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 This
type
of infectious illness are second only to diarrhoea
as a cause of illness in travellers. Certain situations
encountered when travelling place travellers at
an increased risk of acquiring a respiratory infection.
Catching a cold at home is easy enough but
travelling will increase your susceptibility and
expose you to new germs to which you have no natural
immunity.
Coughs,
colds and sore throats are very common in
travellers but can be easily treated using over
the counter remedies which are available in pharmacies
and drug stores world-wide. Antibiotics can be
purchased over the counter in many countries but
should be avoided in this instance since they
are totally ineffective against cold viruses.
The
majority of respiratory tract infections are viral
and are therefore not susceptible to antibiotic
treatment. When prescribed, antibiotics are often
for secondary infections.
Many
travellers spend long periods of time in crowded
conditions such as airports, hotels etc. These
places provide ideal conditions for spreading
many acute respiratory infections like common
colds and influenza.
 Dry
aircraft cabin atmospheres and smoking more
than usual (even passively), exposure to new allergens,
dust and city air pollution will all contribute
to respiratory symptoms.
Meningococcal
infections, although not themselves infections
of the respiratory tract are also spread through
the respiratory route and there have been outbreaks
in tourist resorts. Vaccination should be considered
for those at risk in endemic areas during outbreaks.
Click
here for more information about Meningitis.
These
infections are difficult to prevent because
of the ease with which they are spread from person
to person. Those liable to chest infections may
benefit from taking an 'emergency' course of antibiotics
with them.
 Influenza
Influenza,
also known as the flu, is a very contagious disease
that is caused by the influenza virus. It attacks
the respiratory tract in humans and is different
from a cold. Influenza usually comes on suddenly
and may include the following symptoms:-
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Fever
Cough
Sore throat
Nasal congestion
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Headache
Body aches
Tiredness
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These
are known as the classic "flu-like" symptoms and
are not unlike the symptoms of other illnesses
such as malaria. Indeed many people have mistaken
the onset of malaria for a bout of flu and have
not taken appropriate action with sometimes serious
consequences.
Flu
is most common during the winter season, which
in the southern hemisphere is summer in the northern
hemisphere and visa-versa. It can occur year round
in the tropics. Although Influenza is a familiar
illness, and is often fairly mild in many healthy
adults it is however, a serious and sometimes
fatal illness among frail and elderly persons.
Vaccination should be considered for those at
risk.
 Influenza
viruses are spread is from person to person by
"droplet spread". This happens when droplets from
a cough or sneeze of an infected person are propelled
through the air. The viruse also can be spread
when a person touches respiratory droplets on
another person (e.g. by shaking hands) and that
person then touches their own mouth or nose (or
someone else’s mouth or nose) before washing their
hands.
A person can start spreading the flu virus one
day before he or she feels sick and can continue
to pass the flu virus to others for another three
to seven days after the symptoms start. Symptoms
start one to four days after the virus enters
the body. Some persons can be infected with the
flu virus but have no symptoms but they can still
spread the virus to others.
The
disease can spread more easily amongst large groups
of people living in relatively close proximity
to each other e.g. cruise ships.
 Treatment:
Influenza is caused by a virus, so antibiotics
don't work to cure it. The best way to prevent
the flu is to get an influenza vaccine each autumn,
before the flu season. If you do happen to get
it, then the following treatment should be undertaken:-
- Rest
- Drink
plenty of fluids
- Avoid
drinking alcohol and smoking tobacco
- Take
medication to relieve the symptoms
 Diphtheria
Respiratory diphtheria is a bacterial
infection that causes a moderately sore throat
with a greyish membrane over the infected area
(usually membranes of the tonsils, pharynx, or
nose) with low grade fever. In severe cases the
neck tissue may become very swollen.
It
is passed from person to person by droplet transmission,
usually by breathing in diphtheria bacteria after
an infected person has coughed, sneezed or even
laughed. It can also be spread by handling used
tissues or by drinking from a glass used by an
infected person.
In
tropical countries the infection may occur as
skin ulcers and is known as cutaneous diphtheria
which presents as infected skin lesions which
lack a characteristic appearance.
 After
two to six weeks, the effects of toxins produced
by the bacteria become apparent with severe muscle
weakness, mainly affecting the muscles of the
head and neck. Inflammation of the heart muscle
may cause heart failure. Myocarditis, polyneuritis,
and airway obstruction are common complications
of respiratory diphtheria; death occurs in 5%-10%
of respiratory cases.
Transmission
is usually by direct person to person contact.
