contaminated. Your travel doctor can advise if you need a booster before your holiday. The bacteria can be found all over the world, so it is good practice to keep your tetanus vaccination up to date at all times. Usually vaccinated in combination with Diphtheria and Pertussis (DPT)
Is a bacterial infection easily spread by person-to-person contact, and especially sneezing and coughing. It affects the mucus membranes of the nasal passages and the throat. Untreated it can cause severe damage to the heart, kidneys and nervous system.
It is preventable by vaccine, and is usually administered as a combination preventing Pertussis and Tetanus (DPT).
Pertussis (Whooping Cough)
Sometimes known as the 100 day cough. Initial symptoms are similar to the common cold – runny nose, mild cough and a fever. It soon develops into prolonged periods of severe coughing.
Caused by highly contagious bacteria and transmitted person-to-person usually through sneezing and coughing.
Prevented through vaccination, in combination with that for Diphtheria and Tetnus (DPT).
Animals transmit this deadly viral infection of the brain via bites and scratches. The best way to prevent rabies is to avoid all animal contact, especially dogs, cats and monkeys. Even a lick on broken skin from an animal which carries rabies skin is a risk. This means no petting of cats and dogs when on holiday.
Once the disease has developed, there is no cure. Make sure you check with your travel doctor if you are recommended to get vaccinated pre-travel, discuss the seriousness of this illness and know what to do when exposed to the illness.
High Altitude Sickness
This is only applicable for those intending to hike or climb at high altitude ( over 2500m / 8000 ft). Symptoms can already start after a few hours at that altitude (or higher).
There are 2 types of acute mountain sickness (AMS): benign and malignant.
Benign is the most common and symptoms include headache, loss of appetite, dizziness, nausea / vomiting and sleeping difficulties. These symptoms should disappear after a day or two at the same altitude, or descent 500m. If they don’t, immediately return to lower altitudes.
Malignant altitude sickness can start with the above symptoms, but can also appear without any warning. It is very serious and can be fatal. Usually it is either the lungs or the brain (or both) that are affected. If the brain is affected, confusion is an early sign which can quickly lead to coma and death. If the lungs are affected, increased difficulty in breathing can quickly lead to respiratory failure and death. A rapid descent to lower altitude is crucial.
You can prevent / reduce the effect of high altitude sickness:
- Ask your doctor about prophylaxis (medicines that prevent) for AMS before you travel.
- Ascending slowly (no more than 300m per day and a rest day after every 1000m, sleep at a lower level than you reached that day)
- Drink extra water and include a dose of rehydration salts to ensure you stay hydrated as mountain air is cold and moisture is lost with every breath.
- Avoid alcohol and sedatives
- Eat light, high-carbonated meals to ensure you have enough energy
Motion sickness is usually just a nuisance, but when on holiday you might be exposed to more travel on bumpy roads, ferry crossings, sunset cruises or small plane flights than in your normal day-to-day activities.
Not everybody is affected by motion sickness, but for those who are, there are several medicinal and behavioural options to try to prevent it. Your travel doctor can advise, but things like looking at the horizon in the direction of travel helps, fresh air and making sure you drink enough water can also make you feel better.
Medication is available, as well as pressure point bracelets which can help. It is best to avoid alcohol.
Prickly heat, or heat rash, is caused by excessive sweating and your body’s inability to get rid of its heat. This is a common problem in tropical areas where it is hot and humid as this prevents evaporation of sweat. A rash occurs, sometimes blisters, and the skin feels ‘prickly’ or stings and is itchy.
To prevent prickly heat, wear loose, light-coloured, and non-synthetic clothing (for example cotton or linen). You can relieve the symptoms with cool showers, spending time in air conditioned areas and not scratching.
HIV is a virus transmitted through the transfer of bodily fluids: blood, semen, vaginal fluid, breast milk, pre-ejaculate. Effectively, the virus leads to the breakdown of the body’s immune system thus enabling opportunistic infections and cancers to thrive. AIDS (Acquired Immunodeficiency Syndrome) is the result of an active HIV infection.
A prophylaxis or prevention is the ONLY approach to take – do not under any circumstances exchange bodily fluids without adequate protection with anyone with whose history you are not familiar.
There are no short term symptoms.
Consultation with a doctor is mandatory should anyone believe that there has been any chance of infection.
Everybody has now heard of Ebola after the outbreak in Guinea, Liberia and Sierra Leone in 2014. It is a viral disease which has been reported in western Africa, Zaire, Gabon and Uganda. Travellers usually don’t enter areas of risk.
The illness begins with flu-like symptoms, vomiting and bloody diarrhoea and is spread through contact with body fluids like mucus, saliva or blood. It is highly contagious. After 10-15 days bleeding occurs through the mouth, nose and eyes.
An experimental vaccine was highly protective in Guinea during a major trial. This might become available for those travelling to at-risk areas, your travel doctor can advise.
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