Bhutan - Lindsay Brown [223]
Malaria is caused by a parasite transmitted by the bite of an infected mosquito. The most important symptom of malaria is fever, but general symptoms such as headache, diarrhoea, cough or chills may also occur. Diagnosis can only be made by taking a blood sample.
Two strategies should be combined to prevent malaria – mosquito avoidance and antimalaria medications. Most people who catch malaria are taking inadequate or no antimalarial medication.
Travellers are advised to prevent mosquito bites by taking these steps:
Use a DEET-containing insect repellent on exposed skin. Wash this off at night, as long as you are sleeping under a mosquito net. Natural repellents such as citronella can be effective, but must be applied more frequently than products containing DEET.
Sleep under a mosquito net impregnated with pyrethrin
Choose accommodation with screens and fans (if not air-conditioned)
Impregnate clothing with pyrethrin in high-risk areas
Wear long sleeves and trousers in light colours
Use mosquito coils
Spray your room with insect repellent before going out for your evening meal
There are a variety of medications available. The effectiveness of the Chloroquine and Paludrine combination is now limited in many parts of south Asia. Common side effects include nausea (40% of people) and mouth ulcers.
The daily tablet Doxycycline is a broad-spectrum antibiotic that has the added benefit of helping to prevent a variety of tropical diseases, including leptospirosis, tick-borne disease and typhus. The potential side effects include photosensitivity (a tendency to sunburn), thrush (in women), indigestion, heartburn, nausea and interference with the contraceptive pill. More serious side effects include ulceration of the oesophagus – you can help prevent this by taking your tablet with a meal and a large glass of water, and never lying down within half an hour of taking it. It must be taken for four weeks after leaving the risk area.
Lariam (Mefloquine) has received much bad press, some of it justified, some not. This weekly tablet suits many people. Serious side effects are rare but include depression, anxiety, psychosis and having fits. Anyone with a history of depression, anxiety, another psychological disorder, or epilepsy should not take Lariam. It is considered safe in the second and third trimesters of pregnancy. Tablets must be taken for four weeks after leaving the risk area.
The new drug Malarone is a combination of Atovaquone and Proguanil. Side effects are uncommon and mild, most commonly nausea and headache. It is the best tablet for those on short trips to high-risk areas. It must be taken for one week after leaving the risk area.
Rabies
Rabies is considered to be highly endemic in Bhutan. This uniformly fatal disease is spread by the bite or lick of an infected animal – most commonly a dog or monkey. You should seek medical advice immediately after any animal bite and commence post-exposure treatment. Having pre-travel vaccination means the post-bite treatment is greatly simplified. If an animal bites you, gently wash the wound with soap and water, and apply iodine based antiseptic. If you are not pre-vaccinated you will need to receive rabies immunoglobulin as soon as possible.
STDs
Sexually transmitted diseases most common in south Asia include herpes, warts, syphilis, gonorrhoea and chlamydia. People carrying these diseases often have no signs of infection. Condoms will prevent gonorrhoea and chlamydia but not warts or herpes. If after a sexual encounter you develop any rash, lumps, discharge or pain when passing urine, seek immediate medical attention. If you have been sexually active during your travels, have an STD check on your return home.
Tuberculosis
While rare in travellers, medical