Avoid very close contact with infected people
particularly kissing and sharing bottles or glasses.
It spreads quickly amongst infected people in
crowded places. Cutaneous lesions are also important
in transmission.
Diphtheria
remains endemic in developing countries and the
countries of the former Soviet Union have reported
an epidemic which began in 1990.
Treatment:
is specialised and requires medical supervision
in hospital where Diphtheria antitoxin is given
as an intramuscular or intravenous injection as
soon as possible. The infection is then treated
with antibiotics, such as penicillin or erythromycin.
Prevention:
There is a vaccine for diphtheria. Most people
in the UK receive their first dose as a child
in the form of a combined vaccine called DTP (diphtheria-tetanus-pertussis).
Immunisation: is very effective but protective
immunity is not present longer than 10 years after
the last vaccination, so it is important for adults
at risk to get a booster of tetanus-diptheria
(Td) vaccine every 10 years.
 Legionnaires
Disease
Legionnaires'
disease, a form of pneumonia is a severe infection
which is caused by the bacterium Legionella Pneumophila.
It has been linked
to contaminated water used in water cooled air-conditioning
systems and sometimes showers. It
is believed to occur worldwide.
Legionella organisms can be found in many types
of water systems. However, the bacteria reproduce
to high numbers in warm, stagnant water such as
that found in certain plumbing systems and hot
water tanks, cooling towers and evaporative condensers
of large air-conditioning systems, and whirlpool
spas.
 Outbreaks
of legionellosis have occurred after persons have
breathed mists that come from a water source (e.g.,
air conditioning cooling towers, whirlpool spas,
showers) contaminated with Legionella bacteria.
Persons may be exposed to these mists in hotels,
hospitals, or public places.
Legionaires' is not passed from person to person,
and there is no evidence of persons becoming infected
from auto air conditioners or household window
air-conditioning units.
People of any age may get Legionnaires' disease,
but the illness most often affects middle-aged
and older persons, particularly those who smoke
cigarettes or have chronic lung disease. The time
between the patient's exposure to the bacterium
and the onset of illness for Legionnaires' disease
is 2 to 10 days.
There is a significant mortality rate particularly
among the elderly.
Patients with Legionnaires' disease usually have
fever, chills, and a cough, which may be dry or
may produce sputum. Some patients also have muscle
aches, headache, tiredness, loss of appetite,
and, occasionally, diarrhoea.
Erythromycin is the antibiotic currently recommended
for treating persons with Legionnaires' disease.
In severe cases, a second drug, rifampicin, may
be used in addition. Other drugs are available
for patients unable to tolerate erythromycin.
 Tuberculosis
Pulmonary tuberculosis
is a contagious bacterial infection caused by
Mycobacterium tuberculosis (TB). The lungs are
primarily involved causing persistent cough with
fever and sweating, but the infection can spread
to other organs. The disease is slow to establish
itself and general malaise, weakness and weight
loss are characteristic during this incubation
which may be up to twelve weeks. The disease is
characterised by the development of granulomas
(granular tumours) in the infected tissues.
 TB
is much more common in some parts of the world
than in the UK. The risk to travellers is limited
since transmission of the disease usually requires
prolonged close contact. Sometimes the disease
can be overwhelming; producing meningitis and
coma; this particularly dangerous form is usually
found in children and those who have not previously
been vaccinated or exposed to the disease. Recently,
antibiotic-resistant strains of tuberculosis have
appeared.
Tuberculosis
can develop after inhaling droplets sprayed into
the air from a cough or sneeze from an infected
person and it can also spread through infected
sputum and there is a form spread through milk
from infected cows. The risk of contracting TB
increases with the frequency of contact with people
who have the disease, and with crowded or unsanitary
living conditions and poor nutrition.
 Pulmonary
TB develops in the minority of people whose immune
systems do not successfully contain the primary
infection. The disease may occur within weeks
after the primary infection, or it may lie dormant
for years before causing disease. The extent of
the disease can vary from minimal to massive involvement,
but without effective therapy, the disease becomes
progressive.
Infants,
the elderly, and individuals who are immunocompromised,
those undergoing transplant surgery who are taking
anti rejection medications are at higher risk
for progression of the disease or reactivation
of dormant disease. Those who have not received
BCG immunisation are advised to do so and if for
travel purposes, at least six weeks before departure
to ensure a protective level of immunity.
 Treatment
with anti microbial drugs is effective but is
prolonged and requires medical supervision. It
is also expensive and not always available abroad.
Incomplete treatment of TB infections (such as
failure to take medications for the prescribed
length of time) can contribute to the emergence
of drug-resistant strains of bacteria.
Prevention:
Avoid overcrowded places in endemic areas, particularly
where spitting is common. Never drink unpasteurised
milk. If in doubt, boil it before drinking. There
is a vaccination (BCG) which can give a valuable
degree of protection, particularly in children.
Travellers who plan to spend more than a month
in an area with a high tuberculosis rate and who
have not been previously immunised should consider
immunisation with BCG.
 SARS
(Severe Acute Respiratory Syndrome)
is a severe
pneumonia that has been reported in China, Hong
Kong, Vietnam, Singapore, Taiwan, Indonesia, the
Philippines, Thailand and Canada. It appears to
have spread in a short period of time and is now
regarded by the World Health Organisation as a
worldwide threat.
Travellers to areas where SARS has been reported
should be aware of the symptoms and seek immediate
medical advice should they develop any symptoms
within ten days of returning from an infected
region.
Since April 2nd (2003) the Department of Health
has strongly advised against travel to Hong Kong
and Guangdong Province in southern China where
the disease appears to have its origins. More
recently they have added Beijing and Shanxi Province
in China and Toronto in Canada. Travellers are
also advised to ensure that they have adequate
insurance to cover medical care and unplanned
extensions to their stay.
Cases in the UK are most likely to occur in people
returning from an affected area, especially one
where transmission is thought to be  continuing
such as Hong Kong or Guangdong Province. Recent
data suggests that transmission has slowed or
stopped in certain areas i.e. Canada, Singapore,
Vietnam and Taiwan but caution is still advised.
The infection is thought to be passed on by close
contact with an infected person, aerosol infection
if it occurs is rare. The initial signs are a
flu like illness developing within ten days of
contact. Symptoms include rapid onset of high
fever followed by headache, muscle aches and respiratory
symptoms including cough, sore throat, shortness
of breath and difficulty breathing. There have
been numerous fatalities.
 The
organism responsible for SARS was originally thought
to be a paramyxo virus similar to the viruses
responsible for causing measles and mumps but
It has now been identified as a member of the
coronavirus family never previously seen in humans.
Identification of the coronavirus means that scientists
can now move towards developing treatments for
SARS and successfully controlling the disease.
At present there is no specific treatment.
Outbreaks
such as the one in Toronto which affected family
members and health care workers are thought to
have occurred early in the epidemic when the significance
of the condition was not appreciated. Where infection
control measures are applied, outbreaks seem not
to occur. Therefore, anyone thought to be suffering
from the illness should be isolated and nursed
using barrier techniques. Secondary infections
can be controlled with antibiotics and symptomatic
treatment undertaken.
 Avian
Influenza
(Bird Flu)
Type A influenza viruses can infect
several animal species, including birds, pigs
& horses. Birds are an especially important
species because all known subtypes of the virus
circulate among wild birds, which are considered
the natural hosts for influenza A viruses and
when they infect birds they are known as "avian
influenza viruses." Avian influenza viruses do
not usually directly infect humans or circulate
among humans.
Avian
influenza usually does not make wild birds sick,
but can make domesticated birds very sick and
kill them. They do not usually infect humans;
however, several instances of human infections
and outbreaks have been reported since 1997. When
such infections occur, public health authorities
monitor the situation closely because of concerns
about the potential for more widespread infection
in the human population.
 The
reported symptoms of avian influenza in humans
have ranged from typical influenza-like symptoms
(e.g., fever, cough, sore throat and muscle aches)
to eye infections, pneumonia, acute respiratory
distress, viral pneumonia, and other severe and
life-threatening complications.
Currently
there is no definitive evidence of human-to-human
transmission of avian influenza and no infections
have been documented among health-care workers.
While it is unusual for people to get influenza
infections directly from animals, such transmission
has been documented several times in recent years
and is under investigation although most human
cases have been linked to direct contact with
diseased birds.
 The
World Health Organisation and other health authorities
worldwide are seriously concerned over the co-circulation
of human and highly pathogenic animal influenza
viruses since an exchange of genes between the
two viruses might occur if individuals were co-infected
with both viruses which could give rise to a new
virus to which humans would have little or no
immunity and which could be transmitted from person
to person.
It
is recommended that travellers to countries experiencing
outbreaks of avian influenza in poultry should
avoid areas with live poultry, such as live animal
markets and poultry farms. Large amounts of the
virus are known to be excreted in the droppings
from infected birds. Be sure to include a thermometer
and alcohol-based hand sanitiser for hand hygiene
in your travel health kit.
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